Federal state level management of an imported Lassa fever case to North Rhine-Westphalia, Germany, March 2016

Abstract

Purpose: Lessons learned from a Federal state level regarding contact person management. One imported Lassa fever case in March 2016 from Togo to Germany involved 57 contact persons and 16 local public health departments in North Rhine-Westphalia (NRW). The patient was flown out to Cologne on 25 Feb with diagnosis of malaria and sepsis and died on 26 Feb. Lassa virus diagnosis on 9 March immediately set off a number of public health measures. This case was part of a WHO outbreak investigation with one secondary case in another German Federal state and one more case in Togo, who was repatriated to the US. Methods & Materials: Contact persons of the index case were categorised, informed and followed up accordingly to their category of contact. An anonymous line list of contact persons was available on state level with the contacts’ data being investigated on local level. Results: Overall 57 contact persons were followed up in NRW. Of those 52 were health care personnel. Contact categories included zero high risk contacts, 33 persons with increased, 18 with moderate and 6 with low risk. Public health measurements such as domestic quarantine, measuring temperature twice daily and interrogation by the local public health department were implemented. Several teleconferences were held to exchange information between the health departments and other authorities involved. One major problem was the unreliableness of some contact persons, who did not adhere to communicated control measures and provoked a number of further contacts. Six contact persons developed mild symptoms consistent with a mild Lassa virus infection and were therefore biosafety level 3 isolated. All of whom were finally tested negative for Lassa virus. Conclusion: Information between different authorities involved has to be shared rapidly and should be facilitated by a central coordination. It is mandatory to well-inform those affected, reinforced by a written order for the contact person from the authority in charge. Implementing public health measures requires sufficient staff on all levels to be able to meet such challenges. Even one imported case may have an impact on an international level. Rapid communication and cooperation at all levels is crucial.