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Lassa fever. Effective therapy with ribavirin.

J B McCormick, I J King, P A Webb

    The New England Journal of Medicine
    |January 2, 1986
    PubMed
    Summary
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    Early treatment with ribavirin significantly reduces Lassa fever mortality. This antiviral medication is effective at any stage of illness and for postexposure prophylaxis, unlike Lassa-convalescent plasma.

    Area of Science:

    • Infectious Diseases
    • Viral Hemorrhagic Fevers
    • Clinical Pharmacology

    Background:

    • Lassa fever is a severe viral hemorrhagic fever endemic in West Africa.
    • High-risk indicators for mortality include elevated serum aspartate aminotransferase (AST) and viremia.
    • Limited effective treatment options exist for Lassa fever.

    Purpose of the Study:

    • To identify variables associated with high mortality in Lassa fever patients.
    • To evaluate the efficacy of ribavirin and Lassa virus-convalescent plasma in treating Lassa fever.
    • To determine optimal timing for ribavirin administration.

    Main Methods:

    • Prospective study in Sierra Leone involving Lassa fever patients.
    • Analysis of risk factors: serum AST levels and viremia.

    Related Experiment Videos

  • Evaluation of treatment outcomes with intravenous and oral ribavirin, and Lassa-convalescent plasma, based on timing of administration relative to fever onset.

    • Main Results:

    • Serum AST ≥ 150 IU/L was associated with 55% case-fatality rate; treatment with IV ribavirin within 6 days of fever onset reduced this to 5% (P=0.0002).
    • Viremia ≥ 10(3.6) TCID50/mL was associated with 76% case-fatality rate; IV ribavirin within 6 days reduced this to 9% (P=0.006).
    • Lassa-convalescent plasma showed no significant mortality benefit in high-risk groups; oral ribavirin was also effective.

    Conclusions:

    • Ribavirin is an effective treatment for Lassa fever, significantly reducing mortality.
    • Early administration of ribavirin (within 6 days of fever onset) yields the best outcomes.
    • Ribavirin should be considered for treatment at any stage of Lassa fever and for postexposure prophylaxis.