- Lassa fever is an acute viral haemorrhagic illness of 2-21 days duration that occurs in West Africa.
- The Lassa virus is transmitted to humans via contact with food or household items contaminated with rodent urine or faeces.
- Person-to-person infections and laboratory transmission can also occur, particularly in hospitals lacking adequate infection prevention and control measures.
- Lassa fever is known to be endemic in Benin, Ghana, Guinea, Liberia, Mali, Sierra Leone, and Nigeria, but probably exists in other West African countries as well.
- The overall case-fatality rate is 1%. Observed case-fatality rate among patients hospitalized with severe cases of Lassa fever is 15%.
- Early supportive care with rehydration and symptomatic treatment improves survival.
Symptoms of Lassa fever
The incubation period of Lassa fever ranges from 6–21 days. The onset of the disease, when it is symptomatic, is usually gradual, starting with fever, general weakness, and malaise. After a few days, headache, sore throat, muscle pain, chest pain, nausea, vomiting, diarrhoea, cough, and abdominal pain may follow. In severe cases facial swelling, fluid in the lung cavity, bleeding from the mouth, nose, vagina or gastrointestinal tract and low blood pressure may develop.
Protein may be noted in the urine. Shock, seizures, tremor, disorientation, and coma may be seen in the later stages. Deafness occurs in 25% of patients who survive the disease. In half of these cases, hearing returns partially after 1–3 months. Transient hair loss and gait disturbance may occur during recovery.
Death usually occurs within 14 days of onset in fatal cases. The disease is especially severe late in pregnancy, with maternal death and/or fetal loss occurring in more than 80% of cases during the third trimester.
Prevention and control
Prevention of Lassa fever relies on promoting good “community hygiene” to discourage rodents from entering homes. Effective measures include storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, maintaining clean households and keeping cats. Because Mastomys are so abundant in endemic areas, it is not possible to completely eliminate them from the environment. Family members should always be careful to avoid contact with blood and body fluids while caring for sick persons.
In health-care settings, staff should always apply standard infection prevention and control precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.
Health-care workers caring for patients with suspected or confirmed Lassa fever should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with Lassa fever, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).
Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Lassa virus infection should be handled by trained staff and processed in suitably equipped laboratories under maximum biological containment conditions.
On rare occasions, travellers from areas where Lassa fever is endemic export the disease to other countries. Although malaria, typhoid fever, and many other tropical infections are much more common, the diagnosis of Lassa fever should be considered in febrile patients returning from West Africa, especially if they have had exposures in rural areas or hospitals in countries where Lassa fever is known to be endemic. Health-care workers seeing a patient suspected to have Lassa fever should immediately contact local and national experts for advice and to arrange for laboratory testing.