Lassa fever practice challenges in Nigeria

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

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.

Risk factors for Lassa fever infection among survivors at the Federal Medical Center, Owo, Ondo State, Nigeria

Background and Aim: There is insufficient information about the successfully managed Lassa fever (LF) patients in Nigeria. This study aimed to utilize the One Health approach to identify the risk factors for LF infection among LF patients who were managed and on follow-up at the Federal Medical Center, Owo, Ondo State, Nigeria. Materials and Methods: A cross-sectional study was done on 101 LF survivors who were managed and on follow-up at the Federal Medical Center. The data were collected using a semi-structured interviewer-administered questionnaire. The respondents were assessed for symptoms and factors that might have predisposed them to LF, and the data were analyzed with SPSS version 23 (IBM Corp., NY, USA). Those who had more than 3 identifiable risks were categorized as high risk. Descriptive statistics were done, and the association between sociodemographic characteristics and high risk was explored using Chi-square test. Results: The median age of the respondents was 33 years (8-85 years); 62 (61.4%) were male, and 93 (92.1%) have heard of LF before diagnosis. The perceived cause of LF infection among the respondents included the consumption of food contaminated by rats' feces among 57 (56.4%) persons, while 16 (15.8) attributed their infection to contact with LF-infected persons. Among the respondents with primary education and below, 5 (29.4%) were at higher risk for LF infection compared to 7 (8.3%) with secondary education and above (p=0.014). Conclusion: The mass media and other sources of information should be well-harnessed in the communication of risks and preventive practices for LF. Public information campaigns should be organized to discourage bush burning in affected communities.

A rapid research needs appraisal methodology to identify evidence gaps to inform clinical research priorities in response to outbreaks-results from the Lassa fever pilot

BACKGROUND

Infectious disease epidemics are a constant threat, and while we can strengthen preparedness in advance, inevitably, we will sometimes be caught unaware by novel outbreaks. To address the challenge of rapidly identifying clinical research priorities in those circumstances, we developed and piloted a protocol for carrying out a systematic, rapid research needs appraisal (RRNA) of existing evidence within 5 days in response to outbreaks globally, with the aim to inform clinical research prioritization.

METHODS

The protocol was derived from rapid review methodologies and optimized through effective use of pre-defined templates and global time zones. It was piloted using a Lassa fever (LF) outbreak scenario. Databases were searched from 1969 to July 2017. Systematic reviewers based in Canada, the UK, and the Philippines screened and extracted data using a systematic review software. The pilot was evaluated through internal analysis and by comparing the research priorities identified from the data, with those identified by an external LF expert panel.

RESULTS

The RRNA pilot was completed within 5 days. To accommodate the high number of articles identified, data extraction was prioritized by study design and year, and the clinical research prioritization done post-day 5. Of 118 potentially eligible articles, 52 met the data extraction criteria, of which 46 were extracted within the 5-day time frame. The RRNA team identified 19 clinical research priorities; the expert panel independently identified 21, of which 11 priorities overlapped. Each method identified a unique set of priorities, showing that combining both methods for clinical research prioritization is more robust than using either method alone.

CONCLUSIONS

This pilot study shows that it is feasible to carry out a systematic RRNA within 5 days in response to a (re-) emerging outbreak to identify gaps in existing evidence, as long as sufficient resources are identified, and reviewers are experienced and trained in advance. Use of an online systematic review software and global time zones effectively optimized resources. Another 3 to 5 days are recommended for review of the extracted data and to formulate clinical research priorities. The RRNA can be used for a "Disease X" scenario and should optimally be combined with an expert panel to ensure breadth and depth of coverage of clinical research priorities.