Ebola 2.0? NJ Man Dies of Lassa Fever, Ebola’s Less Deadly Cousin

A New Jersey man died Monday evening after been diagnosed with Lassa fever, a frightening infectious disease from West Africa that is rarely seen in the United States.

The man recently returned from Liberia. He arrived at New York City’s JFK International Airport on May 17. After his return, he grew seriously ill and suffered from multiple organ failure, said Dr. Tom Frieden, director of the U.S. Centers for Disease Control and Prevention in Atlanta.

Like Ebola, Lassa is a viral hemorrhagic fever, and like Ebola, Lassa is deadly: the number of infections per year in West Africa is estimated at 100,000 to 300,000, with approximately 5,000 deaths, according to the CDC.

The reservoir, or host, of Lassa virus is a rodent known as the “multimammate rat” (Mastomys natalensis). Because Mastomys rodents are rampant in West Africa and often live in and around homes, transmission is common, through ingestion of the animals themselves or via inhalation of infected particles in the air.

Rat-to-human transmission isn’t the only way the virus spreads: person-to-person transmission may occur after exposure to virus in the blood, tissue, secretions, or excretions of an infected individual. According to the CDC, casual contact (without exchange of bodily fluids) does not spread Lassa. Person-to-person transmission is common in health care settings when proper personal protective equipment (PPE) is not available or not used. Lassa virus may be spread in contaminated medical equipment, such as reused needles. (Uh oh – does all of this sound familiar?)

Symptoms of Lassa infection usually begin 1-3 weeks after contact with the virus.

From the CDC:

For the majority of Lassa fever virus infections (approximately 80%), symptoms are mild and are undiagnosed. Mild symptoms include slight fever, general malaise and weakness, and headache. In 20% of infected individuals, however, disease may progress to more serious symptoms including hemorrhaging (in gums, eyes, or nose, as examples), respiratory distress, repeated vomiting, facial swelling, pain in the chest, back, and abdomen, and shock. Neurological problems have also been described, including hearing loss, tremors, and encephalitis. Death may occur within two weeks after symptom onset due to multi-organ failure.

Approximately 15%-20% of patients hospitalized for Lassa fever die from the illness. However, only 1% of all Lassa virus infections result in death.

Because the symptoms of Lassa fever are so varied and nonspecific, clinical diagnosis is often difficult. Lassa fever is also associated with occasional epidemics, during which the case-fatality rate can reach 50% in hospitalized patients.

Back to the New Jersey case.

CDC officials have not released the name or any identifying information about the man, other than to say he frequently traveled to Liberia for business and worked in the mining industry.

Officials also declined to identify the New Jersey hospital where the man first went for care, or the SECOND NJ hospital were he was going to be treated with Ribavirin, an antiviral medication used in suspected Lassa fever cases. The man died before he could receive the antiviral drug. (Uh oh – this sounds familiar too…)

The man reportedly had no symptoms during his flight to NJ. The next day, he went to a hospital with a sore throat and lethargy. Hospital officials say the man was asked about his travel history and did not say he had recently been to West Africa.

Three days later, the man returned to the hospital with more serious symptoms. On Saturday, he was transferred to the second hospital. On Monday, CDC lab tests of the man’s blood confirmed he had Lassa fever.

A “special response team” including a Lassa expert and specialists in occupational safety and waste management will be sent by the CDC to the second hospital today.

Health officials said they don’t think the case is cause for alarm. But as a precaution, the CDC and New Jersey health officials are trying to track down and monitor anyone the man was in contact with during the past week, including health workers at two New Jersey hospitals and people who sat close to him on his recent flight from Morocco to New York.

The last confirmed case of Lassa in the U.S. was in Minnesota last year. Prior to that was a case in Pennsylvania in 2010.

CDC director Dr. Tom Frieden said “We expect to see Lassa fever and other infections like this. Because of Ebola, we’re now better prepared to deal with it.”

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