Contact Tracing
On the night of September 2nd patient G-1180 was admitted to the KGH LFW and as routine procedure in the KGH Lassa fever program, the outreach team was dispatched to the village of origin to further investigate the case. Three prior deaths of relatives of G-1180 living in the same dwelling were reported to the outreach team at that time. These deaths were attributed to an undetermined febrile illness and all occurred within the previous month. The deceased family members included a 69-year-old woman, a 42-year-old man and a third individual whose symptoms before death were not known. The histories of the 2 known individuals are as follows: On July 9th the 69-year-old female reportedly experienced persistent high fever, vomiting, diarrhoea and severe headaches. A few days after the initial onset of symptoms the woman travelled to Kenema to seek medical treatment. The 69-year-old woman was admitted at the Arab Hospital, Hangha Road, Kenema for treatment but succumbed on July 16, 2010 without definitive diagnosis. The body was subsequently transported to Hangha and buried at the town cemetery (Figure 1). Two weeks after the death of the 69-year-old woman, her 42-year-old son living in the same dwelling as G-1180 fell ill with similar presentations, including profuse bleeding from all orifices, and succumbed on August 7, 2010 without visiting a health facility. The 42-year-old man was buried at Sembehun Town cemetery. The history of the third, expired relative is unknown.
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The outreach team performed a close investigation of the dwelling, which revealed rodent faeces and holes in the walls of all rooms, poor food and water storage and congested home settings. At this time, eight close contacts of G-1180 were identified and blood samples were collected and transported to KGH LFL for LASV Ag and IgM analyses. None of the subjects had a recent travelling history outside the township.
Two of the contacts (G-1180-A, female, age 20, and G-1180-B, female, age 38) tested positive for LASV Ag and IgM, and were subsequently transported to the KGH LFW for ribavirin treatment. Despite detecting LASV Ag and IgM in both patient sera, neither presented with classical symptoms of the disease. G-1180-A and -B, provided only three serum samples each during their 10 day stay in the ward on three consecutive days starting with date of admission on September 4, 2010. Patient G-1180-A was admitted with an elevated TP that declined during ribavirin therapy. Her Alb and Ca2+ remained low. The daily cytokine profile was unremarkable when compared to the healthy volunteers except for a one day increase in IL-8 observed on day two. Patient G-1180-B developed several abnormalities during the 3 day monitoring period. Her TP and TBil increased drastically; though, her cytokine profile was unremarkable.
The outreach team conducted sensitization meetings with the community, including a close door conference with village heads and health committee members. General education on Lassa fever and preventative measures were conveyed to the community through a film on the subject. The team also set rodent traps during their overnight stay, but Mastomys species, the known rodent reservoir of Lassa fever virus, were not trapped. The team was informed that shortly after the onset of G-1180’s illness, rat poison was applied in the dwelling.