• 1.

    Mylne AQ, Pigott DM, Longbottom J, Shearer F, Duda KA, Messina JP, Weiss DJ, Moyes CL, Golding N, Hay SI, 2015. Mapping the zoonotic niche of Lassa fever in Africa. Trans R Soc Trop Med Hyg 109: 483492.

    • Search Google Scholar
    • Export Citation
  • 2.

    Enria DA, Mills JN, Bausch D, Shieh WJ, Peters CJ, 2011. Arenavirus infections. Guerrant RL, Walker DH, Weller PF, eds. Tropical Infectious Diseases: Principles, Pathogens and Practice. Edinburgh, Scotland: Saunders/Elsevier.

    • Search Google Scholar
    • Export Citation
  • 3.

    Gibb R, Moses LM, Redding DW, Jones KE, 2017. Understanding the cryptic nature of Lassa fever in west Africa. Pathog Glob Health 111: 276288.

  • 4.

    Nigeria Centre for Disease Control, 2018. An Update of Lassa Fever Outbreak in Nigeria. Available at: http://www.ncdc.gov.ng/diseases/sitreps/?cat=5&name=An%20update%20of%20Lassa%20fever%20outbreak%20in%20Nigeria. Accessed August 31, 2018.

    • Search Google Scholar
    • Export Citation
  • 5.

    Virological.org, 2018. Real-Time Lassa Virus Sequencing in Nigeria. Available at: http://virological.org/t/2018-lasv-sequencing-continued/192. Accessed May 3, 2018.

    • Search Google Scholar
    • Export Citation
  • 6.

    Amorosa V et al. 2010. Imported Lassa fever, Pennsylvania, USA, 2010. Emerg Infect Dis 16: 15981600.

  • 7.

    Kitching A et al. 2009. A fatal case of Lassa fever in London, January 2009. Euro Surveill 14: 19117.

  • 8.

    Ehlkes L, George M, Samosny G, Burckhardt F, Vogt M, Bent S, Jahn K, Zanger P, 2017. Management of a Lassa fever outbreak, Rhineland-Palatinate, Germany, 2016. Euro Surveill 22: pii=16-00728.

    • Search Google Scholar
    • Export Citation
  • 9.

    World Health Organization, 2015. Lassa Fever—United States of America. Disease Outbreak News. Available at: http://www.who.int/csr/don/28-may-2015-lassa-fever-usa/en/. Accessed August 31, 2018.

    • Search Google Scholar
    • Export Citation
  • 10.

    Lewnard JA, Gonsalves G, Ko AI, 2016. Low risk of international Zika virus spread due to the 2016 Olympics in Brazil. Ann Intern Med 165: 286287.

    • Search Google Scholar
    • Export Citation
  • 11.

    Nigeria Centre for Disease Control, 2018 Lassa Fever Outbreak in Nigeria: Situation Report, serial number: 27, 8 Jul 2018. Available at: https://ncdc.gov.ng/themes/common/files/sitreps/00235292b8a3f55c01f9ea2eb15c8d3a.pdf. Accessed August 31, 2018.

    • Search Google Scholar
    • Export Citation
  • 12.

    International Air Transport Association, 2017. Airport Intelligence Services (AirportIS). Available at: http://www.iata.org/services/statistics/intelligence/paxis/Pages/index.aspx. Accessed August 31, 2018.

    • Search Google Scholar
    • Export Citation
  • 13.

    World Tourism Organization, 2018. Compendium of Tourist Statistics Dataset [Electronic]. Madrid, Spain: UNWTO. Available at: https://www.e-unwto.org/doi/abs/10.5555/unwtotfb0566010020122016201801. Accessed August 31, 2018.

    • Search Google Scholar
    • Export Citation
  • 14.

    World Health Organization, 2018. Lassa Fever—Nigeria. Disease Outbreak News. Available at: http://www.who.int/csr/don/20-april-2018-lassa-fever-nigeria/en/. Accessed August 31, 2018.

    • Search Google Scholar
    • Export Citation
  • 15.

    Haas WH et al. 2003. Imported Lassa fever in Germany: surveillance and management of contact persons. Clin Infect Dis 36: 12541258.

  • 16.

    Moore M, Gelfeld B, Okunogbe A, Paul C, 2017. Identifying future disease hot spots: infectious disease vulnerability index. Rand Health Q 6: 5.

  • 17.

    Fichet-Calvet E, Rogers DJ, 2009. Risk maps of Lassa fever in west Africa. PLoS Negl Trop Dis 3: e388.

  • 18.

    Kraemer MUG et al. 2017. Spread of yellow fever virus outbreak in Angola and the Democratic Republic of the Congo 2015–16: a modelling study. Lancet Infect Dis 17: 330338.

    • Search Google Scholar
    • Export Citation
  • 19.

    United Nations, Department of Economic and Social Affairs, Population Division, 2017. World Population Prospects: The 2017 Revision, Key Findings and Advance Tables. Working Paper No. ESA/P/WP/248. Available at: https://population.un.org/wpp/Publications/Files/WPP2017_KeyFindings.pdf. Accessed December 17, 2018.

  • 20.

    Houlihan C, Behrens R, 2017. Lassa fever. BMJ 358: j2986.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Potential for Seasonal Lassa Fever Case Exportation from Nigeria

View More View Less
  • 1 Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada;
  • | 2 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;
  • | 3 Boston Children’s Hospital, Boston, Massachusetts;
  • | 4 Department of Zoology, University of Oxford, Oxford, United Kingdom;
  • | 5 Department of Medicine, Division of Infectious Diseases, University of Toronto, Toronto, Canada;
  • | 6 Divisions of General Internal Medicine and Infectious Diseases, University Health Network, Toronto, Canada
Restricted access

The largest epidemic of Lassa fever in recent history occurred in Nigeria in 2018. We assessed the potential for cases of Lassa fever originating in Nigeria to arrive at international destinations via air travel using a probabilistic model. We estimated no exported cases in 62% of 1,000 model simulations. In 30% of simulations, a single exported case was projected. Greater than 40% of outbound travelers from Nigeria arrived in the United States, the United Kingdom, and Ghana, placing these countries at greatest risk for receiving an exported case. There was a wide range in the capacity of highly connected countries to respond to infectious disease threats, as measured by the Infectious Disease Vulnerability Index. Although we quantified a low probability of case exportation during this outbreak, countries with the greatest connectivity to Nigeria should be alert to the potential risks of Lassa fever importation and be prepared to manage infected individuals.

Author Notes

Address correspondence to Kamran Khan, Division of Infectious Disease, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada, E-mail: khank@smh.ca or Isaac I. Bogoch, Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, 14EN-209, 200 Elizabeth St., Toronto, ON M5G 2C4, Canada, E-mail: isaac.bogoch@uhn.ca.

Financial support: This study was supported in part by the Canadian Institutes of Health Research.

Disclosure: K. K. is the founder of BlueDot, a social enterprise that develops digital technologies for public health. A. R. T., A. W., and K. K. received employment or consulting income from BlueDot during this research. I. I. B. has consulted for BlueDot.

Authors’ addresses: Ashleigh R. Tuite, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada, and Dalla Lana School of Public Health, Toronto, Canada, E-mail: ashleigh.tuite@utoronto.ca. Alexander G. Watts, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada, E-mail: wattsa@smh.ca. Moritz U. G. Kraemer, Boston Children’s Hospital, Boston, MA, and Department of Zoology, University of Oxford, Oxford, United Kingdom, E-mail: moritz.kraemer@zoo.ox.ac.uk. Kamran Khan, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada, and Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, Canada, E-mail: khank@smh.ca. Isaac Bogoch, Divisions of General Internal Medicine and Infectious Diseases, Toronto General Hospital, Toronto, Canada, and Department of Medicine, University of Toronto, Toronto, Canada, E-mail: isaac.bogoch@uhn.ca.

Save