Lassa Fever

Recognition of Africa's major endemic diseases of human beings was apparently well advanced by 1900. Malaria, trypanosomiasis, yellow fever, schistosomiasis, typhoid fever, brucellosis, and a long list of other afflictions had been characterized. But then, in 1969, a new member of the coterie of major endemic diseases of Africa entered the scene: Lassa fever.

The events leading to the discovery were dramatic. A nurse, Laura Wine, in a mission hospital in Lassa, Nigeria, became ill, progressed unfavorably, and died, despite the marshaling of antimalarials, antibiotics, antimicrobial agents, and supportive therapy. This death, as a statistic, would probably have been labeled "malaria" and thus been registered as such in national and World Health Organization disease records. But another nurse, Charlotte Shaw, who attended the first, also became ill. She was taken by small plane from Lassa to the Evangel Hospital in Jos, Nigeria, operated by the Sudan Interior Mission, where she died while being attended by physicians Harold White and Janet Troup, and nurse Lily Pinneo. Again, there was no firm diagnosis. Pinneo then got sick. Doctors at the hospital were thoroughly alarmed. She was evacuated, via Jos and Lagos, to America by plane, and was admitted to the College of Physicians and Surgeons at Columbia University, where she was attended by John Frame, E. Leifer, and D. J. Gocke.

The Yale Arbovirus Research Unit in New Haven, Connecticut, was alerted by Frame, who helped to get specimens for the unit. By a combination of serendipity and skill, an agent was isolated — a virus, unknown hitherto to humans. It was called "Lassa virus" (Buckley, Casals, and Downs 1970). Two laboratory-acquired cases occurred in Yale personnel working on the virus. One of them, Juan Roman, died. The other, Jordi Casals, was given immune plasma from the recently recovered nurse, Pinneo, and made a full recovery. In due course and with unfailing collaboration from many services, the agent was established as belonging to a grouping including lymphocytic choriomeningitis virus of nearly worldwide distribution. (Examples are Taca-ribe virus from bats in Trinidad; Junin virus, the causative agent of Argentine hemorrhagic fever; and Machupo virus, causative agent of Bolivian hemorrhagic fever.) The grouping of these agents has

Table VIII.76.1. Lassa fever outbreaks: West Africa, 1969-88

Location

Dates

Statistics

Lassa and Jos, Nigeria Jos, Nigeria Zorzor, Liberia Panguma and Tongo, Sierra Leone

Onitsha, Nigeria Sierra Leone, inland

Vom (near Jos), Nigeria Bombereke, Benin

Jan.—Feb. 1970 Mar.-Apr. 1972 Oct. 1970—Oct. 1972

Feb. 1977

23 cases, 13 deaths 10 cases, 4 deaths 64 cases, 23 deaths

2 cases, 1 death 441 cases, 76 deaths

5 cases, 2 deaths

1 case, 1 death

Note: Seropositive individuals have been detected in Senegal, Guinea, Central African Republic, and the Camer-oons.

been officially designated Arenavirus in the family Arenaviridae (Fenner 1976). As portrayed in Table VIII.76.1, seven other outbreaks of Lassa fever are known to have occurred in Africa since 1969. Unfortunately, Nurse Troup, who attended cases in the 1969 outbreak at Jos, became infected through a finger prick in an outbreak at Jos the following year and died.

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