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Erameh CO, Koch T, Edeawe OI, Oestereich L, Omansen T, Jochum J, Adomeh DI, Ikponmwonsa O, Aire C, Pahlmann M, Asogun DA, Ogbaini-Emovon E, Okogbenin SA, Günther S, Ramharter M, Akideno PE, Kreuels B. Focussed Assessment with Sonography in acute Lassa Fever (FASLa): Development of a point-of-care protocol and description of common ultrasound findings. J Infect 2023; 87:27-33. [PMID: 37075910 DOI: 10.1016/j.jinf.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/07/2023] [Accepted: 04/13/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Managing Lassa fever (LF) patients is challenging because of the complexity of this life-threatening infectious disease, the necessary isolation measures, and the limited resources in countries where it is endemic. Point-of-care ultrasonography (POCUS) is a promising low-cost imaging technique that may help in guiding the management of patients. METHODS We conducted this observational study at the Irrua Specialist Teaching Hospital in Nigeria. We developed a POCUS protocol, trained local physicians who applied the protocol to LF patients and recorded and interpreted the clips. These were then independently re-evaluated by an external expert, and associations with clinical, laboratory and virological data were analyzed. FINDINGS We developed the POCUS protocol based on existing literature and expert opinion and trained two clinicians, who then used POCUS to examine 46 patients. We observed at least one pathological finding in 29 (63%) patients. Ascites was found in 14 (30%), pericardial effusion in 10 (22%), pleural effusion in 5 (11%), and polyserositis in 7 (15%) patients, respectively. Eight patients (17%) showed hyperechoic kidneys. Seven patients succumbed to the disease while 39 patients survived, resulting in a fatality rate of 15%. Pleural effusions and hyper-echoic kidneys were associated with increased mortality. INTERPRETATION In acute LF, a newly established POCUS protocol readily identified a high prevalence of clinically relevant pathological findings. The assessment by POCUS required minimal resources and training; the detected pathologies such as pleural effusions and kidney injury may help to guide the clinical management of the most at-risk LF patients.
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Affiliation(s)
- Cyril O Erameh
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria; Department of Internal Medicine, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria
| | - Till Koch
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Osahogie Isaac Edeawe
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Lisa Oestereich
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Till Omansen
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Johannes Jochum
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Donatus I Adomeh
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Odia Ikponmwonsa
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Chris Aire
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Meike Pahlmann
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Danny A Asogun
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria; Department of Pharmacology & Therapeutics, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria
| | - Ephraim Ogbaini-Emovon
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sylvanus A Okogbenin
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Stephan Günther
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Michael Ramharter
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Peter E Akideno
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Benno Kreuels
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany.
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2
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Strampe J, Asogun DA, Speranza E, Pahlmann M, Soucy A, Bockholt S, Pallasch E, Becker-Ziaja B, Duraffour S, Bhadelia N, Ighodalo Y, Oyakhilome J, Omomoh EO, Olokor T, Adomeh DI, Ikponwonsa O, Aire C, Tobin E, Akpede N, Okokhere PO, Okogbenin SA, Akpede GO, Muñoz-Fontela C, Ogbaini-Emovon E, Günther S, Connor JH, Oestereich L. Factors associated with progression to death in patients with Lassa fever in Nigeria: an observational study. Lancet Infect Dis 2021; 21:876-886. [PMID: 33484646 DOI: 10.1016/s1473-3099(20)30737-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/29/2020] [Accepted: 08/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Lassa fever is endemic in several west African countries. Case-fatality rates ranging from 21% to 69% have been reported. The pathophysiology of the disease in humans and determinants of mortality remain poorly understood. We aimed to determine host protein biomarkers capable of determining disease outcome. METHODS In this observational study, we analysed left-over blood samples from patients who tested positive for Lassa fever at Irrua Specialist Teaching Hospital, Nigeria, between January, 2014, and April, 2017. We measured viral load, concentrations of clinical chemistry parameters, and levels of 62 circulating proteins involved in inflammation, immune response, and haemostasis. Patients with a known outcome (survival or death) and at least 200 μL of good-quality diagnostic sample were included in logistic regression modelling to assess the correlation of parameters with Lassa fever outcome. Individuals who gave consent could further be enrolled into a longitudinal analysis to assess the association of parameters with Lassa fever outcome over time. Participants were divided into two datasets for the statistical analysis: a primary dataset (samples taken between Jan 1, 2014, and April 1, 2016), and a secondary dataset (samples taken between April 1, 2016, and April 1, 2017). Biomarkers were ranked by area under the receiver operating characteristic curve (AUC) from highest (most predictive) to lowest (least predictive). FINDINGS Of 554 patients who tested positive for Lassa fever during the study period, 201 (131 in the primary dataset and 70 in the secondary dataset) were included in the biomarker analysis, of whom 74 (49 in the primary dataset and 25 in the secondary dataset) had died and 127 (82 in the primary dataset and 45 in the secondary dataset) had survived. Cycle threshold values (indicating viral load) and levels of 18 host proteins at the time of admission to hospital were significantly correlated with fatal outcome. The best predictors of outcome in both datasets were plasminogen activator inhibitor-1 (PAI-1; AUC 0·878 in the primary dataset and 0·876 in the secondary dataset), soluble thrombomodulin (TM; 0·839 in the primary dataset and 0·875 in the secondary dataset), and soluble tumour necrosis factor receptor superfamily member 1A (TNF-R1; 0·807 in the primary dataset and 0·851 in the secondary dataset), all of which had higher prediction accuracy than viral load (0·774 in the primary dataset and 0·837 in the secondary dataset). Longitudinal analysis (150 patients, of whom 36 died) showed that of the biomarkers that were predictive at admission, PAI-1 levels consistently decreased to normal levels in survivors but not in those who died. INTERPRETATION The identification of PAI-1 and soluble TM as markers of fatal Lassa fever at admission, and of PAI-1 as a marker of fatal Lassa fever over time, suggests that dysregulated coagulation and fibrinolysis and endothelial damage have roles in the pathophysiology of Lassa fever, providing a mechanistic explanation for the association of Lassa fever with oedema and bleeding. These novel markers might aid in clinical risk stratification and disease monitoring. FUNDING German Research Foundation, Leibniz Association, and US National Institutes of Health.
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Affiliation(s)
- Jamie Strampe
- Bioinformatics Program, Boston University, Boston, MA, USA; National Emerging Infectious Diseases Laboratories, Boston, MA, USA
| | - Danny A Asogun
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Emily Speranza
- Bioinformatics Program, Boston University, Boston, MA, USA; National Emerging Infectious Diseases Laboratories, Boston, MA, USA; National Institutes of Health, National Institute of Allergy and Infectious disease, Laboratory of Virology, Laboratory of Immune System Biology, Bethesda, MD, USA
| | - Meike Pahlmann
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Ali Soucy
- Department of Microbiology, School of Medicine, Boston University, Boston, MA, USA; National Emerging Infectious Diseases Laboratories, Boston, MA, USA
| | - Sabrina Bockholt
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Elisa Pallasch
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Beate Becker-Ziaja
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany; Robert Koch Institute, Berlin, Germany
| | - Sophie Duraffour
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - Nahid Bhadelia
- National Emerging Infectious Diseases Laboratories, Boston, MA, USA
| | - Yemisi Ighodalo
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | | | | | - Thomas Olokor
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | | | - Odia Ikponwonsa
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Chris Aire
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ekaete Tobin
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Nosa Akpede
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | | | | | - George O Akpede
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - César Muñoz-Fontela
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | | | - Stephan Günther
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany
| | - John H Connor
- Bioinformatics Program, Boston University, Boston, MA, USA; Department of Microbiology, School of Medicine, Boston University, Boston, MA, USA; National Emerging Infectious Diseases Laboratories, Boston, MA, USA.
| | - Lisa Oestereich
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research (DZIF), Partner site Hamburg-Lübeck-Borstel-Riems, Germany.
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3
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Adetunji AE, Ayenale M, Akhigbe I, Akerele LO, Isibor E, Idialu J, Aideloje FO, Emuebonam E, Aire C, Adomeh DI, Odia I, Atafo RO, Okonofua MO, Owobu A, Ogbaini-Emovon E, Tobin EA, Asogun DA, Okogbenin SA, Sabeti P, Happi CT, Günther S, Azubuike CO, Rafiu M, Odike A, Olomu SC, Ibadin MO, Okokhere PO, Akpede GO. Acute kidney injury and mortality in pediatric Lassa fever versus question of access to dialysis. Int J Infect Dis 2020; 103:124-131. [PMID: 33176203 DOI: 10.1016/j.ijid.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/31/2020] [Accepted: 11/03/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To assess the prevalence of acute kidney injury (AKI), and its impact on outcome in hospitalized pediatric patients with Lassa fever (LF). METHODS We reviewed the presenting clinical and laboratory features and outcomes of 40 successive hospitalized children with PCR-confirmed LF. The diagnosis and staging of AKI was based on KDIGO criteria. We compared groups of patients using t- or χ2 tests as necessary, and took p-values <0.05 as indicative of the presence of significant differences. RESULTS Sixteen (40%) children had AKI. Case fatality rate (CFR) was 9/16 (56%) in children with and 1/24 (4%) in those without AKI (OR [95% CI] of CFR associated with AKI = 29.57 [3.17, 275.7]). Presentation with abnormal bleeding (p = 0.008), encephalopathy (p = 0.004), hematuria plus proteinuria (p = 0.013), and elevated serum transaminase levels (p <0.02) were significantly associated with an increased prevalence of AKI. CONCLUSION AKI prevalence in hospitalized pediatric patients with Lassa fever is high, and correlated with illness severity/CFR. The high prevalence underscores the need for access to hemodialysis, and clinical presentation and/or presence of hematuria plus proteinuria could serve as a ready prompt for referral for such specialized care.
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Affiliation(s)
- Adewale E Adetunji
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Magdalene Ayenale
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Irene Akhigbe
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Lilian O Akerele
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Efosa Isibor
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Juliet Idialu
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Florence O Aideloje
- Department of Nursing Services, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ekene Emuebonam
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Chris Aire
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Donatus I Adomeh
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ikponmwosa Odia
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Rebecca O Atafo
- Nursing Services Unit, Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Martha O Okonofua
- Nursing Services Unit, Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Adaugo Owobu
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ephraim Ogbaini-Emovon
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Ekaete A Tobin
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Danny A Asogun
- Institute of Lassa Fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sylvanus A Okogbenin
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Pardis Sabeti
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, United States
| | - Christian T Happi
- Department of Biological Sciences and African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Ede, Nigeria
| | - Stephan Günther
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany, and German Center for Infection Research (DZIF), Partner site Hamburg - Lübeck - Borstel - Riems, Germany
| | | | - Mojeed Rafiu
- Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Angela Odike
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Sylvia C Olomu
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Michael O Ibadin
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Peter O Okokhere
- Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - George O Akpede
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
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4
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Okogbenin S, Okoeguale J, Akpede G, Colubri A, Barnes KG, Mehta S, Eifediyi R, Okogbo F, Eigbefoh J, Momoh M, Rafiu M, Adomeh D, Odia I, Aire C, Atafo R, Okonofua M, Pahlman M, Becker-Ziaja B, Asogun D, Okokhere P, Happi C, Günther S, Sabeti PC, Ogbaini-Emovon E. Retrospective Cohort Study of Lassa Fever in Pregnancy, Southern Nigeria. Emerg Infect Dis 2019; 25. [PMID: 31310586 PMCID: PMC6649346 DOI: 10.3201/eid2508.181299] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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5
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Kafetzopoulou LE, Pullan ST, Lemey P, Suchard MA, Ehichioya DU, Pahlmann M, Thielebein A, Hinzmann J, Oestereich L, Wozniak DM, Efthymiadis K, Schachten D, Koenig F, Matjeschk J, Lorenzen S, Lumley S, Ighodalo Y, Adomeh DI, Olokor T, Omomoh E, Omiunu R, Agbukor J, Ebo B, Aiyepada J, Ebhodaghe P, Osiemi B, Ehikhametalor S, Akhilomen P, Airende M, Esumeh R, Muoebonam E, Giwa R, Ekanem A, Igenegbale G, Odigie G, Okonofua G, Enigbe R, Oyakhilome J, Yerumoh EO, Odia I, Aire C, Okonofua M, Atafo R, Tobin E, Asogun D, Akpede N, Okokhere PO, Rafiu MO, Iraoyah KO, Iruolagbe CO, Akhideno P, Erameh C, Akpede G, Isibor E, Naidoo D, Hewson R, Hiscox JA, Vipond R, Carroll MW, Ihekweazu C, Formenty P, Okogbenin S, Ogbaini-Emovon E, Günther S, Duraffour S. Metagenomic sequencing at the epicenter of the Nigeria 2018 Lassa fever outbreak. Science 2019; 363:74-77. [PMID: 30606844 DOI: 10.1126/science.aau9343] [Citation(s) in RCA: 146] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/12/2018] [Indexed: 12/15/2022]
Abstract
The 2018 Nigerian Lassa fever season saw the largest ever recorded upsurge of cases, raising concerns over the emergence of a strain with increased transmission rate. To understand the molecular epidemiology of this upsurge, we performed, for the first time at the epicenter of an unfolding outbreak, metagenomic nanopore sequencing directly from patient samples, an approach dictated by the highly variable genome of the target pathogen. Genomic data and phylogenetic reconstructions were communicated immediately to Nigerian authorities and the World Health Organization to inform the public health response. Real-time analysis of 36 genomes and subsequent confirmation using all 120 samples sequenced in the country of origin revealed extensive diversity and phylogenetic intermingling with strains from previous years, suggesting independent zoonotic transmission events and thus allaying concerns of an emergent strain or extensive human-to-human transmission.
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Affiliation(s)
- L E Kafetzopoulou
- Public Health England, National Infection Service, Porton Down, UK.,National Institute of Health Research (NIHR), Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - S T Pullan
- Public Health England, National Infection Service, Porton Down, UK.,National Institute of Health Research (NIHR), Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - P Lemey
- Department of Microbiology and Immunology, Rega Institute, KU Leuven - University of Leuven, Leuven, Belgium
| | - M A Suchard
- Departments of Biomathematics, Biostatistics, and Human Genetics, University of California, Los Angeles, CA, USA
| | - D U Ehichioya
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg, Germany
| | - M Pahlmann
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg, Germany
| | - A Thielebein
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg, Germany
| | - J Hinzmann
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg, Germany
| | - L Oestereich
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg, Germany
| | - D M Wozniak
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg, Germany
| | - K Efthymiadis
- Artificial Intelligence Laboratory, Vrije Universiteit Brussel, Brussels, Belgium
| | - D Schachten
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - F Koenig
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - J Matjeschk
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - S Lorenzen
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - S Lumley
- Public Health England, National Infection Service, Porton Down, UK
| | - Y Ighodalo
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - D I Adomeh
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - T Olokor
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - E Omomoh
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - R Omiunu
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - J Agbukor
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - B Ebo
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - J Aiyepada
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - P Ebhodaghe
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - B Osiemi
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | | | - P Akhilomen
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - M Airende
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - R Esumeh
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - E Muoebonam
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - R Giwa
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - A Ekanem
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - G Igenegbale
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - G Odigie
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - G Okonofua
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - R Enigbe
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - J Oyakhilome
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - E O Yerumoh
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - I Odia
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - C Aire
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - M Okonofua
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - R Atafo
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - E Tobin
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - D Asogun
- Irrua Specialist Teaching Hospital, Irrua, Nigeria.,Faculty of Clinical Sciences, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria
| | - N Akpede
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - P O Okokhere
- Irrua Specialist Teaching Hospital, Irrua, Nigeria.,Faculty of Clinical Sciences, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria
| | - M O Rafiu
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - K O Iraoyah
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | | | - P Akhideno
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - C Erameh
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - G Akpede
- Irrua Specialist Teaching Hospital, Irrua, Nigeria.,Faculty of Clinical Sciences, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria
| | - E Isibor
- Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - D Naidoo
- World Health Organization, Geneva, Switzerland
| | - R Hewson
- Public Health England, National Infection Service, Porton Down, UK.,National Institute of Health Research (NIHR), Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.,Faculty of Infectious and Tropical Diseases, Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, UK.,Faculty of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J A Hiscox
- National Institute of Health Research (NIHR), Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK.,Singapore Immunology Network, Agency for Science, Technology and Research (A*STAR), Singapore.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
| | - R Vipond
- Public Health England, National Infection Service, Porton Down, UK.,National Institute of Health Research (NIHR), Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - M W Carroll
- Public Health England, National Infection Service, Porton Down, UK.,National Institute of Health Research (NIHR), Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - C Ihekweazu
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | - P Formenty
- World Health Organization, Geneva, Switzerland
| | - S Okogbenin
- Irrua Specialist Teaching Hospital, Irrua, Nigeria.,Faculty of Clinical Sciences, College of Medicine, Ambrose Alli University, Ekpoma, Nigeria
| | | | - S Günther
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany. .,German Center for Infection Research (DZIF), partner site Hamburg, Germany
| | - S Duraffour
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,German Center for Infection Research (DZIF), partner site Hamburg, Germany
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6
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Okokhere P, Colubri A, Azubike C, Iruolagbe C, Osazuwa O, Tabrizi S, Chin E, Asad S, Ediale E, Rafiu M, Adomeh D, Odia I, Atafo R, Aire C, Okogbenin S, Pahlman M, Becker-Ziaja B, Asogun D, Fradet T, Fry B, Schaffner SF, Happi C, Akpede G, Günther S, Sabeti PC. Clinical and laboratory predictors of Lassa fever outcome in a dedicated treatment facility in Nigeria: a retrospective, observational cohort study. Lancet Infect Dis 2018; 18:684-695. [PMID: 29523497 PMCID: PMC5984133 DOI: 10.1016/s1473-3099(18)30121-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/17/2018] [Accepted: 01/19/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Lassa fever is a viral haemorrhagic disease endemic to west Africa. No large-scale studies exist from Nigeria, where the Lassa virus (LASV) is most diverse. LASV diversity, coupled with host genetic and environmental factors, might cause differences in disease pathophysiology. Small-scale studies in Nigeria suggest that acute kidney injury is an important clinical feature and might be a determinant of survival. We aimed to establish the demographic, clinical, and laboratory factors associated with mortality in Nigerian patients with Lassa fever, and hypothesised that LASV was the direct cause of intrinsic renal damage for a subset of the patients with Lassa fever. METHODS We did a retrospective, observational cohort study of consecutive patients in Nigeria with Lassa fever, who tested positive for LASV with RT-PCR, and were treated in Irrua Specialist Teaching Hospital. We did univariate and multivariate statistical analyses, including logistic regression, of all demographic, clinical, and laboratory variables available at presentation to identify the factors associated with patient mortality. FINDINGS Of 291 patients treated in Irrua Specialist Teaching Hospital between Jan 3, 2011, and Dec 11, 2015, 284 (98%) had known outcomes (died or survived) and seven (2%) were discharged against medical advice. Overall case-fatality rate was 24% (68 of 284 patients), with a 1·4 times increase in mortality risk for each 10 years of age (p=0·00017), reaching 39% (22 of 57) for patients older than 50 years. Of 284 patients, 81 (28%) had acute kidney injury and 104 (37%) had CNS manifestations and thus both were considered important complications of acute Lassa fever in Nigeria. Acute kidney injury was strongly associated with poor outcome (case-fatality rate of 60% [49 of 81 patients]; odds ratio [OR] 15, p<0·00001). Compared with patients without acute kidney injury, those with acute kidney injury had higher incidence of proteinuria (32 [82%] of 39 patients) and haematuria (29 [76%] of 38) and higher mean serum potassium (4·63 [SD 1·04] mmol/L) and lower blood urea nitrogen to creatinine ratio (8·6 for patients without clinical history of fluid loss), suggesting intrinsic renal damage. Normalisation of creatinine concentration was associated with recovery. Elevated serum creatinine (OR 1·3; p=0·046), aspartate aminotransferase (OR 1·5; p=0·075), and potassium (OR 3·6; p=0·0024) were independent predictors of death. INTERPRETATION Our study presents detailed clinical and laboratory data for Nigerian patients with Lassa fever and provides strong evidence for intrinsic renal dysfunction in acute Lassa fever. Early recognition and treatment of acute kidney injury might significantly reduce mortality. FUNDING German Research Foundation, German Center for Infection Research, Howard Hughes Medical Institute, US National Institutes of Health, and World Bank.
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Affiliation(s)
- Peter Okokhere
- Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria; Institute of Lassa fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria; Department of Medicine, Faculty of Clinical Sciences, Ambrose Alli University, Ekpoma, Edo, Nigeria.
| | - Andres Colubri
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Howard Hughes Medical Institute, Maryland, MD, USA.
| | | | | | - Omoregie Osazuwa
- Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | | | - Elizabeth Chin
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA; University of California, Los Angeles, CA, USA; Department of Bioinformatics, Los Angeles, CA, USA
| | - Sara Asad
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Ehi Ediale
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Mojeed Rafiu
- Department of Medicine, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Donatus Adomeh
- Institute of Lassa fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Ikponmwosa Odia
- Institute of Lassa fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Rebecca Atafo
- Lassa fever Ward, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Chris Aire
- Institute of Lassa fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Sylvanus Okogbenin
- Department of Obstetrics and Gynaecology, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Meike Pahlman
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research, Partner site, Hamburg, Germany
| | - Beate Becker-Ziaja
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research, Partner site, Hamburg, Germany
| | - Danny Asogun
- Institute of Lassa fever Research and Control, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | | | - Ben Fry
- Fathom Information Design, Boston, MA, USA
| | - Stephen F Schaffner
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Harvard School of Public Health, Boston, MA, USA
| | - Christian Happi
- Department of Biological Sciences and African Center of Excellence for Genomics of Infectious Diseases, Redeemer's University, Edo, Nigeria
| | - George Akpede
- Department of Paediatrics, Irrua Specialist Teaching Hospital, Irrua, Nigeria; Department of Paediatrics, Faculty of Clinical Sciences, Ambrose Alli University, Ekpoma, Edo, Nigeria
| | - Stephan Günther
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany; German Centre for Infection Research, Partner site, Hamburg, Germany
| | - Pardis C Sabeti
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Howard Hughes Medical Institute, Maryland, MD, USA; Harvard School of Public Health, Boston, MA, USA
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7
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Arias A, Watson SJ, Asogun D, Tobin EA, Lu J, Phan MVT, Jah U, Wadoum REG, Meredith L, Thorne L, Caddy S, Tarawalie A, Langat P, Dudas G, Faria NR, Dellicour S, Kamara A, Kargbo B, Kamara BO, Gevao S, Cooper D, Newport M, Horby P, Dunning J, Sahr F, Brooks T, Simpson AJH, Groppelli E, Liu G, Mulakken N, Rhodes K, Akpablie J, Yoti Z, Lamunu M, Vitto E, Otim P, Owilli C, Boateng I, Okoror L, Omomoh E, Oyakhilome J, Omiunu R, Yemisis I, Adomeh D, Ehikhiametalor S, Akhilomen P, Aire C, Kurth A, Cook N, Baumann J, Gabriel M, Wölfel R, Di Caro A, Carroll MW, Günther S, Redd J, Naidoo D, Pybus OG, Rambaut A, Kellam P, Goodfellow I, Cotten M. Rapid outbreak sequencing of Ebola virus in Sierra Leone identifies transmission chains linked to sporadic cases. Virus Evol 2016; 2:vew016. [PMID: 28694998 PMCID: PMC5499387 DOI: 10.1093/ve/vew016] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
To end the largest known outbreak of Ebola virus disease (EVD) in West Africa and to prevent new transmissions, rapid epidemiological tracing of cases and contacts was required. The ability to quickly identify unknown sources and chains of transmission is key to ending the EVD epidemic and of even greater importance in the context of recent reports of Ebola virus (EBOV) persistence in survivors. Phylogenetic analysis of complete EBOV genomes can provide important information on the source of any new infection. A local deep sequencing facility was established at the Mateneh Ebola Treatment Centre in central Sierra Leone. The facility included all wetlab and computational resources to rapidly process EBOV diagnostic samples into full genome sequences. We produced 554 EBOV genomes from EVD cases across Sierra Leone. These genomes provided a detailed description of EBOV evolution and facilitated phylogenetic tracking of new EVD cases. Importantly, we show that linked genomic and epidemiological data can not only support contact tracing but also identify unconventional transmission chains involving body fluids, including semen. Rapid EBOV genome sequencing, when linked to epidemiological information and a comprehensive database of virus sequences across the outbreak, provided a powerful tool for public health epidemic control efforts.
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Affiliation(s)
- Armando Arias
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Simon J Watson
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Danny Asogun
- Irrua Specialist Teaching Hospital, Institute of Lassa Fever Research and Control, Irrua, Nigeria.,The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ekaete Alice Tobin
- Irrua Specialist Teaching Hospital, Institute of Lassa Fever Research and Control, Irrua, Nigeria.,The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jia Lu
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - My V T Phan
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Umaru Jah
- University of Makeni, Makeni, Sierra Leone
| | | | - Luke Meredith
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Lucy Thorne
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | - Sarah Caddy
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, United Kingdom
| | | | - Pinky Langat
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
| | - Gytis Dudas
- Institute of Evolutionary Biology, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Nuno R Faria
- Department of Zoology, University of Oxford, Oxford, UK
| | | | - Abdul Kamara
- Sierra Leone Ministry of Health, Freetown, Sierra Leone
| | - Brima Kargbo
- Sierra Leone Ministry of Health, Freetown, Sierra Leone
| | | | - Sahr Gevao
- Sierra Leone Ministry of Health, Freetown, Sierra Leone
| | | | | | - Peter Horby
- Department of Medicine, Epidemic Diseases Research Group Oxford (ERGO), Centre for Tropical Medicine and Global Health Nuffield, University of Oxford, Oxford, United Kingdom
| | - Jake Dunning
- Department of Medicine, Epidemic Diseases Research Group Oxford (ERGO), Centre for Tropical Medicine and Global Health Nuffield, University of Oxford, Oxford, United Kingdom
| | - Foday Sahr
- Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Tim Brooks
- Rare and Imported Pathogens Laboratory, Public Health England, United Kingdom
| | - Andrew J H Simpson
- Rare and Imported Pathogens Laboratory, Public Health England, United Kingdom
| | | | - Guoying Liu
- Thermo Fisher Scientific, South San Francisco, CA, USA
| | | | - Kate Rhodes
- Thermo Fisher Scientific, South San Francisco, CA, USA
| | | | | | | | | | | | | | | | | | - Emmanuel Omomoh
- Irrua Specialist Teaching Hospital, Institute of Lassa Fever Research and Control, Irrua, Nigeria.,The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Jennifer Oyakhilome
- Irrua Specialist Teaching Hospital, Institute of Lassa Fever Research and Control, Irrua, Nigeria.,The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Racheal Omiunu
- Irrua Specialist Teaching Hospital, Institute of Lassa Fever Research and Control, Irrua, Nigeria.,The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Ighodalo Yemisis
- Irrua Specialist Teaching Hospital, Institute of Lassa Fever Research and Control, Irrua, Nigeria.,The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Donatus Adomeh
- Irrua Specialist Teaching Hospital, Institute of Lassa Fever Research and Control, Irrua, Nigeria.,The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Solomon Ehikhiametalor
- Irrua Specialist Teaching Hospital, Institute of Lassa Fever Research and Control, Irrua, Nigeria.,The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Patience Akhilomen
- Irrua Specialist Teaching Hospital, Institute of Lassa Fever Research and Control, Irrua, Nigeria.,The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Chris Aire
- Irrua Specialist Teaching Hospital, Institute of Lassa Fever Research and Control, Irrua, Nigeria.,The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Andreas Kurth
- The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Robert Koch Institute, Berlin, Germany
| | - Nicola Cook
- The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Public Health England, Porton Down, United Kingdom
| | - Jan Baumann
- The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Martin Gabriel
- The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Roman Wölfel
- The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Bundeswehr Institute of Microbiology, Munich, Germany
| | - Antonino Di Caro
- The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,National Institute for Infectious Diseases "L. Spallanzani", Rome, Italy
| | - Miles W Carroll
- The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Public Health England, Porton Down, United Kingdom
| | - Stephan Günther
- The European Mobile Laboratory Consortium, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany.,Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - John Redd
- Sierra Leone and Division of Global Health Protection, CDC Country Office, Georgia Center for Global Health Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Andrew Rambaut
- Institute of Evolutionary Biology, Ashworth Laboratories, Edinburgh, United Kingdom.,Fogarty International Center, NIH, Bethesda, MD, USA.,Infection and Evolution, Centre for Immunology, Ashworth Laboratories, Edinburgh, United Kingdom
| | - Paul Kellam
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom.,Division of Infection and Immunity, University College London, London, United Kingdom
| | - Ian Goodfellow
- Division of Virology, Department of Pathology, University of Cambridge, Cambridge, United Kingdom.,University of Makeni, Makeni, Sierra Leone
| | - Matthew Cotten
- Wellcome Trust Sanger Institute, Hinxton, United Kingdom
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