UK-Public Health Rapid Support Team and London School of Hygiene and Tropical Medicine, London, United Kingdom.
PLoS Negl Trop Dis. 2022 May 19;16(5):e0010423. doi: 10.1371/journal.pntd.0010423. eCollection 2022 May.
Lassa fever (LF) often presents clinically as undifferentiated febrile illness. Lassa Fever cases in Sierra Leone have been falling since the 2014-2016 Ebola epidemic. Data from other LF endemic countries suggest that this is not a true reflection of local epidemiological decline, but rather a function of either health seeking behaviour or the health/referral system. In Sierra Leone, many other diseases present with a similar early clinical picture, including COVID-19 and Marburg Disease (which has recently emerged in neighbouring Guinea). This empirical study explores the implementation of health system processes associated with International Health Regulations (IHR) requirements for early detection and timely and effective responses to the spread of febrile disease, through the case study of LF in Sierra Leone.
METHODOLOGY/PRINCIPAL FINDINGS: This study used a qualitative approach to analyse local policy and guidance documents, key informant interviews with policy and practice actors, and focus group discussions and in-depth interviews with health care workers (HCWs) and community health workers (CHWs) in Kenema District to examine the ways in which undifferentiated fever surveillance and response policies and processes were implemented in the post-Ebola period. Multiple challenges were identified, including: issues with the LF case definition, approaches to differential diagnosis, specimen transport and the provision of results, and ownership of laboratory data. These issues lead to delays in diagnosis, and potentially worse outcomes for individual patients, as well as affecting the system's ability to respond to outbreak-prone disease.
CONCLUSIONS/SIGNIFICANCE: Identification of ways to improve the system requires balancing vertical disease surveillance programmes against other population health needs. Therefore, health system challenges to early identification of LF specifically have implications for the effectiveness of the wider Integrated Disease Surveillance and Response (IDSR) system in Sierra Leone more generally. Sentinel surveillance or improved surveillance at maternity facilities would help improve viral haemorrhagic fever (VHF) surveillance, as well as knowledge of LF epidemiology. Strengthening surveillance for vertical disease programmes, if correctly targeted, could have downstream benefits for COVID-19 surveillance and response as well as the wider health system-and therefore patient outcomes more generally.
拉沙热（LF）通常表现为临床无差异发热疾病。自 2014-2016 年埃博拉疫情以来，塞拉利昂的拉沙热病例一直在减少。来自其他 LF 流行国家的数据表明，这并不是当地流行病学下降的真实反映，而是健康寻求行为或卫生/转诊系统的功能。在塞拉利昂，许多其他疾病也表现出类似的早期临床症状，包括 COVID-19 和马尔堡病（最近在邻国几内亚出现）。这项实证研究通过塞拉利昂 LF 的案例研究，探讨了与国际卫生条例（IHR）要求相关的卫生系统流程的实施情况，以实现早期发现和对发热疾病传播的及时有效应对。
方法/主要发现：本研究采用定性方法分析了当地政策和指导文件，对政策和实践行为者进行了关键人物访谈，并对凯内马区的卫生保健工作者（HCWs）和社区卫生工作者（CHWs）进行了焦点小组讨论和深入访谈，以检查在埃博拉疫情后实施的未分化发热监测和应对政策和流程的方式。确定了多个挑战，包括 LF 病例定义、鉴别诊断方法、标本运输和结果提供以及实验室数据归属方面的问题。这些问题导致诊断延迟，可能对个别患者的预后产生影响，也影响了系统对易爆发疾病的应对能力。
结论/意义：确定改善系统的方法需要平衡垂直疾病监测计划与其他人口健康需求。因此，LF 特定的卫生系统挑战对广泛的综合疾病监测和反应（IDSR）系统在塞拉利昂的有效性具有影响。哨点监测或改善产妇保健机构的监测将有助于改善病毒出血热（VHF）监测以及 LF 流行病学知识。加强垂直疾病规划的监测，如果目标正确，对 COVID-19 监测和反应以及更广泛的卫生系统——从而更普遍地对患者预后——也会产生下游效益。
