Lassa fever (LF) virus (LASV) is endemic in Sierra Leone (SL) and poses a significant public health threat to the region; however, no risk factors for clinical LF have been reported in SL. The objective of this study was to identify the risk factors for clinical LF in an endemic community in SL. We conducted a case–control study by enrolling 37 laboratory-confirmed LF cases identified through the national LF surveillance system in SL and 140 controls resided within a one-kilometre radius of the case household. We performed a conditional multiple logistic regression analysis to identify the risk factors for clinical LF. Of the 37 cases enrolled, 23 died (62% case fatality rate). Cases were younger than controls (19.5 years vs 28.9 years, p < 0.05) and more frequently female (64.8% vs 52.8%). Compared to the controls, clinical LF cases had higher contact with rodents (rats or mice) in their households in the preceding three weeks (83.8% vs 47.8%). Households with a cat reported a lower presence of rodents (73% vs 38%, p < 0.01) and contributed to a lower rate of clinical LF (48.6% vs 55.7%) although not statistically significant (p = 0.56). The presence of rodents in the households (matched adjusted odds ratio (mAOR): 11.1) and younger age (mAOR: 0.99) were independently associated with clinical LF.

Rodent access to households and younger age were independently associated with clinical LF. Rodent access to households is likely a key risk factor for clinical LF in rural SL and potentially in other countries within the West African region. Implementing measures to control rodents and their access to households could potentially decrease the number of clinical LF cases in rural SL and West Africa.