Systematic review and meta-analysis of the epidemiology of Lassa virus in humans, rodents and other mammals in sub-Saharan Africa

Kenmoe, Sébastien; Tchatchouang, Serges; Ebogo‐Belobo, Jean Thierry; Ka’e, Aude Christelle; Mahamat, Gadji; Simo, Raïssa Estelle Guiamdjo; Bowo‐Ngandji, Arnol; Emoh, Cynthia Paola Demeni; Che, Emmanuel; Ngongang, Dimitri Tchami; Amougou-Atsama, Marie; Nzukui, Nathalie Diane; Mikangue, Chris Andre Mbongue; Mbaga, Donatien Serge; Kenfack, Sorel; Bebey, Sandrine Rachel Kingue; Amvongo-Adjia, Nathalie; Efietngab, Atembeh Noura; Tazokong, Hervé Raoul; Modiyinji, Abdou Fatawou; Kengne‐Nde, Cyprien; Sadeuh-Mba, Serge Alain; Njouom, Richard

doi:10.1371/journal.pntd.0008589

Cited by 27 publications

(25 citation statements)

References 130 publications

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“…LF is a seasonal disease that is estimated to cause 100,000 to 300,000 new cases and 5,000 deaths each year. [4] The reported case fatality rate (CFR) is approximately 30% in patients who present to health care settings [5]-although this figure is lower (12%) in the most recent large cohort study taking place in a research setting. [6] During the peak season it is possible for large outbreaks to occur.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10] Healthcare workers and pregnant women are considered to be at significant risk of severe Lassa fever outcomes. [11] High prevalence of LF has been identified in healthcare workers [5] which is thought to be a result of low levels of clinical suspicion of LF and an inadequate supply of quality protective equipment, making adherence to infection prevention and control (IPC) measures challenging. [12,13] Pregnant women are three-times more likely to have a fatal outcome than non-pregnant adults.…”

Section: Introductionmentioning

confidence: 99%

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Clinical characterization of Lassa fever: A systematic review of clinical reports and research to inform clinical trial design

Merson

Bourner

Jalloh³

et al. 2021

PLoS Negl Trop Dis

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Background Research is urgently needed to reduce the morbidity and mortality of Lassa fever (LF), including clinical trials to test new therapies and to verify the efficacy and safety of the only current treatment recommendation, ribavirin, which has a weak clinical evidence base. To help establish a basis for the development of an adaptable, standardised clinical trial methodology, we conducted a systematic review to identify the clinical characteristics and outcomes of LF and describe how LF has historically been defined and assessed in the scientific literature. Methodology Primary clinical studies and reports of patients with suspected and confirmed diagnosis of LF published in the peer-reviewed literature before 15 April 2021 were included. Publications were selected following a two-stage screening of abstracts, then full-texts, by two independent reviewers at each stage. Data were extracted, verified, and summarised using descriptive statistics. Results 147 publications were included, primarily case reports (36%), case series (28%), and cohort studies (20%); only 2 quasi-randomised studies (1%) were found. Data are mostly from Nigeria (52% of individuals, 41% of publications) and Sierra Leone (42% of individuals, 31% of publications). The results corroborate the World Health Organisation characterisation of LF presentation. However, a broader spectrum of presenting symptoms is evident, such as gastrointestinal illness and other nervous system and musculoskeletal disorders that are not commonly included as indicators of LF. The overall case fatality ratio was 30% in laboratory-confirmed cases (1896/6373 reported in 109 publications). Conclusion Systematic review is an important tool in the clinical characterisation of diseases with limited publications. The results herein provide a more complete understanding of the spectrum of disease which is relevant to clinical trial design. This review demonstrates the need for coordination across the LF research community to generate harmonised research methods that can contribute to building a strong evidence base for new treatments and foster confidence in their integration into clinical care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical characterization of Lassa fever: A systematic review of clinical reports and research to inform clinical trial design

Merson

Bourner

Jalloh³

et al. 2021

PLoS Negl Trop Dis

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“…Countries reporting LF outside of Sierra Leone have historically reported lower CFRs. In 2020, a meta-analysis for 25 countries in Sub-Saharan Africa reported 29% CFRs for LF patients [ 24 ]. In Nigeria, CFRs declined from 94% in 2001 to 15% in 2018, while the caseload increased from 0.3 to 3.4% over the same period [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

Space-Time Trends in Lassa Fever in Sierra Leone by ELISA Serostatus, 2012–2019

Shaffer

Schieffelin

Momoh³

et al. 2021

Microorganisms

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Lassa fever (LF) is a viral hemorrhagic disease found in Sub-Saharan Africa and is responsible for up to 300,000 cases and 5000 deaths annually. LF is highly endemic in Sierra Leone, particularly in its Eastern Province. Kenema Government Hospital (KGH) maintains one of only a few LF isolation facilities in the world with year-round diagnostic testing. Here we focus on space-time trends for LF occurring in Sierra Leone between 2012 and 2019 to provide a current account of LF in the wake of the 2014–2016 Ebola epidemic. Data were analyzed for 3277 suspected LF cases and classified as acute, recent, and non-LF or prior LF exposure using enzyme-linked immunosorbent assays (ELISAs). Presentation rates for acute, recent, and non-LF or prior LF exposure were 6.0% (195/3277), 25.6% (838/3277), and 68.4% (2244/3277), respectively. Among 2051 non-LF or prior LF exposures, 33.2% (682/2051) tested positive for convalescent LF exposure. The overall LF case-fatality rate (CFR) was 78.5% (106/135). Both clinical presentations and confirmed LF cases declined following the Ebola epidemic. These declines coincided with an increased duration between illness onset and clinical presentation, perhaps suggesting more severe disease or presentation at later stages of illness. Acute LF cases and their corresponding CFRs peaked during the dry season (November to April). Subjects with recent (but not acute) LF exposure were more likely to present during the rainy season (May to October) than the dry season (p < 0.001). The findings here suggest that LF remains endemic in Sierra Leone and that caseloads are likely to resume at levels observed prior to the Ebola epidemic. The results provide insight on the current epidemiological profile of LF in Sierra Leone to facilitate LF vaccine studies and accentuate the need for LF cohort studies and continued advancements in LF diagnostics.

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“…We analysed the data as outlined in a previously published study [ 15 ]. The main outcome of the study was the combined incidence according to population categories (humans, dogs or other animal species) and the types of RABV infection (active, recent, past RABV infection).…”

Section: Methodsmentioning

confidence: 99%

Incidence and seroprevalence of rabies virus in humans, dogs and other animal species in Africa, a systematic review and meta-analysis

et al. 2021

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Rabies is transmitted to humans mainly by dogs but also by other animal species. Reliable data on the incidence of Rabies virus (RABV) in humans, dogs, and other animal species in Africa, could be essential in the implementation of a global strategic plan to eliminate the RABV by 2030 as adopted by the WHO, OIE, and FAO. We searched the Pubmed, Embase, Scopus, African Journal Online, and African Index Medicus databases for relevant studies that report data on the incidence of RABV in Africa up to February 17, 2020. Information on active and past RABV exposures in various categories of dogs, humans and other animal species were extracted. Incidence and seroprevalence estimates were pooled using a random-effect meta-analysis. We included 73 articles which provided 142 RABV incidence and seroprevalence records in 21 African countries. The estimated incidence of RABV in 222 humans, 15,600 dogs, and 12,865 other animal species was 83.4% (95% CI = 64.6–96.5), 44.1% (95% CI = 35.1–53.4), and 41.4% (95% CI = 29.6–53.8), respectively. The estimated seroprevalence of RABV in 420 humans, 3577 dogs, and 8,55 other animal species was 33.8% (95% CI = 21.9–46.8), 19.8% (95% CI = 13.3–27.3), and 3.6% (95% CI = 0.3–9.2), respectively. The incidence of RABV in general was higher in suspected rabid dogs, other animal species of the Orders Perissodactyla, Artiodactyla and Carnivora. The incidence of RABV was higher for humans in regions of West and East Africa, for dogs in urban areas and in regions of Central and South Africa, and for animals of the order Perissodactyla in urban areas. This meta-analysis demonstrated a high incidence of RABV in Africa. Itis necessary to improve surveillance system to provide reliable data on RABV in Africa, essential for the implementation of an effective control strategy.

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Systematic review and meta-analysis of the epidemiology of Lassa virus in humans, rodents and other mammals in sub-Saharan Africa

Cited by 27 publications

References 130 publications

Clinical characterization of Lassa fever: A systematic review of clinical reports and research to inform clinical trial design

Clinical characterization of Lassa fever: A systematic review of clinical reports and research to inform clinical trial design

Space-Time Trends in Lassa Fever in Sierra Leone by ELISA Serostatus, 2012–2019

Incidence and seroprevalence of rabies virus in humans, dogs and other animal species in Africa, a systematic review and meta-analysis

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