Control measures following a case of imported Lassa fever from Togo, North Rhine Westphalia, Germany, 2016

Abstract

In a patient transferred from Togo to Cologne, Germany, Lassa fever was diagnosed 12 days post mortem. Sixty-two contacts in Cologne were categorised according to the level of exposure, and gradual infection control measures were applied. No clinical signs of Lassa virus infection or Lassa specific antibodies were observed in the 62 contacts. Thirty-three individuals had direct contact to blood, other body fluids or tissue of the patients. Notably, with standard precautions, no transmission occurred between the index patient and healthcare workers. However, one secondary infection occurred in an undertaker exposed to the corpse in Rhineland-Palatinate, who was treated on the isolation unit at the University Hospital of Frankfurt. After German authorities raised an alert regarding the imported Lassa fever case, an American healthcare worker who had cared for the index patient in Togo, and who presented with diarrhoea, vomiting and fever, was placed in isolation and medevacked to the United States. The event and the transmission of Lassa virus infection outside of Africa underlines the need for early diagnosis and use of adequate personal protection equipment (PPE), when highly contagious infections cannot be excluded. It also demonstrates that larger outbreaks can be prevented by infection control measures, including standard PPE.

Diagnostics for Lassa fever virus: a genetically diverse pathogen found in low-resource settings

“…First identified in 1969 in Nigeria,11 Lassa fever is now endemic in West Africa including Nigeria, Sierra Leone, Guinea, Liberia, Benin, Ghana and Mali and has spread to neighbouring countries (figure 1). 12–15 In some areas, 10%–16% of people admitted to hospitals every year have LASV 1. Cases have also been identified in Germany,13 15 16 the Netherlands,17 18 Sweden,19 the USA,20–22 the UK23 24 and Japan,25 largely imported after travel in West Africa 17 26–28.…”

From Social Determinants of Health Actions to Fight against the Lassa Virus Hemorrhagic Fever Epidemic in Tchaourou Commune in Benin, 2018

“…In our study, 9 cases were female while 3 were male. Clara Lehmann et al in Germany in 2016 about an outbreak from imported case found 30 female cases and 25 male cases out of the 55 cases registered [14]. This difference between gender seems justifiable, because the household activity of the woman involves her more in the dynamics of the transmission of the Lassa virus infection especially if it is the contamination of the food by the excrements of the rats.…”

“…In our study, during the year outbreaks of 2016, 2017 and 2018, the commune of Tchaourou recorded 27 cases including 12 confirmed LHF cases when direct observations of various Social determinants of health found that the commune had a weak health-promoting environment for fighting against Lassa fever outbreak in Benin where the index case was always imported from Nigeria, the basic origin of Lassa fever [2] [8] [12] [13]. In this repetitive situation of imported Lassa fever from outside the country, the need for early diagnosis and infection control measures, including use of adequate personal protection equipment (PPE) at every level of contact is required, when highly contagious infections cannot be excluded [14]. In our study, according to the health workers, the post-epidemic guidelines were followed at least at 80% for each measure.…”

U.S. Medical Examiner/Coroner capability to handle highly infectious decedents

“…Careful handling of highly infectious remains was particularly imperative given that viral loads were found to be high immediately after an EVD-infected individual died, thereby posing hazardous to pathology and mortuary personnel [16,18,19]. The risk of infection for death care sector workers posed by HIDs was exemplified by the 2016 infection of a German mortuary worker with Lassa fever following the processing of remains previously unknown to be infected with Lassa virus [20]. At the height of the 2014-2016 outbreak, the CDC published guidelines for handling EVD-infected human remains informed by evidence-based best practices to address the transmission risk posed to workers [18]; however, a recent gap analysis survey of the U.S. death care sector-specifically of funeral homes and crematories-revealed that most were unaware of these guidelines.…”