Liberia’s almost non-existent health and sanitation infrastructure was again brought into sharp focus this week as officials confirmed that Lassa fever, a virus transmitted by rats usually found in areas with poor sanitation, is endemic for the second time in six months in three Liberian counties.

Liberia, which experienced a devastating 14-year civil war that ended in 2003, last registered Lassa fever outbreaks in September, mostly in Nimba County. Health officials said at the time they did not have the capacity to diagnose or treat the deadly disease but the outbreak ended after the Chinese Embassy stepped in with funds for medicines and testing kits.

Mildred Wesseh, a Ministry of Health spokesperson, told IRIN on Wednesday that the ministry has now confirmed a further 13 cases in Nimba County, close to the border with Guinea and Côte d’Ivoire. Cases have also been reported in Bong County (central Liberia) and Lofa (north), according to the Health Ministry.

"We are very concerned about the active circulation of Lassa fever and are now putting in place mechanisms to deal with the disease, especially in the affected areas,” Wesseh said

She said five people suspected of having the disease died, but health authorities had not confirmed whether the cause of death was Lassa. Some 21 suspected cases have been reported but only 13 were confirmed, and those who were currently infected with Lassa were being given medication, she said.

Lassa is a viral haemorrhagic fever known to be endemic in Liberia, Guinea, Sierra Leone and parts of Nigeria. It probably exists in other West African countries as well, according to the World Health Organisation (WHO).

Humans become infected with Lassa from contact with infected rodents. The virus can also be transmitted from one human to another through direct contact with body fluids. Rural dwellers, especially those living in areas of poor sanitation or crowded living conditions, are at greatest risk of contracting the illness, WHO says.

According to Liberia’s Human Development Report (2006), by the end of the country’s civil war 95 percent of health facilities had been destroyed and just 20 trained Liberian doctors were left in the country, while the United Nations children’s agency (UNICEF) estimated in September 2006 that just 7 percent of people in rural areas have access to clean drinking water.

The UN this week appealed for an additional US$117 million in donor assistance for Liberia to help rebuild basic social services. It estimated that 70 percent of health facilities in the country were still being run by international nongovernmental organisations.