Epidemiological characteristics and hospital outcomes of hospitalized Lassa fever cases during the 2022-2023 outbreak in Liberia

Abstract

Background: Lassa fever (LF) is an endemic and immediately notifiable disease in Liberia, and one laboratory confirmed case constitutes an outbreak. We described the epidemiological characteristics and hospital outcomes of LF cases hospitalized during the 2022-2023 outbreak in Liberia.

Methods: A retrospective cohort study was conducted using routine LF surveillance data from the 2022-2023 outbreak in Liberia. Descriptive statistics were used to summarize the data and log binomial regression to assess the association between epidemiological characteristics and mortality.

Results: A total of 439 suspected LF cases were reported. The median age was 22 (interquartile range (IQR): 10-33) years and 233 (53%) were females. The median number of days between symptom onset and admission was 4 (IQR 2-7). Of the 439 cases, 416 (95%) were tested for LF and 138 were confirmed with 33% positivity rate. The majority, 95 (69%), of confirmed cases were <30 years, 78 (57%) were females, and 81 (59%) were reported during the dry season (October - March). Contact with rodents, 95 (69%), was the commonest mode of exposure. Fever, 128 (93%), malaise, 121 (88%), headache, 114 (83%) and myalgia, 114 (83%) were the most common clinical presentations. There were 83 (19%) deaths among hospitalized suspected LF cases - 42 deaths (15%) among 278 individuals who tested negative and 41 among confirmed cases with 30% case fatality rate (CFR). Presenting CFR per age group, age 40-49 years accounted for 8/12 (67%) and those aged≥50 reported 5/8 (63%) of the deaths among the confirmed cases. There was no significant association between epidemiological characteristics and LF mortality.

Conclusions: The outbreak highlighted a high disease burden of LF with young adults disproportionately infected, and mortality, even among those who tested negative for the virus. This underscores the urgent need for preventive measures like vaccines and health education campaigns.

Keywords: Integrated Disease Surveillance and Response; Lassa fever; Liberia; SORT IT; case fatality rate; operational research; outbreak; positivity rate.