title: Lassa fever in post-conflict sierra leone.
abstract: BACKGROUND
  Lassa fever (LF), an often-fatal hemorrhagic disease caused by Lassa virus (LASV), is a major public health threat in West Africa. When the violent civil conflict in Sierra Leone (1991 to 2002) ended, an international consortium assisted in restoration of the LF program at Kenema Government Hospital (KGH) in an area with the world's highest incidence of the disease.
  
  
  RESULTS
  Clinical and laboratory records of patients presenting to the KGH Lassa Ward in the post-conflict period were organized electronically. Recombinant antigen-based LF immunoassays were used to assess LASV antigenemia and LASV-specific antibodies in patients who met criteria for suspected LF. KGH has been reestablished as a center for LF treatment and research, with over 500 suspected cases now presenting yearly. Higher case fatality rates (CFRs) in LF patients were observed compared to studies conducted prior to the civil conflict. Different criteria for defining LF stages and differences in sensitivity of assays likely account for these differences. The highest incidence of LF in Sierra Leone was observed during the dry season. LF cases were observed in ten of Sierra Leone's thirteen districts, with numerous cases from outside the traditional endemic zone. Deaths in patients presenting with LASV antigenemia were skewed towards individuals less than 29 years of age. Women self-reporting as pregnant were significantly overrepresented among LASV antigenemic patients. The CFR of ribavirin-treated patients presenting early in acute infection was lower than in untreated subjects.
  
  
  CONCLUSIONS
  Lassa fever remains a major public health threat in Sierra Leone. Outreach activities should expand because LF may be more widespread in Sierra Leone than previously recognized. Enhanced case finding to ensure rapid diagnosis and treatment is imperative to reduce mortality. Even with ribavirin treatment, there was a high rate of fatalities underscoring the need to develop more effective and/or supplemental treatments for LF.
authors.affiliation: Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Shaffer
authors.affiliation: Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Grant
authors.affiliation: Sections of Infectious Disease, Departments of Pediatrics and Internal Medicine, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America.
authors.forename: John S
authors.initials: JS
authors.lastname: Schieffelin
authors.affiliation: Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America; Corgenix, Inc., Broomfield, Colorado, United States of America.
authors.forename: Matt L
authors.initials: ML
authors.lastname: Boisen
authors.affiliation: Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.
authors.forename: Augustine
authors.initials: A
authors.lastname: Goba
authors.affiliation: Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Hartnett
authors.affiliation: Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America.
authors.forename: Danielle C
authors.initials: DC
authors.lastname: Levy
authors.affiliation: Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America.
authors.forename: Rachael E
authors.initials: RE
authors.lastname: Yenni
authors.affiliation: Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America; Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Lina M
authors.initials: LM
authors.lastname: Moses
authors.affiliation: Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Fullah
authors.affiliation: Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.
authors.forename: Mambo
authors.initials: M
authors.lastname: Momoh
authors.affiliation: Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.
authors.forename: Mbalu
authors.initials: M
authors.lastname: Fonnie
authors.affiliation: Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.
authors.forename: Richard
authors.initials: R
authors.lastname: Fonnie
authors.affiliation: Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.
authors.forename: Lansana
authors.initials: L
authors.lastname: Kanneh
authors.affiliation: Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.
authors.forename: Veronica J
authors.initials: VJ
authors.lastname: Koroma
authors.affiliation: Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.
authors.forename: Kandeh
authors.initials: K
authors.lastname: Kargbo
authors.affiliation: Corgenix, Inc., Broomfield, Colorado, United States of America.
authors.forename: Darin
authors.initials: D
authors.lastname: Ottomassathien
authors.affiliation: Corgenix, Inc., Broomfield, Colorado, United States of America.
authors.forename: Ivana J
authors.initials: IJ
authors.lastname: Muncy
authors.affiliation: Corgenix, Inc., Broomfield, Colorado, United States of America.
authors.forename: Abigail B
authors.initials: AB
authors.lastname: Jones
authors.affiliation: Biofactura Inc., Rockville, Maryland, United States of America.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Illick
authors.affiliation: Autoimmune Technologies, LLC, New Orleans, Louisiana, United States of America.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Kulakosky
authors.affiliation: Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America.
authors.forename: Allyson M
authors.initials: AM
authors.lastname: Haislip
authors.affiliation: Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bishop
authors.affiliation: Sections of Infectious Disease, Departments of Pediatrics and Internal Medicine, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America.
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Elliot
authors.affiliation: Corgenix, Inc., Broomfield, Colorado, United States of America.
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Brown
authors.affiliation: Vybion Inc., Ithaca, New York, United States of America.
authors.forename: Hu
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, California, United States of America.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Hastie
authors.affiliation: FAS Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America; Broad Institute, Cambridge, Massachusetts, United States of America.
authors.forename: Kristian G
authors.initials: KG
authors.lastname: Andersen
authors.affiliation: FAS Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America; Broad Institute, Cambridge, Massachusetts, United States of America.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Gire
authors.affiliation: FAS Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America; Broad Institute, Cambridge, Massachusetts, United States of America.
authors.forename: Shervin
authors.initials: S
authors.lastname: Tabrizi
authors.affiliation: Broad Institute, Cambridge, Massachusetts, United States of America.
authors.forename: Ridhi
authors.initials: R
authors.lastname: Tariyal
authors.affiliation: FAS Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America; Broad Institute, Cambridge, Massachusetts, United States of America.
authors.forename: Mathew
authors.initials: M
authors.lastname: Stremlau
authors.affiliation: Biofactura Inc., Rockville, Maryland, United States of America.
authors.forename: Alex
authors.initials: A
authors.lastname: Matschiner
authors.affiliation: Biofactura Inc., Rockville, Maryland, United States of America.
authors.forename: Darryl B
authors.initials: DB
authors.lastname: Sampey
authors.affiliation: Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Spence
authors.affiliation: Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America; Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, Texas, United States of America.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Cross
authors.affiliation: Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, Texas, United States of America.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Geisbert
authors.affiliation: Department of Biological Sciences, College of Natural Sciences, Redeemers University, Redemption City, Ogun State, Nigeria.
authors.forename: Onikepe A
authors.initials: OA
authors.lastname: Folarin
authors.affiliation: Department of Biological Sciences, College of Natural Sciences, Redeemers University, Redemption City, Ogun State, Nigeria.
authors.forename: Christian T
authors.initials: CT
authors.lastname: Happi
authors.affiliation: Corgenix, Inc., Broomfield, Colorado, United States of America.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Pitts
authors.affiliation: Corgenix, Inc., Broomfield, Colorado, United States of America.
authors.forename: F Jon
authors.initials: FJ
authors.lastname: Geske
authors.affiliation: Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston, Galveston, Texas, United States of America.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Geisbert
authors.affiliation: Vybion Inc., Ithaca, New York, United States of America; The Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla, California, United States of America.
authors.forename: Erica Ollmann
authors.initials: EO
authors.lastname: Saphire
authors.affiliation: Sections of Infectious Disease, Departments of Pediatrics and Internal Medicine, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America.
authors.forename: James E
authors.initials: JE
authors.lastname: Robinson
authors.affiliation: Autoimmune Technologies, LLC, New Orleans, Louisiana, United States of America.
authors.forename: Russell B
authors.initials: RB
authors.lastname: Wilson
authors.affiliation: Department of Immunology and Microbial Science, The Scripps Research Institute, La Jolla, California, United States of America; FAS Center for Systems Biology, Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, Massachusetts, United States of America; Department of Immunology and Infectious Disease, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Pardis C
authors.initials: PC
authors.lastname: Sabeti
authors.affiliation: Autoimmune Technologies, LLC, New Orleans, Louisiana, United States of America.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Henderson
authors.affiliation: Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone.
authors.forename: S Humarr
authors.initials: SH
authors.lastname: Khan
authors.affiliation: Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, United States of America.
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Bausch
authors.affiliation: Autoimmune Technologies, LLC, New Orleans, Louisiana, United States of America; Zalgen Labs, LLC, Germantown, Maryland, United States of America.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Branco
authors.affiliation: Department of Microbiology and Immunology, Tulane University, New Orleans, Louisiana, United States of America; Broad Institute, Cambridge, Massachusetts, United States of America; Zalgen Labs, LLC, Germantown, Maryland, United States of America.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Garry
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000914:Antibodies, Viral / Q000097:blood; D000956:Antigens, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007118:Immunoassay; D015994:Incidence; D007223:Infant; D007835:Lassa Fever / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D007836:Lassa virus / Q000302:isolation & purification*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D012254:Ribavirin / Q000627:therapeutic use; D012621:Seasons; D012807:Sierra Leone / Q000453:epidemiology; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral; D012254:Ribavirin