title: An Outbreak of Ebola Virus Disease in the Lassa Fever Zone.
abstract: Kenema Government Hospital (KGH) has developed an advanced clinical and laboratory research capacity to manage the threat of Lassa fever, a viral hemorrhagic fever (VHF). The 2013-2016 Ebola virus (EBOV) disease (EVD) outbreak is the first to have occurred in an area close to a facility with established clinical and laboratory capacity for study of VHFs.
  
  
  
  Because of its proximity to the epicenter of the EVD outbreak, which began in Guinea in March 2014, the KGH Lassa fever Team mobilized to establish EBOV surveillance and diagnostic capabilities.
  
  
  
  Augustine Goba, director of the KGH Lassa laboratory, diagnosed the first documented case of EVD in Sierra Leone, on 25 May 2014. Thereafter, KGH received and cared for numbers of patients with EVD that quickly overwhelmed the capacity for safe management. Numerous healthcare workers contracted and lost their lives to EVD. The vast majority of subsequent EVD cases in West Africa can be traced back to a single transmission chain that includes this first diagnosed case.
  
  
  
  Responding to the challenges of confronting 2 hemorrhagic fever viruses will require continued investments in the development of countermeasures (vaccines, therapeutic agents, and diagnostic assays), infrastructure, and human resources.
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Augustine
authors.initials: A
authors.lastname: Goba
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: S Humarr
authors.initials: SH
authors.lastname: Khan
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Mbalu
authors.initials: M
authors.lastname: Fonnie
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Fullah
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Alex
authors.initials: A
authors.lastname: Moigboi
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Alice
authors.initials: A
authors.lastname: Kovoma
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Vandi
authors.initials: V
authors.lastname: Sinnah
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Nancy
authors.initials: N
authors.lastname: Yoko
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Hawa
authors.initials: H
authors.lastname: Rogers
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Siddiki
authors.initials: S
authors.lastname: Safai
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Mambu
authors.initials: M
authors.lastname: Momoh
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Veronica
authors.initials: V
authors.lastname: Koroma
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Fatima K
authors.initials: FK
authors.lastname: Kamara
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Edwin
authors.initials: E
authors.lastname: Konowu
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Yillah
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Issa
authors.initials: I
authors.lastname: French
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Ibraham
authors.initials: I
authors.lastname: Mustapha
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Franklyn
authors.initials: F
authors.lastname: Kanneh
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Momoh
authors.initials: M
authors.lastname: Foday
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Helena
authors.initials: H
authors.lastname: McCarthy
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Tiangay
authors.initials: T
authors.lastname: Kallon
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Mustupha
authors.initials: M
authors.lastname: Kallon
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Jenneh
authors.initials: J
authors.lastname: Naiebu
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Josephine
authors.initials: J
authors.lastname: Sellu
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Abdul A
authors.initials: AA
authors.lastname: Jalloh
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Michael
authors.initials: M
authors.lastname: Gbakie
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Lansana
authors.initials: L
authors.lastname: Kanneh
authors.affiliation: Ministry of Health and Sanitation.
authors.forename: James L B
authors.initials: JL
authors.lastname: Massaly
authors.affiliation: Ministry of Health and Sanitation.
authors.forename: David
authors.initials: D
authors.lastname: Kargbo
authors.affiliation: Ministry of Health and Sanitation.
authors.forename: Brima
authors.initials: B
authors.lastname: Kargbo
authors.affiliation: Ministry of Health and Sanitation.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Vandi
authors.affiliation: Ministry of Health and Sanitation.
authors.forename: Momoh
authors.initials: M
authors.lastname: Gbetuwa
authors.affiliation: University of Sierra Leone.
authors.forename: Sahr M
authors.initials: SM
authors.lastname: Gevao
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: John D
authors.initials: JD
authors.lastname: Sandi
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital.
authors.forename: Simbirie C
authors.initials: SC
authors.lastname: Jalloh
authors.affiliation: Viral Hemorrhagic Fever Program, Kenema Government Hospital Ministry of Health and Sanitation.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Grant
authors.affiliation: Ministry of Social Welfare, Gender, and Children's Affairs.
authors.forename: Sylvia O
authors.initials: SO
authors.lastname: Blyden
authors.affiliation: World Health Organization Sierra Leone Ebola Response Team, Freetown, Sierra Leone Infectious Diseases Institute, Mulago Hospital Complex, Kampala, Uganda.
authors.forename: Ian
authors.initials: I
authors.lastname: Crozier
authors.affiliation: Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine.
authors.forename: John S
authors.initials: JS
authors.lastname: Schieffelin
authors.affiliation: Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine Department of Tropical Medicine.
authors.forename: Susan L
authors.initials: SL
authors.lastname: McLellan
authors.affiliation: Division of Allergy and Infectious Diseases, University of Washington, Seattle.
authors.forename: Shevin T
authors.initials: ST
authors.lastname: Jacob
authors.affiliation: Corgenix, Broomfield, Colorado Zalgen Labs, Germantown, Maryland.
authors.forename: Matt L
authors.initials: ML
authors.lastname: Boisen
authors.affiliation: Department of Microbiology and Immunology.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Hartnett
authors.affiliation: Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Cross
authors.affiliation: Zalgen Labs, Germantown, Maryland.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Branco
authors.affiliation: Scripps Translational Science Institute.
authors.forename: Kristian G
authors.initials: KG
authors.lastname: Andersen
authors.affiliation: Broad Institute of MIT and Harvard.
authors.forename: Nathan L
authors.initials: NL
authors.lastname: Yozwiak
authors.affiliation: NextGen Jane, San Francisco, California.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Gire
authors.affiliation: NextGen Jane, San Francisco, California.
authors.forename: Ridhi
authors.initials: R
authors.lastname: Tariyal
authors.affiliation: Broad Institute of MIT and Harvard.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Park
authors.affiliation: Department of Microbiology and Immunology.
authors.forename: Allyson M
authors.initials: AM
authors.lastname: Haislip
authors.affiliation: Department of Microbiology and Immunology.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bishop
authors.affiliation: Department of Microbiology and Immunology.
authors.forename: Lilia I
authors.initials: LI
authors.lastname: Melnik
authors.affiliation: Department of Microbiology, Immunology, and Parasitology, LSU Health Mockingbird Nature Research Group, Pearl River, Louisiana.
authors.forename: William R
authors.initials: WR
authors.lastname: Gallaher
authors.affiliation: Department of Biochemistry, Tulane University.
authors.forename: William C
authors.initials: WC
authors.lastname: Wimley
authors.affiliation: Department of Biochemistry, Tulane University.
authors.forename: Jing
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Biostatistics and Bioinformatics, Tulane School of Public Health and Tropical Medicine.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Shaffer
authors.affiliation: Department of Immunology and Microbial Science.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Sullivan
authors.affiliation: Naval Engineering Facilities Command, Naples, Italy.
authors.forename: Sonia
authors.initials: S
authors.lastname: Grillo
authors.affiliation: South Coast Solar.
authors.forename: Scott
authors.initials: S
authors.lastname: Oman
authors.affiliation: Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine Autoimmune Technologies, New Orleans.
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Garry
authors.affiliation: Mount Sinai School of Medicine.
authors.forename: Donna R
authors.initials: DR
authors.lastname: Edwards
authors.affiliation: Autoimmune Technologies, New Orleans.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: McCormick
authors.affiliation: Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine.
authors.forename: Deborah H
authors.initials: DH
authors.lastname: Elliott
authors.affiliation: Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Rouelle
authors.affiliation: Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine.
authors.forename: Chandrika B
authors.initials: CB
authors.lastname: Kannadka
authors.affiliation: Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Reyna
authors.affiliation: Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Bradley
authors.affiliation: Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine.
authors.forename: Haini
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Microbiology and Immunology.
authors.forename: Rachael E
authors.initials: RE
authors.lastname: Yenni
authors.affiliation: Department of Immunology and Microbial Science.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Hastie
authors.affiliation: Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston.
authors.forename: Joan B
authors.initials: JB
authors.lastname: Geisbert
authors.affiliation: Autoimmune Technologies, New Orleans.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Kulakosky
authors.affiliation: Autoimmune Technologies, New Orleans.
authors.forename: Russell B
authors.initials: RB
authors.lastname: Wilson
authors.affiliation: Department of Immunology and Microbial Science.
authors.forename: Michael B A
authors.initials: MB
authors.lastname: Oldstone
authors.affiliation: Corgenix, Broomfield, Colorado.
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Pitts
authors.affiliation: Vybion, Ithaca, New York, New York.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Henderson
authors.affiliation: Section of Infectious Disease, Department of Pediatrics Section of Infectious Disease, Department of Internal Medicine, School of Medicine.
authors.forename: James E
authors.initials: JE
authors.lastname: Robinson
authors.affiliation: Department of Microbiology and Immunology, University of Texas Medical Branch at Galveston.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Geisbert
authors.affiliation: Department of Immunology and Microbial Science The Skaggs Institute for Chemical Biology, The Scripps Research Institute, La Jolla.
authors.forename: Erica Ollmann
authors.initials: EO
authors.lastname: Saphire
authors.affiliation: Redeemer's University, Ede Irrua Specialist Teaching Hospital, Nigeria.
authors.forename: Christian T
authors.initials: CT
authors.lastname: Happi
authors.affiliation: Irrua Specialist Teaching Hospital, Nigeria.
authors.forename: Danny A
authors.initials: DA
authors.lastname: Asogun
authors.affiliation: Broad Institute of MIT and Harvard Department of Organismic and Evolutionary Biology, Center for Systems Biology, Harvard University, Cambridge, Massachusetts.
authors.forename: Pardis C
authors.initials: PC
authors.lastname: Sabeti
authors.affiliation: Department of Microbiology and Immunology Zalgen Labs, Germantown, Maryland.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Garry
mesh_terms: D000293:Adolescent; D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D029043:Ebolavirus / Q000235:genetics / Q000302:isolation & purification*; D062665:Epidemiological Monitoring; D005260:Female; D016679:Genome, Viral / Q000235:genetics*; D023281:Genomics; D016701:Guinea / Q000453:epidemiology; D019142:Hemorrhagic Fever, Ebola / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D006801:Humans; D007835:Lassa Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D007836:Lassa virus / Q000235:genetics / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D017422:Sequence Analysis, DNA; D012807:Sierra Leone / Q000453:epidemiology; D055815:Young Adult
keywords: Ebola virus; Lassa virus; West African Ebola outbreak 2013–16; epidemiology; genomic sequencing; research capacity building; viral hemorrhagic fever diagnostics