The Challenges Of Mounting A Successful Response To A Lassa Fever Outbreak In A Post-Evd Resource Limited Setting, Liberia 2016

Purpose: Lassa Fever (LF), endemic in Liberia, is difficult to distinguish from other viral haemorrhagic fevers such as EVD and other diseases that cause fever. Definitive diagnosis requires laboratory confirmation not widely available in relevant settings.. Here we report the significant challenges encountered when mounting an effective response to a Lassa fever outbreak in a post-EVD setting. Methods & Materials: A rapid response team was deployed to Bong County in February 2016 in response to a cluster of three LF cases. Case investigation, contact tracing and community education and awareness raising were undertaken. Specimens were tested for EVD in-country and the referral system to the regional laboratory in Sierra Leone for LF testing was re-established. Previously notified LF cases were reviewed to determine the size of the outbreak and epidemiological links. Results: In 2016 to date 54 suspected LF cases have been reported through IDSR across four counties. All cases tested negative for EVD. 39 samples were sent for LF testing, 7 (18%) were confirmed (RT-PCR or ELISA Antigen), 8 (21%) were in convalescent stage (ELISA Antibody) and 24(61%) were not a case. A lack of response interventions to early cases were identified. Conclusion: The delay in response to this outbreak can be related to a number of challenges in the post-EVD setting. There is a need to strengthen the IDSR system, develop preparedness plans, train rapid response teams including specific response activities for epidemic prone diseases and build laboratory capacity to test in country. Prioritising these actions will aid timely response to future outbreaks.