{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:53:53Z","timestamp":1792601633666,"version":"4.5.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000060","name":"U.S. Department of Health & Human Services | NIH | National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["U19AI135995"],"award-info":[{"award-number":["U19AI135995"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Commun Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Lassa fever is a fulminant viral illness associated with high in-hospital mortality. This disease constitutes a serious public health concern in West Africa, in particular Nigeria and the Mano River Union region (Guinea, Liberia, and Sierra Leone). In Sierra Leone, continuous monitoring of critically ill patients is hindered by a lack of equipment and personnel.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We used wearable biosensor devices to remotely monitor hospitalized individuals with acute Lassa fever in order to describe vital sign trends that may be associated with clinical outcome and to evaluate the feasibility of this approach in a resource-limited setting.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The case fatality rate among participants (<jats:italic>n<\/jats:italic>\u2009=\u20098) was 62.5%, with a median time from hospital presentation to death of 2 days. Our results show that non-survivors (<jats:italic>n<\/jats:italic>\u2009=\u20095) spent a greater proportion of their monitoring period in the age-specific tachycardia range (45.8%) compared to survivors (1.7%), and had lower mean heart rate variability (10\u2009ms) compared to those that survived (59\u2009ms). Due to inconsistent sensor adhesion, as well as Bluetooth and cellular connectivity issues, over 80% of collected vital sign data was discarded for poor quality.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Real-time monitoring of vital signs using wearable biosensors may have the potential to identify individuals at increased risk for poor outcomes in Lassa fever by detecting age-specific tachycardia and reductions in heart rate variability. Whether this represents an improvement upon traditional bedside vital sign collection in resource-limited settings is not clear, as a substantial proportion of monitoring data was of poor quality. Technical improvements in sensor connectivity and adhesion are needed to enable widespread use of this device, for both clinical and research purposes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1038\/s43856-025-01002-6","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T13:19:52Z","timestamp":1752239992000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Continuous vital sign monitoring of acute Lassa fever using wearable biosensor devices in West Africa"],"prefix":"10.1038","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-4306-4440","authenticated-orcid":false,"given":"Brady","family":"Page","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rapha\u00eblle","family":"Klitting","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9212-4307","authenticated-orcid":false,"given":"Matthias G.","family":"Pauthner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9256-7914","authenticated-orcid":false,"given":"Steven","family":"Steinhubl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Wegerich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Kaiser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Foday","family":"Alhasan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin","family":"Konuwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Koroma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Sumah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenneh","family":"Brima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiangay","family":"Kallon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brima","family":"Jusu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sia","family":"Mator-Mabay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Kamara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"Kamara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"Jaward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angella","family":"Massally","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Kanneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"McGraw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Schieffelin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Grant","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6431-5982","authenticated-orcid":false,"given":"Kristian G.","family":"Andersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"1002_CR1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0002748","volume":"8","author":"JG Shaffer","year":"2014","unstructured":"Shaffer, J. G. et al. Lassa fever in post-conflict Sierra Leone. PLoS Negl. Trop. Dis. 8, e2748 (2014).","journal-title":"PLoS Negl. Trop. Dis."},{"key":"1002_CR2","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1093\/infdis\/155.3.437","volume":"155","author":"JB McCormick","year":"1987","unstructured":"McCormick, J. B., Webb, P. A., Krebs, J. W., Johnson, K. M. & Smith, E. S. A prospective study of the epidemiology and ecology of Lassa fever. J. Infect. Dis. 155, 437\u2013444 (1987).","journal-title":"J. Infect. Dis."},{"key":"1002_CR3","doi-asserted-by":"publisher","first-page":"2989","DOI":"10.1080\/21505594.2021.2000290","volume":"12","author":"HL Murphy","year":"2021","unstructured":"Murphy, H. L. & Ly, H. Pathogenicity and virulence mechanisms of Lassa virus and its animal modeling, diagnostic, prophylactic, and therapeutic developments. Virulence 12, 2989\u20133014 (2021).","journal-title":"Virulence"},{"key":"1002_CR4","unstructured":"UNDP (United Nations Development Programme). Human Development Report 2021-22: Uncertain Times, Unsettled Lives: Shaping Our Future in a Transforming World. (New York, 2022)."},{"key":"1002_CR5","doi-asserted-by":"publisher","DOI":"10.1186\/cc9410","volume":"15","author":"I Baelani","year":"2011","unstructured":"Baelani, I. et al. Availability of critical care resources to treat patients with severe sepsis or septic shock in Africa: a self-reported, continent-wide survey of anaesthesia providers. Crit. Care 15, R10 (2011).","journal-title":"Crit. Care"},{"key":"1002_CR6","doi-asserted-by":"publisher","first-page":"793","DOI":"10.12688\/f1000research.18566.1","volume":"8","author":"JS Squire","year":"2019","unstructured":"Squire, J. S., Hann, K., Denisiuk, O. & Zachariah, R. Staffing in public health facilities after the Ebola outbreak in rural Sierra Leone: How much has changed? F1000Res 8, 793 (2019).","journal-title":"F1000Res"},{"key":"1002_CR7","doi-asserted-by":"publisher","DOI":"10.1177\/2055207619879349","volume":"5","author":"SC Garbern","year":"2019","unstructured":"Garbern, S. C. et al. Validation of a wearable biosensor device for vital sign monitoring in septic emergency department patients in Rwanda. Digit Health 5, 2055207619879349 (2019).","journal-title":"Digit Health"},{"key":"1002_CR8","doi-asserted-by":"publisher","first-page":"516","DOI":"10.9745\/GHSP-D-15-00189","volume":"15","author":"SR Steinhubl","year":"2015","unstructured":"Steinhubl, S. R., Marriott, M. P. & Wegerich, S. W. Remote sensing of vital signs: a wearable, wireless band-aid\u2019\u2018 sensor with personalized analytics for improved Ebola patient care and worker safety. Glob Health Sci Pract 15, 516\u2013519 (2015).","journal-title":"Glob Health Sci Pract"},{"key":"1002_CR9","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1038\/s41591-020-0798-3","volume":"26","author":"PS Shah","year":"2020","unstructured":"Shah, P. S. Wireless monitoring in the ICU on the horizon. Nat. Med. 26, 316\u2013317 (2020).","journal-title":"Nat. Med."},{"key":"1002_CR10","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.1136\/archdischild-2016-310875","volume":"101","author":"H Edgcombe","year":"2016","unstructured":"Edgcombe, H., Paton, C. & English, M. Enhancing emergency care in low-income countries using mobile technology-based training tools. Arch. Dis. Child. 101, 1149\u20131152 (2016).","journal-title":"Arch. Dis. Child."},{"key":"1002_CR11","doi-asserted-by":"publisher","first-page":"e6642","DOI":"10.1371\/journal.pone.0006642","volume":"4","author":"S Ahmad","year":"2009","unstructured":"Ahmad, S. et al. Continuous multi-parameter heart rate variability analysis heralds onset of sepsis in adults. PLoS ONE 4, e6642 (2009).","journal-title":"PLoS ONE"},{"key":"1002_CR12","doi-asserted-by":"publisher","first-page":"e000070","DOI":"10.1136\/bmjgh-2016-000070","volume":"1","author":"SR Steinhubl","year":"2016","unstructured":"Steinhubl, S. R. et al. Validation of a portable, deployable system for continuous vital sign monitoring using a multiparametric wearable sensor and personalised analytics in an Ebola treatment center. BMJ Glob. Health 1, e000070 (2016).","journal-title":"BMJ Glob. Health"},{"key":"1002_CR13","first-page":"1","volume":"4","author":"J Ngonzi","year":"2017","unstructured":"Ngonzi, J., Boatin, A., Mugyenyi, G., Wylie, B. J. & Haberer, J. E. A functionality and acceptability study of wireless maternal vital sign monitor in a tertiary university teaching hospital in rural Uganda. J. Womens Health Gyn. 4, 1\u20138 (2017).","journal-title":"J. Womens Health Gyn."},{"key":"1002_CR14","doi-asserted-by":"crossref","unstructured":"Ghiasi, S. et al. Sepsis mortality prediction using wearable monitoring in low-middle income countries. Sensors 22, 3866 (2022).","DOI":"10.3390\/s22103866"},{"key":"1002_CR15","unstructured":"How to Safely Collect Blood Samples by Phlebotomy from Patients Suspected to Be Infected with Lassa Fever."},{"key":"1002_CR16","unstructured":"Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever."},{"key":"1002_CR17","unstructured":"U.S. Food and Drug Administration. Premarket notification 510(k) number K183322: physIQ Heart Rhythm and Respiratory Module. U.S. Dep. Health Hum. Serv. (2019)."},{"key":"1002_CR18","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1161\/01.CIR.8.6.920","volume":"8","author":"CE Kossmann","year":"1953","unstructured":"Kossmann, C. E. The normal electrocardiogram. Circulation 8, 920\u2013936 (1953).","journal-title":"Circulation"},{"key":"1002_CR19","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1016\/S0140-6736(10)62226-X","volume":"377","author":"S Fleming","year":"2011","unstructured":"Fleming, S. et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 377, 1011\u20131018 (2011).","journal-title":"Lancet"},{"key":"1002_CR20","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1136\/heart.89.3.333","volume":"89","author":"MP van den Berg","year":"2003","unstructured":"van den Berg, M. P., Hassink, R. J., Balj\u00e9-Volkers, C. & Crijns, H. Role of the autonomic nervous system in vagal atrial fibrillation. Heart 89, 333\u2013335 (2003).","journal-title":"Heart"},{"key":"1002_CR21","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1097\/00003246-198710000-00006","volume":"15","author":"MM Parker","year":"1987","unstructured":"Parker, M. M., Shelhamer, J. H., Natanson, C., Alling, D. W. & Parrillo, J. E. Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis. Crit. Care Med. 15, 923\u2013929 (1987).","journal-title":"Crit. Care Med."},{"key":"1002_CR22","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1038\/s41579-022-00789-8","volume":"21","author":"RF Garry","year":"2023","unstructured":"Garry, R. F. Lassa fever - the road ahead. Nat. Rev. Microbiol. 21, 87\u201396 (2023).","journal-title":"Nat. Rev. Microbiol."},{"key":"1002_CR23","doi-asserted-by":"publisher","first-page":"e469","DOI":"10.1016\/S2214-109X(20)30518-0","volume":"9","author":"A Duvignaud","year":"2021","unstructured":"Duvignaud, A. et al. Lassa fever outcomes and prognostic factors in Nigeria (LASCOPE): a prospective cohort study. Lancet Glob. Health 9, e469\u2013e478 (2021).","journal-title":"Lancet Glob. Health"},{"key":"1002_CR24","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.ajem.2007.06.016","volume":"26","author":"W-L Chen","year":"2008","unstructured":"Chen, W.-L. et al. Heart rate variability measures as predictors of in-hospital mortality in ED patients with sepsis. Am. J. Emerg. Med. 26, 395\u2013401 (2008).","journal-title":"Am. J. Emerg. Med."},{"key":"1002_CR25","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.jcrc.2003.08.005","volume":"18","author":"J Pontet","year":"2003","unstructured":"Pontet, J. et al. Heart rate variability as early marker of multiple organ dysfunction syndrome in septic patients. J. Crit. Care 18, 156\u2013163 (2003).","journal-title":"J. Crit. Care"},{"key":"1002_CR26","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-018259","volume":"7","author":"VM Quinten","year":"2017","unstructured":"Quinten, V. M., van Meurs, M., Renes, M. H., Ligtenberg, J. J. M. & Ter Maaten, J. C. Protocol of the sepsivit study: a prospective observational study to determine whether continuous heart rate variability measurement during the first 48 hours of hospitalisation provides an early warning for deterioration in patients presenting with infection or sepsis to the emergency department of a Dutch academic teaching hospital. BMJ Open 7, e018259 (2017).","journal-title":"BMJ Open"},{"key":"1002_CR27","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1007\/s00421-012-2572-9","volume":"113","author":"N Michels","year":"2013","unstructured":"Michels, N. et al. Determinants and reference values of short-term heart rate variability in children. Eur. J. Appl. Physiol. 113, 1477\u20131488 (2013).","journal-title":"Eur. J. Appl. Physiol."},{"key":"1002_CR28","unstructured":"Task Force of the European Society of Cardiology the North American Society of Pacing Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Circulation 93, 1043\u20131065 (1996)."},{"key":"1002_CR29","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1007\/BF01726532","volume":"21","author":"M Piepoli","year":"1995","unstructured":"Piepoli, M., Garrard, C. S., Kontoyannis, D. A. & Bernardi, L. Autonomic control of the heart and peripheral vessels in human septic shock. Intensive Care Med. 21, 112\u2013119 (1995).","journal-title":"Intensive Care Med."},{"key":"1002_CR30","doi-asserted-by":"publisher","first-page":"2198","DOI":"10.4236\/ojapps.2023.1311171","volume":"13","author":"RT Simbo","year":"2023","unstructured":"Simbo, R. T., Gogra, A. B., Kawa, Y. K. & Moiwo, P. J. Seasonal effect on weather elements on water table fluctuation in potable wells in Kono district, Eastern Sierra Leone. Open J. Appl. Sci. 13, 2198\u20132209 (2023).","journal-title":"Open J. Appl. Sci."},{"key":"1002_CR31","unstructured":"VitalConnect, Inc. Instructions for Use, VitalPatch\u00ae Biosensor (Rev 7). Preprint at https:\/\/www.fda.gov\/media\/137398\/download (2020)."},{"key":"1002_CR32","unstructured":"World Health Organization. The National Health Workforce Accounts database. https:\/\/apps.who.int\/nhwaportal, https:\/\/www.who.int\/activities\/improving-health-workforce-data-and-evidence."}],"container-title":["Communications Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s43856-025-01002-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s43856-025-01002-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s43856-025-01002-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T05:32:59Z","timestamp":1757223179000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s43856-025-01002-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,11]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1002"],"URL":"https:\/\/doi.org\/10.1038\/s43856-025-01002-6","relation":{},"ISSN":["2730-664X"],"issn-type":[{"value":"2730-664X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,11]]},"assertion":[{"value":"30 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare the following competing interests: S.S., S.W., and M.K. report being employed by physIQ during the study period. No competing interests were declared for the remaining authors.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"290"}}