Lassa Fever Slithers Through Ebola Monitors

By now, most people know of the imported, and ultimately fatal, Lassa Fever case in New Jersey in a traveler from Liberia. This isn't a cause for panic and we've dealt with Lassa importations several times before and though there are many overlapping symptoms between Ebola and Lassa, Lassa is unequivocally more benign.

To me the most fascinating aspect of this case is how this man's travel history was not fully known to treating clinicians in the state in which Kaci Hickox was unjustifiably quarantined during the height of the Ebola hysteria. There's a great New York Times piece on this part of the story. A few important timeline highlights:

  • The man arrived at JFK airport on May 17 from Liberia via Morocco (presumably passing exit screening in Liberia)
  • He deplaned and was not febrile during his entry screen at JFK
  • His case was passed off to local health officials in New Jersey for active monitoring
  • The man developed fever and sore throat prompting a visit to an emergency department where he was treated and released on May 18. 
  • He was unable to be contacted by health department officials on May 18
  • He was reached on May 20 and May 21 and was apparently without fever
  • He represented with worsened symptoms on May 22 and was admitted
  • He died on May 25

There are important implications that arise from the New York Times piece that include:

  • Did the health department in New Jersey know of the patient's visit to the hospital on May 18 at any time prior to his readmission?
  • How are hospitals to know and have situational awareness of who is under active monitoring if the patient doesn't volunteer that information? 
  • All public health response systems require cooperation from the public for optimal function

These events should prompt a re-examing of the current system and emphasize the importance of emphasizing a travel history be taken in all patients with infectious syndromes whether they may have come from Lassa-laden West Africa or Legionnaire's Disease laden Pittsburgh. 

In a more stigmatizing and prejudicial time, bells were unfortunately tied around lepers to warn others of their approach. Such an approach was and is unnecessary for a better alarm bell is simply taking the travel history.