O0243 Oct.5: 10:27am - Diagnosis and Management of Lassa Fever Among Children in Eastern Province, Sierra Leone: A 7-year Retrospective Analysis

Background
Lassa fever (LF) is endemic to at least nine countries in West Africa, including Sierra Leone, where it is hyperendemic1 with a prevalence of antibodies to the Lassa Fever Virus of 8-52% depending on region and village.2,3 There are few studies to date on LF in children, making it difficult to fully understand best practices for pediatric LF management.1,4–9 In West Africa, this dilemma is further challenged as the clinical presentation of LF can be indistinguishable from other VHFs, from other febrile illnesses such as malaria and typhoid fever, and at times can present as co-infections with other febrile illnesses.9,10 Care for patients with LF in Sierra Leone, including pediatric cases, is centered at the Kenema Government Hospital (KGH), in the Eastern Province of Sierra Leone.6 We aimed to use data collected at KGH to further understand the epidemiology of pediatric LF and to gain insight into predictors of outcome.

Methods
A retrospective cohort study was conducted using routinely collected programmatic data from the LF ward at KGH. All children (0-18 years of age) with either antigen-positive LF or who were LF suspect cases upon admission to the LF ward between January 1, 2012 and December 31, 2018 were included in this analysis. Outcome was determined at hospital day 10. Chi-squared, Fisher’s Exact, and Wilcoxon rank-sum tests were used to analyze results.

Results
A total of 292 children were included in the analyses, and 19.5% were antigen-positive. Antigen-positive children were more likely to be male (63% vs. 47%; p=0.031) and were more likely to die (63% vs. 11%; p<0.001). Among antigen-positive children, those that would eventually die were more likely to present with low oxygen saturation, bleeding, and confusion (Table 2). These children were also more likely to have acute kidney injury, transaminitis, and electrolyte abnormalities (Table 2).

Conclusion
Previous studies describing presentation and management of pediatric LF occurred before the civil war in Sierra Leone and prior to many currently available diagnostic tests. These new data provide insight into current pediatric LF cases and will inform further studies to create predictive algorithms around antigen-positivity and outcomes. These findings are important both for LF and more broadly for viral hemorrhagic fevers, such as Ebola.