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Huang C, Mantlo E, Paessler S. Lassa virus NP DEDDh 3'-5' exoribonuclease activity is required for optimal viral RNA replication and mutation control. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.12.536665. [PMID: 37090668 PMCID: PMC10120729 DOI: 10.1101/2023.04.12.536665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Lassa virus (LASV), a mammarenavirus from Arenaviridae, is the causative agent of Lassa fever (LF) endemic in West Africa. Currently, there are no vaccines or antivirals approved for LF. The RNA-dependent RNA polymerases (RdRp) of RNA viruses are error-prone. As a negative-sense RNA virus, how LASV copes with errors in RNA synthesis and ensures optimal RNA replication are not well elucidated. LASV nucleoprotein (NP) contains a DEDDH 3'-to-5' exoribonuclease motif (ExoN), which is known to be essential for LASV evasion of the interferon response via its ability to degrade virus-derived double-stranded RNA. Herein, we present evidence that LASV NP ExoN has an additional function important for viral RNA replication. We rescued an ExoN-deficient LASV mutant (ExoN- rLASV) by using a reverse genetics system. Our data indicated that abrogation of NP ExoN led to impaired LASV growth and RNA replication in interferon-deficient cells as compared with wild-type rLASV. By utilizing PacBio Single Molecule, Real-Time (SMRT) long-read sequencing technology, we found that rLASV lacking ExoN activity was prone to producing aberrant viral genomic RNA with structural variations. In addition, NP ExoN deficiency enhanced LASV sensitivity to mutagenic nucleoside analogues in virus titration assay. Next-generation deep sequencing analysis showed increased single nucleotide substitution in ExoN- LASV RNA following mutagenic 5-flurouracil treatment. In conclusion, our study revealed that LASV NP ExoN is required for efficient viral RNA replication and mutation control. Among negative-sense RNA viruses, LASV NP is the first example that a viral protein, other than the RdRp, contributes to reduce errors in RNA replication and maintain genomic RNA integrity. These new findings promote our understanding of the basics of LASV infection and inform antiviral and vaccine development.
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Affiliation(s)
- Cheng Huang
- Department of Pathology, Galveston National Laboratory and
Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston,
TX, USA
| | - Emily Mantlo
- Department of Pathology, Galveston National Laboratory and
Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston,
TX, USA
- Current address: Department of Microbiology & Immunology,
Upstate Medical University, Syracuse, NY, USA
| | - Slobodan Paessler
- Department of Pathology, Galveston National Laboratory and
Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston,
TX, USA
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2
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Elebesunu EE, Effiong FB, Asika MO, Fadele PK, Onyeogalu FA, Okafor CA, Scott GY. Combating the zoonotic trio of Ebola virus disease, Lassa fever, and COVID-19 in Nigeria: a retrospection of the challenges and lessons. Ann Med Surg (Lond) 2023; 85:3955-3959. [PMID: 37554890 PMCID: PMC10406064 DOI: 10.1097/ms9.0000000000001038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 08/10/2023] Open
Abstract
Various infectious disease outbreaks linked to zoonotic sources have been recorded over the years, some of which have resulted in epidemics on a national, regional, or global scale. In Africa, a number of such outbreaks occur intermittently, especially in countries like Nigeria with a high-risk of epidemiological transmission. Three viral outbreaks with zoonotic links have hit the Nigerian healthcare system hardest, which are the Ebola virus disease, Lassa fever and Coronavirus disease 2019. Due to the fragile nature of the Nigerian health system, several challenges were encountered in the process of responding to these viral outbreaks, some of which included inadequate healthcare infrastructure, limited diagnostic capacity, unfledged nature of emergency response, unsatisfactory remuneration of health workers, misinformation trends, amongst others. By reminiscing on the challenges and lessons learnt from these viral disease outbreaks, the Nigerian government and policymakers will be able to adopt more effective approaches towards emergency preparedness for future outbreaks of infectious diseases.
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Affiliation(s)
- Emmanuel E. Elebesunu
- Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology
| | | | - Marvellous O. Asika
- Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology
| | | | | | - Charles A. Okafor
- Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology
- Chester Medical School, University of Chester, Cheshire, United Kingdom
| | - Godfred Y. Scott
- Department of Medical Diagnostics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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3
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Jetoh RW, Malik S, Shobayo B, Taweh F, Yeabah TO, George J, Gbelee B, Teahton J, Jaryan F, Tegli M, Umeokonkwo CD, MaCauley J. Epidemiological characteristics of Lassa fever cases in Liberia: a retrospective analysis of surveillance data, 2019-2020. Int J Infect Dis 2022; 122:767-774. [PMID: 35817283 DOI: 10.1016/j.ijid.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Liberia is endemic to Lassa fever (LF) and has the largest reported per capita incidence of LF patients in the West African region. Cases of the disease increased unprecedentedly in 2019 and 2020, characterized by a geographical drift in epidemiology and seasonal variation of occurrence. This study aims to describe the epidemiological and clinical characteristics of Lassa fever in Liberia from 2019 to 2020. METHOD A retrospective study was conducted on cases of LF confirmed at the National Public Health Reference Laboratory from January 2019 to December 2020. Medical records were reviewed, and epidemiological and clinical data were collected in an organized manner. Descriptive and inferential statistics were carried out using Epi Info (version 7.2.5.0) RESULT: : A total of 382 suspected LF cases were reported, of which 103 were laboratory-confirmed, yielding a case positivity rate of 27% (103/382). The median age of the LF cases was 20 (IGR: 9-30) Children less than 18 years of age accounted for 40.8% (42/103) of the cases and healthcare workers case constituted 7.7% of the cases. Bong, Nimba and Grand Bass accounted for 87.4% of the cases with cases in new counties like Lofa, Margibi and Grand Kru. Hemorrhage (aOR:10.2; 95%CI: 3.11-33.81), patients who did not receive ribavirin (aOR: 4.4; 95%CI: 1.12-17.57, p=0.034), and aged 40 years or older (aOR: 6.2; 95%CI: 1.19-32.53, p=0.049) were associated with Lassa fever mortality. CONCLUSION The LF cases in 2019 and 2020 had a high CFR and spread to new counties that had not previously been reporting LF. The disease occurred during most part of the raining season outside the usual dry season. There is urgent need to lower morbidity and mortality, improve early presentation to hospital and early initiation of appropriate medical care.
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Affiliation(s)
| | | | - Bode Shobayo
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Fahn Taweh
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Josiah George
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Burgess Gbelee
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Julius Teahton
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Francis Jaryan
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Momo Tegli
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Jane MaCauley
- National Public Health Institute of Liberia, Monrovia, Liberia
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4
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Joy Okwor T, Gatua J, Umeokonkwo CD, Abah S, Ike IF, Ogunniyi A, Ipadeola O, Attah T, Assad H, Dooga J, Olayinka A, Abubakar J, Oladejo J, Aderinola O, Eneh C, Ilori E, Ibekwe P, Ochu C, Ihekweazu C. An assessment of infection prevention and control preparedness of healthcare facilities in Nigeria in the early phase of the COVID-19 pandemic (February–May 2020). J Infect Prev 2022; 23:101-107. [PMID: 35502165 PMCID: PMC8872810 DOI: 10.1177/17571774211060418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/31/2021] [Indexed: 12/15/2022] Open
Abstract
Background Infection prevention and control (IPC) activities play a large role in preventing the
transmission of SARS-CoV-2 in healthcare settings. This study describes the state of IPC
preparedness within health facilities in Nigeria during the early phase of coronavirus
disease (COVID-19) pandemic. Methods We carried out a cross sectional study of health facilities across Nigeria using a
COVID-19 IPC checklist adapted from the U.S Centers for Disease Control and Prevention.
The IPC aspects assessed were the existence of IPC committee and teams with terms of
reference and workplans, IPC training, availability of personal protective equipment and
having systems in place for screening, isolation and notification of COVID-19 patients.
Existence of the assessed aspects was regarded as preparedness in that aspect. Results In total, 461 health facilities comprising, 350 (75.9%) private and 111 (24.1%) public
health facilities participated. Only 19 (4.1%) health facilities were COVID-19 treatment
centres with 68% of these being public health facilities. Public health facilities were
better prepared in the areas of IPC programme with 69.7% of them having an IPC focal
point versus 32.3% of private facilities. More public facilities (59.6%) had an IPC
workplan versus 26.8% of private facilities. Neither the public nor the private
facilities were adequately prepared for triaging, screening, and notifying suspected
cases, as well as having trained staff and equipment to implement triaging. Conclusions The results highlight the need for government, organisations and policymakers to
establish conducive IPC structures to reduce the risk of COVID-19 transmission in
healthcare settings.
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Affiliation(s)
| | - Josephine Gatua
- Nigeria Centre for Disease Control, Abuja, Nigeria
- Overseas Development Institute, Abuja, Nigeria
| | - Chukwuma David Umeokonkwo
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria
| | - Stephen Abah
- Department of Community Medicine, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | | | | | | | | | - Hassan Assad
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Jerome Dooga
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | - John Oladejo
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | - Chibuzo Eneh
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | - Chinwe Ochu
- Nigeria Centre for Disease Control, Abuja, Nigeria
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5
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Furuse Y. [Comprehensive understanding of viral diseases by field, molecular, and theoretical studies]. Uirusu 2022; 72:87-92. [PMID: 37899235 DOI: 10.2222/jsv.72.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Viral diseases are responsible for substantial morbidity and mortality and continue to be of great concern. To ensure better control of viral infections, I have been tackling the issue as a medical doctor, an academic researcher, and a public health officer. Especially, I have studied respiratory viruses, such as the influenza virus, from the perspectives of molecular virology, theoretical modeling, and field epidemiology. RNA biology and its involvement with viral life-cycle and pathogenicity are central topics of molecular study, while mathematical models of transmission dynamics and phylogenetics are major components of theoretical research. As a field epidemiologist, I work with public health authorities during viral disease outbreaks. I was deployed to West Africa for viral hemorrhagic fever outbreak responses as a WHO consultant, and I have served the Japanese Government as an advisor for COVID-19 countermeasures. I would like to integrate various approaches from clinical medicine to epidemiology, theoretical modeling, evolutionary biology, genetics, and molecular biology in my research. In that way, we could gain a more comprehensive understanding of viral diseases. I hope these findings will help ease the disease burden of viral infections around the world.
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Affiliation(s)
- Yuki Furuse
- Nagasaki University Graduate School of Biomedical Sciences/Nagasaki University Hospital Medical Education Development Center
- Institute for Frontier Life and Medical Sciences/Hakubi Center for Advanced Research, Kyoto University
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6
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Grace JUA, Egoh IJ, Udensi N. Epidemiological trends of Lassa fever in Nigeria from 2015-2021: A review. Ther Adv Infect Dis 2021; 8:20499361211058252. [PMID: 34868582 PMCID: PMC8637796 DOI: 10.1177/20499361211058252] [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: 07/02/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: Lassa fever is a viral haemorrhagic fever with
non-specific symptoms that has shown an upward trend in Nigeria and other
West African countries, which is depicted by high incidence and case
fatality in recent years. There are different reports on the yearly case
burden of Lassa fever from the Federal Ministry of Health in Nigeria,
through the regulatory body – Nigeria Centre for Disease Control (NCDC).
Being the epicentre of the disease, Lassa fever has been exported from
Nigeria to both neighbouring and distant countries.Methods: The aim of this
review was to carry out a retrospective analysis from January 2015 to 26
September 2021 of the weekly and yearly outbreak of Lassa fever in Nigeria
based on selected publications. The focus was on timely diagnosis, treatment
option, public health interventions and progress of clinical trials for
vaccine candidates, and to identify proactive measures that can be sustained
to curb periodic outbreaks. The review was done using percentages,
cross-tabulation and graphical charts. Results: The predominant age group infected was 21 to 40 years
with a male to female ratio of 1:0.8. A total of 3311 laboratory-confirmed
Lassa fever cases out of 20,588 suspected cases were identified from 29
states. Edo, Ondo, Taraba, Ebonyi, Bauchi, Plateau and Nasarawa had yearly
Lassa fever incidence over the time frame considered. Contact tracing was
done on over 33,804 individuals with about 90% completing follow-up. Case
fatality rate within the period ranged from 9.3% to 29.2%. There is a sharp
decline in the epidemiological trend of Lassa fever in the yearly seasonal
peaks from weeks 1 to 13 with about 75% reduction in incidence between 2020
and 2021. Conclusion: The effective management of Lassa fever needs the
implementation of preventive methods, prompt laboratory diagnosis, timely
treatment, provision of personal protective equipment, cross-border
surveillance, contact tracing, community awareness and vector control in
order to minimise spread.
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Affiliation(s)
| | - Ifunanya J Egoh
- Department of Virology, University of Ibadan, Ibadan, Nigeria
| | - Nnenna Udensi
- Department of Haematology, Federal Medical Centre, Abia, Nigeria
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7
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Geographical drivers and climate-linked dynamics of Lassa fever in Nigeria. Nat Commun 2021; 12:5759. [PMID: 34599162 PMCID: PMC8486829 DOI: 10.1038/s41467-021-25910-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 09/08/2021] [Indexed: 02/08/2023] Open
Abstract
Lassa fever is a longstanding public health concern in West Africa. Recent molecular studies have confirmed the fundamental role of the rodent host (Mastomys natalensis) in driving human infections, but control and prevention efforts remain hampered by a limited baseline understanding of the disease's true incidence, geographical distribution and underlying drivers. Here, we show that Lassa fever occurrence and incidence is influenced by climate, poverty, agriculture and urbanisation factors. However, heterogeneous reporting processes and diagnostic laboratory access also appear to be important drivers of the patchy distribution of observed disease incidence. Using spatiotemporal predictive models we show that including climatic variability added retrospective predictive value over a baseline model (11% decrease in out-of-sample predictive error). However, predictions for 2020 show that a climate-driven model performs similarly overall to the baseline model. Overall, with ongoing improvements in surveillance there may be potential for forecasting Lassa fever incidence to inform health planning.
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8
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Koch MR, Kanneh L, Wise PH, Kurina LM, Alhasan F, Garry RF, Schieffelin JS, Shaffer JG, Grant DS. Health seeking behavior after the 2013-16 Ebola epidemic: Lassa fever as a metric of persistent changes in Kenema District, Sierra Leone. PLoS Negl Trop Dis 2021; 15:e0009576. [PMID: 34260615 PMCID: PMC8312964 DOI: 10.1371/journal.pntd.0009576] [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: 06/26/2020] [Revised: 07/26/2021] [Accepted: 06/19/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The West African Ebola epidemic of 2013-2016 killed nearly 4,000 Sierra Leoneans and devastated health infrastructure across West Africa. Changes in health seeking behavior (HSB) during the outbreak resulted in dramatic underreporting and substantial declines in hospital presentations to public health facilities, resulting in an estimated tens of thousands of additional maternal, infant, and adult deaths per year. Sierra Leone's Kenema District, a major Ebola hotspot, is also endemic for Lassa fever (LF), another often-fatal hemorrhagic disease. Here we assess the impact of the West African Ebola epidemic on health seeking behaviors with respect to presentations to the Kenema Government Hospital (KGH) Lassa Ward, which serves as the primary health care referral center for suspected Lassa fever cases in the Eastern Province of Sierra Leone. METHODOLOGY/PRINCIPAL FINDINGS Presentation frequencies for suspected Lassa fever presenting to KGH or one of its referral centers from 2011-2019 were analyzed to consider the potential impact of the West African Ebola epidemic on presentation patterns. There was a significant decline in suspected LF cases presenting to KGH following the epidemic, and a lower percentage of subjects were admitted to the KGH Lassa Ward following the epidemic. To assess general HSB, a questionnaire was developed and administered to 200 residents from 8 villages in Kenema District. Among 194 completed interviews, 151 (78%) of respondents stated they felt hospitals were safer post-epidemic with no significant differences noted among subjects according to religious background, age, gender, or education. However, 37 (19%) subjects reported decreased attendance at hospitals since the epidemic, which suggests that trust in the healthcare system has not fully rebounded. Cost was identified as a major deterrent to seeking healthcare. CONCLUSIONS/SIGNIFICANCE Analysis of patient demographic data suggests that fewer individuals sought care for Lassa fever and other febrile illnesses in Kenema District after the West African Ebola epidemic. Re-establishing trust in health care services will require efforts beyond rebuilding infrastructure and require concerted efforts to rebuild the trust of local residents who may be wary of seeking healthcare post epidemic.
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Affiliation(s)
- Mikaela R. Koch
- Program in Human Biology, Stanford University, Stanford, California, United States of America
- * E-mail: (MRK); (JGS); (DSG)
| | - Lansana Kanneh
- Pediatrics–Neonatal and Developmental Medicine, Stanford University, Stanford, California, United States of America
| | - Paul H. Wise
- Pediatrics–Neonatal and Developmental Medicine, Stanford University, Stanford, California, United States of America
| | - Lianne M. Kurina
- Program in Human Biology, Stanford University, Stanford, California, United States of America
| | - Foday Alhasan
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
| | - Robert F. Garry
- Tulane University, School of Medicine, Department of Microbiology and Immunology, New Orleans, Louisiana, United States of America
- Zalgen Labs, LCC, Germantown, MD, United States of America
| | - John S. Schieffelin
- Sections of Infectious Disease, Department of Pediatrics, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Jeffrey G. Shaffer
- Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America
- * E-mail: (MRK); (JGS); (DSG)
| | - Donald S. Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- * E-mail: (MRK); (JGS); (DSG)
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Salam AP, Cheng V, Edwards T, Olliaro P, Sterne J, Horby P. Time to reconsider the role of ribavirin in Lassa fever. PLoS Negl Trop Dis 2021; 15:e0009522. [PMID: 34237063 PMCID: PMC8266111 DOI: 10.1371/journal.pntd.0009522] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Ribavirin is the only available Lassa fever treatment. The rationale for using ribavirin is based on one clinical study conducted in the early 1980s. However, reanalysis of previous unpublished data reveals that ribavirin may actually be harmful in some Lassa fever patients. An urgent reevaluation of ribavirin is therefore needed.
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Affiliation(s)
- Alex Paddy Salam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- United Kingdom Public Health Rapid Support Team, London, United Kingdom
| | - Vincent Cheng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tansy Edwards
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Piero Olliaro
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jonathan Sterne
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Peter Horby
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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10
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Arruda LB, Haider N, Olayemi A, Simons D, Ehichioya D, Yinka-Ogunleye A, Ansumana R, Thomason MJ, Asogun D, Ihekweazu C, Fichet-Calvet E, Kock RA. The niche of One Health approaches in Lassa fever surveillance and control. Ann Clin Microbiol Antimicrob 2021; 20:29. [PMID: 33894784 PMCID: PMC8067790 DOI: 10.1186/s12941-021-00431-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 04/12/2021] [Indexed: 12/20/2022] Open
Abstract
Lassa fever (LF), a zoonotic illness, represents a public health burden in West African countries where the Lassa virus (LASV) circulates among rodents. Human exposure hinges significantly on LASV ecology, which is in turn shaped by various parameters such as weather seasonality and even virus and rodent-host genetics. Furthermore, human behaviour, despite playing a key role in the zoonotic nature of the disease, critically affects either the spread or control of human-to-human transmission. Previous estimations on LF burden date from the 80s and it is unclear how the population expansion and the improvement on diagnostics and surveillance methods have affected such predictions. Although recent data have contributed to the awareness of epidemics, the real impact of LF in West African communities will only be possible with the intensification of interdisciplinary efforts in research and public health approaches. This review discusses the causes and consequences of LF from a One Health perspective, and how the application of this concept can improve the surveillance and control of this disease in West Africa.
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Affiliation(s)
- Liã Bárbara Arruda
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK.
| | - Najmul Haider
- The Royal Veterinary College, University of London, Hatfield, UK
| | - Ayodeji Olayemi
- Natural History Museum, Obafemi Awolowo University, Ile Ife, Nigeria
| | - David Simons
- The Royal Veterinary College, University of London, Hatfield, UK
| | - Deborah Ehichioya
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria.,Department of Microbiology, Ambrose Alli University, Ekpoma, Nigeria
| | | | - Rashid Ansumana
- School of Community Health Sciences, Njala University, Bo, Sierra Leone
| | - Margaret J Thomason
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - Danny Asogun
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | | | | | - Richard A Kock
- The Royal Veterinary College, University of London, Hatfield, UK
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11
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Guillén E, Buissonnière M, Lee CT. From lionizing to protecting health care workers during and after COVID-19-systems solutions for human tragedies. Int J Health Plann Manage 2021; 36:20-25. [PMID: 33647178 PMCID: PMC8013553 DOI: 10.1002/hpm.3138] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/05/2021] [Accepted: 02/09/2021] [Indexed: 11/18/2022] Open
Abstract
During the COVID‐19 pandemic, health care workers (HCWs) have been lauded as heroes, yet both before and during the pandemic, they lacked the protections needed to keep them safe. We summarize data on HCW infections and deaths during previous epidemics, the costs of the failure to protect them, and provide recommendations for strengthening HCW protections by investments in and implementation of infection prevention and control and water, sanitation, and hygiene programs, training and career development, and national and global monitoring of HCW infections. We must move from placing individuals at undue risk to accepting collective responsibility and accountability for the well‐being of our HCWs and take concrete actions to protect HCWs who risk their lives to protect patients and populations.
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Affiliation(s)
- Ethan Guillén
- Prevent Epidemics, Resolve to Save Lives, an Initiative of Vital Strategies, New York, USA
| | - Marine Buissonnière
- Prevent Epidemics, Resolve to Save Lives, an Initiative of Vital Strategies, New York, USA
| | - Christopher T Lee
- Prevent Epidemics, Resolve to Save Lives, an Initiative of Vital Strategies, New York, USA
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12
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Chika-Igwenyi NM, Harrison RE, Psarra C, Gil-Cuesta J, Gulamhusein M, Onwe EO, Onoh RC, Unigwe US, Ajayi NA, Nnadozie UU, Ojide CK, Nwidi DU, Ezeanosike O, Sampson E, Adeke AS, Ugwu CN, Anebonam U, Tshiang JK, Maikere J, Reid A. Early onset of neurological features differentiates two outbreaks of Lassa fever in Ebonyi state, Nigeria during 2017-2018. PLoS Negl Trop Dis 2021; 15:e0009169. [PMID: 33684118 PMCID: PMC7984835 DOI: 10.1371/journal.pntd.0009169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/22/2021] [Accepted: 01/22/2021] [Indexed: 01/15/2023] Open
Abstract
Lassa fever (LF) is an acute viral haemorrhagic illness with various non-specific clinical manifestations. Neurological symptoms are rare at the early stage of the disease, but may be seen in late stages, in severely ill patients.The aim of this study was to describe the epidemiological evolution, socio-demographic profiles, clinical characteristics, and outcomes of patients seen during two Lassa fever outbreaks in Ebonyi State, between December 2017 and December 2018. Routinely collected clinical data from all patients admitted to the Virology Centre of the hospital during the period were analysed retrospectively. Out of a total of 83 cases, 70(84.3%) were RT-PCR confirmed while 13 (15.7%) were probable cases. Sixty-nine (83.1%) patients were seen in outbreak 1 of whom 53.6% were urban residents, while 19%, 15%, and 10% were farmers, students and health workers respectively. There were 14 (16.8%) patients, seen in second outbreak with 92.9% rural residents. There were differences in clinical symptoms, signs and laboratory findings between the two outbreaks. The case fatality rates were 29.9% in outbreak 1 and 85.7% for outbreak 2. Neurological features and abnormal laboratory test results were associated with higher mortality rate, seen in outbreak 2. This study revealed significant differences between the two outbreaks. Of particular concern was the higher case fatality during the outbreak 2 which may be from a more virulent strain of the Lassa virus. This has important public health implications and further molecular studies are needed to better define its characteristics.
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Affiliation(s)
- Nneka M. Chika-Igwenyi
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | | | - Christina Psarra
- Médecins sans Frontières Operational Research Unit (LuxOR), Operational Centre Brussels, Belgium
| | - Julita Gil-Cuesta
- Médecins sans Frontières Operational Research Unit (LuxOR), Operational Centre Brussels, Belgium
| | - Maria Gulamhusein
- Médecins sans Frontières Operational Research Unit (LuxOR), Operational Centre Brussels, Belgium
| | - Emeka O. Onwe
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Robinson C. Onoh
- Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Uche S. Unigwe
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
- University of Nigeria Teaching Hospital, Ituku Ozalla Enugu, Nigeria
| | - Nnennaya A. Ajayi
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Ugochukwu U. Nnadozie
- Division of Plastic Surgery, Department of Surgery, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Chiedozie K. Ojide
- Department of Medical Microbiology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
- Virology Laboratory, Virology Centre,AlexEkwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Damian U. Nwidi
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Obumneme Ezeanosike
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Emeka Sampson
- Ebonyi State Ministry of Health, Abakaliki, Ebonyi, Nigeria
| | - Azuka S. Adeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakiliki, Abakaliki, Ebonyi, Nigeria
| | - Collins N. Ugwu
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | | | | | | | - Anthony Reid
- Médecins sans Frontières Operational Research Unit (LuxOR), Operational Centre Brussels, Belgium
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13
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Chandra NL, Bolt H, Dan-Nwafor C, Ipadeola O, Ilori E, Namara G, Olayinka AT, Ukponu W, Iniobong A, Amedu M, Akano A, Akabike KO, Okhuarobo U, Fagbemi S, Sampson E, Newitt S, Verlander NQ, Bausch DG, le Polain de Waroux O, Ihekweazu C. Factors associated with delayed presentation to healthcare facilities for Lassa fever cases, Nigeria 2019: a retrospective cohort study. BMC Infect Dis 2021; 21:143. [PMID: 33541278 PMCID: PMC7863257 DOI: 10.1186/s12879-021-05822-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/19/2021] [Indexed: 11/18/2022] Open
Abstract
Background Large outbreaks of Lassa fever (LF) occur annually in Nigeria. The case fatality rate among hospitalised cases is ~ 20%. The antiviral drug ribavirin along with supportive care and rehydration are the recommended treatments but must be administered early (within 6 days of symptom onset) for optimal results. We aimed to identify factors associated with late presentation of LF cases to a healthcare facility to inform interventions. Methods We undertook a retrospective cohort study of all laboratory confirmed LF cases reported in Nigeria from December 2018 to April 2019. We performed descriptive epidemiology and a univariate Cox proportional-hazards regression analysis to investigate the effect of clinical (symptom severity), epidemiological (age, sex, education, occupation, residential State) and exposure (travel, attendance at funeral, exposure to rodents or confirmed case) factors on time to presentation. Results Of 389 cases, median presentation time was 6 days (IQR 4–10 days), with 53% attending within 6 days. There were no differences in presentation times by sex but differences were noted by age-group; 60+ year-olds had the longest delays while 13–17 year-olds had the shortest. By sex and age, there were differences seen among the younger ages, with 0–4-year-old females presenting earlier than males (4 days and 73% vs. 10 days and 30%). For 5–12 and 13–17 year-olds, males presented sooner than females (males: 5 days, 65% and 3 days, 85% vs. females: 6 days, 50% and 5 days, 61%, respectively). Presentation times differed across occupations 4.5–9 days and 20–60%, transporters (people who drive informal public transport vehicles) had the longest delays. Other data were limited (41–95% missing). However, the Cox regression showed no factors were statistically associated with longer presentation time. Conclusions Whilst we observed important differences in presentation delays across factors, our sample size was insufficient to show any statistically significant differences that might exist. However, almost half of cases presented after 6 days of onset, highlighting the need for more accurate and complete surveillance data to determine if there is a systemic or specific cause for delays, so to inform, monitor and evaluate public health strategies and improve outcomes.
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Affiliation(s)
- Nastassya L Chandra
- UK Field Epidemiology Training Programme, Public Health England, London, UK. .,UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK.
| | - Hikaru Bolt
- UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Geoffrey Namara
- Nigeria Centre for Disease Control, Abuja, Nigeria.,World Health Organization, Abuja, Nigeria
| | - Adebola T Olayinka
- Nigeria Centre for Disease Control, Abuja, Nigeria.,World Health Organization, Abuja, Nigeria
| | - Winifred Ukponu
- Georgetown University, Centre for Global Health Practice and Impact, Abuja, Nigeria
| | | | | | | | | | | | | | | | - Sophie Newitt
- Public Health England, National Infection Service, London, UK
| | | | - Daniel G Bausch
- UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK
| | - Olivier le Polain de Waroux
- UK Public Health Rapid Support Team - Public Health England/London School of Hygiene & Tropical Medicine, London, UK
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14
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Furuse Y. [Epidemiology of Viral Hemorrhagic Fever in Africa]. Uirusu 2021; 71:11-18. [PMID: 35526990 DOI: 10.2222/jsv.71.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A variety of viral hemorrhagic fevers such as Ebola virus disease exist in Africa and impose a great threat in public health due to their high fatality. It is considered to be difficult to eradicate the etiological agents of viral hemorrhagic fever because they have non-human natural hosts. Therefore, the importance of public health measures remains high in addition to the urgent need for the development of medicines for treatment and prevention. Furthermore, public health measures directly lead to the accumulation of epidemiological knowledge about the diseases. As an infectious disease consultant for the World Health Organization, I have been involved with public health activities including the development of clinical guidelines, the establishment of laboratory diagnostic systems, the training for infection, prevention and control, the planning of budget for outbreak response, and the analysis of epidemiological data. On the last point, I reported the situation of Ebola virus disease outbreak in Liberia, 2014-2015 and Lassa fever outbreak in Nigeria, 2018-2019 describing the risk factors, morbidity, and mortality of the diseases.
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Affiliation(s)
- Yuki Furuse
- Institute for Frontier Life and Medical Sciences, Kyoto University
- Hakubi Center for Advanced Research, Kyoto University
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15
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Ipadeola O, Furuse Y, de Gooyer T, Dan-Nwafor C, Namara G, Ilori E, Ihekweazu C. Determination of the emergency phase for response against endemic disease outbreak: A case of Lassa fever outbreak in Nigeria. J Glob Health 2020; 10:020353. [PMID: 33110549 PMCID: PMC7568005 DOI: 10.7189/jogh.10.020353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Yuki Furuse
- World Health Organization, Abuja, Nigeria.,Kyoto University, Kyoto, Japan
| | - Tanyth de Gooyer
- World Health Organization, Abuja, Nigeria.,Victorian Department of Health and Human Services, Melbourne, Australia
| | | | | | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
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16
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Olayinka AT, Nwafor CD, Akano A, Jan K, Ebhodaghe B, Elimian K, Ochu C, Okwor T, Ipadeola O, Ukponu W, Okudo I, Peter C, Ilori E, Ihekweazu C. Research as a pillar of Lassa fever emergency response: lessons from Nigeria. Pan Afr Med J 2020; 37:179. [PMID: 33447334 PMCID: PMC7778227 DOI: 10.11604/pamj.2020.37.179.26425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022] Open
Abstract
Emerging and re-emerging infectious diseases are becoming more frequent and developing countries are especially at increased risk. A recurring infectious disease outbreak in Nigeria has been that of Lassa fever (LF), a disease that is endemic in Nigeria and other West African countries. Nigeria, between 1st January and 27th October 2019, reported 743 confirmed cases of LF and 157 deaths in confirmed cases. Lassa fever outbreaks continue to be recurrent after fifty years of its identification. The true burden of the disease in Nigeria is unknown while gaps in knowledge about the infection still persist. Based on the Nigeria national Lassa fever research agenda and the World Health Organisation's roadmap initiative for accelerating research and product development which enables effective and timely emergency response to LF disease epidemics among other infectious diseases; a research pillar was added to the seven existing LF emergency operations centre response pillars in 2019. We describe lessons learnt from the integration of a research pillar into the LF national emergency response.
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Affiliation(s)
| | | | | | - Kamji Jan
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | - Chinwe Ochu
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Tochi Okwor
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | | | | | - Elsie Ilori
- Nigeria Centre for Disease Control, Abuja, Nigeria
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17
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Olumade TJ, Adesanya OA, Fred-Akintunwa IJ, Babalola DO, Oguzie JU, Ogunsanya OA, George UE, Akin-Ajani OD, Osasona DG. Infectious disease outbreak preparedness and response in Nigeria: history, limitations and recommendations for global health policy and practice. AIMS Public Health 2020; 7:736-757. [PMID: 33294478 PMCID: PMC7719556 DOI: 10.3934/publichealth.2020057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/18/2020] [Indexed: 01/31/2023] Open
Abstract
Effective disease outbreak response has historically been a challenging accomplishment for the Nigerian health system due to an array of hurdles not unique to Nigeria but also found in other African nations which share its large size and complexity. However, the efficiency of the response mounted against the Ebola Virus Disease (EVD) outbreak of 2014 proved that indeed, though challenging, proactive and effective outbreak response is not impossible. With over 20 public health emergencies and infectious disease outbreaks between 2016 and 2018 alone, Nigeria is one of only five members of the World Health Organization (WHO) African Region to report five or more public health events per annum. There are many lessons that can be drawn from Nigeria's experience in handling outbreaks of infectious diseases. In this review, we discuss the history of emerging and re-emerging infectious disease outbreaks in Nigeria and explore the response strategies mounted towards each. We also highlight the significant successes and note-worthy limitations, which we have then utilized to proffer policy recommendations to strengthen the Nigerian public health emergency response systems.
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Affiliation(s)
- Testimony J Olumade
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
| | | | | | - David O Babalola
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Judith U Oguzie
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
| | - Olusola A Ogunsanya
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
| | - Uwem E George
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
| | | | - Damilola G Osasona
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Osun, Nigeria
- Department of Biological Sciences, Redeemer's University, Ede, Osun, Nigeria
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18
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Mummah RO, Hoff NA, Rimoin AW, Lloyd-Smith JO. Controlling emerging zoonoses at the animal-human interface. ONE HEALTH OUTLOOK 2020; 2:17. [PMID: 33073176 PMCID: PMC7550773 DOI: 10.1186/s42522-020-00024-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 07/09/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND For many emerging or re-emerging pathogens, cases in humans arise from a mixture of introductions (via zoonotic spillover from animal reservoirs or geographic spillover from endemic regions) and secondary human-to-human transmission. Interventions aiming to reduce incidence of these infections can be focused on preventing spillover or reducing human-to-human transmission, or sometimes both at once, and typically are governed by resource constraints that require policymakers to make choices. Despite increasing emphasis on using mathematical models to inform disease control policies, little attention has been paid to guiding rational disease control at the animal-human interface. METHODS We introduce a modeling framework to analyze the impacts of different disease control policies, focusing on pathogens exhibiting subcritical transmission among humans (i.e. pathogens that cannot establish sustained human-to-human transmission). We quantify the relative effectiveness of measures to reduce spillover (e.g. reducing contact with animal hosts), human-to-human transmission (e.g. case isolation), or both at once (e.g. vaccination), across a range of epidemiological contexts. RESULTS We provide guidelines for choosing which mode of control to prioritize in different epidemiological scenarios and considering different levels of resource and relative costs. We contextualize our analysis with current zoonotic pathogens and other subcritical pathogens, such as post-elimination measles, and control policies that have been applied. CONCLUSIONS Our work provides a model-based, theoretical foundation to understand and guide policy for subcritical zoonoses, integrating across disciplinary and species boundaries in a manner consistent with One Health principles.
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Affiliation(s)
- Riley O. Mummah
- Department of Ecology and Evolutionary Biology, University of California, 610 Charles E Young Dr S, Los Angeles, CA 90095 USA
- Department of Epidemiology, University of California, Los Angeles, CA 90095 USA
| | - Nicole A. Hoff
- Department of Epidemiology, University of California, Los Angeles, CA 90095 USA
| | - Anne W. Rimoin
- Department of Epidemiology, University of California, Los Angeles, CA 90095 USA
| | - James O. Lloyd-Smith
- Department of Ecology and Evolutionary Biology, University of California, 610 Charles E Young Dr S, Los Angeles, CA 90095 USA
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892 USA
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19
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Kenmoe S, Tchatchouang S, Ebogo-Belobo JT, Ka'e AC, Mahamat G, Guiamdjo Simo RE, Bowo-Ngandji A, Demeni Emoh CP, Che E, Tchami Ngongang D, Amougou-Atsama M, Nzukui ND, Mbongue Mikangue CA, Mbaga DS, Kenfack S, Kingue Bebey SR, Amvongo Adjia N, Efietngab AN, Tazokong HR, Modiyinji AF, Kengne-Nde C, Sadeuh-Mba SA, Njouom R. Systematic review and meta-analysis of the epidemiology of Lassa virus in humans, rodents and other mammals in sub-Saharan Africa. PLoS Negl Trop Dis 2020; 14:e0008589. [PMID: 32845889 PMCID: PMC7478710 DOI: 10.1371/journal.pntd.0008589] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/08/2020] [Accepted: 07/13/2020] [Indexed: 12/27/2022] Open
Abstract
Accurate data on the Lassa virus (LASV) human case fatality rate (CFR) and the prevalence of LASV in humans, rodents and other mammals are needed for better planning of actions that will ultimately reduce the burden of LASV infection in sub-Saharan Africa. In this systematic review with meta-analysis, we searched PubMed, Scopus, Africa Journal Online, and African Index Medicus from 1969 to 2020 to obtain studies that reported enough data to calculate LASV infection CFR or prevalence. Study selection, data extraction, and risk of bias assessment were conducted independently. We extracted all measures of current, recent, and past infections with LASV. Prevalence and CFR estimates were pooled using a random-effect meta-analysis. Factors associated with CFR, prevalence, and sources of between-study heterogeneity were determined using subgroup and metaregression analyses. This review was registered with PROSPERO, CRD42020166465. We initially identified 1,399 records and finally retained 109 reports that contributed to 291 prevalence records from 25 countries. The overall CFR was 29.7% (22.3-37.5) in humans. Pooled prevalence of LASV infection was 8.7% (95% confidence interval: 6.8-10.8) in humans, 3.2% (1.9-4.6) in rodents, and 0.7% (0.0-2.3) in other mammals. Subgroup and metaregression analyses revealed a substantial statistical heterogeneity explained by higher prevalence in tissue organs, in case-control, in hospital outbreak, and surveys, in retrospective studies, in urban and hospital setting, in hospitalized patients, and in West African countries. This study suggests that LASV infections is an important cause of death in humans and that LASV are common in humans, rodents and other mammals in sub-Saharan Africa. These estimates highlight disparities between sub-regions, and population risk profiles. Western Africa, and specific key populations were identified as having higher LASV CFR and prevalence, hence, deserving more attention for cost-effective preventive interventions.
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Affiliation(s)
- Sebastien Kenmoe
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institut of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Aude Christelle Ka'e
- Virology Department, Chantal Biya International Reference Centre, Yaoundé, Cameroon
| | - Gadji Mahamat
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | | | - Arnol Bowo-Ngandji
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | | | - Emmanuel Che
- Vaccinology and Biobank, Chantal Biya International Reference Centre, Yaounde, Cameroon
| | - Dimitri Tchami Ngongang
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | - Marie Amougou-Atsama
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- Medical Research Centre, Institut of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Nathalie Diane Nzukui
- School of Health Sciences-Catholic University of Central Africa, Department of Medical Microbiology, Yaoundé, Cameroon
| | | | - Donatien Serge Mbaga
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | - Sorel Kenfack
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | | | - Nathalie Amvongo Adjia
- Medical Research Centre, Institut of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Atembeh Noura Efietngab
- Medical Research Centre, Institut of Medical Research and Medicinal Plants Studies, Yaoundé, Cameroon
| | - Hervé Raoul Tazokong
- Department of Microbiology, Faculty of Science, The University of Yaounde I, Yaoundé, Cameroon
| | - Abdou Fatawou Modiyinji
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
- Department of Animals Biology and Physiology, Faculty of Science, The University of Yaoundé I, Yaoundé, Cameroon
| | - Cyprien Kengne-Nde
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Yaoundé, Cameroon
| | | | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
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20
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Pattis JG, May ER. Markov State Model of Lassa Virus Nucleoprotein Reveals Large Structural Changes during the Trimer to Monomer Transition. Structure 2020; 28:548-554.e3. [PMID: 32234493 DOI: 10.1016/j.str.2020.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/23/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022]
Abstract
Lassa virus contains a nucleoprotein (NP) that encapsulates the viral genomic RNA forming the ribonucleoprotein (RNP). The NP forms trimers that do not bind RNA, but a structure of only the NP N-terminal domain was co-crystallized with RNA bound. These structures suggested a model in which the NP forms a trimer to keep the RNA gate closed, but then is triggered to undergo a change to a form competent for RNA binding. Here, we investigate the scenario in which the trimer is disrupted to observe whether monomeric NP undergoes significant conformational changes. From multi-microsecond molecular dynamics simulations and an adaptive sampling scheme to sample the conformational space, a Markov state model (MSM) is constructed. The MSM reveals an energetically favorable conformational change, with the most significant changes occurring at the domain interface. These results support a model in which significant structural reorganization of the NP is required for RNP formation.
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Affiliation(s)
- Jason G Pattis
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT 06269, USA
| | - Eric R May
- Department of Molecular and Cell Biology, University of Connecticut, Storrs, CT 06269, USA.
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21
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Animal Models of Lassa Fever. Pathogens 2020; 9:pathogens9030197. [PMID: 32155851 PMCID: PMC7157617 DOI: 10.3390/pathogens9030197] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/31/2022] Open
Abstract
Lassa virus (LASV), the causative agent of Lassa fever, is estimated to be responsible for up to 300,000 new infections and 5000 deaths each year across Western Africa. The most recent 2018 and 2019 Nigerian outbreaks featured alarmingly high fatality rates of up to 25.4%. In addition to the severity and high fatality of the disease, a significant population of survivors suffer from long-term sequelae, such as sensorineural hearing loss, resulting in a huge socioeconomic burden in endemic regions. There are no Food and Drug Administration (FDA)-approved vaccines, and therapeutics remain extremely limited for Lassa fever. Development of countermeasures depends on relevant animal models that can develop a disease strongly mimicking the pathogenic features of Lassa fever in humans. The objective of this review is to evaluate the currently available animal models for LASV infection with an emphasis on their pathogenic and histologic characteristics as well as recent advances in the development of a suitable rodent model. This information may facilitate the development of an improved animal model for understanding disease pathogenesis of Lassa fever and for vaccine or antiviral testing.
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