title: Lassa fever in Guinea: I. Epidemiology of human disease and clinical observations.
abstract: The arenavirus Lassa is found in West Africa, where it sometimes causes a severe illness called Lassa fever. Lassa fever has been seldom investigated outside of a few hyperendemic regions, where the described epidemiology may differ from that in areas of low or moderate incidence of disease. Through a prospective cohort study, we investigated the epidemiology and clinical presentation of Lassa fever in Guinea, where the disease has been infrequently recognized. A surveillance system was established, and suspected cases were enrolled at five Guinean hospitals. Clinical observations were made, and blood was taken for enzyme-linked immunosorbent assay testing and isolation of Lassa virus. Lassa fever was confirmed in 22 (7%) of 311 suspected cases. Another 43 (14%) had Lassa IgG antibodies, indicating past exposure. Both sexes and a wide variety of age and ethnic groups were affected. The disease was more frequently found, and the IgG seroprevalence generally higher, in the southeastern forest region. In some areas, there were significant discrepancies between the incidence of Lassa fever and the prevalence of antibody. Clinical presentations between those with Lassa fever and other febrile illnesses were essentially indistinguishable. Clinical predictors of a poor outcome were noted, but again were not specific for Lassa fever. Case-fatality rates for those with Lassa fever and non-Lassa febrile illnesses were 18% and 15%, respectively. Seasonal fluctuation in the incidence of Lassa fever was noted, but occurred similarly with non-Lassa febrile illnesses. Our results, perhaps typical of the scenario throughout much of West Africa, indicate Lassa virus infection to be widespread in certain areas of Guinea, but difficult to distinguish clinically.
authors.affiliation: Special Pathogens Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases (NCID), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA. dsb8@cdc.gov
authors.forename: D G
authors.initials: DG
authors.lastname: Bausch
authors.forename: A H
authors.initials: AH
authors.lastname: Demby
authors.forename: M
authors.initials: M
authors.lastname: Coulibaly
authors.forename: J
authors.initials: J
authors.lastname: Kanu
authors.forename: A
authors.initials: A
authors.lastname: Goba
authors.forename: A
authors.initials: A
authors.lastname: Bah
authors.forename: N
authors.initials: N
authors.lastname: Condé
authors.forename: H L
authors.initials: HL
authors.lastname: Wurtzel
authors.forename: K F
authors.initials: KF
authors.lastname: Cavallaro
authors.forename: E
authors.initials: E
authors.lastname: Lloyd
authors.forename: F B
authors.initials: FB
authors.lastname: Baldet
authors.forename: S D
authors.initials: SD
authors.lastname: Cissé
authors.forename: D
authors.initials: D
authors.lastname: Fofona
authors.forename: I K
authors.initials: IK
authors.lastname: Savané
authors.forename: R T
authors.initials: RT
authors.lastname: Tolno
authors.forename: B
authors.initials: B
authors.lastname: Mahy
authors.forename: K D
authors.initials: KD
authors.lastname: Wagoner
authors.forename: T G
authors.initials: TG
authors.lastname: Ksiazek
authors.forename: C J
authors.initials: CJ
authors.lastname: Peters
authors.forename: P E
authors.initials: PE
authors.lastname: Rollin
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000914:Antibodies, Viral / Q000032:analysis; D005006:Ethnicity; D005260:Female; D016701:Guinea / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007835:Lassa Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D007836:Lassa virus / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011891:Rain; D012621:Seasons; D012737:Sex Factors
chemical_list: D000914:Antibodies, Viral