The Killer from Lassa

"The discovery of a new disease is always exciting," Dr. John D. Frame told the New York Society of Tropical Medicine, "especially when it proves to be as contagious, lethal and apparently widespread as Lassa fever."

Such adjectives, coming from a Columbia University professor, sounded unscientifically hyperbolic. In fact, they represented an understatement of the facts. When Dr. Frame, an assistant professor of tropical medicine at Columbia, reported his findings late last month, Lassa fever had already proved so deadly that one of the world's most expert virologists had fallen ill of the disease, a lab assistant and two nurses had died of it, and research with the virus had been abandoned until more exacting safety precautions could be devised.

Frame has been concerned for 17 years with the medical care of missionaries, many of them working in Africa. He has been struck repeatedly by the number reported each year to have died from fever of unknown origin, despite proper treatment for such diseases as malaria and typhus. Frame suspected that some of these mysterious fevers might be caused by still unrecognized viruses, so he arranged to get blood specimens from returning missionaries and from sick missionaries still in Africa. His reasoning: the viruses would have left indelible footprints, in the form of antibodies, in their victims' blood.

Chain Reaction. Frame arranged to have the blood serums tested for antibodies at the Yale Arbovirus* Research Unit. There Dr. Jordi Casals found the footprints of several arbo-viruses, but nothing exciting happened until last winter. Then the excitement came in an explosive chain reaction.

At Lassa, a sun-baked herdsmen's village (pop. 1,000) in western Nigeria, Nurse Laura Wine of the Church of the Brethren Mission fell ill. She suffered fever and pain in her joints, and developed small red blotches on her skin and ulcers in her throat and mouth. Nurse Wine was flown to a larger mission hospital at Jos, in centra] Nigeria. There she died within 30 hours, but not until Nurse Charlotte Shaw had used her finger and a swab to cleanse the mouth ulcers. Nurse Shaw had nicked her finger earlier in the day while cutting roses. Although she had bandaged it and used an antiseptic, she fell ill soon after treating Nurse Wine. Her symptoms were as various as they were baffling. Dr. Jeanette Troup drew a blood specimen, to be frozen and sent with Nurse Wine's to

Dr. Frame. Head Nurse Lily Pinneo cared for her, but within eleven days Nurse Shaw was dead. Three days after that, Nurse Pinneo fell ill. She had throat ulcers, and her fever rose to 103DEG.

Dr. Troup determined to get Miss Pinneo to New York for treatment and, she hoped, a definite diagnosis. En route, the patient spent four days in a pesthouse in Lagos. Then Dorothy Davis bravely volunteered to nurse her during the journey to New York. Dr. Frame was alerted about her arrival; so were Dr. John Baldwin and other physicians, who arranged for her admission to Presbyterian Hospital under conditions of the strictest isolation.

Nurse Pinneo was treated first for malaria, but within 24 hours of admission her temperature had soared to 107DEG. To get that fiery fever down, the doctors put her in an oxygen tent and packed her in ice. Her sister, Rose Pinneo, a nursing instructor at the University of Rochester, flew down to care for her. Lily Pinneo was dehydrated and had to have her fluid balance restored. Then her chest cavity filled with fluid and had to be punctured and drained. She developed pneumonia. Even after her throat ulcers had cleared, she could swallow only a few sips, and for five weeks had to be fed intravenously. In nine weeks in the hospital, the nurse-patient lost 28 Ibs. and almost all her hair. But, unlike the first two victims, she somehow survived the ordeal.

Patient's Plague. In his Yale laboratory, Dr. Casals was busy with the three nurses' blood serums. Using extreme precautions and working with two other expert virologists, he cultured a virus from the serums and injected it into mice. The adult mice died. Then in June, Casals fell ill. His first symptoms did not suggest what Frame had now christened Lassa fever. But at Presbyterian Hospital this diagnosis was confirmed. What to do? No known treatment was effective, but Patient Casals was more fortunate than his predecessors. Nurse Pinneo was convalescing, and there should still be antibodies in her blood. She flew to New York and gave two pints of blood. The cells were returned to her veins; only the plasma, containing gamma globulin with its antibodies, was given to Casals by transfusion. The technique was highly effective; he recovered in a few days.

A Yale lab technician, Juan Roman, was less fortunate. He had not worked directly with the Lassa serums or infected mice, so when he visited relatives in York, Pa., over Thanksgiving and fell ill, no one suspected the mystery virus. Roman died. Later, when his serum revealed that he had somehow been infected with the dread fever,

Casals decided that it would be wise to call a halt to Lassa research in the Yale laboratory.

No one can yet be sure whether Lassa virus belongs to Casals' favorite group of arboviruses. It is related, he suggests, to a virus that causes a devastating Bolivian hemorrhagic fever (TIME, July 19, 1963). Whatever its nature, it may be widespread in sub-Saharan Africa, but relatively unknown to authorities because natives die of it in the bush without seeking medical aid.

Where does the virus live, and how is it transmitted? No one knows, but Frame's serum collection offered a clue. It contained a Lassa-positive specimen from Carrie Moore, who had a similar illness in Guinea, 1,500 miles west of Lassa, when she worked there as a teacher in 1965. Although Mrs. Moore recovered, her fever left her stone-deaf. Her quarters, she recalls, were infested with mice that left their droppings all over her room and the kitchen. Nurse Pinneo also remembers mice droppings in the mission hospital at Jos. If mice are indeed carriers of the disease, the virus may well be wafted into the air by dust when the droppings are swept away.

Last week, while such points were still only speculation, the National Communicable Disease Center in Atlanta announced that it was setting up a special isolation laboratory, in which the strange and deadly disease can be studied. There appeared to be good reason for haste. From the mission hospital at Jos came reports of an influx of patients, some dying, with symptoms that closely matched those of the "new" Lassa fever.

*A telescoped designation for arthropod-borne viruses--those transmitted by mosquitoes and other insects.

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