More details emerge on German, US Lassa cases linked to Togo

The World Health Organization (WHO) today released more details on two linked American Lassa fever patients who had worked in Togo, one of whom died, and a secondary case in a German funeral home worker who had contact with the deceased American.

Index case

The index case involved a 47-year-old American man who worked as a healthcare provider in the Savanes region of northern Togo. He exhibited gastrointestinal symptoms and fever on Feb 12 and was treated for malaria before being medically evacuated to Cologne, Germany, on Feb 25.

The man died of multiple organ failure on Feb 26, and, on Mar 9, German officials issued a post-mortem diagnosis of Lassa fever based on autopsy findings, the WHO said. Media reports have said he was a nurse.

Secondary infections in healthcare, funeral home workers

Secondary infections involve an American physician's assistant who cared for the index patient in Togo and a German funeral home worker who handled the deceased's body.

The American patient is a 33-year-old man whose symptoms began in Togo on Mar 5. He was placed in isolation on Mar 9 and evacuated to the Emory University Hospital in Georgia on Mar 12, where he tested positive for Lassa fever virus. He remains isolated in stable condition and continues to undergo treatment, the WHO said.

The German patient is a funeral home worker who had contact with the deceased American's body on Mar 2. He wore gloves and was not exposed to bodily fluids when he handled the remains. He was quarantined at home after the post-mortem Lassa fever diagnosis was issued, tested negative for Lassa virus on Mar 10, and then tested positive on Mar 15.

The funeral home worker is being cared for in a special isolation unit in Frankfurt, along with four family members who have been voluntarily quarantined. His infection represents Europe's first case of locally acquired Lassa fever, the WHO said.

Outbreak investigation, contact tracing

Togo's Ministry of Health, the WHO, and the US Centers for Disease Control and Prevention are conducting an outbreak investigation focused on the affected health facility in Togo, along with monitoring the index case-patient's contacts, which include 13 people in Togo, 1 in the US, and 52 healthcare workers or funeral home employees in Germany.

All contacts of the secondary case-patient in Germany are also being monitored.

Northern Togo borders Benin, which has been experiencing a Lassa fever outbreak since December 2015. Cross-border travel may be contributing to Lassa virus cases in Togo, the WHO said.

See also:

Mar 23 WHO update on American cases

Mar 23 WHO update on index and German cases

Mar 17 CIDRAP News item on German secondary case

Mar 14 CIDRAP News item on American secondary case

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