# LHF - Trying to understand an Obscure disease.



## Sheilawisz (Oct 14, 2014)

Hello, everyone who dwells at the Research Forum.

I really need some help from you, in the research of something important... this is for a story that I am planning to start writing very soon, and I ask for your assistance because I have failed to understand this subject by myself as well as I would like.

The story will be called _Winter Hollow_, and it will be set in the real world in modern times. The idea is that a peaceful Connecticut town is suddenly attacked by an obscure disease that few people know about, and the drama is described from the point of view of a common family.

To start with, I needed the obscure disease in question. I wanted something that few people have ever heard about, but dangerous and scary at the same time... The disease must be from the real world instead of something fictional, and I found a good candidate in an illness called Lassa Fever.

This Lassa Fever is the kind of thing that people search in Google the first time that they hear about it. Most likely you never heard about it before checking out this thread, so I want to start by giving you a picture about the history of this real world disease:

Back in January of 1969, there was a Nurse called Laura Wine. She was working at a small Nigerian village called Lassa, as part of the Church of the Brethren missionaries. One day they attended a patient who displayed a febrile illness, and a few days later Laura began to feel muscle pains in her back.

Laura's illness grew worse, and soon she was unable to work. She began to suffer from a very sore throat, hemorrhages, swelling and delirium, and sadly she died a short time later despite having been sent to a hospital for a better treatment.

Two other nurses cared for Laura: Charlotte Shaw died, but Penny Pinneo managed to recover after receiving intensive care at a New York hospital for several weeks.

This became the subject of a book and a TV documentary back then. The disease killed other medical staff and researchers some time later, and even Yale University decided to destroy its samples of the virus. You can read more about Laura Wine following the link right here.

The problem here is that Wikipedia and other sources describe Lassa Fever as a much milder and unimportant disease.

As far as I know this illness affects hundreds of thousands of people every year, killing thousands and causing deafness to many others. It's a very serious health problem in the countries affected, because it is spread by a particular species of rats and that makes it impossible to eradicate.

Some sources report that about 80% of the cases develop only minor effects, 20% suffer a more malignant form of the disease and just 1% dies. Other sources speak about fatality rates reaching 60% causing devastation of villages and destroying entire families, so I do not know what to think...

There are four different known strains of the responsible virus, and at least one of them is more aggressive than the others. It seems that a victim is likely to develop a severe form of the illness in case that it comes directly from another person, and some sources even report that the severity of the disease and your chances of survival depend on your racial background.

After a very extensive research I have failed to understand what Lassa Fever is and how it works.

In case that you can help me to research better and obtain a better idea of the disease, I would appreciate it a lot. I want to dedicate my story to the memories of Laura Wine and the other people that discovered it, and also raise some public awareness about the problem that it represents.


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## CupofJoe (Oct 14, 2014)

You've probably seen it already, but the CDC have an interesting fact sheet that has a lot of academic references that might give you a next step...
Lassa Fever Fact Sheet
[In fact the whole CDC pages on it look pretty good for info.]
As Lassa Fever is a virus a Doctor might say "we don't really know" if you asked them how it works... its sort of a life form [but not really] that gains a hold on you and your cells and goes crazy... 
Viruses have to cruise that fine line in their ability to spread and their affect on their host. 
If they are easy to spread then they are not [usually] that disabling - the common cold. 
If they are are far more disabling [ and therefore lethal] then they are usually harder to catch.
Every so often a freak virus appears [1918 Flu springs to mind] that runs riot for a while, but eventually all that are most susceptible are exposed and either die or recover and an uneasy peace is restored [there is no mind behind a virus but I sort of think of it that way.]
As to what Lassa Fever does - if it follows other haemorrhagic fevers - you get an extremely high temperature and the physical shock that goes with it. This alone can be more than enough to kill someone if you don't have access to fluids and good care. 
I've just read that [apparently] Lassa Fever is considered one of the less severe haemorrhagic fevers - gulp...


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## Captain Loye (Oct 14, 2014)

I'm on my phone so please excuse any mistakes! I don't know much about medicine but I studied viruses and evolution so I can tell you a little about that. Viruses are technically alive (though debatable) and have co-evolved with their hosts. A virus normally acts like the cold sore virus - sits pretty benignly in its host, quietly replicating and then spreading to other hosts occasionally. 

The viruses we see as diseases are generally ones that have jumped from the species they evolved with to humans. The lack of evolutionary history sees the virus spread too fast in us, or in different tissues and causes disease-like symptoms. The Lassa virus jumped from rodents (from Wiki). Once they jump these viruses CAN be really easy to catch and cause epidemics or peter out pretty harmlessly - it's all dependent on how quickly the virus spreads in the body and how easily it is transmitted.

Just quickly, viruses are obligate parasites which means they need a host to survive. Viruses enter our cells and use our proteins to replicate their DNA and make copies of themselves.

I hope this helps, sorry I can't help about about the medical side of viruses, but let me know if you want to know more about how their infection actually happens.


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## Sheilawisz (Oct 14, 2014)

Hi CupofJoe, thanks for your reply to my request.

I checked the CDC Fact Sheet about LHF several times during my research, indeed. It gives good information about the disease just like many other resources, but in general, it's just basic information. I know all the general facts about it, so I need deeper and more precise information.

What I do not understand is the conflicting information about LHF.

Some resources describe it as a mild disease (the milder of the HFs as you said) while others talk about devastating outbreaks and panic caused by this illness. So, which side is right? Apparently it can behave both ways in different situations and with different strains of the virus, but I am not sure.

This is another interesting link about the problems caused by LHF.

My personal theory is that it strikes a human population in a way similar to Smallpox or Measles: The people that become exposed to the disease for many generations develop certain resistance, but the same pathogen can cause a disaster if a new population is suddenly exposed to it.

The best option would be to create an imaginary strain of LHF for my story, but I want to keep the disease as realistic as possible and avoid a sensationalism approach.

@Captain Loye, hello and Welcome to Mythic Scribes!

Thank you for explaining in more detail what viruses are. I thought that they were not really alive, that they were just incredibly tiny capsules of protein and genetic material... It's curious to think that they are technically life forms after all, the simplest expression of life on the planet.

The other night I heard in a documentary that viruses have played a key role in the evolution of plants and animals, too.

Anyway, I'll try to find key information about the illness so I can write the story without an imaginary strain. My other option would be to fictionalize some other real world disease, but I want to write about Lassa Fever because it's really obscure and nobody has written a story about it yet.


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## stephenspower (Oct 14, 2014)

Search for Nigerian sources: http://thenationonlineng.net/new/29-million-nigerians-at-risk-of-lassa-fever/


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## Trick (Oct 14, 2014)

I think your best bet is direct communication with an expert. Titus Ibekwe wrote this very detailed article and I found him on LinkedIn. Even if he can't give you knew information, he may know who else can. He is a researcher so maybe he would appreciate your endeavor to correctly represent the disease in your work.


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## Sheilawisz (Oct 14, 2014)

Trick, thank you very much for the link to that article.

I had never seen it during my long hours of LHF research, this is excellent material and it's full of interesting facts that I did not know until now. I especially appreciate that it was written by a serious expert on this difficult subject, because this person really knows what he is talking about.

It finally confirms to me that the clinical cases of LHF indeed take different forms, which depends on various factors and eliminates the idea of a predictable and clear disease. It also speaks against the idea of a harmless infection happening most of the times, which is a myth described by other sources and misguides the people researching about this.

One of the reasons that push me really hard to write _Winter Hollow_ is that I just cannot believe how ignored and neglected the Lassa Fever problem is. People and TV news always talk about other diseases and epidemics, but very few have even heard about LHF. It's like the world was pretending that it does not exist...

@Stephenspower: I tried that too, I mean trying to obtain information from a variety of Nigerian websites. That allowed me to read some very creepy stories here and there, but I obtained little useful information out of them.


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## K.S. Crooks (Oct 17, 2014)

Interesting idea. What I would suggest if you want to use a real infectious disease is first decide how the people are being infected, how long you want them to last before they die and what the treatment will be. Remember that it can be a unknown strain or crossed over from an animal or have been genetically modified or a vaccine gone wrong. Use whichever real disease you choose as a template not an absolute script.


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## Caged Maiden (Oct 18, 2014)

SO there's a book I read in High School, about infectious diseseas and it was by far the most riveting book I've ever read on the subject.  SO much so, I renewed it twice.  I instantly remember a few of the diseases, Lassa Fever being one of them, but also Bolivian Hemmoraging Disease (can't spell late, sorry), Ebola, Plague, and others.  OMG, I WISH I remembered the title, because I NEED it in my collection.  if only my library from back then had records of my Library Card records, because I would pay any amount to own a copy of that book.  If I ever find it, I'll send you the link, but it'll probably be too late for your project.  In short, check your library.  A lot of good books on the subject were published in the 70s and 80s.  Those books aren't online though.  You actually have to go check them out.  I'd start there.


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## Caged Maiden (Oct 18, 2014)

Just a note about Bolivian Hemorraghic Fever, since I remember its causes and I was profoundly inspired by the book I mentioned above, it was ultimately caused by DDT.  When the planes sprayed the forests with DDT to keep the mosquitoes in check, the people and dogs were unfazed by the pesticide.  Cats, however, died.  All of them.  With cats absent, mouse populations exploded and the mice infected people by coming into contact with food supplies.  Where there are mouse droppings in human food, there is disease like this.  The United States shipped crates of homeless cats down to Bolivia and the plague stopped.  Interesting tidbit.  Many other infectious diseases can be tied to similar situations, including the Black Death outbreak in the fourteenth century.  When flooding after periods of drought pushed the Mongolian marmots out of the steppes and into populated areas, they came into contact with animals and people.  Rats became new hosts for the fleas carrying the disease and the rest is history (haha).  I wrote a paper on Post-plague European Art and it's really interesting the cause and effect of the Black Death on Europe.  I mean, it ended the feudal system and changed religious outlooks, class structures, warfare, population density, EVERYTHING for centuries.  In fact, the population of Europe didn't fully recover from the losses until the 1800s.  By that I mean countries didn't attain a Pre-plague population until then.

We're very lucky that epidemics aren't more common, but every time one springs up in a rural place, it's almost always animal contact in a way that points to environmental change or human encroachment into wild areas.  

So what information do you need about your disease?  I did a quick Google search and it looks like there are dozens of books that talk about it.  I'm confused why you're having a hard time finding information on the subject.


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## Caged Maiden (Oct 18, 2014)

You know, I remember reading the exact account you describe.  Where is that BOOK!?!  I NEED IT!  Anyways, plague isn't altogether different.  Though it's a bacteria, not  virus, right?  Anyways, there re different strains of it and have been many over the past centuries.  Some strains kill very few people ( and in New Mexico we had about 6-10 cases each year of plague), but others are deadly and kill up to 75%.  There was certainly a difference between whether you were bit by a flea or caught the disease once it had been coughed into your face by a sufferer.  I don't know why that differentiation happened.  It wasn't in the scope of my research.  Anyways, I'd look at older books, because I checked that out in 1995 and it wasn't new back then.  It was a seriously good study of all those diseases in the 60s-80s that made public the problem of epidemics in faraway places that Americans didn't hear about every day.  I'll check back in when I have more for you.  You have lit a fire and maybe I can find my long lost book now.  

It's weird, because my nano is about infectious disease, too.  But I'm using Rabies and Syphilis.  I know it's weird, but I kinda fell in love with those two for this story.  But yeah, I could use some help with my own diseases too, so thanks for this thread and I'll see whether I can be of any further help.


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## Sheilawisz (Oct 18, 2014)

Thanks everyone for your interest, response and valuable assistance.

K.S. Crooks, first of all Welcome to Mythic Scribes. Thanks for your point of view, I think that you are right... I cannot use the technical information about an infectious disease as an absolute template, because a story needs some degree of flexibility in order to develop well.

I have decided to create an imaginary strain of Lassa Fever for the story.

It will probably be called _Lassa Winter_ (after Winter Hollow, the fictional town), but I will try to remain as realistic as possible, and also my other goal is to keep a cool head about the disease.

Caged Maiden, this is your lucky day because I know exactly what book you are talking about.

Judging from your description of the book, it must be _The Coming Plague_ by author Laurie Garrett. I have never read it, but I know that it dedicates a considerable number of its pages to the history of Lassa Fever and its American cousin, the Machupo virus which is the cause of the Black Typhus or BHF.

I also recommend reading _The Black Death and the World it Made_, by Norman Cantor.

The difficulty I have been experiencing in my research is not only because of how obscure Lassa Fever is, but also because it's a very complex and mysterious disease. To this day there still are more questions than answers about it, and that makes it really difficult to write a story about the monster.

For some reason, I am really intrigued and moved by the history and consequences of Lassa Fever. I'll tell you when _Winter Hollow_ comes to the Showcase, and I hope that you'll read it.


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## psychotick (Oct 18, 2014)

Hi,

To understand Lassa you have to understand the societies that it's found in. These west African countries (yes same as ebola) have all sorts of issues that make the spread and control of certain diseases almost unique to them. In Lassa's case the important factors are that:
1 It's harboured by certain rats that are endemic to these countries.
2 You pick up the virus largely by eating the rats or coming into contact with their excement.
3 Eating these rats is popular - in fact it's considered a delicacy
4 The rats are literally everywhere and that includes in many people's homes.
5 There is a higher value placed on the word of alternative healers in these countries - many who have no medical training.
6 The people are poor, so attending the actual doctor is discouraged because of the costs involved including travel.
7 The illness for most people is mild lasting a few weeks, and including fever and hearing loss in some cases.
8 Wars an social disorders have made it difficult for researchers to work in these countries.

Given all of that it's not surprising that estimates of the presence of antibodies in patients presenting at hospitals are shockingly high. In some cases up to fifty percent of people arriving at the hospital are found to have them, indicating that they have been exposed to the disease at some point.

So the likelihood of this disease arriving in a first world country is minute - save as a passenger from one of these countries, and the chance of it being then spread from them to others is almost non-existent since we don't have the particular rats that they do to harbour the disease. (Nor do we eat them or allow them in our homes - I hope!)

Hope that's what you need,

Cheers, Greg.


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## Sheilawisz (Oct 19, 2014)

Thanks for your reply, Greg.

I know and understand the limitations of Lassa Fever, and the factors that exist behind it and make everything worse in the countries that remain affected by it.

The likelihood of a LHF epidemic in a fully developed country is very small, but isolated cases of the disease have been reported in many countries. There was a tragic case of a Lassa Fever fatality in Chicago in 1989, recently there was another case in Minnesota and the same has happened in the UK and other countries as well.

I do need a special plot to explain how the pathogen would spread in a small town, so I am working on that.

The very high presence of antibodies in the affected population explains why a very aggressive and deadly disease often presents itself as a minor ailment, which confused me a lot during my research. In the case of my fictional town there would be no antibodies in the people there, so the outbreak could be devastating.

@Caged Maiden: I have read parts of _The Coming Plague_ by Laurie Garrett, last night. It does feature an entire chapter dedicated to the history of BHF and another chapter to LHF, just like you described.

I hope that you will find it at your local library.


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## psychotick (Oct 19, 2014)

Hi,

Actually it's the other way around. The very high presence of antibodies in the population is explained by the fact that this illness is both mild in severity and ubiquitous in the environment. Ie many people are exposed and few become seriously ill or die.

The lack of antibodies in your town would not make the people more susceptible to serious illness. It would just mean that since no one has been previously exposed, all the people in the town would be susceptible. If half the people had been antibody positive, than that half would have likely been immune, so only the other half could have become ill. Severity of the illness would be determined by other factors - most importantly genetics of both the virus and the host population. I would go with this being a new strain of the disease. 

This would also fit well with your strain needing a new host. Viruses do jump species from time to time, and not knowing the makeup of your town, I would suggest that if it has its local rat population under control and out of the house, you would need another animal vector. Preferably one that does have access to the house. Cats would seem to be an ideal alternative since they hunt and kill rats - though dogs of course are more social animals allowing faster dog to dog spread.

Also there is one group of people who are susceptible to serious illness from this disease, pregnant women and their unborn children.

Cheers, Greg.


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## Sheilawisz (Oct 19, 2014)

Greg, that is a great point but after all of my research I have to disagree with it.

Many sources describe LHF as something barely more serious than the common cold, but if that was true then there would be no reason to keep and study the virus inside of highly controlled BSL-4 laboratories. All of the nurses, doctors and researchers that suffered dramatic and tragic deaths when the disease was first discovered would have survived, as well.

I think that the severity of the disease depends on a variety of factors, but in general it seems to function in a way similar to Smallpox. The Europeans of the 16th Century were very resistant to the disease, but when Smallpox was brought to the American continent it became a deadly epidemic of catastrophic consequences.

Something similar happened to French troops with Yellow Fever, when they fought against the Haitian forces between 1802 and 1803.

The local population was pretty much immune to Yellow Fever, but the disease caused such a devastation to the French soldiers that their commanders sent letters back home to describe the dramatic effects and the terror caused by the epidemic. They began to acquire immunity after some time, but it was too late and their campaign was doomed.

LHF remains mysterious despite all these years of scientific research, but at least a vaccine has been developed and the aggressive treatment with Ribavirin helps to save many lives.

My story will describe an imaginary strain, but dogs and cats will not be involved.


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## psychotick (Oct 19, 2014)

Hi,

A few points. First westerners were more resitant to smallpox when they came to America - but it had nothing to do with an antibody response. It was a genetic resistance tied to the fact that three and four centuries before a third to a half of Europe had been wiped out by the disease, and that those who survived were more likely to have genes confering resistance upon them. They could still however get the disease and die. Vaccination was what killed the disease. And vaccination works by confering an antibody resistance upon people. I recommend "Smallpox: The Death of a Disease" by DA Henderson for a more detailed and interesting work on how smallpox was vanquished.

Second Lassa disease is nothing more serious than a mild febrile illness for most people. But for one in five it will require hospitalisation, and for one in a hundred it will kill. And all viruses with the potential for killing should be handled in a secure biocontainment facility. It's international law.

Third the tragic stories of those doctors and nurses who died of Lassa Fever are what's called anecdotal evidence. There is no reason to believe that of those westerners living in these countries where the disease is endemic, they were at any greater risk of becoming sick or dying than the locals. Probably eighty percent of them who contracted the illness also had only a mild febrile illness.

Last, you need a vector for this illness since Lassa Disease is not passed person to person.

Cheers, Greg.


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## Sheilawisz (Oct 20, 2014)

Greg, I appreciate your contribution to my research but now I am getting confused again.

I have seen this same information in many medical sites before, I mean the same percentages that you are talking about. I used to think the same about LHF, but this data does not explain why the disease sometimes causes epidemics that reach very high fatality rates and why the virus samples are kept at the highest level of biosafety laboratories.

Pathogen agents as deadly as Yersinia Pestis and Yellow Fever are kept at Level 3, but for some reason Lassa has always been at Level 4 despite the fact that a vaccine and a treatment are available.

Also, I would not call the deaths of Laura Wine and her friends anecdotal evidence.

Those cases are well documented, and their blood and tissue samples were analyzed at Yale University where the virus was isolated for the first time by Jordi Cassals. The appearance of a mild disease would not have attracted the international attention that developed during the first months of 1969, it was a serious thing.

There is something really intriguing and mysterious about this disease, and apparently nobody really understands it well.

This is what confuses me so much while researching LHF. In one side, I have many sources explaining simply that the disease is mild and unimportant. In the other side I have other sources that paint a very different picture, something more like the Plague, and I end up unable to decide which side is correct.

It's also possible that the Pinneo strain of LV (the original strain from 1969) is particularly aggressive, while other strains are much less dangerous. It could be something genetic like you explain, or the antibodies developed in a population after a long time, who knows... anyway, in my story the fictional _Winter Strain_ will be a very destructive agent.

Instead of using an animal vector, the disease will spread through contaminated food and drinks at the town's Halloween festivities.

I'll let you know when I start writing the story, it would be good to receive feedback. Thanks for recommending that Smallpox book to me, I'll try to find it somewhere.


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## psychotick (Oct 20, 2014)

Hi,

I'll try to arrange this in order of the points you raise.

1 First the virus is maintained in a level four biosecurity containment facility rather than level three because currently there is no vaccine for the disease. There have been a number developed but as far as I know none have completed their trials. There are effective treatments for both the Plague and Yellow Fever including vaccination. (In fact one of my first and ongoing jobs was to check the vaccination records of ship crews arriving in New Zealand for their yellow fever status, and arrange vaccination for them as required.)

2 To understand epidemics and why they occur it is sometimes necessary to consider diseases and hosts as a predator prey dynamic. So consider foxes and rabbits as an example - assuming that rabbits are only eaten by foxes. What happens is that you get a cycle whereby the rabbits start building up in numbers and then the foxes start eating and breeding. At some point however the foxes increase to such numbers that they consume large proportions of the rabbits. Thereafter the rabbit numbers thin, followed in time by the numbers of foxes as they starve.

This cycle is seen throughout all of ecology with predators and prey, whereby the numbers cycle over periods of months and years. Thus you get cricket cycles where the insects become epidemic every seven years from memory. Viruses and their hosts follow the same cycle, though the hosts don't always die. Becomming immune is sufficient for the virus to no longer be able to reproduce in the host leading to lessor viral shedding.

The cycles of human epidemics of Lassa fever probably relate more to the numbers of rats available to host the virus and their access to humans, since the rats act as the reservoir.

3 I know my use of the word anecdotal may sound controversial or even harsh. But my background is as an epidemiologist. We analyse cases of disease including outbreaks not in terms of individual cases but rather in statistics. A few single cases here and there no matter how tragic do not sway the overall statistics. Not when in this case you have three to five hundred thousand hospitalised cases annually, an unknown number of cases that are not treated, and probably a larger number of asymptomatic cases.

These people who became ill must be considered by an epidemiologist within terms of the population exposed, the total number affected in terms of morbidity and mortality, in order to determine the severity of an illness within a population. Individual cases don't tell us a lot unfortunately.

4 Is it a mild illness or a plague? The answer is both. For eighty percent of people it's a mild illness. For twenty percent it may require hospital care. And for one percent it may be lethal. That last one percent account for perhaps five thousand deaths per year.

To give a comparable example, the flu is generally considered a mild illness. But for a certain percentage it may result in a need for hospital care, and for a few it will kill. And while the numbers killed as a percentage are usually small, just a small change in the severity of the illness as different strains arise, can result in shocking differences in morbidity. The Spanish Influenza for example killed something like eighteen million people world wide. That made it probably the worst epidemic of the twentieth century in terms of the numbers killed. And yet for most people it was still a mild illness - just the flu as they say.

By the way I do strongly recommend that people get their annual flu shots.

Cheers, Greg.


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## Sheilawisz (Oct 20, 2014)

Thank you Greg, it's really great to be discussing these matters with an epidemiologist.

The vaccine for Lassa Fever was developed by Thomas Geisbert, but you are right, it has not completed all the complicated trials. However, the treatment with Antiserum or with Ribavirin is effective against LHF and yet the pathogen remains at Level 4 anyway... Why is that? What are they afraid of, if it's really just a mild illness after all?

I question the numbers and statistics available about LHF, really I do not trust those percentages at all.

The disease can be easily confused with Malaria and other things, so we have no way to know for sure the true epidemiology statistics in this case. In the affected countries many LHF victims could be assumed to have died of something else, so to talk about those _80% mild and 20% severe_ calculations is too simplistic.

The supposed five thousand casualties every year could be thirty thousand in reality, we cannot know for sure.

There is another aspect to consider here:

Even though the mild form of LHF does not cause death, the severe type of Lassa Fever reaches mortality rates as high as 50%. It is the prompt and aggressive treatment with Ribavirin which helps to lower the rates to around 15% in hospitalized cases, and that's where the supposed fatality between 1 and 3% is calculated from.

Without the valuable Ribavirin it turns out that the fatal rates from LHF can exceed 10%, even if we assume that the disease is really mild in 80% of cases. This is part of the reasons why I refuse to believe the happy side of the story. It's too easy, too simple and it fails to explain the darkest parts of LHF. The other reason is this:

January, 1969. Laura Wine develops a severe disease caught from an unidentified patient. She is flown from the small village of Lassa to the Bingham Hospital (later renamed Evangel) at Jos, where she dies. Nurse Charlotte Shaw contracts the infection while looking after Laura. She too develops a severe disease and dies. Nurse Penny Pinneo contracts the infection during Shaw's autopsy, and she develops a severe disease too.

Penny is flown to New York, where she recovers after enduring a gruesome illness for nine weeks. Her life is saved only thanks to the intensive medical care provided for her all that time. Later, Yale scientist Jordi Casals contracts the infection from laboratory mice infected with the Pinneo strain, and he too develops a life-threatening disease.

Jordi's life is saved by Pinneo's Antiserum. Lab Technician Juan Roman contracts the infection from the laboratory, develops a severe illness and dies.

Am I supposed to believe that all of these people, one after the other, were unlucky enough to be part of the tragic 1% of cases? What a coincidence! No, something strange happens with this LHF thing. Some sources describe that a person that contracts the virus directly from a patient usually develops severe LHF and I think that's correct.

That would explain why there are epidemics of severe LHF that are not associated to the mild form of the disease, and why recently the CDC dedicated its efforts to track every passenger that traveled aboard the same flight of the Minnesota case.

What can you tell me about the four different known strains of Lassa virus? I know they are the original Pinneo strain, the Josiah strain that is more common at Sierra Leone, the AV and another that is called Nigeria strain. My theory is that the interaction between strains can lead to outbreaks of severe LHF, but I'll talk about that in a different post later.

Sometimes I feel tempted to conclude that this whole thing is a total mystery and abandon my research once and for all, but I am very intrigued by LHF and I really want to get to the bottom of everything.

I love your cat avatar, by the way =)


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## psychotick (Oct 20, 2014)

Hi,

There's a lot we don't know about this illness I'm afraid. But yes these cases you mention are individual cases. And two of them at least are unconnected with the others. 

Your two lab infections, are - at least in one case - associated with mice infected with the virus. The reality is that this is dangerous work and should have been done under stringent bio-control conditions. The fact that we have two people infected indicates that there was a mistake made somewhere, and mistakes in micro labs are often extremely serious. The innoculum from a cut for example is often larger than would be received through normal exposure routes, and the viral strains may vary. However the real question you need to ask, going back always to the statistics - is how many people working in that lab were exposed to the pathogen, how many became ill or developed an antibody responce, how many didn't, and how many died. We don't have that data.

The autopsy is an interesting route of exposure, and again if it was known that the patient had died of a viral haemorragic fever, should have been done under extremely controlled conditions. My guess is that it wasn't. And again the severity of the illness experienced from cutting open a body saturated with virus particles, was always likely to be high.

Laura Wine in all probability did not pick up the illness from contact with her unknown patient. That is not the normal route of infection for the illness. It's unfortunately more likely that there were rats and rat faeces in the clinic / hospital. Unfortunately in countries like those in West Africa hospitals are often extremely primitive.

This may also have applied to conditions in Bingham Hospital in Nigeria - though since its currently a teaching hospital attached to a university, I would hope not. However, forty or fifty years ago? I don't know.

The stats for morbidity and mortality in hospital admissions are worrying, and as you say they do seem high. But remember these are people who have been admitted to hospital. So as an example if twenty percent of people with the illness are admitted to hospital, and fifteen percent of them die, that is actually only three percent of all cases. Further the deaths are likely associated with the level of care received by patients, and the timeliness with which they arrive in the hospital. Many people do not go at all, or only if they are already at death's door.

Cheers, Greg.


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## Sheilawisz (Oct 20, 2014)

That's an interesting point of view, Greg.

It's very likely that the LHF infections acquired in hospital and laboratory settings tend to be severe because they have cut their finger, pierced their skin with a contaminated needle or something like that. That would introduce a larger number of pathogens into the body, even right into the bloodstream and this would explain why this causes the malignant form of the disease.

The severity of the infection would depend on the route of exposure to the agent.

I have read from some sources that catching the disease from food contaminated with rat urine is also particularly dangerous. Maybe other, more common methods of exposure result in the mild forms of LHF that are far more widespread, but I have another interesting theory:

You know that Dengue Fever is usually a mild disease, but the danger of developing the malignant Dengue comes when a person is repeatedly infected by different strains of the virus. I am not sure how it works, but I know that this is how Hemorrhagic Dengue develops and then the life of the person becomes endangered.

Do you think that something similar could be happening with Lassa Fever?

Penny Pinneo's antiserum saved lives, but eventually it was discovered that it didn't work in patients sickened by strains of LV different to the one that she became infected with. Perhaps getting one of the strains for the first time results in mild disease, and the malignant form develops when the same person catches a different strain.

What do you think of this?

According to the book _The Coming Plague_ by Laurie Garrett, only Jordi Casals was authorized to work inside of the Lassa laboratory of Yale University. It remained unclear how Juan Roman had caught the disease, but surely there was an accident at some point during the research.

Juan Roman's death finally convinced Yale to stop their LHF program and send their remaining samples to the CDC.


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## psychotick (Oct 21, 2014)

Hi,

Dengue is an interesting illness - and one much closer to my home literally as I live in New Zealand. No one really knows why in up to five perecent of cases Dengue fever  goes onto become Dengue Haemorragic Fever, or why it seems to be associated with previous infection with another strain. The current hypothesis is a thing called Antibody Dependant Enhancement, but the mechanism behind this is unclear. 

One suggested mechanism is that those previously exposed to previous strains and with antibodies developed to that strain then react to the new strain with the old antibodies, and that this is a mistake. The new strain of the virus and the antibodies to the old strain, are not a good match, and the resultant binding is damaging to white blood cells leading to capillary collapse.

Could something similar be happening in the case of Lassa Fever? Maybe. But there is no evidence for it. No evidence that previous infection with one strain of the disease makes infection with another strain more dangerous.

Cheers, Greg.


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## stephenspower (Oct 21, 2014)

"The United States shipped crates of homeless cats down to Bolivia and the plague stopped."

I'm going to spend some time looking into this. Sounds as fascinating as the bat bomb program.


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## stephenspower (Oct 21, 2014)

BTW, I presume you've read THE HOT ZONE, which is amazing. I wouldn't recommend you do so on a plane, like I did.


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## Sheilawisz (Oct 21, 2014)

Greg, New Zealand is one of the countries that I want to visit someday.

The landscapes look fantastic in the Lord of the Rings movies, and I think that also The Hobbit and the Narnia movies were filmed there. I know that New Zealand also has excellent mountains to practice climbing and skiing, so yeah, it sounds like a wonderful place from my point of view =)

I did not know that you had risk of Dengue Fever there.

There is also a considerable danger of Dengue where I live, but not in my city because we are 2400 meters above sea level and the responsible mosquitoes cannot survive up here. It was very surprising when a nearby city suffered an outbreak not a long time ago, because they are 1800 meters high and they should have been safe...

It's intriguing that there is no vaccine against Dengue, and also there is no drug that can attack it directly.

@Stephenspower: I have read _The Hot Zone_ indeed, a long time ago and also recently. I have a strong dislike for that book because it's not really a scientific account of the diseases described in it. Richard Preston is a powerful narrator, but The Hot Zone is a Thriller with a sensationalistic approach designed more to scare people than to inform them correctly.

_The Coming Plague_ is a more complete and scientific book, I recommend it a lot if you are interested in obscure diseases. There is also a book all about LHF called _The Lassa Ward_ by Ross Donaldson, but unfortunately I have never had a chance to read it.

My story _Winter Hollow_ is coming soon to the Showcase, I promise!


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## psychotick (Oct 21, 2014)

Hi,

No we don't have Dengue here. We don't have the mosquitoes. What we do have are a lot of visitors from the islands like Fiji and Samoa.

Cheers, Greg.


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## Caged Maiden (Oct 22, 2014)

one other thing I want to mention is Valley Fever, a disease common in the American Southwest.  I lived in Albuquerque for the last seven years, and I went camping all over and was generally out and about there.  When I went to Arizona for a camping event, it was the first time I heard of Valley Fever, but my friends warned me that I might come home sick.

Valley Fever is a fungus found in the soil in the area, and it gets into the lungs when you breathe in dust.  They recommend you wear a mask if your immune system isn't strong, but nothing else.  Well, other than a few people coming home with cold-like symptoms that last a few weeks, nothing happened on our trip, but the CDC says if you're exposed, you can see your doctor for treatment with an anti-fungal medication and be back to full health within a week

I was watching a program called Monsters Inside Me, where a woman got Valley Fever and she had a terrible illness.  Open sores, physical weakness.  She was incapacitated and the fungus tore her up.  Not only that, but there are other accounts of people visiting the southwest and going home and having severe responses.  SOme actually suffer severe, permanent mobility issues.  How in the world does that happen? One young man went to college in Albuquerque and he returned home to the East Coast when he became ill.  THey spent eight months trying to figure out what was physically crippling him, and finally the doctor found it was Valley Fever.  That was ten years ago and his mother says he aged twenty years in the one year, and now he's got severe arthritis and can hardly walk.  WHy would something that affects most people mildly, cause that kind of reaction?

Most people exposed get no symptoms or very mild ones.  Some people can have cold-like symptoms that last a few (up to six) weeks.  Then there seem to be some extreme cases that just baffle me, how they can all be caused by the same fungus.


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## psychotick (Oct 22, 2014)

Hi,

Had never even heard of this disease before and had to do some quick fact checking - so please bear that in mind. But basically it is a fungus as you say that grows in the soil - the correct term for the disease is coccidiodomycosis - and it seems to follow the same basic rules as other fungal diseases such as stachybotris (the one found in rotting wall cavities in damp ridden homes).

Essentially the severity of the illness depends on a couple of factors. The first is the dose or inoculum. And that in turn will depend on many things. First how long was the person exposed to the fungal spores? A few hours hiking or a week camping? Was the soil disturbed in any way? Ie people digging the soil say to build house foundations etc, will be exposed to a lot more spores than others because the digging releases the spores. Weather conditions may also be important since fungi find certain conditions - damp? warm? and dark? - preferable for growing in. Of course different fungi like different conditions - hence the question marks.

Next is the health of the person. Most people exposed to this fungu and who develop the illness will recover naturally and relatively easily from a mild illness. But for some it may be more serious. These people will generally have some sort of condition that affects their imunity. Thus people suffering from AIDS, those on certain drugs (steroids) that depress the immune function, the elderly and diabetes sufferers are at greater risk. There also appears to be some difference in genetics such that people of certain races are more suceptible to it. And pregnant women as well. I suspect, though I coul not find any references to it, that lung health will also play a role. Those with damaged lungs from say smoking, will probably be at greater risk.

Now for the illness itself, this will vary. Sixty percent of those exposed do not get ill. (They may however still develop an antibody response, which will make them imune to the disease if they are exposed again.) Most of the rest will develop a flu like illness lasting perhaps a few weeks. Typically this includes fever and breathing issues - the sort of thing you would expect if a foreign micro-organism was in your lungs trying to set up home. The fever is generally an indication of infection. A rash is also common. More serious illness in other parts of the body, means that the fungus has travelled from the lungs into the body, and the infection has become what's called systemic. This would generally only happen in someone with a compromised immune system.

As for the arthritis, that sounds like an immune response over reaction to me. (Guessing a little bit here.) Certain diseases such as campylobacter, in rare cases can trigger the immune system to over react, and sometimes that over reaction can include off target actions - ie the antibodies start identifying certain body tissues as non-self and attack them. Arthritis is a form of immune misfire where the tissues of joints are attacked by the body's own antibodies.

Cheers, Greg.


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## Sheilawisz (Oct 22, 2014)

Hello Maiden, it's good to see you posting in this thread again.

I have watched _Monsters Inside Me_ too, and I enjoy the show a lot. It's a little creepy sometimes and I am often surprised at the carelessness of many of the people involved in those cases, but in general it can be very engaging.

Now that you mentioned it, I watched that Valley Fever episode some time ago. We almost never consider the possibility of a destructive Fungus agent... It's a different possibility.

Maybe somebody should write a story about a dangerous Fungal pandemic instead of a virus or a bacteria.

Meanwhile, I continue to seek for new and updated information about Lassa Fever for my story. I found something quite interesting last night, but I'll talk about that in a different post.


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## Sheilawisz (Oct 23, 2014)

Hello, everyone.

I am not sure of how I could use this in my story, but new research efforts have recently discovered a potential weakness in the way that LV operates. It seems that the virus uses an unexpected two-step process to infect cells within a person, and that could open the door to new treatments.

Please check out this link: Army research sheds light on Lassa Fever.

How about that?

They could soon figure out a way to prevent LV from causing pathogenic effects, rendering the virus inactive by blocking its access to cells. I know that any new medication needs years and years of development and trials and so on, but it's good news anyway.

Also, I have noticed that this source in particular speaks against the common practice of downplaying and underestimating LHF. It clearly says that the mortality rates are between 20 and 50%, also giving numbers of up to a hundred thousand fatal victims every year.

It's time for the world to wake up and realize the threat.

I am not very sure about such high numbers of damage, but I am sure that they are more realistic than other sources. Why this Lassa Fever thing is rarely spoken about, downplayed and ignored by most of the world, is beyond my understanding.


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