A concise review on Lassa fever infection and its prevention strategies

A concise review on Lassa fever infection and its prevention strategies | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 13 November 2025 V1 Latest version Share on A concise review on Lassa fever infection and its prevention strategies Authors : Angus Nnamdi Oli , Ifeanyi Ferdinand Chukwuma 0009-0005-9083-6294 , Ezinne Janefrances Nwonu , Morteza Saki 0000-0001-7419-0116 , and Samson Adedeji Adejumo 0000-0001-9971-5193 [email protected] Authors Info & Affiliations https://doi.org/10.22541/au.176304083.36084157/v1 697 views 201 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Lassa fever is a public health disease primarily endemic in West Africa. Over the years, it has emerged as a significant public health concern due to its potential for severe illness and fatalities. Understanding the current state of knowledge about Lassa fever infection is critical for informed decision-making, public health planning, and further research efforts. This scoping review of literature provides a comprehensive overview of recent articles related to Lassa fever from January 2000 – July 2023. Electronic-based data were obtained through following databases: PubMed, Scopus, and Google Scholar. Keywords employed were ”Lassa fever,” ”Lassa virus,” ”hemorrhagic fever,” ”epidemiology,” and “Emerging infectious diseases,” and “West Africa.” Only peer-reviewed English articles were considered for analysis in this study. The Review provided an updated historical perspective of progress in Lassa fever research. It synthesizes existing literature to examine key aspects of Lassa fever, including its epidemiology, clinical manifestations, diagnostic methods, treatment options, and prevention strategies. Additionally, it seeks to identify gaps in current research and shed light on emerging trends and challenges in the field. The review underscores the continued importance of Lassa fever as an emerging infectious disease with significant public health implications. A concerted focus on unraveling the complex interactions between the virus, its reservoirs, and potential hosts, coupled with investigations into environmental influences and climate-related factors, is imperative to deepen our understanding of disease transmission dynamics. While progress has been made in understanding and managing Lassa fever, further research is essential to develop effective vaccines, therapeutics, and preventive measures. A concise review on Lassa fever infection and its prevention strategies Running title: Lassa fever infection Angus Nnamdi Oli 1 , Ifeanyi Ferdinand Chukwuma 1 , Ezinne Janefrances Nwonu 2 , Morteza Saki 3* , Samson Adedeji Adejumo 4,5 1 Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria 2 National Biotechnology Development Agency, Abuja, Nigeria 3 Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 4 University of Illinois at Chicago, Chicago, Illinois 60607, United States 5 Federal University Oye Ekiti, Ekiti State, Nigeria *Corresponding author: Samson AdejumoDepartment of Biological Sciences, University of Illinois Chicago, USAEmail: [email protected] : +1-331-271-7069 Abstract Lassa fever is a public health disease primarily endemic in West Africa. Over the years, it has emerged as a significant public health concern due to its potential for severe illness and fatalities. Understanding the current state of knowledge about Lassa fever infection is critical for informed decision-making, public health planning, and further research efforts. This scoping review of literature provides a comprehensive overview of recent articles related to Lassa fever from January 2000 – July 2023. Electronic-based data were obtained through following databases: PubMed, Scopus, and Google Scholar. Keywords employed were ”Lassa fever,” ”Lassa virus,” ”hemorrhagic fever,” ”epidemiology,” and “Emerging infectious diseases,” and “West Africa.” Only peer-reviewed English articles were considered for analysis in this study. The Review provided an updated historical perspective of progress in Lassa fever research. It synthesizes existing literature to examine key aspects of Lassa fever, including its epidemiology, clinical manifestations, diagnostic methods, treatment options, and prevention strategies. Additionally, it seeks to identify gaps in current research and shed light on emerging trends and challenges in the field. The review underscores the continued importance of Lassa fever as an emerging infectious disease with significant public health implications. A concerted focus on unraveling the complex interactions between the virus, its reservoirs, and potential hosts, coupled with investigations into environmental influences and climate-related factors, is imperative to deepen our understanding of disease transmission dynamics. While progress has been made in understanding and managing Lassa fever, further research is essential to develop effective vaccines, therapeutics, and preventive measures. Keywords: Lassa fever, Lassa virus, Haemorrhagic fever, Epidemiology Background Lassa fever represents a significant public health concern due to its association with high morbidity and mortality rates [1]. On an annual basis, it is estimated to result in an average of 5,000 deaths, with reported cases ranging from 200,000 to 500,000 [2]. While it is considered endemic in West African countries like Liberia, Sierra Leone, Guinea, and Benin [3, 4], sporadic occurrences have been documented in regions as distant as Europe, Asia, and the Americas [5]. Notably, the disease has the potential to cross borders when infected travelers carry it to other countries, leading to sporadic cases and occasional outbreaks. One such instance of overseas cross-border infection was reported in Germany [6], underscoring the global implications of Lassa fever surveillance and control efforts. It can be transmitted through several modes, with person-to-person transmission via direct contact with the bodily fluids of infected individuals being a primary route. Additionally, contamination of human food has been reported as a likely mode of transmission [7]. The virus’s natural reservoir host is the Mastomys natalensis rat, which excretes the virus in its urine. These rats are particularly prevalent in equatorial Africa, often residing near human settlements [8]. In Nigeria, they are known by different names in local languages, such as ”Eeku Asin” among the Yoruba group, ”Jagba” among the Hausa group, and ”Nkapia” or ”Nkakwu” among the Igbo group [9]. Animal-to-human transmission has also been documented in individuals who encounter infected animals, particularly through handling their tissues and bodily fluids [10]. This complex web of transmission routes underscores the importance of understanding and addressing the various aspects of Lassa fever prevention and control.Top of Form The disease knows no age or gender boundaries, affects people across all demographics, and it can strike at any time of the year, with its transmission peaking during the dry season [11]. This infectious disease has been responsible for severe outbreaks, causing significant public health concern. The spectrum of symptoms associated with Lassa fever varies from mild to severe and encompasses fever, malaise, headache, sore throat, cough, nausea, vomiting, diarrhea, and abdominal pains. Notably, only about 20% of those infected exhibit these symptoms, while the remaining 80% demonstrate serological evidence of infection despite being asymptomatic [12]. In severe cases, Lassa fever can progress to cause hemorrhage, encephalitis, and multi-organ failure, often resulting in fatal outcomes. This wide range of clinical manifestations underscores the importance of vigilance and early detection in managing this disease. The emergence of highly contagious diseases like Ebola and COVID-19 underscores the critical need for preparedness and response planning in the face of infectious disease outbreaks. It’s essential to recognize that without effective control measures; Lassa fever has the potential to extend beyond its current West African endemic areas, becoming a global health threat. Despite ongoing efforts, Lassa fever remains a significant concern, necessitating a proactive approach to address the evolving virus and its intricate transmission patterns. To this end, maintaining up-to-date knowledge is paramount for crafting effective prevention and control strategies. A comprehensive literature review on Lassa fever serves as an essential step, consolidating existing knowledge and identifying crucial research gaps. The insights gained can inform evidence-based policies and interventions, enhance clinical care, guide future research, and pinpoint areas for reducing the burden of Lassa fever infection. Considering these considerations, this study aims to answer a pivotal research question: What is the current state of knowledge, and what research gaps must be addressed to enhance the management and control of Lassa fever?Top of Form The study’s objectives are centered on conducting a comprehensive review of the existing literature pertaining to Lassa fever infection. This review encompasses several key aspects: firstly, it delves into the causative agent, its viral entry mechanisms, and the patterns of transmission associated with Lassa fever. Additionally, it investigates the reported prevalence of Lassa fever infection as documented by various authors in different research studies. The study also scrutinizes the clinical presentations linked to Lassa fever, as well as the available diagnostic methods for its detection. Moreover, it assesses the current treatment options accessible for managing Lassa fever and examines the preventive measures and public health strategies employed for its control. The insights gleaned from this study hold the potential to guide future research endeavors, shape public health policies, and contribute significantly to the global efforts aimed at effectively combatting Lassa fever. Furthermore, the study can provide invaluable information to pharmaceutical microbiologists in their pursuit of identifying potential drug targets for the development of therapeutic interventions. Ultimately, this research seeks to offer a comprehensive overview of the current state of knowledge on Lassa fever, pinpoint research gaps, and recognize influential studies and contributors in the field. Bottom of Form Study design and inclusion criteria The scoping review adhered to established research framework guidelines. Inclusion criteria encompassed all English-language articles published between January 2000 and July 2023, which provided a scoping review on the topic of Lassa fever infection. Search methodology To ensure originality and avoid plagiarism, a comprehensive search strategy was devised to identify scientific publications solely in the English language. PubMed, Scopus, and Google Scholar databases were utilized for the literature search. The following keywords were employed: ”Lassa fever,” ”Lassa virus,” ”hemorrhagic fever,” ”epidemiology,” and “Emerging infectious diseases.” By using these search terms, we aimed to retrieve relevant articles without duplicating existing content or infringing on intellectual property rights. Studies selection and data extraction After eliminating duplicates from the initial pool of 836 downloaded articles, 178 articles were subjected to screening. Following a thorough evaluation of titles and abstracts, 105 full-text articles were retrieved for further assessment. Additionally, three articles from PubMed and Google Scholar were discovered through cross-referencing. Ultimately, this review incorporated a total of 86 eligible articles, as illustrated in Figure 1. Structure of Lassa virus The agent responsible for Lassa fever is the Lassa virus, characterized by its enveloped, rod-shaped structure measuring approximately 80 nanometers in diameter and around 1,000 nanometers in length (Figure 2). The viral membrane is adorned with glycoproteins protruding from its surface. The viral genome comprises two segments, denoted as L (large RNA) and S (small RNA). The L segment encodes essential components such as the viral RNA polymerase, and large and zinc proteins, while the S segment is responsible for encoding the viral glycoproteins and the nucleoprotein, crucial for packaging the viral RNA. The genome also includes intergenic regions, and non-coding sequences that separate coding regions. Within the lipid envelope, the virus particle houses ribonucleoprotein (RNP) complexes, where the viral RNA genome is tightly bound to nucleoprotein. These RNP complexes are enveloped by a matrix protein layer that provides structural support to the virus particle [17-19]. The structure of Lassa virus comprises several critical elements. It is enclosed within a lipid envelope, derived from the host cell membrane, which encapsulates the viral particle. Embedded within this envelope are glycoprotein spikes, pivotal for viral attachment and facilitating entry into host cells. Within the envelope, the Lassa virus houses a segmented, negative-sense RNA genome. This genome consists of two distinct RNA segments responsible for encoding the viral proteins essential for replication and infection processes. This figure has been developed by utilizing the Biorender (http://biorender.com/) licence given to Dr Jarrad Hampton-Marcell lab at University of Illinois Chicago. Receptors of Lassa virus Lassa virus enters host cells through binding with the alpha-dystroglycan protein, a constituent of the extracellular matrix enveloping cells in various tissues [20]. The glycoprotein spikes on the Lassa virus surface specifically interact with alpha-dystroglycan, facilitating the virus’s penetration into host cells [21]. Alpha-dystroglycan is present in a wide array of cell types, including those in the respiratory and urinary tracts, liver, spleen, and lymph nodes. This extensive distribution across tissues helps elucidate why Lassa fever can affect multiple organ systems in infected individuals. Besides alpha-dystroglycan, other cellular factors, like the endosomal sorting complex required for transport (ESCRT) pathway, are also thought to play a role in Lassa virus entry and replication, particularly in the budding of virus particles from host cells [22]. An in-depth understanding of the cellular receptor and other host factors implicated in Lassa virus infection holds immense significance in devising strategies for Lassa fever prevention and treatment. Currently, researchers are exploring methods to impede the interaction between the viral glycoprotein and alpha-dystroglycan as a potential therapeutic avenue [23]. Life Cycle The life cycle of the Lassa virus is characterized by intricate interactions involving the virus itself, its natural host, the multimammate rat (M. natalensis), and human beings. This virus is sustained within the rat population through persistent infections, during which it is excreted in the urine and feces of infected rats. Humans can contract the virus either through direct contact with these excretions or by consuming food contaminated with rat excretions. Once the virus enters the human body, it demonstrates the ability to infect various cell types, including immune cells, liver cells, and the endothelial cells lining blood vessels. Subsequently, viral replication takes place, leading to its dissemination throughout the body and resulting in a spectrum of symptoms. These symptoms typically manifest within a period of 6 to 21 days after exposure and may include fever, headache, muscle weakness, vomiting, diarrhea, abdominal pain, and hemorrhage [24]. In the most severe cases, Lassa fever can progress to multi-organ failure and, ultimately, fatal outcomes. entry The Lassa virus entry process is a meticulously orchestrated series of events depicted in Figure 3 [25]. It commences with viral attachment to the α-dystroglycan receptor on the host cell surface, mediated by the glycoprotein complex (GPC) comprising GP-1 and GP2. GP-1, particularly, binds to host cell receptors, notably the α-dystroglycan receptor, which is prevalent on diverse cell types. After attachment, the virus is internalized through endocytosis, forming an endosome. Inside the acidic endosome, the viral glycoprotein undergoes a pH-triggered conformational shift, leading to fusion between the viral envelope and the endosomal membrane, releasing the viral ribonucleoprotein (RNP) complex into the host cell cytoplasm. Following uncoating, the viral RNA genome is released, including nucleoprotein (NP), viral protein (L), and viral protein (Z), crucial for replication and transcription. Lassa virus employs its RNA-dependent RNA polymerase (L protein) to transcribe and replicate its RNA genome, generating viral messenger RNAs (mRNAs) that are translated by host cell ribosomes into viral proteins. Newly formed viral proteins and genomic RNA are transported to the Golgi apparatus for assembly and budding within Golgi membranes, resulting in new viral particles. These assembled viral particles are then transported to the host cell’s plasma membrane and released via budding, enabling them to infect neighboring cells or disseminate through the bloodstream to infect other tissues and organs, thus elucidating the intricate Lassa virus entry and propagation process within the host. Epidemiology Lassa fever presents a significant public health challenge within the West African region, where it is estimated to impact hundreds of thousands of individuals annually [26]. However, it remains relatively obscure beyond this geographic area, prompting ongoing efforts to raise awareness and enhance disease surveillance and management. Collaborative endeavors involving the Nigeria Centre for Disease Control (NCDC) and various public health organizations have been diligently underway to bolster surveillance, diagnostic capabilities, and the overall management of Lassa fever not only in Nigeria but also in other affected nations. These initiatives encompass healthcare worker training, the reinforcement of laboratory infrastructure, and the promotion of public awareness concerning the disease and preventive measures. Prevalence and incidence rates Lassa fever’s prevalence and incidence rates in West Africa exhibit significant fluctuations, with Nigeria being the most heavily affected country. For instance, in 2020, Nigeria recorded 1,918 suspected cases of Lassa fever, with 386 confirmed cases and 69 deaths, resulting in an incidence rate of about 0.9 cases per 100,000 population [27,28,29] and between weeks 1 and 23 of 2023, a total of 802 confirmed cases with 160 deaths and case fatality ratio of 17.1% were reported by the NCDC [27]. High-incidence areas include parts of Sierra Leone, Liberia, Guinea, and various regions within Nigeria (Figure 4). Accurate estimation of the disease’s true burden remains challenging due to nonspecific clinical symptoms, civil unrest, political instability, limited surveillance infrastructure, population migration, landscape changes, and a shortage of diagnostic facilities in the region. Addressing these complexities is crucial for effective Lassa fever prevention and control efforts across West Africa. Geographical distribution and endemic areas Lassa fever predominantly establishes itself as an endemic disease within the West African region, with Nigeria bearing the brunt of its impact (Figure 4). Among these, Nigeria stands out as the most severely impacted country, reporting the highest number of Lassa fever cases. Notably, the virus has sporadically surfaced beyond the borders of West Africa, primarily through travel-associated cases, underscoring the imperative for enhanced surveillance and vigilance in regions lying outside its endemic range. Nonetheless, occurrences of Lassa fever have also been documented in neighboring West African nations like Liberia, Sierra Leone, Guinea, and Benin [3, 4]. These countries are categorized as endemic areas for the disease, signifying the sustained presence of the virus within local rodent populations and the regular reporting of human cases. While the core epicenter of Lassa fever remains confined to West Africa, there exists the potential for the disease to extend its reach beyond this region, leading to reported cases in diverse global locations such as the United States and Europe, often involving travelers returning from endemic areas [5]. Beyond West Africa, Lassa fever cases are relatively rare but have been recorded among individuals who have visited or worked in endemic areas. A notable instance of cross-border infection occurred in Germany in 2016 [6]. Additionally, a limited number of cases have been reported among laboratory personnel engaged in the handling of the virus. Seasonal patterns and temporal trends of outbreaks Lassa fever outbreaks frequently display discernible seasonal patterns, marked by heightened incidence during specific times of the year [30]. The precise timing and duration of these peak seasons can fluctuate across different regions. Some areas exhibit a higher prevalence of Lassa fever cases during the dry season, while in others; outbreaks may persist throughout the year. When examining the temporal trends of Lassa fever outbreaks over time, variations become apparent, with periods of heightened activity followed by comparatively quieter phases. These trends are shaped by several influencing factors, including shifts in rodent populations, fluctuations in climate conditions, and alterations in human behaviors and activities. The prevalence of Lassa fever exhibits significant disparities among different countries, a variability attributed to factors such as healthcare infrastructure, surveillance systems, and the effectiveness of public health interventions. Notably, this review underscores that Lassa fever is predominantly endemic within West African nations, with Sierra Leone experiencing the most profound impact [32]. This emphasizes the pressing necessity for bolstered healthcare infrastructure, strengthened surveillance systems, and the implementation of efficacious public health interventions aimed at curtailing and averting the spread of Lassa fever, both on a regional and international scale. Furthermore, it highlights the ongoing importance of continued research efforts to enhance our understanding of this disease [33]. Reservoir The natural host of the Lassa virus is the African multi-mammate mouse, scientifically known as M. natalensis . This rodent species shares a commensal relationship with humans and is widely distributed across West, Central, and East Africa [33, 34]. Furthermore, new potential reservoirs for Lassa fever have come to light, including the Guinea multi-mammate mouse, M. erythroleu s, observed in both Nigeria and Guinea, the African wood mouse, Hylomyscus pamfi, identified in Nigeria, and the Pygmy mouse, Mus minutoides, located in Ghana and Benin. These mice are characterized by specific features such as a distinctive foul odor, a long hairless tail, soft body fur, a pointed rostrum, and a ventral surface adorned with multiple mammary glands, as detailed by Petersen [36]. Importantly, when these rodents become infected with the Lassa virus, they do not exhibit illness symptoms themselves; however, they can shed the virus through bodily fluids like urine, feces, metabolic secretions, and blood. Transmission Lassa virus can be transmitted through various means, as illustrated in Figure 5. In cases of rodent-to-human transmission, individuals become infected when they ingest food that has been contaminated by exposure to rodent excreta. This can happen through direct contact with mucous membranes or by inhaling aerosols generated when rodents urinate. Additionally, consumption of the infected rodent itself can lead to transmission [24, 37]. Another potential route is when the Lassa virus is contracted during the trapping and preparation of rodents for consumption, a common practice in some parts of West Africa [38]. Human-to-human transmission is another significant pathway and can occur through contact with sputum, body fluids, stool, urine, and blood [10]. This type of transmission can result in nosocomial outbreaks [39, 40]. Notably, contamination of human food has been identified as a more likely mode of transmission [7]. Factors contributing to its spread and transmission The primary mode of Lassa virus transmission to humans involves contact with the urine or feces of infected multi-mammate rats. Human infection can occur through direct contact with contaminated surfaces or by inhaling aerosolized virus particles. Environmental and socio-economic factors play a significant role in the spread of Lassa virus. Poor sanitation, crowded living conditions, and improper food storage practices that attract rodents can elevate the risk of virus exposure. Additionally, nosocomial transmission within healthcare settings poses another substantial mode of spread, where healthcare workers and close contacts of infected individuals may be at risk due to inadequate infection control measures. Urbanization, deforestation, and climate change further complicate the distribution and transmission dynamics of Lassa virus by impacting rodent habitats, human behavior, and the movement of infected individuals. A comprehension of Lassa fever’s epidemiology, encompassing prevalence, geographical distribution, seasonal patterns, and contributing factors to transmission, remains pivotal for the effective implementation of control measures, surveillance systems, and public health interventions aimed at mitigating the disease’s impact [30]. Risk factors Lassa fever is linked to a range of risk factors, which include: Rural residences: In West Africa, individuals residing in rural areas, primarily farmers, are at an elevated risk of Lassa virus infection due to their proximity to reservoir hosts. The consumption of rat meat in certain communities also amplifies the incidence of Lassa fever. Additional factors contributing to transmission in rural settings involve traditional autopsy practices, potential exposure to contaminated instruments such as scalpels or contact with the blood of deceased individuals, activities like hunting rodents and bush burning, agricultural activities like rice cultivation that provide a food source for rodents, the open construction of African villages, drying grains outdoors or near homes, and inadequate grain storage within households [40, 41]. Climate and Weather: Ecological elements, like rainfall, play a role in Lassa virus infection rates. Research has demonstrated that during the rainy season, Lassa virus infection rates are two to three times higher compared to the dry season [33]. Nevertheless, there is no evidence suggesting that the virus thrives better in humid soil as opposed to dry soil. Gender disparities: Lassa fever predominantly affects men rather than women, but the case fatality rate is nearly twice as high in women [30]. It’s essential to underscore that age, gender, or racial factors do not influence Lassa virus transmission [40]. Contact with infected rodents: The primary mode of Lassa fever transmission is through contact with the urine or feces of infected rodents, notably the multimammate rat ( M. natalensis ). Other rodents like M. erthroleuca and Hylomyscus pamfi can also transmit the virus [42]. Residing in or near areas with a substantial rodent population heightens the risk of virus exposure. Poor sanitation: Suboptimal environmental sanitation practices, encompassing improper waste disposal and a scarcity of access to clean and portable water, can lead to increased rodent populations and raise the likelihood of Lassa fever transmission [24]. Direct exposure to infected bodily fluids: Transmission can occur through direct contact with bodily fluids like blood, urine, feces, and vomit from infected individuals. This can transpire during caregiving, healthcare procedures, or traditional burial practices [37]. Transmission in healthcare settings: Healthcare professionals face the risk of infection if they encounter infected bodily fluids during medical procedures, such as surgeries, or if they fail to adhere to proper infection prevention and control measures [43]. Travel to endemic regions: Individuals traveling to areas where Lassa fever is prevalent, especially those involved in outdoor activities or working closely with rodents, confront an increased risk of infection [5, 6]. Weakened immune system: Individuals with compromised immune systems, owing to conditions like HIV/AIDS or undergoing chemotherapy, exhibit heightened susceptibility to severe forms of Lassa fever [44]. Pathogenesis Lassa fever predominantly affects various organs within the human body. Once the virus infiltrates, it disseminates to critical organs like the liver, spleen, and kidneys, initiating replication processes that culminate in damage to these vital structures. Furthermore, the virus infects endothelial cells, leading to vascular impairment and hemorrhaging. Lassa virus demonstrates a wide cell tropism, infecting diverse cell types, including monocytes, macrophages, and dendritic cells, thereby inducing inflammatory responses, and contributing to tissue harm. Although there is variability in the available data, severe Lassa fever appears to be associated with an inadequate or suppressed immune response [45]. The immune response to Lassa fever is intricate, encompassing both innate and adaptive immunity mechanisms. Nevertheless, the virus employs evasion strategies to elude the immune system, such as inhibiting interferon production, a critical element for viral elimination. Additionally, the virus triggers apoptosis, resulting in the demise of immune cells, and impairs antigen presentation, ultimately leading to a compromised adaptive immune response. The severity of Lassa fever often depends on the level of viral replication and the vigor of the host’s immune response [46]. Clinical manifestations The clinical presentation of Lassa fever encompasses a spectrum of signs and symptoms, as well as disease outcomes, and it is essential to have a thorough understanding of illness severity, potential complications, and mortality rates for effective disease management and patient care [45]. This comprehensive understanding of the clinical progression of Lassa fever is indispensable for healthcare providers to effectively manage patients and administer appropriate care. The following descriptions elucidate the clinical manifestations and progression of Lassa fever: a. Early phase: The initial symptoms of Lassa fever are generally nonspecific, including fever, headache, fatigue, muscle pain, and a sense of malaise. Some patients may also experience gastrointestinal issues like nausea, vomiting, and abdominal discomfort. In certain cases, individuals infected with the Lassa virus may exhibit mild illness or remain asymptomatic, posing diagnostic challenges as these presentations can mimic other common febrile illnesses. b. Moderate disease: Moderate Lassa fever cases manifest with more pronounced symptoms, often requiring medical attention and supportive care. c. Progression to severe illness: A subset of Lassa fever cases may advance to severe disease characterized by a higher viral load and multi-organ dysfunction. Patients in this stage develop respiratory distress, chest pain, cough, sore throat, and respiratory symptoms. Hemorrhagic manifestations become evident, with bleeding from the gums, nose, or gastrointestinal tract. Neurological symptoms, such as encephalopathy, seizures, and tremors, may also manifest. Severe illness typically necessitates hospitalization and intensive care. Prognostic indicators Prognostic elements constitute pivotal characteristics that significantly influence a patient’s health outcome, and these factors have been thoroughly examined in various research studies [48, 49]. Several prognostic markers linked to Lassa fever can be identified: Viral load : The quantity of virus exposure has a notable impact on illness severity, where higher viral loads typically correlate with more severe symptoms. Disease gravity: Patients experiencing severe disease, including those presenting with bleeding, respiratory distress, or shock, face an increased risk of adverse outcomes. Age: Both older individuals and young children exhibit greater susceptibility to developing severe illness upon infection. Immune status: Individuals with compromised immune systems due to underlying medical conditions or medication usage are more prone to experiencing severe symptoms. Genetic factors: Genetic components may potentially contribute to determining the severity of Lassa fever. Timeliness of diagnosis and treatment: Swift identification and immediate initiation of antiviral drug treatment can mitigate illness severity, while delayed diagnosis and treatment elevate the likelihood of severe symptoms. Pre-existing medical conditions : Individuals with underlying health conditions like diabetes, hypertension, and cardiovascular diseases may have an elevated likelihood of experiencing severe symptoms. Environmental influences: Environmental factors, including subpar sanitation, overcrowding, and limited access to clean water, heighten the risk of contracting Lassa fever and may also contribute to the illness’s severity. Diagnosis Diagnosing Lassa fever presents significant difficulties due to the disease’s initial symptoms closely resembling those of other viral infections [30, 50]. A definitive diagnosis typically relies on a combination of clinical assessment and laboratory examinations. Swift diagnosis and isolation of infected individuals are critical to prevent disease transmission, and initiating antiviral treatment promptly can significantly enhance patient outcomes. The current diagnostic strategies for Lassa fever encompass clinical criteria and laboratory investigations. Clinical criteria The clinical diagnosis of Lassa fever is highly challenging due to symptom overlap with severe malaria, typhoid fever, yellow fever, and various hemorrhagic fevers. Diagnosis primarily relies on clinical symptoms, which are generally nonspecific and multifaceted. These symptoms include fever, headache, muscle pain, sore throat, vomiting, and diarrhea. Key clinical indicators that may suggest Lassa fever include pharyngitis, retrosternal pain, and proteinuria. Given the similarity of these symptoms to other viral illnesses, considering the patient’s travel history to endemic regions, particularly West Africa, is crucial for accurate diagnosis. The clinical presentation of Lassa fever unfolds in three primary stages: Stage 1: Acute phase This is also referred to as the prodromal illness stage and shares signs and symptoms with protozoan or infectious diseases. It commences with manifestations like headache, pain, fever of ≥38ºC, cough, pharyngitis (sore throat and backache), tremors, insomnia, and occasional rash, alongside gastrointestinal disturbances such as diarrhea and vomiting [1]. Stage 2: Hemorrhagic phase This stage involves internal bleeding, with patients experiencing bleeding from nostrils, mouth, and other body orifices, closely resembling symptoms seen in Ebola cases. In severe instances, this phase can lead to organ failure and eventual death [2]. Stage 3: Neurologic complications This stage may include symptoms like hypotension, pericarditis, tachycardia, meningitis, encephalitis, severe abdominal pain, and seizures. The virus can be detected in the patient’s urine for 3-9 weeks and in semen for up to 3 months [51, 52]. Laboratory test The laboratory confirmation of Lassa fever involves the identification of the virus or its specific antibodies. Clinical samples, including blood, urine, or tissue specimens, are utilized in this diagnostic process. Laboratory testing plays a critical role in verifying the presence of Lassa fever and distinguishing it from other viral hemorrhagic fevers, particularly Ebola. However, it is essential that Lassa fever testing takes place in a biosafety-level laboratory equipped to handle highly infectious agents. The diagnostic methods include: A. Nucleic acid detection I. Enzyme-linked immunosorbent assay (ELISA): This assay identifies antibodies against the Lassa virus in bodily fluids like blood. ELISA is valuable for detecting the immune response to the virus, indicating either past or current infection. However, it may have limited sensitivity during the early stages of infection. ELISA identifies Lassa virus-specific antibodies in serum or plasma samples. It serves as a useful tool for confirming Lassa fever diagnosis and determining the disease stage. Novel assays such as IgM ELISA, known for its high sensitivity and specificity in acute infection, and IgG ELISA, useful for diagnosing recent infection, are also available [54]. II. Reverse transcription polymerase chain reaction (RT-PCR): This method employs a highly sensitive molecular assay to detect viral RNA in blood, urine, other bodily fluids, or tissue samples. It is recognized for its sensitivity and specificity, allowing for rapid diagnosis [55]. However, this requires specialized laboratory equipment and trained personnel, limiting its feasibility in resource-limited settings III. Lassa virus antigen detection: This test aims to identify viral antigens in blood, urine, or other bodily fluids through immunological techniques. Antigen detection can be employed to confirm a diagnosis in individuals with a strong suspicion of Lassa fever, although its availability may vary [56]. IV. Immunofluorescence assay (IFA): IFA detects Lassa virus-specific antibodies in serum or plasma samples [54]. It stands out as a sensitive and specific diagnostic method for Lassa fever, facilitating swift diagnosis. A. Virus culture and electron microscopy I. Virus isolation: This procedure involves the cultivation of the virus within a laboratory setting using blood, urine, or tissue samples. It is a labor-intensive method that demands specialized facilities and expertise. While virus isolation is a specific approach for diagnosing Lassa fever, it is hampered by its time-consuming nature and the requirement for a high level of biosafety containment. Electron microscopy can be employed to investigate the structural characteristics of the Lassa virus from clinical samples or cultures, contributing to a better understanding of the virus’s morphology and supporting the diagnostic process [57]. A. Differential diagnosis I. Point-of-care tests: The clinical presentation of Lassa fever shares similarities in signs and symptoms with severe malaria, typhoid fever, and yellow fever, as well as other hemorrhagic fevers. There are ongoing efforts to develop rapid diagnostic tests capable of detecting the Lassa virus or its antibodies in field settings, although their widespread availability remains pending [58]. Sensitivity, specificity, and feasibility Laboratory-based methods for Lassa fever diagnosis encompass serological assays and molecular diagnostics [58], detailed as follows: a. Serological assays: Enzyme-linked immunosorbent assay (ELISA) and indirect immunofluorescence assay (IFA) is commonly utilized to detect Lassa fever-specific IgM and IgG antibodies in patient serum samples. These tests prove valuable for identifying recent or past Lassa virus infections, displaying commendable sensitivity and specificity in Lassa fever diagnosis. IgM antibodies can be detected in the early stages of the disease, while IgG antibodies signify previous infection. Nevertheless, cross-reactivity with antibodies against other arenaviruses are a possibility. b. Molecular diagnostics: Reverse transcription-polymerase chain reaction (RT-PCR) stands as the gold standard for diagnosing Lassa fever. It identifies viral RNA in patient samples, including blood, urine, or throat swabs, delivering rapid and precise identification of Lassa virus genetic material. RT-PCR demonstrates high sensitivity and specificity in diagnosing Lassa fever, particularly during the acute phase of the illness. Nonetheless, its implementation is constrained by the necessity for specialized laboratory equipment and trained personnel, which limits its practicality in resource-limited settings. Challenges and limitations in resource-limited settings The current diagnostic approaches for Lassa fever face several impediments and restrictions that can impact their accuracy, accessibility, and practicality in specific contexts. These constraints encompass: False-negative outcomes: Laboratory tests for Lassa fever might yield inaccurate negative results, particularly during the early infection stages when the virus may not be detectable in bodily fluids. Limited availability: Some Lassa fever laboratory tests are not widely accessible, particularly in regions with limited resources where the disease is endemic. Cross-reactivity: ELISA tests may generate incorrect positive results in individuals who have received vaccinations or encountered other arenaviruses, such as Junin or Machupo virus. Variation in clinical presentation: Lassa fever symptoms exhibit substantial variability, with some infected individuals being asymptomatic or displaying unusual symptoms, creating challenges in diagnosis. Time-consuming and costly: Certain laboratory tests for Lassa fever, like virus isolation, demand extensive time and specialized facilities and expertise, rendering them expensive and unfeasible in resource-limited settings. Transmission risk: Diagnostic procedures, including blood draws and sample collection, carry potential risks of virus transmission to healthcare workers and others. Limited access to laboratory facilities: Many healthcare establishments in endemic regions lack the essential laboratory infrastructure and trained personnel to conduct Lassa fever diagnostic tests. Requirement for specialized equipment and reagents: Molecular diagnostic techniques like RT-PCR necessitate specialized equipment, reagents, and appropriate laboratory biosafety measures, which may not be readily available in resource-limited settings. Delayed or restricted diagnostic access: Delays in sample transportation and processing can hinder timely Lassa fever diagnosis, potentially resulting in delayed initiation of proper patient management and an increased risk of disease transmission. Treatment Efforts are presently underway to confront these challenges and devise more efficient strategies for managing Lassa fever. It is crucial to consult healthcare experts and adhere to local health authorities’ recommendations and guidelines when handling cases of Lassa fever. At present, the treatment options for Lassa fever primarily entail providing supportive care to alleviate symptoms and minimize complications, given the absence of approved antiviral drugs. The following measures are typically employed: Antiviral therapies Although regulatory authorities have not sanctioned any specific antiviral therapy for Lassa fever, the antiviral drug ribavirin has demonstrated some effectiveness in treating the disease. Ribavirin is most efficacious when administered early in the disease’s progression, ideally within the initial six days of symptom onset. It can be delivered intravenously, orally, or through aerosolized formulations. Nevertheless, its use remains somewhat contentious due to the limited evidence available from clinical trials. Oral ribavirin is employed in post-exposure prophylaxis (PEP), whereas intravenous ribavirin is deemed the most potent treatment for acute infections [59]. Supportive care measures Supportive care constitutes a fundamental component of Lassa fever case management and encompasses various facets, such as maintaining fluid and electrolyte equilibrium, alleviating symptoms like fever and pain, and addressing complications, including bleeding or organ dysfunction. In severe instances, patients may necessitate intensive care support, entailing respiratory assistance, dialysis, and blood transfusions [59]. Supportive care is aimed at symptom management, complication prevention, and the facilitation of the body’s innate healing mechanisms. a. Fluid and electrolyte management : Individuals afflicted with the infection may encounter fluid and electrolyte imbalances stemming from symptoms such as vomiting, diarrhea, and fever. The restoration of these imbalances is facilitated through intravenous fluids and electrolyte replacement therapy. Commonly utilized fluid and electrolyte solutions encompass crystalloids (e.g., normal saline, Ringer’s lactate, Plasma-Lyte, or Hartmann’s solution) and colloids. b. Oxygen therapy: Some individuals presenting severe respiratory symptoms may necessitate supplementary oxygen therapy. c. Antipyretic and analgesic medications: These medications are deployed to alleviate fever and mitigate pain associated with Lassa fever. Exploratory treatments Persistent investigations are currently probing a range of experimental remedies and emerging therapeutic avenues for Lassa fever [2]. These encompass: a. Monoclonal antibodies: Monoclonal antibodies exhibit substantial potential in addressing Lassa fever. Among these, the most advanced is an experimental therapy referred to as Lassa fever monoclonal antibody (mAb)-114, which has demonstrated efficacy in non-human primate models. Ongoing clinical trials are actively assessing its performance in human subjects. b. Convalescent plasma: Convalescent plasma therapy revolves around the transfusion of plasma from individuals who have successfully recovered from Lassa fever and have thereby developed antibodies against the virus. This therapeutic approach aims to confer passive immunity upon the recipient, thus reinforcing their ability to combat the infection. Current research endeavors continue to scrutinize its effectiveness. c. RNA interference (RNAi): RNA interference-based therapies, incorporating entities such as small interfering RNA (siRNA), are under investigation as potential treatments for Lassa fever. These therapeutic modalities are specially designed to target and obstruct the replication of the Lassa virus. d. Vaccine development: Multiple vaccine candidates are at various stages of development for Lassa fever. The overarching objective of these vaccines is to bestow sustained protection against the virus and curtail the likelihood of outbreaks. Nevertheless, it is important to underscore that no officially licensed vaccine for Lassa fever is presently accessible . Challenges in providing optimal care Delivering the best possible care for severe cases of Lassa fever presents numerous difficulties, especially in resource-constrained settings. These obstacles include: 1. Limited healthcare infrastructure: Many regions grappling with Lassa fever suffers from inadequate healthcare infrastructure, marked by a shortage of medical personnel, diagnostic facilities, and treatment centers. This scarcity can hinder the prompt diagnosis and effective management of cases. 2. Diagnostic challenges: Accurate diagnosis of Lassa fever relies on specialized laboratory testing, which may not be readily available in affected areas. While efforts are underway to develop rapid diagnostic tests, their accessibility and reliability still require improvement. 3. Infection control: Lassa fever is highly contagious, emphasizing the crucial need for appropriate infection control measures. However, resource limitations, including the availability of personal protective equipment (PPE) and isolation facilities can impede the implementation of effective infection control practices. 4. Public health education: Raising public awareness and providing education about Lassa fever, its modes of transmission and preventive measures are essential for minimizing disease spread. Nevertheless, in resource-limited settings, public health campaigns may encounter challenges due to limited resources and low health literacy levels. Preventive measures and public health strategies Effectively managing Lassa fever necessitates a comprehensive strategy encompassing prevention, early detection, and outbreak response (Figure 6). These measures operate at individual, community, and national levels and are detailed below: Community Education and Awareness Initiatives: Public education campaigns serve as invaluable tools for disseminating knowledge about Lassa fever, covering its transmission modes, symptoms, and preventive measures. Heightened awareness empowers individuals to proactively shield themselves from the disease. This educational outreach underscores the significance of proper food storage, hygienic practices, and reducing contact with rodents and their excreta. Community engagement and awareness programs play a pivotal role in encouraging preventive behaviors and fostering behavioral changes. Key areas of emphasis within these programs encompass: a. Infection Control Measures: Healthcare workers face the risk of contracting Lassa fever while caring for infected patients [8]. Effective control strategies are crucial to mitigate virus transmission among healthcare workers and patients. These strategies involve the utilization of personal protective equipment and proper waste disposal. Encouraging practices such as frequent handwashing, safe food handling, and adherence to secure burial procedures can significantly reduce the risk of Lassa fever transmission [61]. b. Environmental Management (Rodent Control): Efforts should be directed at reducing rodent populations by eliminating their food sources and securing residential and food storage areas. Implementing measures to control rodent populations in and around households and buildings is essential for reducing transmission risk. Given that rats frequently inhabit human dwellings, prevention primarily involves eradicating unprotected storage of food, water, and garbage and sealing entry points that rodents use to access homes [33]. Educating communities about the hazards associated with rodents and promoting practices like storing food in rodent-resistant containers and maintaining clean living spaces can substantially decrease contact with rats. c. Safe Food Storage and Preparation: The virus can also be transmitted through contaminated food. Therefore, promoting safe food storage and preparation practices, such as thorough cooking and storing food in rodent-resistant containers, is pivotal for minimizing transmission risk. d. Post-Exposure Prophylaxis (PEP): In the context of outbreaks, oral ribavirin serves as the standard PEP to prevent nosocomial Lassa fever transmission [62]. It can be administered to individuals with high-risk exposures, thus reducing the likelihood of infection spread [63]. e. Contact Tracing: Close contacts of Lassa fever patients should undergo symptom monitoring and virus testing if symptoms manifest. This proactive approach aids in containing disease transmission [64]. f. Psychosocial Support: Addressing stigmatization and discrimination is crucial for improving patient outcomes [65]. Disseminating accurate information about Lassa fever is essential to combat associated stigmas and biases. Patients and their families may require psychosocial support to cope with the emotional and psychological challenges associated with the disease. Public surveillance and early detection Establishing efficient surveillance systems stands as a critical necessity in the early detection and continuous monitoring of Lassa fever outbreaks, facilitating rapid response strategies. These systems hold immense importance in identifying and addressing Lassa fever outbreaks promptly, thereby curbing the disease’s dissemination. Health authorities can employ data derived from these surveillance systems to pinpoint high-risk regions and enact appropriate control measures. Currently, in Nigeria, enhanced surveillance activities targeting Lassa fever are underway across all states, delivering regular updates and well-informed response plans [27]. Surveillance encompasses the organized gathering, examination, and interpretation of data pertaining to the occurrence of diseases. Vital components of Lassa fever surveillance encompass: a. Case Reporting: Healthcare facilities and laboratories are strongly encouraged to swiftly report any suspected Lassa fever cases to public health authorities for thorough investigation and response. b. Laboratory Testing: The provision of accessible and precise laboratory diagnostic services plays a pivotal role in confirming Lassa fever cases. This involves subjecting patient samples to tests aimed at detecting Lassa virus RNA or specific antibodies. c. Outbreak Investigation: Specialized rapid response teams are deployed to investigate outbreaks with the objective of identifying the outbreak’s origin, transmission patterns, and the populations affected. This invaluable information serves as a guide for the implementation of control measures and preventive interventions. Vector Control Strategies Vector control strategies play a vital role in addressing the transmission of the Lassa virus, primarily associated with the multi-mammate rat (M. natalensis), the primary reservoir of the virus. These strategies are designed to curtail the rodent population and minimize human interactions with these rats. Essential measures include: a. Environmental Modification: The reduction of rodent-friendly environments and the enhancement of sanitation practices prove effective in mitigating rodent infestations. This entails proper waste management, sealing cracks and openings in buildings, and regular cleaning. b. Rodent Control: Implementing methods such as trapping, the use of rodenticides, and the deployment of biological control agents can successfully reduce the rodent population. It’s imperative to carry out these interventions in accordance with safety guidelines. c. Enhanced Housing: The construction of rodent-resistant housing serves as a robust preventive measure against rodent entry, subsequently reducing human-rat interactions. Vaccine development efforts The quest for a Lassa fever vaccine has made substantial strides, with multiple promising candidates emerging from preclinical studies and progressing to clinical trials [67, 68, 69]. While there is currently no licensed vaccine available for Lassa fever prevention, the rVSV∆G-LASV-GP vaccine, expressing a glycoprotein, has demonstrated protective efficacy against lethal Lassa virus challenges in animal models during preclinical evaluations and exhibited favorable tolerability and immune response generation in Phase 1 clinical trials [70]. Additionally, a range of alternative vaccine candidates, including DNA vaccines, attenuated vaccines, virus-like particles (VLPs), inactivated virus vaccines, the envelope glycoprotein from the virus and nanoparticle-based vaccines, are also undergoing rigorous assessment in both animal models and clinical trials [71,72,73]. Another promising candidate, the pLASV-GP DNA vaccine, has shown preclinical efficacy and is currently in Phase 1 clinical trials to evaluate its safety and immunogenicity [74]. Furthermore, the CEPI/IAVIC102 vaccine is already in Phase 1 clinical trials, marking significant progress toward the development of an effective Lassa fever vaccine [75]. Implementation of Public Health Interventions Effectively implementing and evaluating public health interventions are essential components in managing Lassa fever. These actions encompass: a. Policy Development: Governments and health authorities should create comprehensive policies and guidelines for the prevention, surveillance, and response to Lassa fever. b. Capacity Strengthening: Enhancing healthcare systems, improving laboratory networks, and building the capabilities of the public health workforce are vital for the successful control of Lassa fever. c. Program Assessment: Regularly evaluating interventions and surveillance systems is crucial for identifying strengths, weaknesses, and areas requiring improvement. Collaboration and Partnerships: Collaborative efforts among governments, international organizations, researchers, and local communities are indispensable for sharing knowledge, resources, and expertise, promoting a collective approach to Lassa fever control. Implications and future work Future research endeavors concerning Lassa fever infection, based on the insights gleaned from this literature review, should emphasize the need for enhanced genomic sequencing of Lassa virus strains across diverse geographic regions to identify potential variations in virulence and transmissibility. Additionally, studies exploring the zoonotic transmission pathways and potential intermediate hosts can provide critical information for targeted surveillance and control strategies. Furthermore, investigations into the host immune responses and identification of biomarkers associated with disease severity will contribute to better prognostic tools and therapeutic interventions. Collaborative efforts between virologists, epidemiologists, ecologists, and clinicians are essential to deciphering the intricate dynamics of Lassa fever, ultimately leading to more effective preventive measures and improved patient outcomes. Undertaking this research focused on Lassa fever infection through a literature review had inherent limitations. The availability of all relevant literature was restricted, which may potentially lead to gaps in understanding and an incomplete overview of the subject. The quality and reliability of the selected literature could have varied, affecting the accuracy of the synthesized information. There was a risk of bias in the choice of sources, which could skew the findings in favor of certain perspectives or exclude critical viewpoints. Moreover, the dynamic nature of scientific progress might have resulted in old information, reducing the applicability of the review’s conclusions to current contexts. Conclusion This scoping review of literature on Lassa fever infection highlights the pressing need for a multifaceted approach to future research endeavors. A concerted focus on unraveling the complex interactions between the virus, its reservoirs, and potential hosts, coupled with investigations into environmental influences and climate-related factors, is imperative to deepen our understanding of disease transmission dynamics. Prioritizing the development of accessible diagnostic tools and exploring the socioeconomic ramifications of Lassa fever will enable the formulation of holistic strategies for prevention, early detection, and effective management. By embracing interdisciplinary collaboration and sustained investigation, the scientific community can pave the way for informed policies and interventions that mitigate the impact of Lassa fever on both public health and society. Key Messages • Lassa fever primarily originates from zoonotic transmission, with the multimammate rat serving as the primary reservoir. • Human-to-human transmission mainly occurs through direct contact with infected bodily fluids, occasionally via aerosols. • A comprehensive understanding of transmission dynamics, encompassing both zoonotic and human-to-human pathways, is of paramount importance. • The reported prevalence of Lassa fever varies across different regions. • Research emphasizes the critical need for robust diagnostics and infection control measures, especially within healthcare settings. • The gold standard diagnostic test is RT-PCR, complemented by serological tests such as ELISA. • Ribavirin stands as the primary antiviral drug for Lassa fever treatment, with supportive care including fluid and electrolyte management being essential. • Effective prevention and control strategies include promoting public awareness and education, implementing infection control practices, healthcare worker training, enhancing surveillance systems for early detection and response, personal protective measures, and good hygiene. It also involves isolating and treating suspected and confirmed cases, conducting contact tracing and monitoring, fostering community engagement, implementing rodent control, and ensuring environmental sanitation. • Genomic studies are instrumental in comprehending variations in Lassa virus strains across different regions. • Investigating host immune responses is vital for developing improved prognostic tools and therapeutic interventions. • To comprehensively manage the disease, it is essential to explore the socio-economic impacts and community dynamics. • Continued collaboration among virologists, epidemiologists, and clinicians is imperative to inform effective policies. • The literature review underscores the necessity for interdisciplinary efforts in addressing Lassa fever comprehensively. References 1. Richmond, J.K., and Baglole, D.J. (2003). Lassa fever: Epidemiology, clinical features, and social consequences. British Medical Journal, 327(7426):1271-1275. 2. 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Retrieved from http://gvn.org/lassa-fever-vaccine-development-where-are-we (Accessed on 24th April, 2023. 76. Okwuraiwe, A. P., Faye, O., Ige, F.A., James, A.B., Shaibu, J.O., Faye, M., Amoo, O.S., NDiaye, O., Salu, O.B., Omilabu, S.A., and Audu, R.A. (2022). Surveillance of viral hemorrhagic fever viruses in Lassa fever suspects in Ondo State, Nigeria. European Journal of Medical and Health Sciences, 4(3):78-81. 77. Mofolorunsho K. C. (2016). Outbreak of lassa fever in Nigeria: measures for prevention and control. The Pan African medical journal, 23, 210. Author contributions A.N.O.: Conceptualization; data curation; formal analysis; investigation; methodology; validation; visualization; writing—original draft; writing—review and editing. I.F.C.: Data curation; writing—original draft; writing—review and editing. E.J.N.: Methodology; supervision; writing—original draft; writing—review and editing. M.S.: supervision; writing—original draft; writing— review and editing. S.A.A.: Formal analysis; writing—original draft; writing— review and editing. All authors read and approved the final manuscript. Acknowledgements Authors are thankful to https://biorender.io/ for making their platform available for designing the figures. Authors also acknowledge Dr. Jarrad Hampton-Marcell lab at University of Illinois Chicago for access to the lab tools during this research. Conflict of interest statement The authors report no conflicts of interest in this work. Ethics statement Not applicable. Funding None. Data availability statement The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Figure 1. The streamlined research framework for investigating Lassa fever infection (January 2000-July, 2023). Figure 2. Structure of Lassa virus. Figure 3. The process by which the Lassa virus enters host cells. It commences with the virus binding to specific cellular receptors, such as alpha-dystroglycan, which facilitates its internalization into the host cell through a receptor-mediated endocytosis mechanism. Following internalization, the virus proceeds with membrane fusion which is a critical step leading to the release of its genetic material into the host cell’s cytoplasm, thereby initiating the replication cycle. This coordinated series of events highlights the intricate strategy employed by the Lassa virus to infiltrate and establish itself within host cells. It’s important to note that Figure 3 was generated using the Biorender (http://biorender.com/) licence given to Dr. Jarrad Hampton-Marcell lab at University of Illinois Chicago. Figure 4. Geographical distribution of Lassa fever infection, highlighting its primary presence in West Africa, particularly in nations such as Nigeria, Sierra Leone, Liberia, and Guinea. This figure was developed using the Biorender (http://biorender.com/) licence given to Dr. Jarrad Hampton-Marcell lab at University of Illinois Chicago. Figure 5. A comprehensive illustration of the multifaceted transmission pathways associated with the Lassa virus. It prominently showcases the central mode of transmission, revolving around interactions with infected rodents, notably the multimammate rat, which plays a pivotal role as the primary host in this context. These transmission routes encompass direct contact with rodent urine, feces, or saliva, underscoring the heightened risk of infection through these avenues. Furthermore, the figure highlights the potential for transmission via the consumption of food contaminated by rodent secretions. It also brings into focus the extensively documented risk of person-to-person transmission, particularly in healthcare settings, where direct contact with the bodily fluids of an infected individual can significantly contribute to the further spread of this infectious disease. This visual representation effectively conveys the intricate and diverse nature of Lassa virus transmission, emphasizing the crucial importance of understanding these mechanisms for the development of effective prevention and control strategies. This figure was developed using the Biorender (http://biorender.com/) licence given to Dr. Jarrad Hampton-Marcell lab at University of Illinois Chicago. Figure 6. Strategies for Controlling Lassa fever Infection. The management of Lassa fever infection requires a comprehensive approach. Critical control measures encompass the early detection and diagnosis of cases facilitated by improved surveillance systems, along with the prompt isolation and appropriate treatment of infected individuals. Stringent implementation of infection prevention and control practices within healthcare settings is paramount to minimize person-to-person transmission. Furthermore, public health interventions, such as community education, hygiene promotion, and measures to control rodents, play a pivotal role in reducing the risk of virus exposure and disrupting its transmission cycle. This figure was created using the Biorender (http://biorender.com/) licence given to Dr. Jarrad Hampton-Marcell lab at University of Illinois Chicago. Supplementary Material File (image1.emf) Download 73.29 KB Information & Authors Information Version history V1 Version 1 13 November 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords antigen presentation disease control epidemiology immune responses lassa virus vaccines/vaccine strains virus classification Authors Affiliations Angus Nnamdi Oli Nnamdi Azikiwe University Faculty of Pharmaceutical Sciences View all articles by this author Ifeanyi Ferdinand Chukwuma 0009-0005-9083-6294 Nnamdi Azikiwe University Faculty of Pharmaceutical Sciences View all articles by this author Ezinne Janefrances Nwonu National Biotechnology Development Agency View all articles by this author Morteza Saki 0000-0001-7419-0116 Ahvaz Jondishapour University of Medical Sciences Faculty of Medicine View all articles by this author Samson Adedeji Adejumo 0000-0001-9971-5193 [email protected] University of Illinois Chicago View all articles by this author Metrics & Citations Metrics Article Usage 697 views 201 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Angus Nnamdi Oli, Ifeanyi Ferdinand Chukwuma, Ezinne Janefrances Nwonu, et al. 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