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Article: Lassa Fever Natural History and Clinical Management.

Grant, Donald S / Samuels, Robert J / Garry, Robert F / Schieffelin, John S

Current topics in microbiology and immunology

2023 Volume 440, Page(s) 165–192

Abstract: Lassa fever is caused by Lassa virus (LASV), an Old World Mammarenavirus that is carried by Mastomys natalensis and other rodents. It is endemic in Sierra Leone, Nigeria, and other countries in West Africa. The clinical presentation of LASV infection is ... ...

Abstract	Lassa fever is caused by Lassa virus (LASV), an Old World Mammarenavirus that is carried by Mastomys natalensis and other rodents. It is endemic in Sierra Leone, Nigeria, and other countries in West Africa. The clinical presentation of LASV infection is heterogenous varying from an inapparent or mild illness to a fatal hemorrhagic fever. Exposure to LASV is usually through contact with rodent excreta. After an incubation period of 1-3 weeks, initial symptoms such as fever, headache, and fatigue develop that may progress to sore throat, retrosternal chest pain, conjunctival injection, vomiting, diarrhea, and abdominal pain. Severe illness, including hypotension, shock, and multiorgan failure, develops in a minority of patients. Patient demographics and case fatality rates are distinctly different in Sierra Leone and Nigeria. Laboratory diagnosis relies on the detection of LASV antigens or genomic RNA. LASV-specific immunoglobulin G and M assays can also contribute to clinical management. The mainstay of treatment for Lassa fever is supportive care. The nucleoside analog ribavirin is commonly used to treat acute Lassa fever but is considered useful only if treatment is begun early in the disease course. Drugs in development, including a monoclonal antibody cocktail, have the potential to impact the management of Lassa fever.
MeSH term(s)	Humans ; Lassa Fever/diagnosis ; Lassa Fever/drug therapy ; Lassa Fever/epidemiology ; Lassa virus/genetics ; Africa, Western ; Sierra Leone/epidemiology ; Antibodies, Viral
Chemical Substances	Antibodies, Viral
Language	English
Publishing date	2023-04-21
Publishing country	Germany
Document type	Journal Article
ZDB-ID	210099-X
ISSN	0070-217X
ISSN	0070-217X
DOI	10.1007/82_2023_263
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Article ; Online: Evaluation of Three Clinical Prediction Tools to Predict Mortality in Hospitalized Patients with Lassa Fever.

Chiosi, John J / Schieffelin, John S / Shaffer, Jeffrey G / Grant, Donald S

The American journal of tropical medicine and hygiene

2022 Volume 107, Issue 4, Page(s) 856–862

Abstract: Lassa fever is a viral hemorrhagic illness with a case fatality rate for hospitalized patients as high as 69%. Identifying cases before they progress to serious illness can lead to earlier treatment and improved clinical outcomes. Three existing clinical ...

Abstract	Lassa fever is a viral hemorrhagic illness with a case fatality rate for hospitalized patients as high as 69%. Identifying cases before they progress to serious illness can lead to earlier treatment and improved clinical outcomes. Three existing clinical prediction tools were evaluated on their ability to predict the in-hospital mortality in Lassa fever: the quick Sequential Organ Failure Assessment (qSOFA), the Modified Early Warning System (MEWS), and the Universal Vital Assessment (UVA). This was a retrospective cohort study of patients admitted to the dedicated Lassa fever ward of the Kenema Government Hospital in Sierra Leone between May 2013 and December 2019. Data among three serology groups were analyzed: Lassa antigen-positive (Ag+) regardless of IgM status, Lassa Ag- and IgM+, and Lassa Ag- and IgM- cases. There were 123 cases of suspected Lassa fever included in this study. Abnormalities in respiratory rate, oxygenation status, mental status, and serum markers of kidney and liver dysfunction were more likely seen in the Ag+ group, which had an in-hospital mortality of 85.7%. For the Lassa Ag+ group, the sensitivity and positive predictive value of qSOFA ≥ 2 was 70.6% and 92.3%, MEWS ≥ 5 was 96.9% and 86.1%, and UVA ≥ 5 was 60.0% and 100.0%. The MEWS and UVA scores show potential for use in Lassa fever, but there is opportunity for future development of a tool that includes the clinical and laboratory markers specific to Lassa fever.
MeSH term(s)	Antibodies, Viral ; Humans ; Immunoglobulin M ; Lassa Fever/diagnosis ; Lassa virus ; Retrospective Studies ; Virus Diseases
Chemical Substances	Antibodies, Viral ; Immunoglobulin M
Language	English
Publishing date	2022-06-27
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.20-1624
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Article ; Online: Upper Airway Epithelial Tissue Transcriptome Analysis Reveals Immune Signatures Associated with COVID-19 Severity in Ghanaians.

Sandi, John Demby / Levy, Joshua I / Tapela, Kesego / Zeller, Mark / Yeboah, Joshua Afari / Saka, Daniel Frimpong / Grant, Donald S / Awandare, Gordon A / Quashie, Peter K / Andersen, Kristian G / Paemka, Lily

Journal of immunology research

2024 Volume 2024, Page(s) 6668017

Abstract: The immunological signatures driving the severity of coronavirus disease 19 (COVID-19) in Ghanaians remain poorly understood. We performed bulk transcriptome sequencing of nasopharyngeal samples from severe acute respiratory syndrome coronavirus-2 (SARS- ... ...

Abstract	The immunological signatures driving the severity of coronavirus disease 19 (COVID-19) in Ghanaians remain poorly understood. We performed bulk transcriptome sequencing of nasopharyngeal samples from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-infected Ghanaians with mild and severe COVID-19, as well as healthy controls to characterize immune signatures at the primary SARS-CoV-2 infection site and identify drivers of disease severity. Generally, a heightened antiviral response was observed in SARS-CoV-2-infected Ghanaians compared with uninfected controls. COVID-19 severity was associated with immune suppression, overexpression of proinflammatory cytokines, including
MeSH term(s)	Humans ; COVID-19/genetics ; Ghana ; SARS-CoV-2 ; Gene Expression Profiling ; Epithelium ; Antiviral Agents ; Transcriptome
Chemical Substances	Antiviral Agents
Language	English
Publishing date	2024-02-12
Publishing country	Egypt
Document type	Journal Article
ZDB-ID	2817541-4
ISSN	2314-7156 ; 2314-7156
ISSN (online)	2314-7156
ISSN	2314-7156
DOI	10.1155/2024/6668017
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Article ; Online: Elevated L-threonine is a biomarker for Lassa fever and Ebola.

Gale, Trevor V / Schieffelin, John S / Branco, Luis M / Garry, Robert F / Grant, Donald S

Virology journal

2020 Volume 17, Issue 1, Page(s) 188

Abstract: Background: Lassa fever and Ebola are characterized by non-specific initial presentations that can progress to severe multisystem illnesses with high fatality rates. Samples from additional subjects are examined to extend and corroborate biomarkers with ...

Abstract	Background: Lassa fever and Ebola are characterized by non-specific initial presentations that can progress to severe multisystem illnesses with high fatality rates. Samples from additional subjects are examined to extend and corroborate biomarkers with prognostic value for these diseases. Methods: Liquid Chromatography Mass Spectrometry metabolomics was used to identify and confirm metabolites disrupted in the blood of Lassa fever and Ebola patients. Authenticated standards are used to confirm the identify of key metabolites. Results: We confirm prior results by other investigators that the amino acid L-threonine is elevated during Ebola virus infection. L-Threonine is also elevated during Lassa virus infection. We also confirmed that platelet-activating factor (PAF) and molecules with PAF moiety are reduced in the blood of patients with fatal Lassa fever. Similar changes in PAF and PAF-like molecules were not observed in the blood of Ebola patients. Conclusions: Metabolomics may provide tools to identify pathways that are differentially affected during viral hemorrhagic fevers and guide development of diagnostics to monitor and predict outcome.
MeSH term(s)	Adolescent ; Adult ; Biomarkers/blood ; Child ; Child, Preschool ; Chromatography, Liquid/methods ; Cohort Studies ; Female ; Hemorrhagic Fever, Ebola/blood ; Hemorrhagic Fever, Ebola/diagnosis ; Hemorrhagic Fever, Ebola/metabolism ; Humans ; Infant ; Lassa Fever/blood ; Lassa Fever/diagnosis ; Lassa Fever/metabolism ; Male ; Mass Spectrometry/methods ; Metabolomics ; Middle Aged ; Threonine/blood ; Threonine/genetics ; Young Adult
Chemical Substances	Biomarkers ; Threonine (2ZD004190S)
Language	English
Publishing date	2020-11-26
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	1743-422X
ISSN (online)	1743-422X
DOI	10.1186/s12985-020-01459-y
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Article ; Online: Respiratory virus surveillance in hospitalized children less than two-years of age in Kenema, Sierra Leone during the COVID-19 pandemic (October 2020- October 2021).

Samuels, Robert J / Sumah, Ibrahim / Alhasan, Foday / McHenry, Rendie / Short, Laura / Chappell, James D / Haddadin, Zaid / Halasa, Natasha B / Valério, Inaê D / Amorim, Gustavo / Grant, Donald S / Schieffelin, John S / Moon, Troy D

PloS one

2023 Volume 18, Issue 10, Page(s) e0292652

Abstract: Globally, viral pathogens are the leading cause of acute respiratory infection in children under-five years. We aim to describe the epidemiology of viral respiratory pathogens in hospitalized children under-two years of age in Eastern Province of Sierra ... ...

Abstract	Globally, viral pathogens are the leading cause of acute respiratory infection in children under-five years. We aim to describe the epidemiology of viral respiratory pathogens in hospitalized children under-two years of age in Eastern Province of Sierra Leone, during the second year of the SARS-CoV-2 pandemic. We conducted a prospective study of children hospitalized with respiratory symptoms between October 2020 and October 2021. We collected demographic and clinical characteristics and calculated each participant´s respiratory symptom severity. Nose and throat swabs were collected at enrollment. Total nucleic acid was purified and tested for multiple respiratory viruses. Statistical analysis was performed using R version 4.2.0 software. 502 children less than two-years of age were enrolled. 376 (74.9%) had at least one respiratory virus detected. The most common viruses isolated were HRV/EV (28.2%), RSV (19.5%) and PIV (13.1%). Influenza and SARS-CoV-2 were identified in only 9.2% and 3.9% of children, respectively. Viral co-detection was common. Human metapneumovirus and RSV had more than two-fold higher odds of requiring O2 therapy while hospitalized. Viral pathogen prevalence was high (74.9%) in our study population. Despite this, 100% of children received antibiotics, underscoring a need to expand laboratory diagnostic capacity and to revisit clinical guidelines implementation in these children. Continuous surveillance and serologic studies among more diverse age groups, with greater geographic breadth, are needed in Sierra Leone to better characterize the long-term impact of COVID-19 on respiratory virus prevalence and to better characterize the seasonality of respiratory viruses in Sierra Leone.
MeSH term(s)	Child ; Humans ; Infant ; Pandemics ; Child, Hospitalized ; Prospective Studies ; Sierra Leone/epidemiology ; Respiratory Syncytial Virus, Human ; COVID-19/epidemiology ; SARS-CoV-2 ; Viruses ; Respiratory Tract Infections/epidemiology
Language	English
Publishing date	2023-10-10
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0292652
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Article ; Online: Antibiotic prescribing practices for acute respiratory illness in children less than 24 months of age in Kenema, Sierra Leone: is it time to move beyond algorithm driven decision making?

Moon, Troy D / Sumah, Ibrahim / Amorim, Gustavo / Alhasan, Foday / Howard, Leigh M / Myers, Harriett / Green, Ann F / Grant, Donald S / Schieffelin, John S / Samuels, Robert J

BMC infectious diseases

2023 Volume 23, Issue 1, Page(s) 626

Abstract: Background: Lower respiratory tract infections are the leading cause of mortality in young children globally. In many resource-limited settings clinicians rely on guidelines such as IMCI or ETAT + that promote empiric antibiotic utilization for ... ...

Abstract	Background: Lower respiratory tract infections are the leading cause of mortality in young children globally. In many resource-limited settings clinicians rely on guidelines such as IMCI or ETAT + that promote empiric antibiotic utilization for management of acute respiratory illness (ARI). Numerous evaluations of both guidelines have shown an overall positive response however, several challenges have also been reported, including the potential for over-prescribing of unnecessary antibiotics. The aims of this study were to describe the antibiotic prescribing practices for children less than 24 months of age with symptoms of ARI, that were admitted to Kenema Government Hospital (KGH) in the Eastern Province of Sierra Leone, and to identify the number of children empirically prescribed antibiotics who were admitted to hospital with ARI, as well as their clinical signs, symptoms, and outcomes. Methods: We conducted a prospective study of children < 24 months of age admitted to the KGH pediatric ward with respiratory symptoms between October 1, 2020 and May 31, 2022. Study nurses collected data on demographic information, medical and medication history, and information on clinical course while hospitalized. Results: A total of 777 children were enrolled. Prior to arrival at the hospital, 224 children (28.8%) reported taking an antibiotic for this illness without improvement. Only 15 (1.9%) children received a chest radiograph to aid in diagnosis and 100% of patients were placed on antibiotics during their hospital stay. Conclusions: Despite the lives saved, reliance on clinical decision-support tools such as IMCI and ETAT + for pediatric ARI, is resulting in the likely over-prescribing of antibiotics. Greater uptake of implementation research is needed to develop strategies and tools designed to optimize antibiotic use for ARI in LMIC settings. Additionally, much greater priority needs to be given to ensuring clinicians have the basic tools for clinical diagnosis, as well as greater investments in essential laboratory and radiographic diagnostics that help LMIC clinicians move beyond the sole reliance on algorithm based clinical decision making.
MeSH term(s)	Humans ; Child ; Child, Preschool ; Sierra Leone ; Prospective Studies ; Algorithms ; Anti-Bacterial Agents/therapeutic use ; Hospitals, Public ; Decision Making
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2023-09-25
Publishing country	England
Document type	Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-023-08606-0
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Article ; Online: Metabolomics analyses identify platelet activating factors and heme breakdown products as Lassa fever biomarkers.

Gale, Trevor V / Horton, Timothy M / Grant, Donald S / Garry, Robert F

PLoS neglected tropical diseases

2017 Volume 11, Issue 9, Page(s) e0005943

Abstract: Lassa fever afflicts tens of thousands of people in West Africa annually. The rapid progression of patients from febrile illness to fulminant syndrome and death provides incentive for development of clinical prognostic markers that can guide case ... ...

Abstract	Lassa fever afflicts tens of thousands of people in West Africa annually. The rapid progression of patients from febrile illness to fulminant syndrome and death provides incentive for development of clinical prognostic markers that can guide case management. The small molecule profile of serum from febrile patients triaged to the Viral Hemorrhagic Fever Ward at Kenema Government Hospital in Sierra Leone was assessed using untargeted Ultra High Performance Liquid Chromatography Mass Spectrometry. Physiological dysregulation resulting from Lassa virus (LASV) infection occurs at the small molecule level. Effects of LASV infection on pathways mediating blood coagulation, and lipid, amino acid, nucleic acid metabolism are manifest in changes in the levels of numerous metabolites in the circulation. Several compounds, including platelet activating factor (PAF), PAF-like molecules and products of heme breakdown emerged as candidates that may prove useful in diagnostic assays to inform better care of Lassa fever patients.
MeSH term(s)	Adolescent ; Adult ; Africa, Western/epidemiology ; Antibodies, Viral/blood ; Antigens, Viral/blood ; Biomarkers/blood ; Female ; Heme/chemistry ; Heme/metabolism ; Humans ; Immunoglobulin M/blood ; Lassa Fever/diagnosis ; Lassa Fever/epidemiology ; Lassa Fever/immunology ; Lassa Fever/metabolism ; Lassa virus/immunology ; Lassa virus/isolation & purification ; Lassa virus/physiology ; Male ; Mass Spectrometry ; Metabolomics/methods ; Platelet Activating Factor/analysis ; Platelet Activating Factor/metabolism ; RNA, Viral/blood ; Sierra Leone/epidemiology ; Young Adult
Chemical Substances	Antibodies, Viral ; Antigens, Viral ; Biomarkers ; Immunoglobulin M ; Platelet Activating Factor ; RNA, Viral ; Heme (42VZT0U6YR)
Language	English
Publishing date	2017-09-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2429704-5
ISSN	1935-2735 ; 1935-2727
ISSN (online)	1935-2735
ISSN	1935-2727
DOI	10.1371/journal.pntd.0005943
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Article ; Online: Expansion of CD8+ T cell population in Lassa virus survivors with low T cell precursor frequency reveals durable immune response in most survivors.

LaVergne, Stephanie M / Sakabe, Saori / Momoh, Mambu / Kanneh, Lansana / Bond, Nell / Garry, Robert F / Grant, Donald S / de la Torre, Juan Carlos / Oldstone, Michael B A / Schieffelin, John S / Sullivan, Brian M

PLoS neglected tropical diseases

2022 Volume 16, Issue 11, Page(s) e0010882

Abstract: Introduction: Lassa virus is a priority pathogen for vaccine research and development, however the duration of cellular immunity and protection in Lassa fever (LF) survivors remains unclear.: Methods: We investigated Lassa virus specific CD8+ T cell ... ...

Abstract	Introduction: Lassa virus is a priority pathogen for vaccine research and development, however the duration of cellular immunity and protection in Lassa fever (LF) survivors remains unclear. Methods: We investigated Lassa virus specific CD8+ T cell responses in 93 LF survivors. Peripheral blood mononuclear cells from these individuals were infected with recombinant vesicular stomatitis virus encoding Lassa virus antigens and virus specific T cell responses were measured after 18-hour incubation. Participants who had undetectable CD8+ T cell response underwent further analysis using a 10-day T cell proliferation assays to evaluate for low T cell precursor frequency. Results: Forty-five of the 93 LF survivors did not have a Lassa virus specific CD8+ T cell response. Of those with responses and a known date of onset of LF (N = 11), 9 had LF within the last ten years. Most participants without a measurable CD8+ T cell response were more than 10 years removed from a clinical history of LF (N = 14/16). Fourteen of 21 patients (67%) with undetectable CD8+ T cell response had a measurable Lassa virus specific CD8+ T cell response with the 10-day assay. Discussion: Despite reports of strong CD8+ T cell responses during acute Lassa virus infection, circulating Lassa virus-specific CD8+ T cells declined to undetectable levels in most Lassa fever survivors after ten years when evaluated with an 18-hour T cell stimulation. However, when Lassa virus-specific T cells were expanded prior to restimulation, a Lassa virus-specific CD8+ T cell response could be detected in many if the samples that were negative in the 18-hour stimulation assay, suggesting that prolonged cellular immunity does exist in Lassa fever survivors at low frequencies.
MeSH term(s)	Humans ; Lassa virus ; Lassa Fever ; Leukocytes, Mononuclear ; Precursor Cells, T-Lymphoid ; Immunity ; CD8-Positive T-Lymphocytes
Language	English
Publishing date	2022-11-28
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2429704-5
ISSN	1935-2735 ; 1935-2735
ISSN (online)	1935-2735
ISSN	1935-2735
DOI	10.1371/journal.pntd.0010882
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Article ; Online: The prevalence of Post-Ebola Syndrome hearing loss, Sierra Leone.

Ficenec, Samuel C / Grant, Donald S / Sumah, Ibrahim / Alhasan, Foday / Yillah, Mohamed S / Brima, Jenneh / Konuwa, Edwin / Gbakie, Michael A / Kamara, Fatima K / Bond, Nell G / Engel, Emily J / Shaffer, Jeffrey G / Fischer, William A / Wohl, David A / Emmett, Susan D / Schieffelin, John S

BMC infectious diseases

2022 Volume 22, Issue 1, Page(s) 624

Abstract: Background: Globally, hearing loss is the second leading cause of disability, affecting approximately 18.7% of the world's population. However, the burden of hearing loss is unequally distributed, with the majority of affected individuals located in ... ...

Abstract	Background: Globally, hearing loss is the second leading cause of disability, affecting approximately 18.7% of the world's population. However, the burden of hearing loss is unequally distributed, with the majority of affected individuals located in Asia or Sub-Saharan Africa. Following the 2014 West African Ebola Outbreak, disease survivors began to describe hearing loss as part of the constellation of symptoms known as Post-Ebola Syndrome. The goal of this study was to more fully characterize hearing loss among Ebola Virus Disease (EVD) survivors. Methodology and principal findings: EVD survivors and their household contacts were recruited (n = 1,12) from Eastern Sierra Leone. Each individual completed a symptom questionnaire, physical exam, and a two-step audiometry process measuring both air and bone conduction thresholds. In comparison to contacts, EVD survivors were more likely to have complaints or abnormal findings affecting every organ system. A significantly greater percentage of EVD survivors were found to have hearing loss in comparison to contacts (23% vs. 9%, p < 0.001). Additionally, survivors were more likely to have bilateral hearing loss of a mixed etiology. Logistic regression revealed that the presence of any symptoms of middle or inner ear (p < 0.001), eye (p = 0.005), psychiatric (p = 0.019), and nervous system (p = 0.037) increased the odds of developing hearing loss. Conclusions and significance: This study is the first to use an objective and standardized measurement to report hearing loss among EVD survivors in a clinically meaningful manner. In this study it was found that greater than 1/5th of EVD survivors develop hearing loss. The association between hearing impairment and symptoms affecting the eye and nervous system may indicate a similar mechanism of pathogenesis, which should be investigated further. Due to the quality of life and socioeconomic detriments associated with untreated hearing loss, a greater emphasis must be placed on understanding and mitigating hearing loss following survival to aid in economic recovery following infectious disease epidemics.
MeSH term(s)	Disease Outbreaks ; Hearing Loss/epidemiology ; Hemorrhagic Fever, Ebola/complications ; Hemorrhagic Fever, Ebola/epidemiology ; Humans ; Prevalence ; Sierra Leone/epidemiology ; Survivors/statistics & numerical data
Language	English
Publishing date	2022-07-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2041550-3
ISSN	1471-2334 ; 1471-2334
ISSN (online)	1471-2334
ISSN	1471-2334
DOI	10.1186/s12879-022-07604-y
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Article: Novel Tools for Lassa Virus Surveillance in Peri-domestic Rodents.

medRxiv : the preprint server for health sciences

2023

Abstract: Background: Lassa fever (LF) is a rodent-borne disease endemic to West Africa. In the absence of licensed therapeutics or vaccines, rodent exclusion from living spaces remains the primary method of preventing LF. Zoonotic surveillance of Lassa virus ( ... ...

Abstract	Background: Lassa fever (LF) is a rodent-borne disease endemic to West Africa. In the absence of licensed therapeutics or vaccines, rodent exclusion from living spaces remains the primary method of preventing LF. Zoonotic surveillance of Lassa virus (LASV), the etiologic agent of LF, can assess the burden of LASV in a region and guide public health measures against LF. Methods: In this study, we adapted commercially available LASV human diagnostics to assess the prevalence of LASV in peri-domestic rodents in Eastern Sierra Leone. Small mammal trapping was conducted in Kenema district, Sierra Leone between November 2018-July 2019. LASV antigen was detected using a commercially available LASV NP antigen rapid diagnostic test. LASV IgG antibodies against LASV nucleoprotein (NP) and glycoprotein (GP) were tested by adapting a commercially available semi-quantitative enzyme linked immunosorbent assay (ELISA) for detection of mouse-related and rat-related species IgG. Findings: Of the 373 tested specimens, 74 (20%) tested positive for LASV antigen. 40 (11%) specimens tested positive for LASV NP IgG, while an additional 12 (3%) specimens only tested positive for LASV GP IgG. Simultaneous antigen presence and IgG antibody presence was linked in Interpretation: The tools developed in this study can aid in the generation of valuable public health data for rapid field assessment of LASV burden during outbreak investigations and general LASV surveillance. Funding: Funding for this work was supported by the National Institute of Allergy and Infectious Diseases National Institute of Health, Department of Health and Human Services under the following grants: International Collaboration in Infectious Disease Research on Lassa fever and Ebola - ICIDR - U19 AI115589, Consortium for Viral Systems Biology - CViSB - 5U19AI135995, West African Emerging Infectious Disease Research Center - WARN-ID - U01AI151812, West African Center for Emerging Infectious Diseases: U01AI151801.
Language	English
Publishing date	2023-03-20
Publishing country	United States
Document type	Preprint
DOI	10.1101/2023.03.17.23287380
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