Chaudhary Manu, Cutland Clare L, Bonet Mercedes, Gentile Angela, Jones Christine E, Marshall Helen S, Stergachis Andy, Voss Gerald, Darko Delese Mimi, Sevene Esperanca, Hyde Terri, Fairlie Lee, Kampmann Beate, Everett Darcie, Munoz Flor M
Department of Infectious Diseases, Rainbow Children's Hospital, Bangalore, India.
African Leadership in Vaccinology Expertise (Wits-Alive), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Vaccine. 2025 Jan 1;43(Pt 1):126479. doi: 10.1016/j.vaccine.2024.126479. Epub 2024 Nov 1.
Lassa fever is a serious epidemic viral disease in West Africa affecting an estimated 2 million people annually with about 5000-10,000 deaths, although supporting data is sparse. Lassa fever significantly affects neonates, children, and pregnant women, however, comprehensive data on its impact in these populations are lacking. We reviewed the available literature on Lassa fever to assess its prevalence and impact in these populations and implications for vaccine development. Clinical features in children were similar to those observed in adults, with complications such as bleeding. Altered mental status, anasarca (swollen baby syndrome), bleeding, and poor urine output were risk factors for death. The case fatality rate (CFR) in 16 paediatric studies ranged from 6 % to 63 % and was 66.7 % and 75.0 % in two neonatal studies. In a systematic review of studies on pregnant women the CFR was 33.73 %. The adverse foetal outcomes included miscarriage, stillbirth, and intrauterine death associated with maternal death. Since Lassa fever significantly affects neonates, children, and pregnant women, developing a safe and effective, single-dose vaccine for these high-risk populations is vital. Currently, there are four clinical trials assessing Lassa virus vaccines. Only one of these trials is enrolling children aged ≥18 months, and exclude pregnant and breast-feeding women. It is essential that pregnant and breast-feeding women and young children are included in clinical trials that incorporate robust safety surveillance and risk mitigation measures. In our review, potential approaches to address the specific gaps in the areas of diagnosis, management, and prevention of Lassa fever in these specific populations, such as disease surveillance systems and vaccine development, were identified. A comprehensive strategy with investment focused on addressing specific knowledge gaps will be essential in protecting the health of these specific populations in Lassa virus endemic regions.
拉沙热是西非一种严重的流行性病毒疾病，尽管相关支持数据稀少，但据估计每年仍有200万人受其影响，约5000至10000人死亡。拉沙热对新生儿、儿童和孕妇有显著影响，然而，关于其对这些人群影响的全面数据却很缺乏。我们回顾了有关拉沙热的现有文献，以评估其在这些人群中的流行情况、影响以及对疫苗研发的意义。儿童的临床特征与成人相似，会出现出血等并发症。精神状态改变、全身性水肿（肿胀婴儿综合征）、出血和少尿是死亡的危险因素。16项儿科研究中的病死率（CFR）在6%至63%之间，两项新生儿研究中的病死率分别为66.7%和75.0%。在一项关于孕妇的系统综述研究中，病死率为33.73%。不良胎儿结局包括流产、死产以及与母亲死亡相关的宫内死亡。由于拉沙热对新生儿、儿童和孕妇有显著影响，为这些高危人群研发一种安全有效的单剂量疫苗至关重要。目前，有四项评估拉沙病毒疫苗的临床试验。其中只有一项试验纳入了18个月及以上的儿童，且排除了孕妇和哺乳期妇女。将孕妇、哺乳期妇女和幼儿纳入具备强有力安全监测和风险缓解措施的临床试验至关重要。在我们的综述中，确定了应对这些特定人群在拉沙热诊断、管理和预防方面具体差距的潜在方法，如疾病监测系统和疫苗研发。一项聚焦于填补特定知识空白的全面投资战略对于保护拉沙病毒流行地区这些特定人群的健康至关重要。
