Niger is a landlocked country in West Africa whose economy is primarily dependent upon livestock and self-sufficient farming (Pacific Prime, 2018). Unfortunately, these areas of income are difficult to consistently maintain due to extreme weather patterns. For instance, Niger usually endures long periods of drought, making it difficult to sustain crops (Pacific Prime, 2018). Occasional flooding also occurs, which wipes out crops and livestock, while also increasing the prevalence of disease-carrying mosquitoes (Pacific Prime, 2018). These conditions lead to poor sanitation standards, widespread malnutrition, and mortality, which are left unchecked due to the country’s weak political infrastructure (USAid, 2014). Niger’s history of political and economic instability discourages international investment and aid, making the nation extremely vulnerable to potential disaster (USAid, 2014). To continue, Niger has one of the highest fertility rates in the world, resulting in a large population that cannot be accommodated by their health care system (USAid, 2014). Due to these factors, Rift Valley fever was able to devastate the country in 2016, as it affected the lives of many people through infection and the elimination of a major food source.
From August to September of 2016, 64 human cases of Rift Valley fever (RVF), 23 of which were fatal, were reported in the Tahoua region of Niger (World Health Organization, 2016). It is likely that more cases had occurred in that time, but only the ones presenting severe symptoms were reported. The majority of the cases were found in males that worked as farmers or stockbreeders. During the same time period, an outbreak occurred among the livestock, making them unsuitable for consumption or commerce (World Health Organization, 2016). The risk of spreading this disease to neighboring countries was of high concern, due to the migration routes in which herders transported their cattle and ruminants. Additionally, a cultural event known as the Cure Salée festival highly increased the risk of transmission, due to the gathering of 2 million cattle and livestock from a variety of countries (World Health Organization, 2016). Thankfully, with the help of WHO and a multi-sectoral national rapid response team, the outbreak was contained and did not reach urban areas (World Health Organization, 2016). The final number of casualties for this outbreak was a total of 348 cases amongst humans, including 33 deaths (Centers for Disease Control and Prevention, 2016). There has yet to be another known outbreak of Rift Valley fever since this one, mostly due to the development of animal vaccinations (World Health Organization, 2018).
Rift Valley fever is caused by a mosquito-borne virus belonging to the genus Phlebovirus, of the Bunyaviridae family, known as RVFV (Ikegami and Makino, 2011). RVFV primarily affects domesticated animals such as cattle and ruminants, mostly resulting in severe illness and high mortality (World Health Organization, 2018). This virus can be transmitted to humans through contact with the blood or organs of these infected animals, which puts stockbreeders, farmers, butchers, and veterinarians at an increased risk (World Health Organization, 2018). For instance, the disease can infect humans if open skin comes into contact with infected animal tissue, if infected aerosols are inhaled, or if unpasteurized milk is consumed (World Health Organization, 2018). To continue, Aedes mosquitoes are considered the main reason for the spread of this disease, as they consume infected animal blood and pass it onto humans in their bites. Female mosquitoes have also been known to transmit the disease directly to their offspring (World Health Organization, 2018). Fortunately, human-to-human transmission has not been documented, including transmission from patients to healthcare workers (World Health Organization, 2018).
The incubation period for Rift Valley fever is 2-6 days, and in mild cases, it may be asymptomatic (World Health Organization, 2018). The early onset of the disease includes symptoms resembling the flu, such as a fever, muscle pain, and joint pain. These may progress to include light sensitivity, neck stiffness, and vomiting, which often leads to a misdiagnosis of meningitis (World Health Organization, 2018). Although mild cases are most common in humans, severe cases may come in three variations: ocular, meningoencephalitis, and hemorrhagic fever (Ikegami and Makino, 2011). Death is uncommon in ocular RVF, although permanent blindness may persist (Ikegami and Makino, 2011). Meningoencephalitis is likely to result in permanent neurological damage, but death still remains uncommon (Ikegami and Makino, 2011). Hemorrhagic fever has a 50% mortality rate, but it is often mistaken for other diseases such as malaria (World Health Organization, 2018). Due to non-specific symptoms, RVF is difficult to diagnose at early stages, but definitive diagnosis can be made in the laboratory setting, using PCR or a viral cell culture (World Health Organization, 2018). Additionally, misdiagnosis can be averted if close attention is paid to the health of the livestock, since RVF affects both animals and humans within a similar timeframe. If mysterious deaths are occurring amongst cattle, coupled with possible symptoms of RVF, it is likely that the patient has been infected by RVFV (World Health Organization, 2018).
Because most cases of Rift Valley fever are mild, no treatment may be required. However, for more severe cases, patients must be closely monitored, and therapy may be given to victims enduring lasting effects of the disease (World Health Organization, 2018). An inactivated vaccine has been created for human use; however, it has only been experimentally administered to veterinarians and lab personnel due to their relatively high risk of infection (World Health Organization, 2018). Otherwise, the vaccine is not commercially available, which may raise an ethical concern. As previously mentioned, stockbreeders, farmers, and butchers also have an increased risk of being infected by RVFV, but the vaccine is not available to them. However, luckily, both inactive and active animal vaccination have proven to be effective against this virus, as long as the vaccinations are administered prior to the onset of an outbreak (World Health Organization, 2018). If the vaccines are given during an outbreak, it could become problematic as reused syringes and needles can transfer the disease to uninfected cattle. Only one dose of the active vaccination is necessary to prevent RVF in cattle and ruminants, but it has been known to result in immediate abortion if administered to a pregnant animal. On the other hand, inactive vaccination does not result in abortion, but it takes multiple doses, which is a slower process (World Health Organization, 2018). In addition to vaccination, it is helpful to restrict the movement of livestock to a certain degree. This may be difficult, as it is the lifestyle of the nomadic stockbreeder to migrate with their cattle, and cultural events such as Cure Salée festival will continue to take place. However, if animal health surveillance is implemented, it can result in early detection of RVF, which would lead to an early response, minimizing the spread of the disease, as well (World Health Organization, 2018).
Although it is impossible to eradicate all mosquitoes and livestock, Rift Valley fever will continue to be suppressed as long as preventative measures are put in place and consistently practiced. The public should be educated in order to protect themselves from this infectious disease. For instance, if a person is slaughtering an animal, they should wear gloves, as well as a face mask and goggles to prevent transmission of the disease through potentially open skin or aerosols (World Health Organization, 2018). When preparing animals to be eaten, it is imperative that they are completely cooked, in order to avoid contact with fresh blood or tissue (World Health Organization, 2018). People should wash their hands frequently, as well. Some form of pasteurization should be implemented in milk, or it should at least be boiled before consumption. Animal carcasses should be disposed of properly, rather than being dumped into a water source. Since bottled water is not readily available to some communities in Niger, it is necessary to boil water before consumption (Pacific Prime, 2018). Because it is unrealistic for farmers and herders to avoid outdoor activity, it is necessary that they wear some form of insect repellent to protect from mosquitoes. They should also wear light clothing that covers their entire body, if the climate permits it. If possible, they should take a break from working during peak mosquito activity. Their homes should be protected using mosquito nets, and they should limit the availability of mosquito breeding sites around their homes. The use of larvicide may be necessary, but in a contained manner, as mosquitoes are an ecologically important food source for other animals (World Health Organization, 2018). For health care providers, it is important to handle the bodily fluids of patients with extreme care, because even though no human transmission has been reported yet, there is still a theoretical risk (World Health Organization, 2018).
Ultimately, the infrastructure of Niger needs to be strengthened and stabilized so that an emphasis toward sanitation and disease prevention can be implemented. The general public must receive more education on potential health risks that exist within their lifestyle, in order for change to be willingly made. Efforts should also be made to provide a more consistent food source, as malnutrition often results in a compromised immune system. The World Health Organization has provided technical and financial support to Niger, allowing them to manage the risk of disease more efficiently (2018). Alongside WHO, a variety of organizations have been working together to allow for sufficient outbreak response (2018). If diseases such as Rift Valley fever can be identified and managed at early stages, and preventative measures can be implicated and followed, many lives will be saved.