The largest-ever Lassa fever research programme in West Africa
Overview
Through the Enable programme, CEPI underscores the significance of collaborative, integrative, and sustainable efforts in future Lassa virus research, including the execution of vaccine trials. Building on previous experience and knowledge gathered in the Enable 1.0 study, Enable 1.5 is now underway to continue to shed light on the epidemiology of Lassa fever in West Africa. Country ownership and lasting community engagement are paramount for the global endeavor to eliminate the threat of Lassa fever.
Background
Lassa fever, a zoonotic acute viral haemorrhagic disease caused by the Lassa virus, has persisted as an endemic threat in Western Africa since its discovery in 1969. While most cases are asymptomatic or mild, severe cases require hospitalisation and often result in death due to organ failure. Survivors may suffer from permanent hearing issues, known as sensorineural hearing loss (SNHL). Current primary treatments for patients involve early supportive care (e.g. fluids & pain relief) and the administration of the anti-viral drug ribavirin; however, the effectiveness of the latter remains debated. Therefore, the need persists for a tailored preventive intervention against Lassa fever infection – leading to the pursuit of an effective vaccine.
Leveraging its unique position as a global partnership between public, private, philanthropic, and civil society organisations, CEPI is a driving force behind these collaborative efforts to combat Lassa fever, setting the stage for ongoing vaccine development and epidemiological research. To address knowledge gaps identified by the World Health Organization for informing the design of future Lassa virus vaccine trials and delivery strategies, CEPI launched a prospective multi-site cohort study and research capacity strengthening effort named the “Enable Lassa Research Programme” in 2019.
Enable 1.0
 In Enable 1.0 over 23,000 participants were followed up in 2019–2023 to estimate the incidence of Lassa fever infection and disease across five West African countries (Benin, Guinea, Liberia, Nigeria, and Sierra Leone). Preliminary results indicate that Lassa fever baseline seroprevalence — a measure of the proportion of people who have antibodies against Lassa virus at a given time, indicating previous exposure — was around 30%, ranging from 2% in Benin to 48% in Liberia. During the study, 39 cases of symptomatic Lassa fever were observed. The results of this study are soon to be published. Notable successes of the programme include the high retention rates of participants due to active local engagement, the collection of extensive data to inform future work, going beyond Lassa infection and disease incidence, the establishment of valuable regional partnerships, and the building of community trust for vaccine research and development.
Despite the wealth of collected data, persistent gaps in our understanding of the epidemiology of the disease remain. For example, the disease burden in infants remains ill-defined — as under 2s were excluded in Enable 1.0 — and the frequently observed co-infections with malaria and Lassa fever need further examination. Furthermore, mounting evidence of mild or subclinical Lassa fever cases with different disease expressions suggests that some non-febrile Lassa fever disease cases may have been missed by the study, which hinged its case definition on fever lasting for at least 48h. Lastly, we observed in some study sites a lack of appreciation of vaccines and health system hesitancy, posing challenges for future Lassa fever vaccine trials.
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