Post-discharge #sequelae of #Lassa fever #survivors in #Nigeria: an analysis of the LASCOPE prospective cohort

 

Summary

Background

Lassa fever is one of the most important viral haemorrhagic fevers, yet post-discharge sequelae remain inadequately characterised. Previous studies have been limited by small sample sizes and unsystematic assessments. We aimed to describe post-discharge sequelae in Lassa fever survivors and explore the effect of disease severity on sequelae patterns.

Methods

LASCOPE was a prospective study of patients with PCR-confirmed Lassa fever hospitalised at Federal Medical Centre Owo, Owo, Nigeria, between April 23, 2018, and Feb 17, 2023. All patients who provided informed consent were included, with no age restriction. Severe disease was defined as the presence of at least one of the following during the acute phase: National Early Warning Score version 2 score of 7 or higher, Kidney Disease Improving Global Outcomes stage 2 or higher, or Lassa virus PCR Ct value of less than 25. At hospital discharge, follow-up of survivors was planned for day 60 after admission, or before that, based on medical need. A systematic symptom assessment was done at each visit. The main outcome was clinical remission, defined as complete absence of symptoms. Other outcomes were post-discharge death, symptom incidence, and prevalence of symptoms over time. Subgroup analyses were performed by age group (children aged <18 years or adults aged ≥18 years) and disease severity (severe or not severe).

Findings

Of 882 survivors (median age 32 years [IQR 22–46], 459 [52%] female and 423 [48%] male), post-discharge data were available for 807 (91%), with a total of 2603 person-months of follow-up. For three of 807 survivors with post-discharge information, only the vital status was collected. 736 (91%) of 807 reached clinical remission, with a median time to clinical remission of 19 days (95% CI 16–23) post discharge. The most frequently reported symptoms were asthenia (158 [20%] of 804), headache (148 [18%]), and post-exertional malaise (123 [15%]). Hearing symptoms were reported by only 17 (2%) of 804 survivors, which was substantially lower than previous studies. Disease severity did not affect time to remission. Six (1%) survivors died after hospital discharge.

Interpretation

Patient-reported symptoms suggest good recovery with few hearing or neurosensory disorders in most survivors of Lassa fever. Future research would benefit from extended follow-up periods and standardised diagnostic assessments, including objective audiometry, to further characterise the full spectrum of post-Lassa fever complications.

Funding

Institut National de la Santé et de la Recherche Médicale, University of Oxford, EU, UK Department for International Development, Wellcome Trust, French Ministry of Foreign Affairs, Agence Nationale de Recherches sur le SIDA et les Hépatites Virales, and French National Research Institute for Sustainable Development.

Source: 

Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(26)00057-5/abstract?rss=yes

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