Lassa Fever in Post-Conflict Sierra Leone

Jeffrey G. Shaffer, Donald S. Grant, John S. Schieffelin, Matt L. Boisen, Augustine Goba, Jessica N. Hartnett, Danielle C. Levy, Rachael E. Yenni, Lina M. Moses, Mohammed Fullah, Mambo Momoh, Mbalu Fonnie, Richard Fonnie, Lansana Kanneh, Veronica J. Koroma, Kandeh Kargbo, Darin Ottomassathien, Ivana J. Muncy, Abigail B. Jones, Megan M. IllickPeter C. Kulakosky, Allyson M. Haislip, Christopher M. Bishop, Deborah H. Elliot, Bethany L. Brown, Hu Zhu, Kathryn M. Hastie, Kristian G. Andersen, Stephen K. Gire, Shervin Tabrizi, Ridhi Tariyal, Mathew Stremlau, Alex Matschiner, Darryl B. Sampey, Jennifer S. Spence, Robert Cross, Joan B. Geisbert, Onikepe A. Folarin, Christian T. Happi, Kelly R. Pitts, F. Jon Geske, Thomas Geisbert, Erica Ollmann Saphire, James E. Robinson, Russell B. Wilson, Pardis C. Sabeti, Lee A. Henderson, S. Humarr Khan, Daniel G. Bausch, Luis M. Branco, Robert F. Garry

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Background:Lassa fever (LF), an often-fatal hemorrhagic disease caused by Lassa virus (LASV), is a major public health threat in West Africa. When the violent civil conflict in Sierra Leone (1991 to 2002) ended, an international consortium assisted in restoration of the LF program at Kenema Government Hospital (KGH) in an area with the world's highest incidence of the disease.Methodology/Principal Findings:Clinical and laboratory records of patients presenting to the KGH Lassa Ward in the post-conflict period were organized electronically. Recombinant antigen-based LF immunoassays were used to assess LASV antigenemia and LASV-specific antibodies in patients who met criteria for suspected LF. KGH has been reestablished as a center for LF treatment and research, with over 500 suspected cases now presenting yearly. Higher case fatality rates (CFRs) in LF patients were observed compared to studies conducted prior to the civil conflict. Different criteria for defining LF stages and differences in sensitivity of assays likely account for these differences. The highest incidence of LF in Sierra Leone was observed during the dry season. LF cases were observed in ten of Sierra Leone's thirteen districts, with numerous cases from outside the traditional endemic zone. Deaths in patients presenting with LASV antigenemia were skewed towards individuals less than 29 years of age. Women self-reporting as pregnant were significantly overrepresented among LASV antigenemic patients. The CFR of ribavirin-treated patients presenting early in acute infection was lower than in untreated subjects.Conclusions/Significance:Lassa fever remains a major public health threat in Sierra Leone. Outreach activities should expand because LF may be more widespread in Sierra Leone than previously recognized. Enhanced case finding to ensure rapid diagnosis and treatment is imperative to reduce mortality. Even with ribavirin treatment, there was a high rate of fatalities underscoring the need to develop more effective and/or supplemental treatments for LF.

Original languageEnglish (US)
Article numbere2748
JournalPLoS Neglected Tropical Diseases
Volume8
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Lassa Fever
Sierra Leone
Lassa virus
Ribavirin
Mortality
Public Health
Western Africa
Incidence
Therapeutics
Immunoassay

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Shaffer, J. G., Grant, D. S., Schieffelin, J. S., Boisen, M. L., Goba, A., Hartnett, J. N., ... Garry, R. F. (2014). Lassa Fever in Post-Conflict Sierra Leone. PLoS Neglected Tropical Diseases, 8(3), [e2748]. https://doi.org/10.1371/journal.pntd.0002748

Lassa Fever in Post-Conflict Sierra Leone. / Shaffer, Jeffrey G.; Grant, Donald S.; Schieffelin, John S.; Boisen, Matt L.; Goba, Augustine; Hartnett, Jessica N.; Levy, Danielle C.; Yenni, Rachael E.; Moses, Lina M.; Fullah, Mohammed; Momoh, Mambo; Fonnie, Mbalu; Fonnie, Richard; Kanneh, Lansana; Koroma, Veronica J.; Kargbo, Kandeh; Ottomassathien, Darin; Muncy, Ivana J.; Jones, Abigail B.; Illick, Megan M.; Kulakosky, Peter C.; Haislip, Allyson M.; Bishop, Christopher M.; Elliot, Deborah H.; Brown, Bethany L.; Zhu, Hu; Hastie, Kathryn M.; Andersen, Kristian G.; Gire, Stephen K.; Tabrizi, Shervin; Tariyal, Ridhi; Stremlau, Mathew; Matschiner, Alex; Sampey, Darryl B.; Spence, Jennifer S.; Cross, Robert; Geisbert, Joan B.; Folarin, Onikepe A.; Happi, Christian T.; Pitts, Kelly R.; Geske, F. Jon; Geisbert, Thomas; Saphire, Erica Ollmann; Robinson, James E.; Wilson, Russell B.; Sabeti, Pardis C.; Henderson, Lee A.; Khan, S. Humarr; Bausch, Daniel G.; Branco, Luis M.; Garry, Robert F.

In: PLoS Neglected Tropical Diseases, Vol. 8, No. 3, e2748, 2014.

Research output: Contribution to journalArticle

Shaffer, JG, Grant, DS, Schieffelin, JS, Boisen, ML, Goba, A, Hartnett, JN, Levy, DC, Yenni, RE, Moses, LM, Fullah, M, Momoh, M, Fonnie, M, Fonnie, R, Kanneh, L, Koroma, VJ, Kargbo, K, Ottomassathien, D, Muncy, IJ, Jones, AB, Illick, MM, Kulakosky, PC, Haislip, AM, Bishop, CM, Elliot, DH, Brown, BL, Zhu, H, Hastie, KM, Andersen, KG, Gire, SK, Tabrizi, S, Tariyal, R, Stremlau, M, Matschiner, A, Sampey, DB, Spence, JS, Cross, R, Geisbert, JB, Folarin, OA, Happi, CT, Pitts, KR, Geske, FJ, Geisbert, T, Saphire, EO, Robinson, JE, Wilson, RB, Sabeti, PC, Henderson, LA, Khan, SH, Bausch, DG, Branco, LM & Garry, RF 2014, 'Lassa Fever in Post-Conflict Sierra Leone', PLoS Neglected Tropical Diseases, vol. 8, no. 3, e2748. https://doi.org/10.1371/journal.pntd.0002748
Shaffer JG, Grant DS, Schieffelin JS, Boisen ML, Goba A, Hartnett JN et al. Lassa Fever in Post-Conflict Sierra Leone. PLoS Neglected Tropical Diseases. 2014;8(3). e2748. https://doi.org/10.1371/journal.pntd.0002748
Shaffer, Jeffrey G. ; Grant, Donald S. ; Schieffelin, John S. ; Boisen, Matt L. ; Goba, Augustine ; Hartnett, Jessica N. ; Levy, Danielle C. ; Yenni, Rachael E. ; Moses, Lina M. ; Fullah, Mohammed ; Momoh, Mambo ; Fonnie, Mbalu ; Fonnie, Richard ; Kanneh, Lansana ; Koroma, Veronica J. ; Kargbo, Kandeh ; Ottomassathien, Darin ; Muncy, Ivana J. ; Jones, Abigail B. ; Illick, Megan M. ; Kulakosky, Peter C. ; Haislip, Allyson M. ; Bishop, Christopher M. ; Elliot, Deborah H. ; Brown, Bethany L. ; Zhu, Hu ; Hastie, Kathryn M. ; Andersen, Kristian G. ; Gire, Stephen K. ; Tabrizi, Shervin ; Tariyal, Ridhi ; Stremlau, Mathew ; Matschiner, Alex ; Sampey, Darryl B. ; Spence, Jennifer S. ; Cross, Robert ; Geisbert, Joan B. ; Folarin, Onikepe A. ; Happi, Christian T. ; Pitts, Kelly R. ; Geske, F. Jon ; Geisbert, Thomas ; Saphire, Erica Ollmann ; Robinson, James E. ; Wilson, Russell B. ; Sabeti, Pardis C. ; Henderson, Lee A. ; Khan, S. Humarr ; Bausch, Daniel G. ; Branco, Luis M. ; Garry, Robert F. / Lassa Fever in Post-Conflict Sierra Leone. In: PLoS Neglected Tropical Diseases. 2014 ; Vol. 8, No. 3.
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title = "Lassa Fever in Post-Conflict Sierra Leone",
abstract = "Background:Lassa fever (LF), an often-fatal hemorrhagic disease caused by Lassa virus (LASV), is a major public health threat in West Africa. When the violent civil conflict in Sierra Leone (1991 to 2002) ended, an international consortium assisted in restoration of the LF program at Kenema Government Hospital (KGH) in an area with the world's highest incidence of the disease.Methodology/Principal Findings:Clinical and laboratory records of patients presenting to the KGH Lassa Ward in the post-conflict period were organized electronically. Recombinant antigen-based LF immunoassays were used to assess LASV antigenemia and LASV-specific antibodies in patients who met criteria for suspected LF. KGH has been reestablished as a center for LF treatment and research, with over 500 suspected cases now presenting yearly. Higher case fatality rates (CFRs) in LF patients were observed compared to studies conducted prior to the civil conflict. Different criteria for defining LF stages and differences in sensitivity of assays likely account for these differences. The highest incidence of LF in Sierra Leone was observed during the dry season. LF cases were observed in ten of Sierra Leone's thirteen districts, with numerous cases from outside the traditional endemic zone. Deaths in patients presenting with LASV antigenemia were skewed towards individuals less than 29 years of age. Women self-reporting as pregnant were significantly overrepresented among LASV antigenemic patients. The CFR of ribavirin-treated patients presenting early in acute infection was lower than in untreated subjects.Conclusions/Significance:Lassa fever remains a major public health threat in Sierra Leone. Outreach activities should expand because LF may be more widespread in Sierra Leone than previously recognized. Enhanced case finding to ensure rapid diagnosis and treatment is imperative to reduce mortality. Even with ribavirin treatment, there was a high rate of fatalities underscoring the need to develop more effective and/or supplemental treatments for LF.",
author = "Shaffer, {Jeffrey G.} and Grant, {Donald S.} and Schieffelin, {John S.} and Boisen, {Matt L.} and Augustine Goba and Hartnett, {Jessica N.} and Levy, {Danielle C.} and Yenni, {Rachael E.} and Moses, {Lina M.} and Mohammed Fullah and Mambo Momoh and Mbalu Fonnie and Richard Fonnie and Lansana Kanneh and Koroma, {Veronica J.} and Kandeh Kargbo and Darin Ottomassathien and Muncy, {Ivana J.} and Jones, {Abigail B.} and Illick, {Megan M.} and Kulakosky, {Peter C.} and Haislip, {Allyson M.} and Bishop, {Christopher M.} and Elliot, {Deborah H.} and Brown, {Bethany L.} and Hu Zhu and Hastie, {Kathryn M.} and Andersen, {Kristian G.} and Gire, {Stephen K.} and Shervin Tabrizi and Ridhi Tariyal and Mathew Stremlau and Alex Matschiner and Sampey, {Darryl B.} and Spence, {Jennifer S.} and Robert Cross and Geisbert, {Joan B.} and Folarin, {Onikepe A.} and Happi, {Christian T.} and Pitts, {Kelly R.} and Geske, {F. Jon} and Thomas Geisbert and Saphire, {Erica Ollmann} and Robinson, {James E.} and Wilson, {Russell B.} and Sabeti, {Pardis C.} and Henderson, {Lee A.} and Khan, {S. Humarr} and Bausch, {Daniel G.} and Branco, {Luis M.} and Garry, {Robert F.}",
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T1 - Lassa Fever in Post-Conflict Sierra Leone

AU - Shaffer, Jeffrey G.

AU - Grant, Donald S.

AU - Schieffelin, John S.

AU - Boisen, Matt L.

AU - Goba, Augustine

AU - Hartnett, Jessica N.

AU - Levy, Danielle C.

AU - Yenni, Rachael E.

AU - Moses, Lina M.

AU - Fullah, Mohammed

AU - Momoh, Mambo

AU - Fonnie, Mbalu

AU - Fonnie, Richard

AU - Kanneh, Lansana

AU - Koroma, Veronica J.

AU - Kargbo, Kandeh

AU - Ottomassathien, Darin

AU - Muncy, Ivana J.

AU - Jones, Abigail B.

AU - Illick, Megan M.

AU - Kulakosky, Peter C.

AU - Haislip, Allyson M.

AU - Bishop, Christopher M.

AU - Elliot, Deborah H.

AU - Brown, Bethany L.

AU - Zhu, Hu

AU - Hastie, Kathryn M.

AU - Andersen, Kristian G.

AU - Gire, Stephen K.

AU - Tabrizi, Shervin

AU - Tariyal, Ridhi

AU - Stremlau, Mathew

AU - Matschiner, Alex

AU - Sampey, Darryl B.

AU - Spence, Jennifer S.

AU - Cross, Robert

AU - Geisbert, Joan B.

AU - Folarin, Onikepe A.

AU - Happi, Christian T.

AU - Pitts, Kelly R.

AU - Geske, F. Jon

AU - Geisbert, Thomas

AU - Saphire, Erica Ollmann

AU - Robinson, James E.

AU - Wilson, Russell B.

AU - Sabeti, Pardis C.

AU - Henderson, Lee A.

AU - Khan, S. Humarr

AU - Bausch, Daniel G.

AU - Branco, Luis M.

AU - Garry, Robert F.

PY - 2014

Y1 - 2014

N2 - Background:Lassa fever (LF), an often-fatal hemorrhagic disease caused by Lassa virus (LASV), is a major public health threat in West Africa. When the violent civil conflict in Sierra Leone (1991 to 2002) ended, an international consortium assisted in restoration of the LF program at Kenema Government Hospital (KGH) in an area with the world's highest incidence of the disease.Methodology/Principal Findings:Clinical and laboratory records of patients presenting to the KGH Lassa Ward in the post-conflict period were organized electronically. Recombinant antigen-based LF immunoassays were used to assess LASV antigenemia and LASV-specific antibodies in patients who met criteria for suspected LF. KGH has been reestablished as a center for LF treatment and research, with over 500 suspected cases now presenting yearly. Higher case fatality rates (CFRs) in LF patients were observed compared to studies conducted prior to the civil conflict. Different criteria for defining LF stages and differences in sensitivity of assays likely account for these differences. The highest incidence of LF in Sierra Leone was observed during the dry season. LF cases were observed in ten of Sierra Leone's thirteen districts, with numerous cases from outside the traditional endemic zone. Deaths in patients presenting with LASV antigenemia were skewed towards individuals less than 29 years of age. Women self-reporting as pregnant were significantly overrepresented among LASV antigenemic patients. The CFR of ribavirin-treated patients presenting early in acute infection was lower than in untreated subjects.Conclusions/Significance:Lassa fever remains a major public health threat in Sierra Leone. Outreach activities should expand because LF may be more widespread in Sierra Leone than previously recognized. Enhanced case finding to ensure rapid diagnosis and treatment is imperative to reduce mortality. Even with ribavirin treatment, there was a high rate of fatalities underscoring the need to develop more effective and/or supplemental treatments for LF.

AB - Background:Lassa fever (LF), an often-fatal hemorrhagic disease caused by Lassa virus (LASV), is a major public health threat in West Africa. When the violent civil conflict in Sierra Leone (1991 to 2002) ended, an international consortium assisted in restoration of the LF program at Kenema Government Hospital (KGH) in an area with the world's highest incidence of the disease.Methodology/Principal Findings:Clinical and laboratory records of patients presenting to the KGH Lassa Ward in the post-conflict period were organized electronically. Recombinant antigen-based LF immunoassays were used to assess LASV antigenemia and LASV-specific antibodies in patients who met criteria for suspected LF. KGH has been reestablished as a center for LF treatment and research, with over 500 suspected cases now presenting yearly. Higher case fatality rates (CFRs) in LF patients were observed compared to studies conducted prior to the civil conflict. Different criteria for defining LF stages and differences in sensitivity of assays likely account for these differences. The highest incidence of LF in Sierra Leone was observed during the dry season. LF cases were observed in ten of Sierra Leone's thirteen districts, with numerous cases from outside the traditional endemic zone. Deaths in patients presenting with LASV antigenemia were skewed towards individuals less than 29 years of age. Women self-reporting as pregnant were significantly overrepresented among LASV antigenemic patients. The CFR of ribavirin-treated patients presenting early in acute infection was lower than in untreated subjects.Conclusions/Significance:Lassa fever remains a major public health threat in Sierra Leone. Outreach activities should expand because LF may be more widespread in Sierra Leone than previously recognized. Enhanced case finding to ensure rapid diagnosis and treatment is imperative to reduce mortality. Even with ribavirin treatment, there was a high rate of fatalities underscoring the need to develop more effective and/or supplemental treatments for LF.

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