Revealing hidden drivers of Lassa fever through a model-informed approach for reproducing and predicting disease dynamics and guiding control strategies.

Lassa fever (LF), caused by the Lassa virus and transmitted primarily by Mastomys natalensis rodents, is a severe hemorrhagic disease endemic to West Africa, particularly Nigeria, with significant morbidity and mortality rates. This study develops dynamic models for LF, incorporating crucial but often overlooked factors such as vertical transmission (i.e., transmission from parents to their offsprings) in rodents, surface contamination, and asymptomatic human carriers. The persistence of the disease is shown analytically. Using data from Nigeria to train the models, the impact of various control and mitigation measures is assessed. The results of the study reveal that asymptomatic individuals are key drivers of LF and that including additional LF virus transmission pathways, e.g., vertical transmission and environmental contamination, increases the estimated reproduction number threefold compared to previous studies. Models incorporating rodent dynamics show the highest disease prevalence, highlighting the critical role of rodent control. Specifically, effective interventions using only rodent control measures require maintaining rodent populations below a specific threshold. In addition, a multifaceted approach, combining antiviral treatment, environmental disinfection, and personal protective equipment, significantly enhances disease control, while the introduction of a competitor rodent species can drastically reduce human and rodent infections. Ultimately, the study underscores the need for integrated, multifaceted strategies, including targeting rodents, asymptomatic cases, and comprehensive treatment and disinfection protocols, for effective LF management.