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BackgroundConvulsions associated with fever (CAWF), are a frequent medical emergency in children. In the tropics, endemic malaria and bacterial infections are established causes. However, knowledge of the contributions of endemic viral haemorrhagic fevers, particularly Lassa fever(LF) which has multiple lineages of the virus, remains unknown It was hypothesised that LF, may be an unrecognised contributor to CAWF in areas of high disease burden.ObjectiveDetermine the prevalence of LF in children with fever, compare seizure characteristics, clinical features and outcomes. MethodA prospective case-control study of emergency admissions presenting with fever of 380 C. A positive Lassa virus Reverse-transcription Polymerase Chain Reaction (LV-RT-PCR) defined a diagnosis of LF.ResultsThree hundred and seventy three febrile children and adolescents were recruited,108 cases (CAWF) compared with 265 controls (fever without convulsions). The prevalence of LF [95% CI] was 3.5% [1.9, 5.7] The prevalence of malaria parasitaemia was significantly higher in CAWF compared with controls (OR [95% CI]=(6.38[2.86, 14.22], p=0.0001 ). There was no significant difference between the prevalence of LF in cases with non-febrile convulsions and their controls ( 2/40 versus 8/94 ) ( Fisher’s exact p=0.759 ). Bleeding was significantly associated with LF in CAWF compared with controls ( Fisher’s exact p=0.008 ).ConclusionLF is an important cause of fever. In this study LF was not significantly associated with CAWF but was a cause of fever presenting with seizures The absence of clear clinical differentiators from other aetiologies of fever without a focus inform the need for a high index of suspicion where the disease is endemic.