4 maybes to change what you know about Lassa fever

Weekly Trust - - Weekend Magazine - Judd-Leonard jour­nal re­port Okafor, 1. The drug ques­tion. 2. Link to strain with 3. Grow­ing knowl­edge 4. A dif­fer­ent ro­dent?

High at­mo­spheric tem­per­a­ture, the winds and low hu­mid­ity sig­nal it is dis­ease out­break sea­son. Those con­di­tions make the spread of in­fec­tious dis­eases com­mon.

These days, the Na­tional Cen­tre for Dis­ease Con­trol has warned states to step up pre­pared­ness for out­break sea­son: Lassa fever, Yel­low fever and cere­brospinal menin­gi­tis.

Lassa has been knock­ing around ev­ery year for 50 odd years. It is even named af­ter the Borno com­mu­nity where it was first iden­ti­fied in the 40s. But there’s still not much known about it.

What’s known is that the mas­to­mys ro­dent car­ries it but is not af­fected.

“From all data we have col­lected, there are lit­tle gaps we have to fill, we have to an­swer those ques­tions,” says epi­demi­ol­o­gist Elsie Ilori, who leads a work­ing group of ex­perts on Lassa fever at the NCDC.

The cen­tre has been con­ven­ing me­dia and civil so­ci­ety or­gan­i­sa­tions from states to gear up for out­break sea­son.

You are bet­ter off tak­ing pre­cau­tion to avoid a Lassa in­fec­tion in the first place. For an in­fec­tion, how­ever, the best bet is early iden­ti­fi­ca­tion and prompt treat­ment us­ing the drug Ribavirin. Man­age­ment lasts 10 days, ac­cord­ing to what’s known at present.

But across treat­ment cen­tres, some pa­tients have been treated for 10 days and still ill, says Ilori. No one knows why.

One pos­si­bil­ity is the ob­ser­va­tions in pa­tients un­der man­age­ment are linked to par­tic­u­lar strains of Lassa virus be­hind the out­break.

Five strains of the virus are in Africa, three of them in Nige­ria.

Surge in out­breaks prompted ex­perts to se­quence the DNA, which has since shown the strain knock­ing about has not changed or been re­placed by any other.

“It is the same strain, and we are hav­ing more of an­i­mal-to-hu­man trans­mis­sion,” says Ilori.

The anti-Lassa ef­forts have come a long way since the 1940’s. Sur­veil­lance has in­creased, peo­ple are more aware and lab­o­ra­tory test­ing has be­come more sen­si­tive. That may also be one rea­son more cases are emerg­ing.

For long, Lassa fever has been linked to a known vector, the mul­ti­mam­mate African ro­dent. On­go­ing cases have been iden­ti­fied in lo­ca­tions with no pres­ence of the mas­to­mys, as it is called, sug­gest­ing re­search might con­sider whether the vector ro­dent is dif­fer­ent from what’s known.

“We did a ro­dent sur­vey but could not find the mas­to­mys rat, but yet there were Lassa cases from about one in four of ba­bies with the prob­lem will not make it through the first surgery.

Mark Payne, a pae­di­atric car­di­ol­o­gist at In­di­ana Univer­sity’s School of Medicine, his col­league Pav­los Vla­chos and re­searcher Brett Meyers from the School of Me­chan­i­cal En­gi­neer­ing at Pur­due Univer­sity are ex­plor­ing how fill­ing me­chan­ics and flow struc­ture change over the course of ges­ta­tion.

“Ex­ist­ing tools to mon­i­tor heart de­fects have been de­signed for larger, slower, more reg­u­lar adult hearts. They do not work as well on smaller, faster, ir­reg­u­lar hearts,” said Vla­chos.

Ba­bies born with sin­gle ven­tri­cle hearts un­dergo a se­ries of surg­eries. “De­pend­ing on the de­fect, only 50 to 75 per­cent of chil­dren make it to the third surgery at 3 years of age,” said Payne.

“Chil­dren are left with one ven­tri­cle to carry them through life and af­ter 18-25 years the sin­gle ven­tri­cle may fail, and it’s still not clear why.”

By look­ing at flow pat­terns in the foetal heart, Payne and his team are op­ti­mistic in fur­ther­ing the field of heart [those lo­ca­tions],” says Ilori.

“It is all maybes. In sci­ence you can’t work with maybes, so it is those maybes we want to prove.”

The gaps in what’s knowl­edge about Lassa fever has pro­moted the World Health Or­gan­i­sa­tion to cat­e­gorise it among dis­eases with lots of in­for­ma­tion gaps, war­rant­ing deeper in­ter­na­tional re­search.

At uni­ver­si­ties and in labs, pock­ets of re­search into Lassa fever have been done or are on­go­ing.

“We want to bring it all out and blow it up to na­tional level,” says Ilori. fail­ure in chil­dren.

“Fe­tal ul­tra­sounds have been per­formed for years, but we have never looked at how flow pat­terns af­fect out­come,” said Vla­chos.

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