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LF is highly endemic in Sierra Leone, particularly in its Eastern Province. Kenema Government Hospital (KGH) maintains one of only a few LF isolation facilities in the world with year-round diagnostic testing. Here we focus on space-time trends for LF occurring in Sierra Leone between 2012 and 2019 to provide a current account of LF in the wake of the 2014\u20132016 Ebola epidemic. Data were analyzed for 3277 suspected LF cases and classified as acute, recent, and non-LF or prior LF exposure using enzyme-linked immunosorbent assays (ELISAs). Presentation rates for acute, recent, and non-LF or prior LF exposure were 6.0% (195\/3277), 25.6% (838\/3277), and 68.4% (2244\/3277), respectively. Among 2051 non-LF or prior LF exposures, 33.2% (682\/2051) tested positive for convalescent LF exposure. The overall LF case-fatality rate (CFR) was 78.5% (106\/135). Both clinical presentations and confirmed LF cases declined following the Ebola epidemic. These declines coincided with an increased duration between illness onset and clinical presentation, perhaps suggesting more severe disease or presentation at later stages of illness. Acute LF cases and their corresponding CFRs peaked during the dry season (November to April). Subjects with recent (but not acute) LF exposure were more likely to present during the rainy season (May to October) than the dry season (p &lt; 0.001). The findings here suggest that LF remains endemic in Sierra Leone and that caseloads are likely to resume at levels observed prior to the Ebola epidemic. The results provide insight on the current epidemiological profile of LF in Sierra Leone to facilitate LF vaccine studies and accentuate the need for LF cohort studies and continued advancements in LF diagnostics.<\/jats:p>","DOI":"10.3390\/microorganisms9030586","type":"journal-article","created":{"date-parts":[[2021,3,14]],"date-time":"2021-03-14T23:52:06Z","timestamp":1615765926000},"page":"586","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Space-Time Trends in Lassa Fever in Sierra Leone by ELISA Serostatus, 2012\u20132019"],"prefix":"10.3390","volume":"9","author":[{"given":"Jeffrey","family":"Shaffer","sequence":"first","affiliation":[{"name":"Department of Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Schieffelin","sequence":"additional","affiliation":[{"name":"Sections of Infectious Disease, Departments of Pediatrics and Internal Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7091-1027","authenticated-orcid":false,"given":"Mambu","family":"Momoh","sequence":"additional","affiliation":[{"name":"Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustine","family":"Goba","sequence":"additional","affiliation":[{"name":"Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lansana","family":"Kanneh","sequence":"additional","affiliation":[{"name":"Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Foday","family":"Alhasan","sequence":"additional","affiliation":[{"name":"Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Gbakie","sequence":"additional","affiliation":[{"name":"Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Engel","sequence":"additional","affiliation":[{"name":"Sections of Infectious Disease, Departments of Pediatrics and Internal Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA"},{"name":"Department of Microbiology and Immunology, Tulane University, New Orleans, LA 70112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nell","family":"Bond","sequence":"additional","affiliation":[{"name":"Sections of Infectious Disease, Departments of Pediatrics and Internal Medicine, School of Medicine, Tulane University, New Orleans, LA 70112, USA"},{"name":"Department of Microbiology and Immunology, Tulane University, New Orleans, LA 70112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Hartnett","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Tulane University, New Orleans, LA 70112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Nelson","sequence":"additional","affiliation":[{"name":"Zalgen Labs, LLC, Germantown, MD 20876, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duane","family":"Bush","sequence":"additional","affiliation":[{"name":"Zalgen Labs, LLC, Germantown, MD 20876, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Boisen","sequence":"additional","affiliation":[{"name":"Zalgen Labs, LLC, Germantown, MD 20876, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Heinrich","sequence":"additional","affiliation":[{"name":"Zalgen Labs, LLC, Germantown, MD 20876, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Rowland","sequence":"additional","affiliation":[{"name":"Zalgen Labs, LLC, Germantown, MD 20876, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Branco","sequence":"additional","affiliation":[{"name":"Zalgen Labs, LLC, Germantown, MD 20876, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Samuels","sequence":"additional","affiliation":[{"name":"Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone"},{"name":"Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TE 37203, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5683-3250","authenticated-orcid":false,"given":"Robert","family":"Garry","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Immunology, Tulane University, New Orleans, LA 70112, USA"},{"name":"Zalgen Labs, LLC, Germantown, MD 20876, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Grant","sequence":"additional","affiliation":[{"name":"Lassa Fever Program, Kenema Government Hospital, Kenema, Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Viral Hemorrhagic Fever Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,12]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2021, January 11). Lassa Fever. Available online: https:\/\/www.who.int\/health-topics\/lassa-fever#tab=tab_1."},{"key":"ref_2","unstructured":"World Health Organization (2021, January 12). Lassa Fever. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/lassa-fever."},{"key":"ref_3","first-page":"1","article-title":"Lassa fever in West African sub-region: An overview","volume":"44","author":"Ogbu","year":"2007","journal-title":"J. Vector Borne Dis."},{"key":"ref_4","first-page":"69","article-title":"Epidemiology and control of Lassa fever","volume":"134","author":"McCormick","year":"1987","journal-title":"Curr. Top. Microbiol. Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Garry, R.F. (2020). 50 Years of Lassa Fever Research. Curr. Top. Microbiol. Immunol.","DOI":"10.1007\/82_2020_214"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1126\/science.185.4147.263","article-title":"Lassa virus isolation from Mastomys natalensis rodents during an epidemic in Sierra Leone","volume":"185","author":"Monath","year":"1974","journal-title":"Science"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1093\/infdis\/155.3.437","article-title":"A prospective study of the epidemiology and ecology of Lassa fever","volume":"155","author":"McCormick","year":"1987","journal-title":"J. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Sattler, R.A., Paessler, S., Ly, H., and Huang, C. (2020). Animal Models of Lassa Fever. Pathogens, 9.","DOI":"10.3390\/pathogens9030197"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1128\/JCM.00170-17","article-title":"Laboratory Diagnosis of Lassa Fever","volume":"55","author":"Raabe","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1038\/90892","article-title":"Lassa fever is unheralded problem in West Africa","volume":"7","author":"Birmingham","year":"2001","journal-title":"Nat. Med."},{"key":"ref_11","unstructured":"Centers for Disease Control and Prevention (2021, January 09). Lassa Fever, Available online: https:\/\/www.cdc.gov\/vhf\/lassa\/index.html."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Iacono, G.L., Cunningham, A.A., Fichet-Calvet, E., Garry, R.F., Grant, D.S., Khan, S.H., Leach, M., Moses, L.M., Schieffelin, J.S., and Shaffer, J.G. (2015). Using modelling to disentangle the relative contributions of zoonotic and anthroponotic transmission: The case of lassa fever. PLoS Negl. Trop. Dis., 9.","DOI":"10.1371\/journal.pntd.0003398"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1093\/infdis\/155.3.445","article-title":"A case-control study of the clinical diagnosis and course of Lassa fever","volume":"155","author":"McCormick","year":"1987","journal-title":"J. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Fichet-Calvet, E., and Rogers, D.J. (2009). Risk maps of Lassa fever in West Africa. PLoS Negl. Trop. Dis., 3.","DOI":"10.1371\/journal.pntd.0000388"},{"key":"ref_15","unstructured":"National Institute of Allergy and Infectious Diseases (2021, January 13). NIAID Emerging Infectious Diseases\/Pathogens, Available online: https:\/\/www.niaid.nih.gov\/research\/emerging-infectious-diseases-pathogens."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1056\/NEJM198601023140104","article-title":"Lassa fever. Effective therapy with ribavirin","volume":"314","author":"McCormick","year":"1986","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.antiviral.2007.11.003","article-title":"New opportunities for field research on the pathogenesis and treatment of Lassa fever","volume":"78","author":"Khan","year":"2008","journal-title":"Antivir. Res."},{"key":"ref_18","unstructured":"Coalition for Epidemic Preparedness Innovations (2021, March 06). Largest-Ever Lassa Fever Research Programme Launches in West Africa. Available online: https:\/\/cepi.net\/news_cepi\/largest-ever-lassa-fever-research-programme-launches-in-west-africa\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.4269\/ajtmh.1974.23.1131","article-title":"Lassa fever in the Eastern Province of Sierra Leone, 1970\u20131972. I. Epidemiologic studies","volume":"23","author":"Fraser","year":"1974","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Shaffer, J.G., Grant, D.S., Schieffelin, J.S., Boisen, M.L., Goba, A., Hartnett, J.N., Levy, D.C., Yenni, R.E., Moses, L.M., and Fullah, M. (2014). Lassa fever in post-conflict sierra leone. PLoS Negl. Trop. Dis., 8.","DOI":"10.1371\/journal.pntd.0002748"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"103673","DOI":"10.1016\/j.dib.2019.01.021","article-title":"Data set on Lassa fever in post-conflict Sierra Leone","volume":"23","author":"Shaffer","year":"2019","journal-title":"Data Brief"},{"key":"ref_22","first-page":"101","article-title":"Lassa Fever in post-Ebola Sierra Leone. Sociodemographics and case fatality rates of in-hospital patients admitted at the Kenema Government Hospital Lassa Fever Ward between 2016\u20132018","volume":"1","author":"Kangbai","year":"2020","journal-title":"J. Virol. Pathog."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Samuels, R.J., Moon, T.D., Starnes, J.R., Alhasan, F., Gbakie, M., Goba, A., Koroma, V., Momoh, M., Sandi, J.D., and Garry, R.F. (2020). Lassa Fever among Children in Eastern Province, Sierra Leone: A 7-year Retrospective Analysis (2012\u20132018). Am. J. Trop. Med. Hyg., tpmd200773.","DOI":"10.4269\/ajtmh.20-0773"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kenmoe, S., Tchatchouang, S., Ebogo-Belobo, J.T., Ka\u2019e, A.C., Mahamat, G., Simo, R.E.G., Bowo-Ngandji, A., Emoh, C.P.D., Che, E., and Ngongang, D.T. (2020). Systematic review and meta-analysis of the epidemiology of Lassa virus in humans, rodents and other mammals in sub-Saharan Africa. PLoS Negl. Trop. Dis., 14.","DOI":"10.1371\/journal.pntd.0008589"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"170","DOI":"10.3389\/fpubh.2019.00170","article-title":"Caseload and Case Fatality of Lassa Fever in Nigeria, 2001\u20132018: A Specialist Center\u2019s Experience and Its Implications","volume":"7","author":"Akpede","year":"2019","journal-title":"Front. Public Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1016\/S1473-3099(20)30299-1","article-title":"Lassa fever outbreak continues across Nigeria","volume":"20","author":"Bagcchi","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"16030","DOI":"10.1038\/s41598-020-72539-w","article-title":"Antibodies from Sierra Leonean and Nigerian Lassa fever survivors cross-react with recombinant proteins representing Lassa viruses of divergent lineages","volume":"10","author":"Heinrich","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Sullivan, B.M., Sakabe, S., Hartnett, J.N., Ngo, N., Goba, A., Momoh, M., Sandi, J.D., Kanneh, L., Cubitt, B., and Garcia, S.D. (2020). High crossreactivity of human T cell responses between Lassa virus lineages. PLoS Pathog., 16.","DOI":"10.1371\/journal.ppat.1008352"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.coviro.2019.06.005","article-title":"A short history of Lassa fever: The first 10\u201315 years after discovery","volume":"37","author":"Monath","year":"2019","journal-title":"Curr. Opin. Virol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1186\/1743-422X-8-478","article-title":"Emerging trends in Lassa fever: Redefining the role of immunoglobulin M and inflammation in diagnosing acute infection","volume":"8","author":"Branco","year":"2011","journal-title":"Virol. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"8724","DOI":"10.1038\/s41598-020-65736-0","article-title":"Field evaluation of a Pan-Lassa rapid diagnostic test during the 2018 Nigerian Lassa fever outbreak","volume":"10","author":"Boisen","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_32","unstructured":"Viral Hemorrhagic Fever Consortium (2021, January 12). Viral Hemorrhagic Fever Consortium. Available online: https:\/\/vhfc.org\/."},{"key":"ref_33","unstructured":"Centers for Disease Control and Prevention (2021, January 19). 2014\u20132016 Ebola Outbreak in West Africa, Available online: https:\/\/www.cdc.gov\/vhf\/ebola\/history\/2014-2016-outbreak\/index.html#:~:text=After%20an%20initial%20declaration%20in,March%20and%20April%20of%202016."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"S110","DOI":"10.1093\/infdis\/jiw239","article-title":"An Outbreak of Ebola Virus Disease in the Lassa Fever Zone","volume":"214","author":"Goba","year":"2016","journal-title":"J. Infect. Dis."},{"key":"ref_35","unstructured":"BBC News (2021, January 21). Ebola Intensifies the Struggle to Cope with Lassa Fever. Available online: https:\/\/www.bbc.com\/news\/world-africa-29868394."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1038\/513474a","article-title":"Infectious disease: Ebola\u2019s lost ward","volume":"513","year":"2014","journal-title":"Nature"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1056\/NEJMoa1411680","article-title":"Clinical illness and outcomes in patients with Ebola in Sierra Leone","volume":"371","author":"Schieffelin","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"e029093","DOI":"10.1136\/bmjopen-2019-029093","article-title":"Impact of Ebola outbreak on reproductive health services in a rural district of Sierra Leone: A prospective observational study","volume":"9","author":"Quaglio","year":"2019","journal-title":"BMJ Open"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e000065","DOI":"10.1136\/bmjgh-2016-000065","article-title":"Women and babies are dying but not of Ebola\u2019: The effect of the Ebola virus epidemic on the availability, uptake and outcomes of maternal and newborn health services in Sierra Leone","volume":"1","author":"Jones","year":"2016","journal-title":"BMJ Glob. Health"},{"key":"ref_40","unstructured":"World Health Organization (2021, January 19). Statement on the End of the Ebola Outbreak in Sierra Leone. Available online: https:\/\/www.afro.who.int\/news\/statement-end-ebola-outbreak-sierra-leone."},{"key":"ref_41","unstructured":"The World Bank (2021, January 20). Sierra Leone. Available online: https:\/\/data.worldbank.org\/country\/SL."},{"key":"ref_42","unstructured":"Worldometer (2021, January 20). Sierra Leone Population. Available online: https:\/\/www.worldometers.info\/world-population\/sierra-leone-population\/."},{"key":"ref_43","unstructured":"Wikipedia (2021, January 29). Districts of Sierra Leone. Available online: https:\/\/en.wikipedia.org\/wiki\/Districts_of_Sierra_Leone."},{"key":"ref_44","unstructured":"Wikipedia (2021, January 23). Geography of Sierra Leone. Available online: https:\/\/en.wikipedia.org\/wiki\/Geography_of_Sierra_Leone#:~:text=Physical%20geography,-Sierra%20Leone%20is&text=Sierra%20Leone%20has%20four%20distinct,1%2C948%20meters%20(6%2C391%20ft)."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1093\/cid\/ciw327","article-title":"Factors Underlying Ebola Virus Infection Among Health Workers, Kenema, Sierra Leone, 2014\u20132015","volume":"63","author":"Senga","year":"2016","journal-title":"Clin. Infect. Dis. Off. Publ. Infect. Dis. Soc. Am."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Shaffer, J.G., Schieffelin, J.S., Gbakie, M., Alhasan, F., Roberts, N.B., Goba, A., Randazzo, J., Momoh, M., Moon, T.D., and Kanneh, L. (2019). A medical records and data capture and management system for Lassa fever in Sierra Leone: Approach, implementation, and challenges. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0214284"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"5939","DOI":"10.1038\/s41598-018-24246-w","article-title":"Field validation of recombinant antigen immunoassays for diagnosis of Lassa fever","volume":"8","author":"Boisen","year":"2018","journal-title":"Sci Rep."},{"key":"ref_48","unstructured":"SAS Institute Inc. (2007). Pharmaceutical Statistics Using SAS, SAS Institute, Inc."},{"key":"ref_49","first-page":"010406","article-title":"Utilization of non-Ebola health care services during Ebola outbreaks: A systematic review and meta-analysis","volume":"9","author":"Wilhelm","year":"2019","journal-title":"J. Glob. Health"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Bolkan, H.A., van Duinen, A., Samai, M., Gassama, I., Waalewijn, B., Wibe, A., and von Schreeb, J. (2018). Admissions and surgery as indicators of hospital functions in Sierra Leone during the west-African Ebola outbreak. BMC Health Serv. Res., 18.","DOI":"10.1186\/s12913-018-3666-9"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Wagenaar, B.H., Augusto, O., Beste, J., Toomay, S.J., Wickett, E., Dunbar, N., Bawo, L., and Wesseh, C.S. (2018). The 2014\u20132015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010\u20132016. PLoS Med., 15.","DOI":"10.1371\/journal.pmed.1002508"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1093\/trstmh\/trx009","article-title":"Effect of the 2014\/2015 Ebola outbreak on reproductive health services in a rural district of Guinea: An ecological study","volume":"111","author":"Camara","year":"2017","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1126\/science.359.6381.1201","article-title":"Nigeria hit by unprecedented Lassa fever outbreak","volume":"359","author":"Roberts","year":"2018","journal-title":"Science"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.imlet.2019.03.008","article-title":"Vaccine platforms for the prevention of Lassa fever","volume":"215","author":"Purushotham","year":"2019","journal-title":"Immunol. Lett."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/9\/3\/586\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:34:51Z","timestamp":1760160891000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/9\/3\/586"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,12]]},"references-count":54,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["microorganisms9030586"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms9030586","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,12]]}}}