{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T04:32:29Z","timestamp":1789187549941,"version":"build-2803163510"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NU2GGH001876"],"award-info":[{"award-number":["NU2GGH001876"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Fever is a common symptom of infectious diseases including for those with epidemic potential. Beyond malaria, the causes of undifferentiated (i.e., non-respiratory, non-diarrheal) acute febrile illnesses are not well characterized in Liberia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      From December 2018 through March 2020, we established two acute febrile illness (AFI) sentinel surveillance sites in urban Monrovia at Redemption Hospital and Star of the Sea Health Centre, health facilities that were among the first to have Ebola cases during the 2014\u20132015 West Africa epidemic. Enrolled AFI patients were two (2) years of age or greater, had a measured fever of \u226537.5\n                      <jats:sup>o<\/jats:sup>\n                      C or history of fever within the past week, and without a known cause of fever. A standardized survey was administered to collect demographic, clinical characteristics, and risk factors. Whole blood was taken, nucleic acid material was extracted and ran on TaqMan Array Cards (TAC), a real-time polymerase chain reaction (RT-PCR) testing platform for 28 pathogens. Data were analyzed using descriptive statistics, and multivariate regression models of any TAC detections stratified by site and age.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We enrolled 1506 AFI patients, 1206 (80%) from Redemption Hospital and 300 (20%) from Star of the Sea. AFI patients were predominantly female (69%) and had a median (interquartile range) age of 18 (7\u201327) years. Among the 699 (46%) that were TAC positive, 627 were detected from Redemption Hospital and 72 were detected from Star of the Sea Health Centre. Overall\n                      <jats:italic>Plasmodium<\/jats:italic>\n                      spp. (malaria) (96%) were the majority of detections followed by dengue virus (2%),\n                      <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                      (2%)\n                      <jats:italic>,<\/jats:italic>\n                      and\n                      <jats:italic>Rickettsia<\/jats:italic>\n                      spp. (1%). We detected 19 co-infections [malaria co-infections (84%) being the most common]. Two pathogens with epidemic potential,\n                      <jats:italic>Neisseria meningitidis<\/jats:italic>\n                      (detected at Star of the Sea Health Centre) and Lassa virus (detected at Redemption Hospital), were also found. Patients with non-malaria TAC detections (n\u2009=\u200929) were higher at Star of the Sea Health Centre than Redemption Hospital (4% versus 1% respectively,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). In multivariate regression for those ages 15 years and older at Redemption Hospital (adjusting for sex, age, pregnancy status, education, occupation, any medication use, measured fever at enrollment, headache, abdominal pain, vomiting\/nausea and joint pain), any medication use (aOR=0.6, 95% CI\u2009=\u20090.4\u20130.9), measured fever at enrollment (aOR=3.5, 95% CI\u2009=\u20091.1\u201312.0), headache (aOR=1.7, 95% CI\u2009=\u20091.1\u20132.6 were statistically significant with any TAC detection. In multivariate regression for those ages 2\u201314 years at Redemption Hospital (adjusting for sex, age, abdominal pain, cough, vomiting\/nausea, runny nose, and any animal exposure), having abdominal pain (aOR=1.9, 95% CI\u2009=\u20091.3\u20132.8), vomiting\/nausea (aOR=0.6, 95% CI\u2009=\u20090.4\u20131.0), and any animal exposure (aOR=1.5, 95% CI\u2009=\u20091.0\u20132.3) were statistically significant with any TAC detection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This is the first laboratory evidence of dengue and rickettsial disease in humans in Liberia. Liberia\u2019s incipient AFI platform was successful exploring causes of fever in emerging infections and detected circulating pathogens beyond malaria. AFI surveillance data can assist in the prioritization of public health diagnostic and clinical capabilities to prevent, detect, and respond to emerging infectious disease threats in Liberia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0013961","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T18:33:11Z","timestamp":1770661991000},"page":"e0013961","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute febrile illness surveillance using TaqMan Array Cards in two urban health facilities, Monrovia, Liberia, December 2018\u2013March 2020"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3858-2275","authenticated-orcid":true,"given":"Terrence Q.","family":"Lo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elijah 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