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Arbovirus-Associated Acute Febrile Illness in Liberia: Exploration of Incidence and Etiology

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Ronan with Hospital Team
Ronan with hospital team

Arbovirus-Associated Acute Febrile Illness in Liberia: Exploration of Incidence and Etiology



1.  Establish AFI surveillance, with a focus on arboviral etiologies in patients with febrile illness, at the Liberian Institute of Biomedical Research satellite laboratory in Lofa County, Liberia.

2.  Estimate the burden of infection from pathogens underlying AFI cases through a combined hospital-based surveillance and population-based community incidence survey for AFI in villages across Lofa County.

3.  Identify types of behavior change that may have affected Ebola transmission dynamics, why and when these changes were enacted, and assess their impacts on subsequent transmission.



Acute Febrile Illness (AFI) is the most common illness in West Africa and Liberia, but accurate treatment of patients and timely responses to potential epidemics remain limited due to scarcity of data on the causes of AFI, particularly arboviruses and hemorrhagic fever viruses. Accurate determination of AFI etiology remains difficult due to similar clinical presentations of various AFI-causing diseases as well as a lack of laboratory diagnostics. Moreover, the 2014-2015 Ebola epidemic changed community perceptions of disease risk as well as corresponding behaviors including healthcare utilization. Understanding causes of AFI is best undertaken by combining hospital-based laboratory surveillance with community catchment surveys.


We aim to fill gaps in knowledge for detection, diagnosis, and prevention of viral-associated AFI that will improve civilian and military, both U.S. and Liberian armed forces, health systems in Liberia. Our objectives are to establish laboratory capacity in Lofa County and in Armed Forces Liberia (AFL) Camp EBK for AFI surveillance, estimate incidences of viral causes of AFI using hospital samples and community surveys, and explore community perceptions of risk and behavior changes during the Ebola epidemic.


Project dates



Stage of work

1.  Institutional Review Board approval received.

2.  Community survey completed in Tubmanburg, Careysburg, and Duazon.



Primary Contact:  Ronan Arthur

Stanford University

.  Dr. Stephen Luby, PI

.  Dr. Lily Horng, Postdoctoral Scholar

National Public Health Institute of Liberia (NPHIL), formerly known as the Liberia Institute for Biomedical Research (LIBR)

.  Dr. Fatorma Bolay (d. 2021)

.  Mr. Philip Bemah

Naval Medical Research Unit 3 (NAMRU-3)

.  Lieutenant Nathaniel Christy

Uniformed Services University (USU)

.  Captain John Gilstad



US Department of Defense (DoD)Global Emerging Infections Surveillance (GEIS)