1887
Surveillance and outbreak report Open Access
Like 2

Abstract

Due to rapid diagnosis and isolation of imported cases, community outbreaks of viral haemorrhagic fevers (VHF) are considered unlikely in industrialised countries. In March 2016, the first documented locally acquired case of Lassa fever (LF) outside Africa occurred, demonstrating the disease’s potential as a cross-border health threat. We describe the management surrounding this case of LF in Rhineland-Palatinate – the German federal state where secondary transmission occurred. Twelve days after having been exposed to the corpse of a LF case imported from Togo, a symptomatic undertaker tested positive for Lassa virus RNA. Potential contacts were traced, categorised based on exposure risk, and monitored. Overall, we identified 21 contact persons with legal residency in Rhineland-Palatinate: seven related to the index case, 13 to the secondary case, and one related to both. The secondary case received treatment and recovered. Five contacts were quarantined and one was temporarily banned from work. No further transmission occurred. Based on the experience gained during the outbreak and a review of national and international guidelines, we conclude that exposure risk attributable to corpses may currently be underestimated, and we present suggestions that may help to improve the anti-epidemic response to imported VHF cases in industrialised countries.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2017.22.39.16-00728
2017-09-28
2017-10-18
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2017.22.39.16-00728
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/22/39/eurosurv-22-39-5.html?itemId=/content/10.2807/1560-7917.ES.2017.22.39.16-00728&mimeType=html&fmt=ahah

References

  1. World Health Organization (WHO). Emergencies preparedness, response. Lassa Fever – Germany. Disease outbreak news. Geneva: WHO; 23 Mar 2016. Available from: http://www.who.int/csr/don/23-march-2016-lassa-fever-germany/en
  2. World Health Organization (WHO). Emergencies preparedness, response. Lassa Fever – Togo. Disease outbreak news. Geneva: WHO; 23 Mar 2016. Available from: http://www.who.int/csr/don/23-march-2016-lassa-fever-togo/en/
  3. Lehmann C, Kochanek M, Abdulla D, Becker S, Böll B, Bunte A, et al. Control measures following a case of imported Lassa fever from Togo, North Rhine Westphalia, Germany, 2016. Euro Surveill. 2017;22(39).  https://doi.org/10.2807/1560-7917.ES.2017.22.39.17-00088 
  4. Centers for Disease Control and Prevention (CDC). Lassa Fever. 2017. Available from: https://www.cdc.gov/vhf/lassa/index
  5. Yun NE, Walker DH. Pathogenesis of Lassa fever. Viruses. 2012;4(10):2031-48.  https://doi.org/10.3390/v4102031  PMID: 23202452 
  6. McCormick JB, King IJ, Webb PA, Scribner CL, Craven RB, Johnson KM, et al. Lassa fever. Effective therapy with ribavirin. N Engl J Med. 1986;314(1):20-6.  https://doi.org/10.1056/NEJM198601023140104  PMID: 3940312 
  7. Bausch DG, Hadi CM, Khan SH, Lertora JJ. Review of the literature and proposed guidelines for the use of oral ribavirin as postexposure prophylaxis for Lassa fever. Clin Infect Dis. 2010;51(12):1435-41.  https://doi.org/10.1086/657315  PMID: 21058912 
  8. Asogun DA, Adomeh DI, Ehimuan J, Odia I, Hass M, Gabriel M, et al. Molecular diagnostics for lassa fever at Irrua specialist teaching hospital, Nigeria: lessons learnt from two years of laboratory operation. PLoS Negl Trop Dis. 2012;6(9):e1839.  https://doi.org/10.1371/journal.pntd.0001839  PMID: 23029594 
  9. Bausch DG, Demby AH, Coulibaly M, Kanu J, Goba A, Bah A, et al. Lassa fever in Guinea: I. Epidemiology of human disease and clinical observations. Vector Borne Zoonotic Dis. 2001;1(4):269-81.  https://doi.org/10.1089/15303660160025903  PMID: 12653127 
  10. Mylne AQ, Pigott DM, Longbottom J, Shearer F, Duda KA, Messina JP, et al. Mapping the zoonotic niche of Lassa fever in Africa. Trans R Soc Trop Med Hyg. 2015;109(8):483-92.  https://doi.org/10.1093/trstmh/trv047  PMID: 26085474 
  11. Fichet-Calvet E, Becker-Ziaja B, Koivogui L, Günther S. Lassa serology in natural populations of rodents and horizontal transmission. Vector Borne Zoonotic Dis. 2014;14(9):665-74.  https://doi.org/10.1089/vbz.2013.1484  PMID: 25229705 
  12. Fichet-Calvet E, Lecompte E, Koivogui L, Soropogui B, Doré A, Kourouma F, et al. Fluctuation of abundance and Lassa virus prevalence in Mastomys natalensis in Guinea, West Africa. Vector Borne Zoonotic Dis. 2007;7(2):119-28.  https://doi.org/10.1089/vbz.2006.0520  PMID: 17627428 
  13. Sogoba N, Rosenke K, Adjemian J, Diawara SI, Maiga O, Keita M, et al. Lassa Virus Seroprevalence in Sibirilia Commune, Bougouni District, Southern Mali. Emerg Infect Dis. 2016;22(4):657-63.  https://doi.org/10.3201/eid2204.151814  PMID: 26981786 
  14. Klempa B, Koulemou K, Auste B, Emmerich P, Thomé-Bolduan C, Günther S, et al. Seroepidemiological study reveals regional co-occurrence of Lassa- and Hantavirus antibodies in Upper Guinea, West Africa. Trop Med Int Health. 2013;18(3):366-71. PMID: 23279760 
  15. Ajayi NA, Nwigwe CG, Azuogu BN, Onyire BN, Nwonwu EU, Ogbonnaya LU, et al. Containing a Lassa fever epidemic in a resource-limited setting: outbreak description and lessons learned from Abakaliki, Nigeria (January-March 2012). Int J Infect Dis. 2013;17(11):e1011-6.  https://doi.org/10.1016/j.ijid.2013.05.015  PMID: 23871405 
  16. Lo Iacono G, Cunningham AA, Fichet-Calvet E, Garry RF, Grant DS, Khan SH, et al. Using modelling to disentangle the relative contributions of zoonotic and anthroponotic transmission: the case of lassa fever. PLoS Negl Trop Dis. 2015;9(1):e3398.  https://doi.org/10.1371/journal.pntd.0003398  PMID: 25569707 
  17. Amorosa V, MacNeil A, McConnell R, Patel A, Dillon KE, Hamilton K, et al. Imported Lassa fever, Pennsylvania, USA, 2010. Emerg Infect Dis. 2010;16(10):1598-600.  https://doi.org/10.3201/eid1610.100774  PMID: 20875288 
  18. Atkin S, Anaraki S, Gothard P, Walsh A, Brown D, Gopal R, et al. The first case of Lassa fever imported from Mali to the United Kingdom, February 2009. Euro Surveill. 2009;14(10):19145. PMID: 19317988 
  19. Woodruff AW, Monath TP, Mahmoud AA, Pain AK, Morris CA. Lassa fever in Britain: an imported case. BMJ. 1973;3(5881):616-7.  https://doi.org/10.1136/bmj.3.5881.616  PMID: 4755184 
  20. Galbraith NS, Berrie JR, Forbes P, Young S. Public health aspects of viral haemorrhagic fevers in Britain. R Soc Health J. 1978;98(4):152-60.  https://doi.org/10.1177/146642407809800407  PMID: 567824 
  21. Haas WH, Breuer T, Pfaff G, Schmitz H, Köhler P, Asper M, et al. Imported Lassa fever in Germany: surveillance and management of contact persons. Clin Infect Dis. 2003;36(10):1254-8.  https://doi.org/10.1086/374853  PMID: 12746770 
  22. Koch-Institute R. (RKI). Framework Ebola Virus Disease. BerlinL RKI; 24 Mar 2016. Available from: http://www.rki.de/EN/Content/infections/epidemiology/outbreaks/Ebola_virus_disease/Framework_EVD.pdf?__blob=publicationFile
  23. European Centre for Disease Prevention and Control (ECDC). Public health management of persons having had contact with Ebola virus disease cases in the EU. Stockholm: ECDC; 7 Nov 2014. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/ebola-public-health-contact-management-update-10-November.pdf
  24. World Health Organization/Centers for Disease Control and Prevention (WHO/CDC). Implementation and management of contact tracing for Ebola virus disease.Geneva: WHO; Sep 2015. Available from: http://apps.who.int/iris/bitstream/10665/185258/1/WHO_EVD_Guidance_Contact_15.1_eng.pdf
  25. Public Health England (PHE). Public health recommendations for asymptomatic contacts of an Ebola case in the UK. London: PHE; 9 Feb 2015. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/402483/Public_health_recommendations_for_asymptomatic_contacts_of_an_Ebola_case.pdf
  26. Fock R, Peters M, Wirtz A, Scholz D, Fell G, Bussmann H. (Skeleton framework concept for defence against risks in unusual epidemics: steps by public health offices). Gesundheitswesen. 2001;63(11):695-702.  https://doi.org/10.1055/s-2001-18412  PMID: 11713701 
  27. Wolff S, Schultze T, Fehling SK, Mengel JP, Kann G, Wolf T, et al. Genome Sequence of Lassa Virus Isolated from the First Domestically Acquired Case in Germany. Genome Announc. 2016;4(5):e00938-16.  https://doi.org/10.1128/genomeA.00938-16  PMID: 27660771 
  28. Spiegel-Online. [Lassa patient in Frankfurt. All signs of severe infection]. Hamburg: Spiegel-Online; 17 Mar 2016. German. Available from: http://www.spiegel.de/gesundheit/diagnose/frankfurt-lassa-patient-schwer-krank-a-1082858.html
  29. Allgemeine A. Lassa-Patient ist in einem sehr schlechtem Zustand. [Lassa patient is in a very bad condition]. Augsburger Zeitung, 18. Mar 2016. German. Available from: http://www.augsburger-allgemeine.de/wissenschaft/Lassa-Patient-ist-in-einem-sehr-schlechtem-Zustand-id37260962.html
  30. Advisory Committee on Dangerous Pathogens. Management of Hazard Group 4 viral haemorrhagic fevers and similar human infectious diseases of high consequence. London: Department of Health; Nov 2015. Available from: https://naru.org.uk/wp-content/uploads/2015/11/VHF_guidance_updated_7_Sept_15.pdf
  31. Emond RT, Bannister B, Lloyd G, Southee TJ, Bowen ET. A case of Lassa fever: clinical and virological findings. Br Med J (Clin Res Ed). 1982;285(6347):1001-2.  https://doi.org/10.1136/bmj.285.6347.1001  PMID: 6812716 
  32. McCormick JB, Fisher-Hoch SP. Lassa fever. Curr Top Microbiol Immunol. 2002;262:75-109.  https://doi.org/10.1007/978-3-642-56029-3_4  PMID: 11987809 
/content/10.2807/1560-7917.ES.2017.22.39.16-00728
Loading

Data & Media loading...

Comment has been disabled for this content
Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error