Incubation period days

Period of communicability All body fluids are infectious from the start of the illness and up to 9 weeks for urine and 3 months for semen.

Occurrence and distribution Lassa fever is found in West and Central Africa including the countries of Guinea, Sierra Leone, Liberia, Nigeria and Central African Republic, but serological testing has found evidence of infection in Senegal, Mali, Guinea Bissau and the Congo.

All ages and both sexes are susceptible, but pregnant women have a severe infection with high mortality and loss of the fetus.

Control and prevention is by control of the rats and careful isolation of patients. M. natalensis lives in close proximity to humans in the home, fields where people tend their crops, and in mines and similar industrial sites. Rats should be controlled (see Box 16.1) and prevented from entering the home. Food and drinking water should be protected with covers and a state of cleanliness observed to minimize rat excreta contamination.

All cases must be hospitalized and:

• rigorous isolation of the patient by the most secure means possible;

• careful sterilization of syringes, needles and all re-used equipment with 0.5%

sodium hypochlorite, 0.5% phenol with a detergent, autoclaving or boiling;

• extreme precautions with any oral secretions, blood, faeces and urine. Blood must be handled with the utmost precaution using, as a minimum, holeless rubber gloves. Faeces and urine should be placed in plastic bags, which are boiled or burnt;

• terminal disinfection with formaldehyde fumigation to all articles used by the patient.

Treatment is with ribavirin intravenously for 10 days within the first 6 days of illness.

Surveillance All close contacts of a case should be identified and followed up for 3 weeks with twice daily temperature, and hospitalized if it becomes more than 38.3°C. With air travel, it is possible that an incubating case may travel to another country before showing symptoms, so if there is any indication, such as coming from an infected area, then the person should be admitted to hospital with strict barrier nursing procedures. Any known or suspected case should be reported to WHO and neighbouring countries.

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