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Cycle 1

Principal Investigator: Donald Grant, Kenema Government Hospital (KGH)
NIH-Supported Collaborator: Robert Garry, Tulane University School of Medicine 
Title of NIH Award: Preclinical Development of Recombinant Antigen Diagnostics for Lassa Fever

Project Overview
Eastern Sierra Leone, particularly the Kenema District, has the highest incidence of Lassa Fever, a severe and often fatal viral hemorrhagic disease transmitted by the rodent Mastomys natalensis, in the world. The rodents are commonly found in homes and transmission occurs from contact with the rodents. Lassa Fever (LF) disproportionately impacts pregnant women and children. Case fatality rates for LF can reach 70% in children under age 5 and 90% in third trimester pregnancies for both the mother and the fetus. The prevalence and true impact of LF is not well understood.This study will address key gaps in knowledge of the epidemiology and natural history of Lassa fever. The goals of the study are to: 1) characterize and contrast the age and sex distribution of Lassa virus (LASV) exposure in endemic and non-endemic areas and 2) elucidate risk factors for LASV infection in pregnant women and children. The target population will consist of the entire Eastern Province of Sierra Leone and women and children in the Kenema District of Sierra Leone. The age and sex distribution of LASV exposure will be determined in a point prevalence study comparing endemic and non-endemic areas. This project will also elucidate risk factors for LASV infection in a case-control study of pregnant women and children, which will identify points in LF transmission. The proposed study will employ field epidemiology, hospital-based surveillance, and advanced laboratory techniques. These efforts will provide informed approaches for treating and controlling LF that can guide evidence-based investments for public health programming and policy.

 PH 1-17 Sierra Leone photo 2 PH 1-17 Sierra Leone photo 1
 Traveling to remote communities.  Engaging the community school children. (photo courtesy of PI Donald Grant)

Summary of Recent Activities:

As of March 2017, the research team continued to recruit Lassa patients for the case-control study and performed ELISA assays on the samples collected. Weekly and monthly visits to communities and health facilities to follow-up on Lassa fever cases were conducted in the Eastern Province of Sierra Leone. The team continued to engage communities, and religious leaders to implement actions based on prevention and control in minimizing the spread of Lassa fever, or detecting re-emergence of Ebola. The study team is collecting data on the seroprevalence, sex, age, and distribution of LASV. Overall Lassa virus seroprevalence is highly variable. Unexpectedly, certain villages, such as Hamdalai, in nonendemic areas (Port Loko) show high levels of seroprevalence. This is an extremely interesting finding and is under active investigation. Infrastructure development with phase I of the new 44-bed VHF Clinical Ward has been completed. A waste incinerator, which meets both WHO and Sierra Leone Ministry of Health and Sanitation standards has been installed. Phase II of the construction will involve further fortification of biosecurity at both the new VHF ward and laboratory and addition of new research capacity on site. It has been decided that patients will not be admitted until Phase II is completed, which should be in the summer of 2017.

Health Cycle 1 Recipients