The document summarizes the 1969 outbreak of Lassa fever that originated in Nigeria. It describes how the American missionary nurse Laura Wine became the first known case and infected the nurse Charlotte Shaw who cared for her. Their deaths prompted an investigation that led to the discovery of the Lassa virus. The virus is endemic in West African countries and transmitted from rodents to humans. It can also spread between humans. The document provides details on the epidemiology, clinical presentation, diagnosis and treatment of Lassa fever.
Lassa fever aka Lassa hemorrhagic fever is caused by lassa virus and is a Zoonotic disease. It is epidemic in Nigeria, Sierra Leone and Liberia.
Limiting direct contact between humans and rodents can help prevent this disease.
Lassa fever aka Lassa hemorrhagic fever is caused by lassa virus and is a Zoonotic disease. It is epidemic in Nigeria, Sierra Leone and Liberia.
Limiting direct contact between humans and rodents can help prevent this disease.
A simple presentation on the Lassa fever endemic in Nigeria - from its first discovery in a town called Lassa in northeastern Nigeria, the mode of transmission, to the control and prevention measures that can be applied to curbing the spread of the virus. Suitable for rural sensitization.
Excerpt from CDC -- [Signs & symptoms]
Signs and symptoms of Lassa fever typically occur 1-3 weeks after the patient comes into contact with the virus. For the majority of Lassa fever virus infections (approximately 80%), symptoms are mild and are undiagnosed. Mild symptoms include slight fever, general malaise and weakness, and headache. In 20% of infected individuals, however, disease may progress to more serious symptoms including hemorrhaging (in gums, eyes, or nose, as examples), respiratory distress, repeated vomiting, facial swelling, pain in the chest, back, and abdomen, and shock. Neurological problems have also been described, including hearing loss, tremors, and encephalitis. Death may occur within two weeks after symptom onset due to multi-organ failure.
The most common complication of Lassa fever is deafness. Various degrees of deafness occur in approximately one-third of infections, and in many cases hearing loss is permanent. As far as is known, severity of the disease does not affect this complication: deafness may develop in mild as well as in severe cases.
Approximately 15%-20% of patients hospitalized for Lassa fever die from the illness. However, only 1% of all Lassa virus infections result in death. The death rates for women in the third trimester of pregnancy are particularly high. Spontaneous abortion is a serious complication of infection with an estimated 95% mortality in fetuses of infected pregnant mothers.
Because the symptoms of Lassa fever are so varied and nonspecific, clinical diagnosis is often difficult. Lassa fever is also associated with occasional epidemics, during which the case-fatality rate can reach 50% in hospitalized patients.
Leptospirosis is a worldwide public health problem. In humid tropical and subtropical areas, where most developing
countries are found, it is a greater problem than in those with a temperate climate. The magnitude of the problem in
tropical and subtropical regions can be largely attributed to climatic and environmental conditions but also to the
great likelihood of contact with a Leptospira-contaminated environment caused by, for example, local agricultural
practices and poor housing and waste disposal, all of which give rise to many sources of infection. In countries with
temperate climates, in addition to locally acquired leptospirosis, the disease may also be acquired by travellers
abroad, and particularly by those visiting the tropics.
Leptospirosis is a potentially serious but treatable disease. Its symptoms may mimic those of a number of other
unrelated infections such as influenza, meningitis, hepatitis, dengue or viral haemorrhagic fevers. Some of these
infections, in particular dengue, may give rise to large epidemics, and cases of leptospirosis that occur during such
epidemics may be overlooked. For this reason, it is important to distinguish leptospirosis from dengue and viral
haemorrhagic fevers, etc. in patients acquiring infections in countries where these diseases are endemic. At present,
this is still difficult, but new developments may reduce the technical problems in the near future. It is necessary,
therefore, to increase awareness and knowledge of leptospirosis as a public health threat.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.
A simple presentation on the Lassa fever endemic in Nigeria - from its first discovery in a town called Lassa in northeastern Nigeria, the mode of transmission, to the control and prevention measures that can be applied to curbing the spread of the virus. Suitable for rural sensitization.
Excerpt from CDC -- [Signs & symptoms]
Signs and symptoms of Lassa fever typically occur 1-3 weeks after the patient comes into contact with the virus. For the majority of Lassa fever virus infections (approximately 80%), symptoms are mild and are undiagnosed. Mild symptoms include slight fever, general malaise and weakness, and headache. In 20% of infected individuals, however, disease may progress to more serious symptoms including hemorrhaging (in gums, eyes, or nose, as examples), respiratory distress, repeated vomiting, facial swelling, pain in the chest, back, and abdomen, and shock. Neurological problems have also been described, including hearing loss, tremors, and encephalitis. Death may occur within two weeks after symptom onset due to multi-organ failure.
The most common complication of Lassa fever is deafness. Various degrees of deafness occur in approximately one-third of infections, and in many cases hearing loss is permanent. As far as is known, severity of the disease does not affect this complication: deafness may develop in mild as well as in severe cases.
Approximately 15%-20% of patients hospitalized for Lassa fever die from the illness. However, only 1% of all Lassa virus infections result in death. The death rates for women in the third trimester of pregnancy are particularly high. Spontaneous abortion is a serious complication of infection with an estimated 95% mortality in fetuses of infected pregnant mothers.
Because the symptoms of Lassa fever are so varied and nonspecific, clinical diagnosis is often difficult. Lassa fever is also associated with occasional epidemics, during which the case-fatality rate can reach 50% in hospitalized patients.
Leptospirosis is a worldwide public health problem. In humid tropical and subtropical areas, where most developing
countries are found, it is a greater problem than in those with a temperate climate. The magnitude of the problem in
tropical and subtropical regions can be largely attributed to climatic and environmental conditions but also to the
great likelihood of contact with a Leptospira-contaminated environment caused by, for example, local agricultural
practices and poor housing and waste disposal, all of which give rise to many sources of infection. In countries with
temperate climates, in addition to locally acquired leptospirosis, the disease may also be acquired by travellers
abroad, and particularly by those visiting the tropics.
Leptospirosis is a potentially serious but treatable disease. Its symptoms may mimic those of a number of other
unrelated infections such as influenza, meningitis, hepatitis, dengue or viral haemorrhagic fevers. Some of these
infections, in particular dengue, may give rise to large epidemics, and cases of leptospirosis that occur during such
epidemics may be overlooked. For this reason, it is important to distinguish leptospirosis from dengue and viral
haemorrhagic fevers, etc. in patients acquiring infections in countries where these diseases are endemic. At present,
this is still difficult, but new developments may reduce the technical problems in the near future. It is necessary,
therefore, to increase awareness and knowledge of leptospirosis as a public health threat.
The lecture gives concise review about the main four groups of viruses causing hemorrhagic fever i.e. Flavivirues, Filoviruses, Arenaviruses and Bunyaviruses.
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. It is preventable and curable.
Bio-preparedness relates to access control & security procedures, to reduce the risk of transmission of infectious diseases and invasive alien species and to prevent the malicious use of dangerous pathogens, parts of them or toxins in direct or indirect act against humans, livestock or crops.
It also refers to the Biological all –hazard approach covering a broad scope of activities relating to the protection of humans, animals, and/or plant health.
Pathogens associated with high morbidity and/or mortality
Pathogens with high likelihood of secondary cases (person-to-person spread)
Absence of an effective vaccine or prophylaxis or treatment
Pathogen for which clinical or public assuredness concerns might prompt the use of a bio-containment unit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. INTRODUCTION
• Acute viral hemorrhagic fever caused by the
Arenavirus Lassa
• Transmitted from rodents to humans
• Discovered in Nigeria, 1969
• Endemic in portions of West Africa
• Seasonal clustering: Late rainy and early dry season
• Affects all age groups and both sexes
3. Also endemic in countries of the Manu river basin in
West Africa- Sierra Leone, Guinea and Liberia.
Zoonosis, with reservoir in the multimammate rat
Mastomys natalensis.
Naturally causes disease only in humans.
4. HISTORY AND CASE STUDIES
19th January 1969
Laura Wine, 65 year old female
American missionary nurse
Described as very hardworking and hardly taking a
holiday
became acutely ill, she had been in Lassa for four
years
Had fever, back pain, sore throat
5. LAURA WINE
• Dr Hamer the only doctor at the
station became worried over her
deteriorating condition
• She had
– petechiae haemorrhage,
– anuria.
– Cloroquine, procaine penicillin
– but no improvement
– She started convulsing,
• Flown to Evangel hospital formerly
Bingham Memorial hospital in Jos.
Laura wine
6. Evangel Hospital Jos
• Dr Jeanette Troup continued treatment
• But Laura Wine
– had internal haemorrhage,
– went into shock
– and DIED.
• Charlotte Shaw
– nurse at the Evangel Hospital in Jos
– Described as kind, loving and generous.
– nursed Laura Wine intimately
7. Charlotte Shaw
• On the day before Laura Wine died,
– Charlotte Shaw had given her oral toileting
– cleaning her mouth with gauze wrapped
round her index finger.
– She had earlier that morning pricked her
finger while plucking flowers for another
patient.
• Soon after Laura Wine died, Charlotte
Shaw became ill.
• Dr. Jeanette Troup, the female doctor
again began to treat Charlotte Shaw.
– Her note describes an illness similar to the
one that killed Laura Wine.
• 11 days after she became ill, Charlotte
Shaw died.
Charlotte Shaw
CHARLOTTE SHAW
8. • Dr. Jeanette Troupe
– Worried and confused by the death of Laura Wine and
Charlotte Shaw
– decided to do an autopsy on Shaw.
• She was assisted by the head nurse Penny Pinneo.
• A week later Penny Pinneo became ill.
• Realizing this illness does not respond to Chloroquine and
Penicillin injections
• Penny Pinneo was flown to New York.
• Dr. Jeanette Troup herself later developed similar illness
and died
9. Penny Pinneo arrived New York alive.
Her specimens were sent to the Yale Arbovirus
research laboratory.
In Yale, a new virus was isolated by a team of
scientists led by Jordi Casals after a couple of them
got infected and one died.
Penny Pinneo survived and returned to Nigeria to
continue her missionary work.
10. The virus that was isolated was named Lassa Virus.
This was the pattern for all haemorrhagic fevers. They were
named after the town where the index case got infected.
In this case in Lassa town, in the Yedseram river valley in
the southern part of Lake Chad, Borno State, North Eastern
Nigeria.
In this way, Lassa virus first announced itself, by claiming a
team of missionary health workers.
That has continued to be the pattern of epidemic outburst.
Between 1969 and 1987, 17 reported outbreaks (11 hopspital-
44% fatality-,2 lab, 2 community), 386 patients, 27%
morality
Lassa Fever has been known to erase families, teams of
health workers and communities
11. The Ihumudumu epidemic was equally dramatic.
In 1984 in Ihumudumu Community of Ekpoma, Edo
state,
a woman had just died
while her burial arrangements were being made, her
husband also died of a similar febrile illness.
12. They had 2 sons
One was a Medical doctor in Ekpoma
The second was a Chicago-based Engineer.
They had all attended the burial.
• Shortly after, the medical doctor in Ekpoma became ill.
• with fever, sore throat and proteinuria,
• a couple of days later he was bleeding from all orifices
including injection sites
• His colleagues desperately tried to save him
• A few days after burying his parents, he died
13. LASSA VIRUS:
GENUS:ARENAVIRUS
FAMILY: ARENAVIRIDADE
• Name derived from “arenosus” (Latin “sandy”) describing
appearance of virions on examination by electron microscopy
• Enveloped virus, round or pleomorphic, 50-300 nm in diameter
• Single-stranded genome divided into 2 RNA segments: small (~3.4
kb) and large (~7.1 kb)
• 2 genes on each segment, arranged in unique “ambisense”
orientation, encoding 5 proteins
• Inactivated by:
– heating to 56o C
– pH<5.5 or >8.5
– UV/gamma irradiation
– detergents
17. EPIDEMIOLOGY
• Endemic in areas of West Africa, including Nigeria,
Liberia, Sierra Leone, and Guinea
• Estimated 300,000-500,000 infections/year, with 5000
deaths
• Rodent-to-human transmission (the “multimammate
rat”, Mastomys species-complex)
• Secondary human-to-human transmission with the
potential for nosocomial outbreaks with high case-fatality
18. Rodent Reservoir
Mastomys species
complex
Taxonomy still unclear
M. huberti: more
common in peridomestic
habitat
M. erytholeucus: more
common in brush habitat
Others
22. The dissemination of the infection can be assessed by
prevalence of antibodies to the virus in populations:
Sierra Leone 8-52%,
Guinea 4-55%
Nigeria 21%.
23. Transmission
• Rodent-to-human:
• Inhalation of aerosolized virus
• Ingestion of food or materials contaminated
by infected rodent excreta
• Catching and preparing Mastomys as a food
source
24. Transmission
Human-to-human:
Direct contact with blood, tissues,
secretions or excretions of infected
humans
Needle stick or cut
Inhalation of aerosolized virus
25. Pathogenesis
Endothelial cell damage/capillary leak
Platelet dysfunction
Suppressed cardiac function
Cytokines and other soluble mediators of shock and
inflammation
26. Clinical course
Once the virus enters human body, it is
asymptomatic in 80%
It is only in 20% that it takes a complicated course of
varied symptoms
incubation period of 1-3 weeks,
thereafter, illness last for another 3-weeks resulting in
death or recovery
27. Clinical Aspects
• Incubation period of 5-21 days
• Gradual onset of fever, headache, malaise and other non-specific
signs and symptoms
• Pharyngitis, myalgias, retro-sternal pain, cough and
gastrointestinal symptoms typically seen
• A minority present with classic symptoms of bleeding,
neck/facial swelling and shock
• Case fatality of hospitalized cases: 15-20% but only 1% of
overall cases
• Particularly severe in pregnant women and their offspring
• Deafness a common sequela
30. Lassa Fever in Pregnancy
• Increased maternal mortality in third trimester
(>30%)
• Increased fetal and neonatal mortality (>85%)
• Increased level of viremia in pregnant women
• Placental infection
• Evacuation of uterus improves mother’s chance of
survival
31. Sensorineural Hearing Deficit in
Lassa Fever
Typically appears during early convalescence
Not related to severity of acute illness
Occurs in one-third of cases
May be bilateral or unilateral
May persist for life in up to one-third of those affected
32. Lassa Fever in Children and Infants
• Significant cause of pediatric hospitalizations in some
areas of West Africa
• Signs and symptoms most often similar to adults
• “Swollen Baby Syndrome”
- Edema/Anasarca
- Abdominal distension
- Bleeding
- Poor prognosis
33. Lassa Fever in Animals
• Natural infection in M. natalensis
• Persistent infection with viremia and viruria
• Carrier females give birth and offspring infected
within 2 weeks
• No clinical signs observed
• Carriers smaller, weighed less and had more frequent
inflammatory lesions than non-carriers -follicular
hyperplasia of the skin, myocarditis, myocitis
34. Definition for a Suspected Case of
Lassa
Fever > 38oC for LESS than 3 weeks AND
ABSENCE of a clinical response after 72 hours of anti-malarial
treatment and/or a broad-spectrum
antibiotic AND
2 major signs OR
1 major sign AND 2 minor signs
35. Major and minor signs for surveillance
Major Signs
Abnormal bleeding (from the mouth,
nose, rectum, and/or vagina)
Edema of the neck and/or face
Conjunctival or sub-conjunctival
haemorrhage
Jaundice
Spontaneous abortion
Buzzing in the ears or acute deafness
Persistent hypotension
Confirmed contact with a patient
suffering from Lassa fever
Elevated liver transaminases
(SGOT/AST
Minor Signs
General malaise
Headache
Retrosternal pain
Muscle or joint pain
Vomiting
Cough
Sore throat
Abdominal pain
Diarrhoea
Proteinuria
Leucopenia < 4000/μL
37. Diagnostics
Clinical diagnosis often difficult
ELISA (Enzyme-linked immunosorbent assays) for
antigen, IgM, and IgG
As research tools:
Virus isolation
Immunohistochemistry (for post-mortem diagnosis)
RT-PCR (Reverse transcription-polymerase chain
reaction)
38. Treatment
• Supportive measures (monitor fluid, electrolyte
and oxygen levels)
• Ribavirin(60mg/kg/day for 4 days IV, then
orally 30mg/kg/day orally thereafter)
– Most effective when started within the first 6 days of
illness
– Major toxicity: mild hemolysis and suppression of
erythropoesis. Both reversible
– Presently contraindicated in pregnancy, although may
be warranted if mother’s life at risk
– Does not appear to reduce incidence or severity of
deafness
39. Associated with Poor Prognosis in
Lassa Fever if…
High viremia ≥ 10(3.6) TCID50 per milliliter on
admission associated with a case-fatality rate of 76%
Serum AST level >150 IU/L at admission associated
with 55% mortality rate
Intravenous ribavirin within first 6-7 days of fever
associated with
reduced mortality (5-9% vs 55-76%)
Bleeding
Encephalitis
Edema
Third trimester of pregnancy
40. Prevention and Control
Village-based programs for rodent control and
avoidance
Safe food storage
Wet down surfaces before sweeping
Hospital training programs to avoid nosocomial
spread: barrier nursing manual
Diagnostic technology transfer
Specific antiviral chemotherapy (ribavirin)
Research is currently underway to develop a vaccine
41.
42. Rodent Control
Proper storage of food in rodent-proof containers
Cleaning around homes
Trapping and killing rodents with proper and safe
disposal of carcasses
Avoid rodents as a food source
Avoid bush burning
44. Lassa Fever in Nigeria as at 27
September 2013
• Disease has spread from six states of the country in 2009 to 23 in 2013.
Institute of Lassa Fever Research and Control at the Irrua Specialist Teaching
Hospital, Irrua, Edo the 2013 World Lassa Fever Day.
• At least 93 persons have died from complications associated with Lassa fever
between January, 2011 and September, 2013 even as 377 patients that were
diagnosed with the disease were admitted within the period under review.
• Of the number of deaths recorded, 17 people have so far died in 2013
• Decline in the number of deaths attributed to the awareness that is being
created by the institute.
• Through the activities of the Institute of Lassa Fever Research and Control at
the ISTH, the case of fatality from Lassa at the hospital, has dropped from
between 60 to 80 per cent in the start of the new millennium to between 30 to
45 per cent.
• Millions of Nigerians are unaware of the dangers posed by Lassa fever and as
a result are not taking preventive measures to avoid the disease.
• before vaccination is available, access to the right information about Lassa
fever would drastically reduce its incidence.
46. Emerging infectious diseases are diseases that (1) have
not occurred in humans before (this type of emergence is
difficult to establish and is probably rare); (2) have occurred
previously but affected only small numbers of people in
isolated places (AIDS and Ebola hemorrhagic fever are
examples); or (3) have occurred throughout human history
but have only recently been recognized as distinct diseases
due to an infectious agent (Lyme disease and gastric ulcers
are examples)
Re-emerging infectious diseases are diseases that once
were major health problems globally or in a particular
country, and then declined dramatically, but are again
becoming health problems for a significant proportion of the
population (malaria and tuberculosis are examples)
NIH (US)
47. Factors Responsible For Emergence
and Re-Emergence of Diseases
Human demographic factors
Human behaviour
Deforestation
Bush burning
International travel and commerce
Land use
Health infrastructure
48. REFERENCES
WHO website
CDC website
PANO (2006).
Richmond and Baglore (2003)
Morens et al. (2004)
Becker and Barry (2009)
Adewuyi et al. (2009)
Palmer et al. (2011)
Punch newspaper (September27, 2013)