The Federal Government and the relevant medical experts have now confirmed the return of endemic, preventable diseases, including yellow fever, cholera, measles, and meningitis. This is traceable to the delay and postponement of preventive programmes, especially vaccination campaigns, as the nation’s attention and resources are absorbed by the COVID-19 pandemic. But the alarming outbreak of yellow fever attracted national outrage due to its high death toll of 133 as the disease ravaged four states – Enugu, Delta, Benue and Bauchi. The Nigeria Centre for Disease Control (NCDC) says at least 100 million Nigerians are unvaccinated and, therefore, at risk, unless urgent measures are taken to resume the vaccination campaign.
Enugu State appears the most affected in the current outbreak where at least four local government areas of the state are affected. The state government recently confirmed the death of 57 persons at Ette-Uno and Umuopu communities in Igbo-Eze North Local Government Area, despite the fumigation of the communities and the flooding of the area with yellow fever vaccines. In the last two weeks, health workers were seen working round the clock to suppress the spread of the disease. Yet, about 21 persons are known to have died in Isiugwu Community, four people at Aji and several others at Okpo and Igogoro communities within the council area. The state’s Commissioner for Health, Dr. Emmanuel Ikechukwu Obi, stated that the disease was confirmed through verifiable diagnostic tests and that the state government was collaborating with the Federal Ministry of Health and adjoining states, and had called for an immediate meeting of the Emergency Operations Centre to keep the disease from spreading. The Enugu Ezike General Hospital and other general hospitals in the area, he said, have been specially prepared to provide needed supportive treatment.
Health officials were moved to Isiugwu community for mass vaccination last week but an official explained that it takes about 10 days for the vaccines to start working and that those who had been vaccinated might still be vulnerable and could, indeed, die, if they were already infected before the vaccination. Authorities have embarked on an aggressive sensitisation and enlightenment campaign to ensure that residents turn out en masse to be vaccinated. Relations of victims expressed fear of the frightening stages of the disease which they say starts with weakness of the body, then changes to body pains. The third stage is what they call the “heaviness of the heart,” which precedes the “vomiting of blood,” the precursor to eventual death.
These outbreaks were only to be expected, but their tragic results, high fatality rate, demonstrate the fragility of our primary healthcare system. Yellow fever is a preventable disease. For it to cause such mass casualties shows a dereliction of duty somewhere in the healthcare chain. Today it is yellow fever. Tomorrow it could be meningitis, or measles each of which we assume to be under control but which, as this case has shown, is far from being controlled. We enjoin mothers to ensure that their children are immunised against the disease.
Medical experts say the disease is transmitted by the aedes or haemogogus specie of mosquitoes, and symptoms appear within three to six days of infection and they range from a mild febrile illness in some individuals to a more toxic illness that can lead to death in others. Only 15 per cent of infected persons enter into the toxic phase.
Initial reaction by health officials to these outbreaks has not helped matters. First, they erroneously, without testing, describe them as “deaths from unknown causes.” This has always tended to buy time for the disease to spread and kill more people before eventual tests accurately diagnose the true cause of death. The Federal Ministry of Health should prohibit the appellation of any outbreak as “deaths from unknown causes” until all the necessary tests have been conducted foreclosing all regular endemics.
But the most painful aspect of the current outbreak is that yellow fever is easily prevented by a vaccine that provides immunity for life. Large epidemic of yellow fever occurs only when infected people introduce the virus into a population with low vaccine coverage. WHO reports show that Nigerian adults who bring their children for immunisation have always presumptively refused to receive yellow fever vaccination when offered by health officials.
The current outbreaks show the need for a new strategy or an adjustment of the WHO-steered “Eliminate Yellow Fever Epidemics (EYE),” which is a 10-year strategic plan for the elimination of yellow fever in Nigeria in conjunction with Gavi the Vaccine Alliance, and the United Nations Children’s Fund (UNICEF). Therefore, we call on the federal, state and local governments to work together and stop further spread of the lethal disease.