Understanding the cryptic nature of Lassa fever in West Africa

Abstract

Lassa fever (LF) is increasingly recognized by global health institutions as an important rodent-borne disease with severe impacts on some of West Africa’s poorest communities. However, our knowledge of LF ecology, epidemiology and distribution is limited, which presents barriers to both short-term disease forecasting and prediction of long-term impacts of environmental change on Lassa virus (LASV) zoonotic transmission dynamics. Here, we synthesize current knowledge to show that extrapolations from past research have produced an incomplete picture of the incidence and distribution of LF, with negative consequences for policy planning, medical treatment and management interventions. Although the recent increase in LF case reports is likely due to improved surveillance, recent studies suggest that future socio-ecological changes in West Africa may drive increases in LF burden. Future research should focus on the geographical distribution and disease burden of LF, in order to improve its integration into public policy and disease control strategies.

Keywords:

• Lassa fever
• arenavirus
• zoonotic disease
• viral haemorrhagic disease
• Mastomys natalensis
• agriculture
• West Africa
• One Health

Acknowledgements

The authors thank James Koninga and Donald Grant (Kenema General Hospital), Alie Kamara, Alhaji Brima Gogra and Morrison Lahai (Njala University), Kelsey Confreda (Tulane University), Melissa Leach (University of Sussex), and Duke Rogers (Brigham Young University) for discussion and comments on the previous versions of the manuscript.

Additional information

Funding

This work was supported by the Ecosystem Services for Poverty Alleviation Programme (ESPA), Dynamic Drivers of Disease in Africa Consortium, NERC [project number NE-J001570-1] for DWR, LMM and KEJ. The ESPA programme is funded by the Department for International Development (DFID), the Economic and Social Research Council (ESRC) and the Natural Environment Research Council (NERC). RG is supported by a Graduate Research Scholarship from University College London.