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AROMOLARAN OLUKEMI, SAMSON TIMOTHYKAYODE, FALODUN OLUTAYOISRAEL. Knowledge and practices associated with Lassa fever in rural Nigeria: Implications for prevention and control. J Public Health Afr 2023; 14:2001. [PMID: 37908393 PMCID: PMC10615167 DOI: 10.4081/jphia.2023.2001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/11/2023] [Indexed: 11/02/2023] Open
Abstract
Lassa fever (LF) is a haemorrhagic illness endemic in West Africa, which can be attributed to poor rat control and poor sanitation, especially in the rural communities. Increasing awareness and education about LF has been advocated for its prevention and control. This study investigated the level of awareness and knowledge associated with LF among the residents of Iwo and Oluponna areas of Osun State, southwest Nigeria. A descriptive cross-sectional study was carried out among the adult residents using a structured questionnaire. Descriptive and inferential statistics were used in analysing the data. In total, 534 (79.11%) respondents had heard about LF, but only 15.4% had good knowledge of the disease. Their main source of information was the media (46.3%, P=0.002, P<0.01), while only 21.2% got information from health workers. About 45% of respondents have rats in their houses. Respondents from Iwo were better informed than Oluponna. Multiple logistic regression analysis indicated location to be significantly associated with awareness (OR=1.62, C.I=1.078-2.433, P<0.05), knowledge of prevention (OR=5.88, C.I=2.807-12.317, P=0.000, P<0.01) and treatment (OR=1.648, C.I=1.122-2.420, P=0.011, P<0.05). Although the residents of Iwo are better informed about LF than Oluponna residents, the knowledge of the disease is poor in both areas. Health workers should be well informed, and the government should increase enlightenment programmes about LF, especially in rural communities of Nigeria, so as to curtail the spread and prevent outbreaks.
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Affiliation(s)
| | - TIMOTHY KAYODE SAMSON
- Statistics Programme, College of Agriculture, Engineering and Science, Bowen University, Iwo
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2
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Dalhat MM, Olayinka A, Meremikwu MM, Dan-Nwafor C, Iniobong A, Ntoimo LF, Onoh I, Mba S, Ohonsi C, Arinze C, Esu EB, Nwafor O, Oladipupo I, Onoja M, Ilori E, Okonofua F, Ochu CL, Igumbor EU, Adetifa I. Epidemiological trends of Lassa fever in Nigeria, 2018-2021. PLoS One 2022; 17:e0279467. [PMID: 36584167 PMCID: PMC9803109 DOI: 10.1371/journal.pone.0279467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lassa fever is a viral haemorrhagic fever endemic in Nigeria. Improved surveillance and testing capacity have revealed in an increased number of reported cases and apparent geographic spread of Lassa fever in Nigeria. We described the recent four-year trend of Lassa fever in Nigeria to improve understanding of its epidemiology and inform the design of appropriate interventions. METHODS We analysed the national surveillance data on Lassa fever maintained by the Nigeria Centre for Diseases Control (NCDC) and described trends, sociodemographic, geographic distribution, and clinical outcomes. We compared cases, positivity, and clinical outcomes in the period January 2018 to December 2021. RESULTS We found Lassa fever to be reported throughout the year with more than half the cases reported within the first quarter of the year, a recent increase in numbers and geographic spread of the virus, and male and adult (>18 years) preponderance. Case fatality rates were worse in males, the under-five and elderly, during off-peak periods, and among low reporting states. CONCLUSION Lassa fever is endemic in Nigeria with a recent increase in numbers and geographical distribution. Sustaining improved surveillance, enhanced laboratory diagnosis and improved case management capacity during off-peak periods should remain a priority. Attention should be paid to the very young and elderly during outbreaks. Further research efforts should identify and address specific factors that determine poor clinical outcomes.
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Affiliation(s)
- Mahmood M. Dalhat
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
- Infectious Diseases Control Centre, Kaduna State, Kaduna, Nigeria
| | - Adebola Olayinka
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
| | - Martin M. Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Chioma Dan-Nwafor
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
| | - Akanimo Iniobong
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Lorretta F. Ntoimo
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University Oye-Ekiti, Oye, Nigeria
| | - Ikenna Onoh
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Sandra Mba
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Cornelius Ohonsi
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
| | - Chinedu Arinze
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Ekpereonne B. Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Obinna Nwafor
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | | | - Michael Onoja
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Elsie Ilori
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
| | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
| | - Chinwe L. Ochu
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
| | - Ehimario U. Igumbor
- Nigeria COVID-19 Research Coalition, Abuja, Nigeria
- Centre for Infectious Disease Research, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Ifedayo Adetifa
- Nigeria Centre for Disease Control and Prevention, Abuja, Nigeria
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Raabe V, Mehta AK, Evans JD. Lassa Virus Infection: a Summary for Clinicians. Int J Infect Dis 2022; 119:187-200. [PMID: 35395384 DOI: 10.1016/j.ijid.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/01/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This summary on Lassa virus (LASV) infection and Lassa fever disease (LF) was developed from a clinical perspective to provide clinicians a condensed, accessible understanding of the current literature. The information provided highlights pathogenesis, clinical features, and diagnostics with an emphasis on therapies and vaccines that have demonstrated potential value for use in clinical or research environments. METHODS An integrative literature review was conducted on the clinical and pathological features, vaccines, and treatments for LASV infection, with a focus on recent studies and in vivo evidence from humans and/or non-human primates (NHPs), when available. RESULTS Two antiviral medications with potential benefit for the treatment of LASV infection and one for post-exposure prophylaxis were identified, although a larger number of potential candidates are currently being evaluated. Multiple vaccine platforms are in pre-clinical development for LASV prevention, but data from human clinical trials are not yet available. CONCLUSION We provide succinct summaries of medical countermeasures against LASV to give the busy clinician a rapid reference. Although there are no approved drugs or vaccines for LF, we provide condensed information from a literature review for measures that can be taken when faced with a suspected infection, including investigational treatment options and hospital engineering controls.
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Affiliation(s)
- Vanessa Raabe
- New York University Grossman School of Medicine, New York, NY.
| | | | - Jared D Evans
- Johns Hopkins Applied Physics Laboratory, Laurel, MD.
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Pfäfflin F, Stegemann MS, Heim KM, Achterberg S, Pfitzner U, Götze L, Oesterhelweg L, Suttorp N, Herzog C, Stadtmann B, Uhrig A. Preparing for patients with high-consequence infectious diseases: Example of a high-level isolation unit. PLoS One 2022; 17:e0264644. [PMID: 35239726 PMCID: PMC8893674 DOI: 10.1371/journal.pone.0264644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Patients with high-consequence infectious diseases (HCID) are rare in Western Europe. However, high-level isolation units (HLIU) must always be prepared for patient admission. Case fatality rates of HCID can be reduced by providing optimal intensive care management. We here describe a single centre’s preparation, its embedding in the national context and the challenges we faced during the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic.
Methods
Ten team leaders organize monthly whole day trainings for a team of doctors and nurses from the HLIU focusing on intensive care medicine. Impact and relevance of training are assessed by a questionnaire and a perception survey, respectively. Furthermore, yearly exercises with several partner institutions are performed to cover different real-life scenarios. Exercises are evaluated by internal and external observers. Both training sessions and exercises are accompanied by intense feedback.
Results
From May 2017 monthly training sessions were held with a two-month and a seven-month break due to the first and second wave of the SARS-CoV-2 pandemic, respectively. Agreement with the statements of the questionnaire was higher after training compared to before training indicating a positive effect of training sessions on competence. Participants rated joint trainings for nurses and doctors at regular intervals as important. Numerous issues with potential for improvement were identified during post processing of exercises. Action plans for their improvement were drafted and as of now mostly implemented. The network of the permanent working group of competence and treatment centres for HCID (Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger (STAKOB)) at the Robert Koch-Institute (RKI) was strengthened throughout the SARS-CoV-2 pandemic.
Discussion
Adequate preparation for the admission of patients with HCID is challenging. We show that joint regular trainings of doctors and nurses are appreciated and that training sessions may improve perceived skills. We also show that real-life scenario exercises may reveal additional deficits, which cannot be easily disclosed in training sessions. Although the SARS-CoV-2 pandemic interfered with our activities the enhanced cooperation among German HLIU during the pandemic ensured constant readiness for the admission of HCID patients to our or to collaborating HLIU. This is a single centre’s experience, which may not be generalized to other centres. However, we believe that our work may address aspects that should be considered when preparing a unit for the admission of patients with HCID. These may then be adapted to the local situations.
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Affiliation(s)
- Frieder Pfäfflin
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
- * E-mail:
| | - Miriam Songa Stegemann
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katrin Moira Heim
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Stephan Achterberg
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ursula Pfitzner
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Louise Götze
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Lars Oesterhelweg
- Institute of Legal Medicine and Forensic Sciences, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Norbert Suttorp
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Christian Herzog
- Centre for Biological Threats, Strategy and Incident Response, Robert Koch-Institute, Berlin, Germany
| | - Benjamin Stadtmann
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Alexander Uhrig
- Department for Infectious Diseases and Respiratory Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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Merson L, Bourner J, Jalloh S, Erber A, Salam AP, Flahault A, Olliaro PL. Clinical characterization of Lassa fever: A systematic review of clinical reports and research to inform clinical trial design. PLoS Negl Trop Dis 2021; 15:e0009788. [PMID: 34547033 PMCID: PMC8486098 DOI: 10.1371/journal.pntd.0009788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/01/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Research is urgently needed to reduce the morbidity and mortality of Lassa fever (LF), including clinical trials to test new therapies and to verify the efficacy and safety of the only current treatment recommendation, ribavirin, which has a weak clinical evidence base. To help establish a basis for the development of an adaptable, standardised clinical trial methodology, we conducted a systematic review to identify the clinical characteristics and outcomes of LF and describe how LF has historically been defined and assessed in the scientific literature. METHODOLOGY Primary clinical studies and reports of patients with suspected and confirmed diagnosis of LF published in the peer-reviewed literature before 15 April 2021 were included. Publications were selected following a two-stage screening of abstracts, then full-texts, by two independent reviewers at each stage. Data were extracted, verified, and summarised using descriptive statistics. RESULTS 147 publications were included, primarily case reports (36%), case series (28%), and cohort studies (20%); only 2 quasi-randomised studies (1%) were found. Data are mostly from Nigeria (52% of individuals, 41% of publications) and Sierra Leone (42% of individuals, 31% of publications). The results corroborate the World Health Organisation characterisation of LF presentation. However, a broader spectrum of presenting symptoms is evident, such as gastrointestinal illness and other nervous system and musculoskeletal disorders that are not commonly included as indicators of LF. The overall case fatality ratio was 30% in laboratory-confirmed cases (1896/6373 reported in 109 publications). CONCLUSION Systematic review is an important tool in the clinical characterisation of diseases with limited publications. The results herein provide a more complete understanding of the spectrum of disease which is relevant to clinical trial design. This review demonstrates the need for coordination across the LF research community to generate harmonised research methods that can contribute to building a strong evidence base for new treatments and foster confidence in their integration into clinical care.
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Affiliation(s)
- Laura Merson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Josephine Bourner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Astrid Erber
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Alex Paddy Salam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Piero L. Olliaro
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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6
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Holt A, Hornsey E, Seale AC, Rohan H, Bausch DG, Ihekweazu C, Okwor T. A mixed-methods analysis of personal protective equipment used in Lassa fever treatment centres in Nigeria. Infect Prev Pract 2021; 3:100168. [PMID: 34430843 PMCID: PMC8367797 DOI: 10.1016/j.infpip.2021.100168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/28/2021] [Indexed: 11/09/2022] Open
Abstract
Background Lassa fever (LF) is a viral haemorrhagic fever endemic in West Africa. Lassa virus is maintained in and spread to humans from rodents, with occasional secondary human-to-human transmission. Present recommendations for personal protective equipment (PPE) for care of patients with LF generally follow those for filovirus diseases. However, the need for such high-level PPE for LF, which is thought to be considerably less transmissible between humans than filoviruses, is unclear. Aim In Nigerian Lassa Treatment Centres (LTCs) we aimed to describe current PPE practices, identify barriers and facilitators to implementation of existing guidance, and assess healthcare workers' understanding. This would inform the development of future PPE guidelines for LF. Methods We performed a mixed-methods study, including short cross-sectional surveys of PPE used in LTCs, observations of practice, and in-depth interviews with key informants. We described the quantitative data and we conducted a thematic analysis of qualitative data. Findings Our survey of 74 HCWs found that approximately half reported problems with recommended PPE. In three LTCs PPE was used highly variably. Full PPE, as recommended in Nigeria CDC guidelines, was used in less than a quarter (21%) of interactions. In-depth interviews suggested this was based on availability and HCWs' own risk assessments. Conclusion Without specific guidance on Lassa, the current approach is both resource and labour-intensive, where these are both limited. This has led to low adherence by health care workers, whose own experience indicates lower risk. The evidence-base to inform PPE required for LF must be improved to inform a more tailored approach.
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Affiliation(s)
- Andrew Holt
- London School of Hygiene & Tropical Medicine, London, UK
| | - Emilio Hornsey
- UK Public Health Rapid Support Team, London, UK.,Public Health England, UK
| | - Anna C Seale
- London School of Hygiene & Tropical Medicine, London, UK.,UK Public Health Rapid Support Team, London, UK
| | - Hana Rohan
- London School of Hygiene & Tropical Medicine, London, UK.,UK Public Health Rapid Support Team, London, UK
| | - Daniel G Bausch
- London School of Hygiene & Tropical Medicine, London, UK.,UK Public Health Rapid Support Team, London, UK.,Public Health England, UK
| | | | - Tochi Okwor
- Nigeria Center for Disease Control, Abuja, Nigeria
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Abstract
Lassa fever (LF) is a lethal hemorrhagic disease primarily concentrated in the tropical savannah regions of Nigeria and the Mano River Union countries of Sierra Leone, Liberia, and Guinea. Endemic hotspots within these countries have had recurrent exposure to Lassa virus (LASV) via continual spillover from the host reservoir Mastomys natalensis. Increased trade and travel throughout the region have spread the virus to previously unexposed countries, including Ghana, Benin, Mali, and Côte d'Ivoire. In the absence of effective treatment or vaccines to LASV, preventative measures against Lassa fever rely heavily on reducing or eliminating rodent exposure, increasing the knowledge base surrounding the virus and disease in communities, and diminishing the stigmas faced by Lassa fever survivors.
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8
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Min KD, Hwang J, Schneider MC, So Y, Lee JY, Cho SI. An exploration of the protective effect of rodent species richness on the geographical expansion of Lassa fever in West Africa. PLoS Negl Trop Dis 2021; 15:e0009108. [PMID: 33524016 PMCID: PMC7877741 DOI: 10.1371/journal.pntd.0009108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/11/2021] [Accepted: 01/05/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Lassa fever (LF) is one of the most devastating rodent-borne diseases in West Africa, causing thousands of deaths annually. The geographical expansion of LF is also a concern; cases were recently identified in Ghana and Benin. Previous ecological studies have suggested that high natural-host biodiversity reduces the likelihood of spillover transmission of rodent-borne diseases, by suppressing the activities of reservoir species. However, the association of biodiversity with the geographical expansion of LF has not been the subject of epidemiological studies. METHODOLOGY/PRINCIPAL FINDINGS We conducted a spatial analysis based on sociodemographic, geographical, and ecological data, and found that higher rodent species richness was significantly associated with a lower risk of LF emergence in West Africa from 2008 to 2017 (Odds Ratio = 0.852, 95% Credible Interval = 0.745-0.971). CONCLUSIONS/SIGNIFICANCE The results reinforce the importance of the 'One Health' approach by demonstrating that a high level of biodiversity could benefit human health.
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Affiliation(s)
- Kyung-Duk Min
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jusun Hwang
- Wildlife Conservation Society, Bronx, New York, United States of America
| | - Maria Cristina Schneider
- Department of International Health, School of Nursing and Health Sciences, Georgetown University, Washington DC, United States of America
- Institute of Collective Health Studies, Federal University of Rio De Janeiro, Rio De Janeiro, Brazil
| | - Yeonghwa So
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Ju-Yeun Lee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sung-il Cho
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
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9
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Tewogbola P, Aung N. Lassa fever: History, causes, effects, and reduction strategies. INTERNATIONAL JOURNAL OF ONE HEALTH 2020. [DOI: 10.14202/ijoh.2020.95-98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Lassa fever is a disease that is not well-known worldwide, particularly due to the inability of the multimammate rat, the primary vector of the Lassa virus, to breed in temperate regions. The aim of this review is to provide an overview of the disease and its modus operandi while also providing information about trends in the past decade, as well as proven strategies that have been used to manage its spread.
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Affiliation(s)
- Promise Tewogbola
- School of Psychological and Behavioral Sciences, Southern Illinois University, Carbondale, 62901, USA
| | - Norah Aung
- Department of Health Sciences and Social Work, Western Illinois University, Macomb, 61455, USA
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10
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Wolf T, Ellwanger R, Goetsch U, Wetzstein N, Gottschalk R. Fifty years of imported Lassa fever: a systematic review of primary and secondary cases. J Travel Med 2020; 27:5808990. [PMID: 32219400 DOI: 10.1093/jtm/taaa035] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 03/08/2020] [Indexed: 01/15/2023]
Abstract
RATIONALE FOR SYSTEMATIC REVIEW Lassa fever is the most common cause of imported haemorrhagic fevers cases in non-endemic countries. As a disease with a high case fatality rate that has regularly caused clusters of nosocomial transmission in endemic areas, prompt diagnosis is vital. We conducted a systematic review of imported cases of the last 50 years with the aim of defining the clinical and epidemiological characteristics that will enhance early diagnosis, prompt initiation of treatment and an appropriate public health response to Lassa fever cases. METHODS We performed a retrospective, systematic review of 36 primary and two secondary cases of Lassa fever in non-endemic countries outside West Africa by searching the PubMed database. This yielded 56 relevant publications that were included in our analysis. RESULTS The case fatality rate of 35.1% for imported cases was higher than that reported for endemic countries. The majority of patients showed clinical features consistent with Lassa fever and had a typical exposure. There was a considerable delay in diagnosis in imported cases with high associated numbers of contacts. Ribavirin was rarely used for post-exposure prophylaxis. Only two secondary transmissions occurred. Thirty-one percent of patients received Lassa fever-specific treatment and five required intensive care. CONCLUSIONS Although importation of Lassa fever to non-endemic countries is a rare event, it has repeatedly happened over five decades. Suspicion of Lassa fever should be based on careful consideration of clinical features and exposure history in order to assist early diagnosis in returning travellers from West Africa.
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Affiliation(s)
- Timo Wolf
- Department of Internal Medicine II-Infectious Diseases, University Hospital Frankfurtxs, Frankfurt, Germany
| | - Regina Ellwanger
- Department of Internal Medicine II-Infectious Diseases, University Hospital Frankfurtxs, Frankfurt, Germany.,Health Protection Authority, Municipality of Frankfurt am Main, Frankfurt, Germany
| | - Udo Goetsch
- Health Protection Authority, Municipality of Frankfurt am Main, Frankfurt, Germany
| | - Nils Wetzstein
- Department of Internal Medicine II-Infectious Diseases, University Hospital Frankfurtxs, Frankfurt, Germany
| | - Rene Gottschalk
- Health Protection Authority, Municipality of Frankfurt am Main, Frankfurt, Germany.,Institute of Medical Virology, University Hospital Frankfurt, Frankfurt, Germany
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Hunger I, Becker S, Frank C, Grunow R, Herzog C, Kurth A, Monazahian M, Nitsche A, Sasse J, Schulz-Weidhaas C, Wollin KM, Schaade L. [Four years after the Ebola crisis : Challenges, experiences, and implications in the German public health context]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1041-1051. [PMID: 31428830 DOI: 10.1007/s00103-019-02995-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Ebola virus disease outbreak in West Africa in 2014/2015 was by far the biggest, most prolonged, and geographically most widespread outbreak of this disease since the discovery of the Ebola virus in 1976. Although no cases of Ebola virus disease were confirmed in Germany, a number of crisis management activities were initiated.Based on a combination of local, national, and international lessons learned, literature research, and a large number of discussions among German colleagues as well as German and foreign colleagues, the experiences of selected German public health actors as well as implications for health protection activities in Germany are presented.On the one hand, preparedness for managing unusual high consequence health events-caused by rare, highly pathogenic biological agents-including the provision of adequate material and personnel resources remains important in Germany. On the other hand, more German engagement in global health is necessary, because the dividing line between global health and local health is increasingly disappearing.
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Affiliation(s)
- Iris Hunger
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland.
| | - Stephan Becker
- Institut für Virologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Christina Frank
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Deutschland
| | - Roland Grunow
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Christian Herzog
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Andreas Kurth
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Masyar Monazahian
- Zentrum für Gesundheits- und Infektionsschutz, Niedersächsisches Landesgesundheitsamt, Hannover, Deutschland
| | - Andreas Nitsche
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Julia Sasse
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Claudia Schulz-Weidhaas
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
| | - Klaus-Michael Wollin
- Zentrum für Gesundheits- und Infektionsschutz, Niedersächsisches Landesgesundheitsamt, Hannover, Deutschland
| | - Lars Schaade
- Zentrum für Biologische Gefahren und Spezielle Pathogene, Robert Koch-Institut, Seestraße 10, 13353, Berlin, Deutschland
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12
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Akpede GO, Asogun DA, Okogbenin SA, Dawodu SO, Momoh MO, Dongo AE, Ike C, Tobin E, Akpede N, Ogbaini-Emovon E, Adewale AE, Ochei O, Onyeke F, Okonofua MO, Atafo RO, Odia I, Adomeh DI, Odigie G, Ogbeifun C, Muebonam E, Ihekweazu C, Ramharter M, Colubri A, Sarbeti PC, Happi CT, Günther S, Agbonlahor DE. Caseload and Case Fatality of Lassa Fever in Nigeria, 2001-2018: A Specialist Center's Experience and Its Implications. Front Public Health 2019; 7:170. [PMID: 31294014 PMCID: PMC6603170 DOI: 10.3389/fpubh.2019.00170] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
Background: The general lack of comprehensive data on the trends of Lassa fever (LF) outbreaks contrasts with its widespread occurrence in West Africa and is an important constraint in the design of effective control measures. We reviewed the contribution of LF to admissions and mortality among hospitalized patients from 2001 to 2018 in the bid to address this gap. Methods: Observational study of LF caseload and mortality from 2001 to 18 in terms of the contribution of confirmed LF to admissions and deaths, and case fatality (CF) among patients with confirmed LF at a specialist center in Nigeria. The diagnosis of LF was confirmed using reverse transcription polymerase chain reaction (RT-PCR) test, and medians and frequencies were compared using Kruskal-Wallis, Mann-Whitney and χ2 tests, with p-values <0.05 taken as significant. Results: The contribution of confirmed LF to deaths (362/9057, 4.0%) was significantly higher than to admissions (1,298/185,707, 0.7%; OR [95% CI] = 5.9 [5.3, 6.7], p < 0.001). The average CF among patients with confirmed LF declined from 154/355 (43%) in 2001–09 to 183/867 (21.1%) (OR [95% CI] = 2.9 [2.2, 3.7], p < 0.001) in 2011–18. The annual CF declined from 94% in 2001 to 15% in 2018 whereas the caseload increased from 0.3 to 3.4%. The outbreaks were characterized by irregular cycles of high caseload in 2005–2007, 2012–2014, and 2016–2018, and progressive blurring of the seasonality. Conclusion: LF outbreaks in Nigeria have upgraded spatially and temporally, with the potential for cycles of increasing severity. The strategic establishment of LF surveillance and clinical case management centers could be a pragmatic and cost-effective approach to mitigating the outbreaks, particularly in reducing the associated CF. Urgent efforts are needed in reinvigorating extant control measures while the search for sustainable solutions continues.
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Affiliation(s)
- George O Akpede
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria.,Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Danny A Asogun
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria.,Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Sylvanus A Okogbenin
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria.,Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Simeon O Dawodu
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Mojeed O Momoh
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Andrew E Dongo
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Chiedozie Ike
- Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Ekaete Tobin
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Nosa Akpede
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Ephraim Ogbaini-Emovon
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Adetunji E Adewale
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Oboratare Ochei
- Department of Community Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Frank Onyeke
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Martha O Okonofua
- Department of Nursing Services, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Rebecca O Atafo
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria.,Department of Nursing Services, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Ikponmwosa Odia
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Donatus I Adomeh
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - George Odigie
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Caroline Ogbeifun
- Department of Medical Records, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Ekene Muebonam
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | | | - Michael Ramharter
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andres Colubri
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | - Pardis C Sarbeti
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | - Christian T Happi
- Department of Biological Sciences and African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria
| | - Stephan Günther
- Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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13
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Grahn A, Bråve A, Tolfvenstam T, Studahl M. Absence of Nosocomial Transmission of Imported Lassa Fever during Use of Standard Barrier Nursing Methods. Emerg Infect Dis 2019; 24:978-987. [PMID: 29775178 PMCID: PMC6004835 DOI: 10.3201/eid2406.172097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Nosocomial transmission of Lassa virus (LASV) is reported to be low when care for the index patient includes proper barrier nursing methods. We investigated whether asymptomatic LASV infection occurred in healthcare workers who used standard barrier nursing methods during the first 15 days of caring for a patient with Lassa fever in Sweden. Of 76 persons who were defined as having been potentially exposed to LASV, 53 provided blood samples for detection of LASV IgG. These persons also responded to a detailed questionnaire to evaluate exposure to different body fluids from the index patient. LASV-specific IgG was not detected in any of the 53 persons. Five of 53 persons had not been using proper barrier nursing methods. Our results strengthen the argument for a low risk of secondary transmission of LASV in humans when standard barrier nursing methods are used and the patient has only mild symptoms.
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14
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Brisse ME, Ly H. Hemorrhagic Fever-Causing Arenaviruses: Lethal Pathogens and Potent Immune Suppressors. Front Immunol 2019; 10:372. [PMID: 30918506 PMCID: PMC6424867 DOI: 10.3389/fimmu.2019.00372] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/14/2019] [Indexed: 12/22/2022] Open
Abstract
Hemorrhagic fevers (HF) resulting from pathogenic arenaviral infections have traditionally been neglected as tropical diseases primarily affecting African and South American regions. There are currently no FDA-approved vaccines for arenaviruses, and treatments have been limited to supportive therapy and use of non-specific nucleoside analogs, such as Ribavirin. Outbreaks of arenaviral infections have been limited to certain geographic areas that are endemic but known cases of exportation of arenaviruses from endemic regions and socioeconomic challenges for local control of rodent reservoirs raise serious concerns about the potential for larger outbreaks in the future. This review synthesizes current knowledge about arenaviral evolution, ecology, transmission patterns, life cycle, modulation of host immunity, disease pathogenesis, as well as discusses recent development of preventative and therapeutic pursuits against this group of deadly viral pathogens.
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Affiliation(s)
- Morgan E Brisse
- Biochemistry, Molecular Biology, and Biophysics Graduate Program, University of Minnesota, St. Paul, MN, United States.,Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, United States
| | - Hinh Ly
- Department of Veterinary and Biomedical Sciences, University of Minnesota, St. Paul, MN, United States
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15
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Mazzola LT, Kelly-Cirino C. Diagnostics for Lassa fever virus: a genetically diverse pathogen found in low-resource settings. BMJ Glob Health 2019; 4:e001116. [PMID: 30899575 PMCID: PMC6407561 DOI: 10.1136/bmjgh-2018-001116] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/31/2018] [Accepted: 11/06/2018] [Indexed: 11/18/2022] Open
Abstract
Lassa fever virus (LASV) causes acute viral haemorrhagic fever with symptoms similar to those seen with Ebola virus infections. LASV is endemic to West Africa and is transmitted through contact with excretions of infected Mastomys natalensis rodents and other rodent species. Due to a high fatality rate, lack of treatment options and difficulties with prevention and control, LASV is one of the high-priority pathogens included in the WHO R&D Blueprint. The WHO LASV vaccine strategy relies on availability of effective diagnostic tests. Current diagnostics for LASV include in-house and commercial (primarily research-only) laboratory-based serological and nucleic acid amplification tests. There are two commercially available (for research use only) rapid diagnostic tests (RDTs), and a number of multiplex panels for differential detection of LASV infection from other endemic diseases with similar symptoms have been evaluated. However, a number of diagnostic gaps remain. Lineage detection is a challenge due to the genomic diversity of LASV, as pan-lineage sensitivity for both molecular and immunological detection is necessary for surveillance and outbreak response. While pan-lineage ELISA and RDTs are commercially available (for research use only), validation and external quality assessment (EQA) is needed to confirm detection sensitivity for all known or relevant strains. Variable sensitivity of LASV PCR tests also highlights the need for improved validation and EQA. Given that LASV outbreaks typically occur in low-resource settings, more options for point-of-care testing would be valuable. These requirements should be taken into account in target product profiles for improved LASV diagnostics.
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16
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Whitmer SL, Strecker T, Cadar D, Dienes HP, Faber K, Patel K, Brown SM, Davis WG, Klena JD, Rollin PE, Schmidt-Chanasit J, Fichet-Calvet E, Noack B, Emmerich P, Rieger T, Wolff S, Fehling SK, Eickmann M, Mengel JP, Schultze T, Hain T, Ampofo W, Bonney K, Aryeequaye JND, Ribner B, Varkey JB, Mehta AK, Lyon GM, Kann G, De Leuw P, Schuettfort G, Stephan C, Wieland U, Fries JW, Kochanek M, Kraft CS, Wolf T, Nichol ST, Becker S, Ströher U, Günther S. New Lineage of Lassa Virus, Togo, 2016. Emerg Infect Dis 2019; 24:599-602. [PMID: 29460758 PMCID: PMC5823357 DOI: 10.3201/eid2403.171905] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We describe a strain of Lassa virus representing a putative new lineage that was isolated from a cluster of human infections with an epidemiologic link to Togo. This finding extends the known range of Lassa virus to Togo.
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17
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Le AB, Brooks EG, McNulty LA, Gill JR, Herstein JJ, Rios J, Patlovich SJ, Jelden KC, Schmid KK, Lowe JJ, Gibbs SG. U.S. Medical Examiner/Coroner capability to handle highly infectious decedents. Forensic Sci Med Pathol 2018; 15:31-40. [PMID: 30402743 PMCID: PMC7090777 DOI: 10.1007/s12024-018-0043-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 12/01/2022]
Abstract
In the United States of America, Medical Examiners and Coroners (ME/Cs) investigate approximately 20% of all deaths. Unexpected deaths, such as those occurring due to a deceased person under investigation for a highly infectious disease, are likely to fall under ME/C jurisdiction, thereby placing the ME/C and other morgue personnel at increased risk of contracting an occupationally acquired infection. This survey of U.S. ME/Cs' capabilities to address highly infectious decedents aimed to determine opportunities for improvement at ME/C facilities serving a state or metropolitan area. Data for this study was gathered via an electronic survey. Of the 177 electronic surveys that were distributed, the overall response rate was N = 108 (61%), with 99 of those 108 respondents completing all the questions within the survey. At least one ME/C responded from 47 of 50 states, and the District of Columbia. Select results were: less than half of respondents (44%) stated that their office had been involved in handling a suspected or confirmed highly infectious remains case and responses indicated medical examiners. Additionally, ME/C altered their personal protective equipment based on suspected versus confirmed highly infectious remains rather than taking an all-hazards approach. Standard operating procedures or guidelines should be updated to take an all-hazards approach, best-practices on handling highly infectious remains could be integrated into a standardized education, and evidence-based information on appropriate personal protective equipment selection could be incorporated into a widely disseminated learning module for addressing suspected or confirmed highly infectious remains, as those areas were revealed to be currently lacking.
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Affiliation(s)
- Aurora B Le
- Department of Environmental and Occupational Health, Indiana University School of Public Health, 1025 E. Seventh Street, PH029, Bloomington, IN, 47405, USA. .,Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA.
| | - Erin G Brooks
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,National Association of Medical Examiners (NAME) Ad Hoc Committee for Bioterrorism and Infectious Disease, Walnut Shade, MO, USA
| | - Lily A McNulty
- Department of Applied Health Science, Indiana University School of Public Health, Bloomington, IN, USA
| | - James R Gill
- National Association of Medical Examiners (NAME) Ad Hoc Committee for Bioterrorism and Infectious Disease, Walnut Shade, MO, USA.,Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Jocelyn J Herstein
- Department of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA
| | - Janelle Rios
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Scott J Patlovich
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Office of Safety, Health, Environment and Risk Management, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Katelyn C Jelden
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Kendra K Schmid
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - John J Lowe
- Department of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.,Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, USA.,Nebraska Biocontainment Unit, Omaha, NE, USA
| | - Shawn G Gibbs
- Department of Environmental and Occupational Health, Indiana University School of Public Health, 1025 E. Seventh Street, PH029, Bloomington, IN, 47405, USA
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18
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Hewson R. Lessons learnt from imported cases and onward transmission of Lassa fever in Europe support broader management of viral haemorrhagic fevers. ACTA ACUST UNITED AC 2018; 22. [PMID: 29019310 PMCID: PMC5709951 DOI: 10.2807/1560-7917.es.2017.22.39.17-00661] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Roger Hewson
- Faculty of Infectious Tropical Disease, London School of Hygiene & Tropical Medicine, United Kingdom.,Public Health England, Porton Down, United Kingdom
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19
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Ehlkes L, George M, Samosny G, Burckhardt F, Vogt M, Bent S, Jahn K, Zanger P. Management of a Lassa fever outbreak, Rhineland-Palatinate, Germany, 2016. ACTA ACUST UNITED AC 2018; 22. [PMID: 29019309 PMCID: PMC5709955 DOI: 10.2807/1560-7917.es.2017.22.39.16-00728] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Due to rapid diagnosis and isolation of imported cases, community outbreaks of viral haemorrhagic fevers (VHF) are considered unlikely in industrialised countries. In March 2016, the first documented locally acquired case of Lassa fever (LF) outside Africa occurred, demonstrating the disease’s potential as a cross-border health threat. We describe the management surrounding this case of LF in Rhineland-Palatinate – the German federal state where secondary transmission occurred. Twelve days after having been exposed to the corpse of a LF case imported from Togo, a symptomatic undertaker tested positive for Lassa virus RNA. Potential contacts were traced, categorised based on exposure risk, and monitored. Overall, we identified 21 contact persons with legal residency in Rhineland-Palatinate: seven related to the index case, 13 to the secondary case, and one related to both. The secondary case received treatment and recovered. Five contacts were quarantined and one was temporarily banned from work. No further transmission occurred. Based on the experience gained during the outbreak and a review of national and international guidelines, we conclude that exposure risk attributable to corpses may currently be underestimated, and we present suggestions that may help to improve the anti-epidemic response to imported VHF cases in industrialised countries.
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Affiliation(s)
- Lutz Ehlkes
- These authors contributed equally to this article and share first authorship.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute (RKI), Berlin, Germany.,Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany
| | - Maja George
- These authors contributed equally to this article and share first authorship.,Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany
| | | | - Florian Burckhardt
- Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany
| | - Manfred Vogt
- Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany
| | - Stefan Bent
- Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany
| | - Klaus Jahn
- Federal State Ministry for Social Affairs, Employment, Health, and Demographics Rhineland-Palatinate, Mainz, Germany
| | - Philipp Zanger
- Department of Infectious Diseases, Medical Microbiology and Hygiene, University Hospitals, Heidelberg, Germany.,Institute of Public Health, University Hospitals, Heidelberg, Germany.,Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany
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