Sierra Leone Telegraph: 25 November 2019:
Health officials, doctors and nurses in Sierra Leone are working hard to contain the spread of a Lassa fever outbreak, reported at a hospital in Masanga, Tonkolili district in the north of the country, where the suspected source carrier (index case) – a pregnant woman, was operated on by doctors. There are no reports of any outbreak, elsewhere in the country.
One of two Dutch nationals who contracted the virus, whose symptoms are similar to Ebola, while working at the hospital in Masanga, died yesterday in Holland. (Photo: The Dutch doctor – Dr Wouter who succumbed to the Lassa Fever he contracted in Masanga).
Ten European doctors including seven Dutch have so far been evacuated from Sierra Leone for Lassa Fever.
Three British nationals have returned to the UK from Sierra Leone for medical assessment, after coming into close contact with two people diagnosed with the virus.
Public Health England (PHE) said three British people who had stayed in Sierra Leone and had close contact with the Dutch pair had been repatriated to be medically assessed and treated, if required. The agency has also got in touch with 15 other British nationals who had contact with the Dutch doctors to monitor them.
“PHE is monitoring those who have had close contact with the foreign national to assess them as necessary and provide advice.
“PHE and the NHS have well-established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed.”
There is no approved vaccine for Lassa fever, the symptoms of which are similar to Ebola. Starting as a fever with aches and pains, Lassa can progress to headache, vomiting and diarrhoea. There can also be bleeding from the mouth and nose in severe cases, according to the World Health Organization.
Like Ebola, Lassa fever can be spread through contact with the bodily fluids of those infected. It can also be contracted from food that has been tainted by the urine or faeces of rodents.
On Saturday, 23rd November 2019, Sierra Leone’s Ministry of Health and Sanitation reported to have found a total of 7 cases of Lassa fever, with 2 deaths between 30th October and 23rd November 2019.
The probable index case date of onset of symptoms was on 30th October 2019; and she died on 4th November 2019.
The two probable cases were operated on 4th November 2019 by a medical team, some of whom are confirmed positive for Lassa fever.
Among the 3 lab confirmed cases, 1 is admitted in Lassa Fever Unit of Kenema District Hospital and 2 were expatriated to Netherlands. One – Dr. Wouter, died yesterday in Holland.
One laboratory indeterminate case (suspected) is also admitted in Lassa Fever Unit Kenema District Hospital.
A total of 45 contacts have been line listed so far, including 29 health workers.
The following are the details of the 7 cases:
Case 1(Probable index case)
A 30 year old pregnant lady was admitted in Masanga hospital on 3rd November 2019 with complaints of fever, side pain, vomiting and bleeding per vagina. The patient was referred from Makonthadae Maternal and Child Health Post (MCHP) where she was first treated. Originally the patient was from Mayorroh community in Kafe Simira chiefdom, Tonkolili District.
The patient was operated on 4th November 2019 due to pregnancy related complications and died shortly (same day) as a result of excessive bleeding mainly from incision sites and other orifices. No sample was taken for this case.
Travel history: Case had only travelled to see parents in a nearby community within the same locality in the last two weeks
Patient was a 33 year old female from Sasaklah community in Kalansogoia chiefdom, Tonkolili District who was admitted on 3rd November at Masanga hospital with septic abortion. The patient underwent manual evacuation on 4th November 2019 by the same medical team that operated on the probable index case (case #1).
The patient later developed acute abdomen and had a laparotomy performed on 4th November 2019. The patient developed fever with bleeding from the gums on 16th November 2019 and died on 19th November 2019. No sample was taken for this case.
Dr. #1 performed Caesarean Section (CS) on case 1 and manual evacuation on case 2 on the same day (4th November 2019). He developed signs of fever, headache, and general malaise on the 10th November 2019. He was treated for typhoid, malaria and influenza but symptoms persisted. He was then repatriated to the Netherlands on the 19th November 2019 where he was tested positive for Lassa fever on the same day.
Dr. #2 assisted in the surgery of case one and was involved in the general management of both cases (1&2). She developed symptoms on the 11th November 2019, her sample was collected and sent to Netherlands where it tested positive for Lassa Fever on the 21st November 2019. She was repatriated to the Netherlands on the 23rd November 2019.
Nurse #1 an anaesthetist who administered anaesthetics for both cases (1&2) also developed signs of fever, body ache on the 16th November 2019. His sample was taken to Kenema and tested positive for Lassa on the 22nd November 2019.
Nurse #2 a ward nurse prepared the corpse of case 1 for burial. She developed symptoms (fever, headache, vomiting, epigastric and body pains) on the 11th November 2019 and travelled to Makeni for family support. Her sample was taken and tested for Lassa Fever but the result is indeterminate.
Dr #3 a trainer/clinician developed symptoms (diarrhoea and vomiting) on the 21st November 2019. Sample has been taken and results pending.
Ministry of health and Sanitation says that the 3 confirmed cases of Lassa fever are health care workers from the same hospital, pointing to hospital based transmission (health care associated); and that successful control of this outbreak is in force.
Hospitals and local health centres are on high alert with strict adherence to and implementation of Infection prevention and control (IPC) procedures, as robust contact tracing and follow are carried out.
About Masanga Hospital
Masanga Hospital is a rural hospital with 120 beds situated in Tonkolili district, centrally located in the Northern Province of Sierra Leone. Sierra Leone has one of the highest maternal and infant mortality rates in the world and has a large and unmet medical and surgical need.
The catchment area of the hospital is widespread with a poor infrastructure. About 440.000 people are dependent on Masanga Hospital for their health care.
We provide (emergency) surgical, obstetrical and paediatric care, as well as general health care for about 12.000 patients per year. This number is increasing every year. This government hospital is supported by the Masanga Hospital Rehabilitation Project (MHRP) since 2006. Besides clinical care, MHRP focuses on capacity building by providing education and promoting medical research. We believe this contributes to sustainable and high quality health care in a country with only 200 medical doctors.
Our staff consists of 4 international doctors trained in global health and tropical medicine. Furthermore, we have 2 permanent Community Health Officers (CHO) managing the outpatient department and 3 midwives ensuring safe deliveries.
Our team is continuously supported by 8 students of the surgical training program, who are not only trained in surgery, but also in emergency and obstetrical care. In the operating theatre we have 2 specialized anesthesia nurses taking care of patients during surgery. And off course, the most important for the quality of care in our Hospital are the 40 nurses who work day and night to provide good quality healthcare.
Every year we admit around 2500 patients and we see around 8000 patients in our outpatient department. We have an emergency unit with about 800 admissions yearly. The cases we see range from acute surgical problems to medical emergencies like acute heart failure and infectious diseases like HIV.
On our isolation ward we treat patients with tuberculosis or suspected viral hemorrhagic fever. Five hundred babies are safely delivered in our labor ward every year and we conduct about 1000 surgical procedures annually, ranging from emergency laparotomies to skin grafts for chronic wound patients. With 600 admission a year pediatrics is one of our busiest wards, most children admitted here suffer from malaria, acute watery diarrhea or pneumonia.
Together with your help we can continue our battle to reduce high child mortality and maternal mortality and ensure good quality healthcare for the people who need it the most. (Source: Masanga Hospital website – visit for more information).