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Yeabah TO, Kaba I, Ramaswamy G, Dahal P, Delamou A, Vonhm BT, Jetoh RW, Merson L, Levine AC, Relan P, Harries AD, Kumar AM. Factors associated with death in patients admitted with Ebola virus disease to Ebola Treatment Units in Guinea, Sierra Leone, and Liberia - December 2013 to March 2016. F1000Res 2025; 13:672. [PMID: 40046245 PMCID: PMC11880755 DOI: 10.12688/f1000research.149612.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2025] [Indexed: 05/13/2025] Open
Abstract
Background The 2013-2016 West African Ebola Virus Disease (EVD) outbreak resulted in 28,600 cases and 11,300 deaths officially reported to the World Health Organization. Previous studies investigating factors associated with death had conflicting findings, interventions showing promising outcomes had small sample sizes, studies were often single- or dual-country based and most focused on laboratory-confirmed EVD and not on clinically-suspected EVD. We used the Ebola data platform of the Infectious Disease Data Observatory (IDDO) to review individual patient records to assess factors associated with death, and particularly whether there were differences between laboratory-confirmed and clinically-suspected cases. Methods This was a cohort study involving analysis of secondary data in the IDDO database. The study population included all patients classified as having either clinically-suspected or laboratory-confirmed EVD, admitted to 22 Ebola Treatment Units (ETU) in Guinea, Liberia and Sierra Leone between December 2013 and March 2016. Baseline characteristics and treatments were documented along with ETU exit outcomes. Factors associated with death were investigated by multivariable modified Poisson regression. Results There were 14,163 patients, of whom 6,208 (43.8%) were laboratory-confirmed and 7,955 (56.2%) were clinically-suspected. Outcomes were not recorded in 2,889 (20.4%) patients. Of the 11,274 patients with known outcomes, 4,090 (36.3%) died: 2,956 (43.6%) with laboratory-confirmed EVD and 1,134 (18.8%) with clinically-suspected EVD. The strongest risk factor for death was confirmed disease status. Patients with laboratory-confirmed disease had 2.9 times higher risk of death compared to clinically-suspected patients, after adjusting for other co-variables. Other factors significantly associated with death included a higher risk for patients aged ≥60 years and a lower risk for patients in Sierra Leone. Conclusions Although laboratory-confirmed patients admitted to ETUs fared worse than clinically-suspected patients, the latter still had a substantial risk of death and more attention needs to be paid to this group in future EVD outbreaks.
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Affiliation(s)
- Trokon Omarley Yeabah
- Department of Technical Services, National Public Health Institute of Liberia, Monrovia, Montserrado, 1000, Liberia
| | - Ibrahima Kaba
- African Center of Excellence for the Prevention and Control of Transmissible Diseases, University Gamal Abdel Nasser, Conakry, Guinea, 1017, Guinea
| | - Gomathi Ramaswamy
- All India Institute of Medical Sciences, Bibinagar, Hyderabad, 508126, India
| | - Prabin Dahal
- Infectious Diseases Data Observatory, Centre for Tropical Medicine & Global Health, University of Oxford, Headington, Oxfordshire, OX3 7LG, UK
| | - Alexandre Delamou
- Centre national de formation et de recherche en santé rurale de Maferinyah, University Gamal Abdel Nasser, Forécariah, Conakry, 1017, Guinea
| | - Benjamin T. Vonhm
- Department of Technical Services, National Public Health Institute of Liberia, Monrovia, Montserrado, 1000, Liberia
| | - Ralph W. Jetoh
- Department of Technical Services, National Public Health Institute of Liberia, Monrovia, Montserrado, 1000, Liberia
| | - Laura Merson
- ISARIC, Pandemic Sciences Institute, University of Oxford, Old Road Campus, Headington, Oxfordshire, OX3 7LG, UK
| | - Adam C. Levine
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, 02903, USA
| | - Pryanka Relan
- Health Emergencies Programme, World Health Organization, Avenue Appia 20, Geneva, 1203, Switzerland
| | - Anthony D. Harries
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- International Union Against Tuberculosis and Lung Disease, The Union, 2 Rue Jean Lantier, Paris, 75001, France
| | - Ajay M.V. Kumar
- International Union Against Tuberculosis and Lung Disease, The Union, 2 Rue Jean Lantier, Paris, 75001, France
- Yenepoya Medical College, Yenepoya Deemed to be University, Deralakatte, Mangalore, 575018, India
- South-East Asia Office, The Union, C6, Qutub Institutional Area, New Delhi, 110016, India
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Rojek A, Fieggen J, Apiyo P, Caluwaerts S, Fowler RA, Kaleebu P, Kojan R, Lado M, Lambe T, Dunning J, Horby P. Ebola disease: bridging scientific discoveries and clinical application. THE LANCET. INFECTIOUS DISEASES 2025; 25:e165-e176. [PMID: 39675368 DOI: 10.1016/s1473-3099(24)00673-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 10/04/2024] [Accepted: 10/07/2024] [Indexed: 12/17/2024]
Abstract
The west Africa Ebola disease epidemic (2014-16) marked a historic change of course for patient care during emerging infectious disease outbreaks. The epidemic response was a failure in many ways-a slow, cumbersome, and disjointed effort by a global architecture that was not fit for purpose for a rapidly spreading outbreak. In the most affected countries, health-care workers and other responders felt helpless-dealing with an overwhelming number of patients but with few, if any, tools at their disposal to provide high-quality care. These inadequacies, however, led to attention and innovation. The decade since then has seen remarkable achievements in clinical care for Ebola disease, including the approval of the first vaccines and treatments. In this paper, the first in a two-part Series, we reflect on this progress and provide expert summary of the modern landscape of Ebola disease, highlighting the priorities and ongoing activities aimed at further improving patient survival and wellbeing in the years ahead.
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Affiliation(s)
| | | | - Paska Apiyo
- Gulu Regional Referral Hospital Ministry of Health, Pece Laroo Division, Gulu City, Uganda
| | - Séverine Caluwaerts
- Medical Department, Médecins Sans Frontières, Brussels, Belgium; Institute of Tropical Medicine, Antwerp, Belgium
| | - Robert A Fowler
- Sunnybrook Health Sciences Centre, Sunnybrook Hospital, Toronto, ON, Canada
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Marta Lado
- Partners In Health, Freetown, Sierra Leone
| | - Teresa Lambe
- Pandemic Sciences Institute, Oxford, UK; Oxford Vaccine Group, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital, Oxford, UK
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3
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Nash RK, Bhatia S, Morgenstern C, Doohan P, Jorgensen D, McCain K, McCabe R, Nikitin D, Forna A, Cuomo-Dannenburg G, Hicks JT, Sheppard RJ, Naidoo T, van Elsland S, Geismar C, Rawson T, Leuba SI, Wardle J, Routledge I, Fraser K, Imai-Eaton N, Cori A, Unwin HJT. Ebola virus disease mathematical models and epidemiological parameters: a systematic review. THE LANCET. INFECTIOUS DISEASES 2024; 24:e762-e773. [PMID: 39127058 PMCID: PMC7616620 DOI: 10.1016/s1473-3099(24)00374-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/07/2024] [Accepted: 06/07/2024] [Indexed: 08/12/2024]
Abstract
Ebola virus disease poses a recurring risk to human health. We conducted a systematic review (PROSPERO CRD42023393345) of Ebola virus disease transmission models and parameters published from database inception to July 7, 2023, from PubMed and Web of Science. Two people screened each abstract and full text. Papers were extracted with a bespoke Access database, 10% were double extracted. We extracted 1280 parameters and 295 models from 522 papers. Basic reproduction number estimates were highly variable, as were effective reproduction numbers, likely reflecting spatiotemporal variability in interventions. Random-effect estimates were 15·4 days (95% CI 13·2-17·5) for the serial interval, 8·5 days (7·7-9·2) for the incubation period, 9·3 days (8·5-10·1) for the symptom-onset-to-death delay, and 13·0 days (10·4-15·7) for symptom-onset-to-recovery. Common effect estimates were similar, albeit with narrower CIs. Case-fatality ratio estimates were generally high but highly variable, which could reflect heterogeneity in underlying risk factors. Although a substantial body of literature exists on Ebola virus disease models and epidemiological parameter estimates, many of these studies focus on the west African Ebola epidemic and are primarily associated with Zaire Ebola virus, which leaves a key gap in our knowledge regarding other Ebola virus species and outbreak contexts.
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Affiliation(s)
- Rebecca K Nash
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Sangeeta Bhatia
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK; Health Protection Research Unit in Modelling and Health Economics, London, UK; Modelling and Economics Unit, UK Health Security Agency, London, UK
| | - Christian Morgenstern
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Patrick Doohan
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - David Jorgensen
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Kelly McCain
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Ruth McCabe
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK; Department of Statistics, University of Oxford, Oxford, UK; Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, Liverpool, UK
| | - Dariya Nikitin
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Alpha Forna
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK; Center for the Ecology of Infectious Diseases, Odum School of Ecology, University of Georgia, Athens, GA, USA
| | - Gina Cuomo-Dannenburg
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Joseph T Hicks
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Richard J Sheppard
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Tristan Naidoo
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Sabine van Elsland
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Cyril Geismar
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Thomas Rawson
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Sequoia Iris Leuba
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Jack Wardle
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Isobel Routledge
- Institute of Global Health Sciences, University of California, San Francisco, CA, USA
| | - Keith Fraser
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Natsuko Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK
| | - Anne Cori
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK; Health Protection Research Unit in Modelling and Health Economics, London, UK
| | - H Juliette T Unwin
- MRC Centre for Global Infectious Disease Analysis and WHO Collaborating Centre for Infectious Disease Modelling, Jameel Institute, School of Public Health, Imperial College London, London, UK; School of Mathematics, University of Bristol, Bristol, UK.
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4
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Tsou TP. Sudan virus disease - A quick review. J Formos Med Assoc 2024; 123:16-22. [PMID: 37355438 DOI: 10.1016/j.jfma.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/29/2023] [Accepted: 06/05/2023] [Indexed: 06/26/2023] Open
Abstract
The recent Sudan virus disease (SVD) outbreak in Uganda is a reminder of threat from Filovirus diseases. Unlike Ebola virus disease, no effective antiviral and vaccine is available for SVD. The outbreak was declared over after 115 days, with 142 confirmed cases and case fatality rate of 39%, before any dose of candidate vaccine could be used on contacts. We provide a quick review of up-to-date information on the Uganda outbreak, summary of previous outbreaks, and detail the existing SVD treatment and vaccine candidates. Evolution of disease attributes and the impact on public health were also discussed. For high consequence infectious disease like SVD, it takes international collaboration to be better prepared for the next outbreak.
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Affiliation(s)
- Tsung-Pei Tsou
- Division of Emerging Infectious Diseases and Pandemic Preparedness, Taiwan Centers for Disease Control, 3F, No 6, Linsen S. Road, Taipei, Taiwan.
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5
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Izudi J, Bajunirwe F. Case fatality rate for Ebola disease, 1976-2022: A meta-analysis of global data. J Infect Public Health 2024; 17:25-34. [PMID: 37992431 DOI: 10.1016/j.jiph.2023.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/07/2023] [Accepted: 10/22/2023] [Indexed: 11/24/2023] Open
Abstract
An up-to-date pooled case fatality rate (CFR) for Ebola disease (EBOD) at the global level is lacking. We abstracted EBOD data from 1976 to 2022 for 16 countries and 42 outbreaks to conduct a meta-analysis. The pooled CFR was 60.6% (95% confidence interval (CI) 51.6-69.4; 95% prediction interval 12.9-99.1). Of the four ebolaviruses, Zaire virus was the most lethal (CFR = 66.6%, 95% CI 55.9-76.8), then Sudan virus (CFR=48.5%, 95% CI 38.6-58.4), Bundibugyo virus (CFR=32.8%, 95% CI 25.8-40.2) and Tai Forest virus (CFR= 0%, 95% CI 0.0-97.5). The CFR in sub-Saharan Africa was 61.3% (95% CI 52.8-69.6) and for the rest of the world was 24.5% (95% CI 0.0-67.9%). CFR declined over time but stabilized at 61.0% (95% CI, 52.0-69.0) between 2014 and 2022. Overall, the EBOD CFR is still high and heterogeneous. Accordingly, early diagnosis, early treatment if available, and supportive care are important to prevent significant morbidity and mortality.
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Affiliation(s)
- Jonathan Izudi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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6
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Rigby I, Michelen M, Dagens A, Cheng V, Dahmash D, Harriss E, Webb E, Cai E, Lipworth S, Oti A, Balan V, Piotrowski H, Nartowski R, Rojek A, Groves H, Hart P, Cevik M, Bosa HK, Blumberg L, Fletcher TE, Horby PW, Jacob ST, Sigfrid L. Standard of care for viral haemorrhagic fevers (VHFs): a systematic review of clinical management guidelines for high-priority VHFs. THE LANCET. INFECTIOUS DISEASES 2023; 23:e240-e252. [PMID: 36758568 DOI: 10.1016/s1473-3099(22)00874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 02/08/2023]
Abstract
The Sudan virus disease outbreak in Uganda in 2022 showed our vulnerability to viral haemorrhagic fevers (VHFs). Although there are regular outbreaks of VHFs with high morbidity and mortality, which disproportionally affect low-income settings, our understanding of how to treat them remains inadequate. In this systematic review, we aim to explore the availability, scope, standardisation, and quality of clinical management guidelines for VHFs. We identified 32 guidelines, 25 (78%) of which were low quality and did not have supporting evidence and eight (25%) of which had been produced or updated in the past 3 years. Guidance on supportive care and therapeutics had little detail and was sometimes contradictory. Guidelines based on uncertain evidence are a risk to patients, an ethical challenge for clinicians, and a challenge to implementing trials due to heterogeneous standards of care. We recommend a standard living guideline framework to improve the quality, scope, and applicability of guidelines. Furthermore, investments into trials should aim to identify optimal treatment strategies for VHFs and prioritise affordable and scalable interventions to improve outcomes globally.
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Affiliation(s)
- Ishmeala Rigby
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Melina Michelen
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Andrew Dagens
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Vincent Cheng
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Dania Dahmash
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Eika Webb
- Department of Clinical Sciences, Imperial College London, London, UK
| | - Erhui Cai
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Samuel Lipworth
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; Department of Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Alexandra Oti
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | - Valeria Balan
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Helen Piotrowski
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Robert Nartowski
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Amanda Rojek
- Emergency Department, Royal Melbourne Hospital, Melbourne, Australia; Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia
| | | | | | - Muge Cevik
- Department of Global Health and Infection Research, School of Medicine, University of St Andrews, St Andrews, UK
| | - Henry Kyobe Bosa
- Ministry of Health, Kampala, Uganda; Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Lucille Blumberg
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Tom E Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Peter W Horby
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Shevin T Jacob
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Louise Sigfrid
- GloPID-R Research and Policy Team, University of Oxford, Oxford, UK; International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK.
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7
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Schultz MJ, Deen J, von Seidlein L, Sivakorn C, Kumar A, Adhikari NKJ, Wills B, Kekulé AS, Day NPJ, Cooper B, White NJ, Salam AP, Horby P, Olliaro P, Dondorp AM. Remote-Controlled and Pulse Pressure-Guided Fluid Treatment for Adult Patients with Viral Hemorrhagic Fevers. Am J Trop Med Hyg 2021; 104:1172-1175. [PMID: 33591934 PMCID: PMC8045617 DOI: 10.4269/ajtmh.20-1515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/17/2020] [Indexed: 11/08/2022] Open
Abstract
Circulatory shock, caused by severe intravascular volume depletion resulting from gastrointestinal losses and profound capillary leak, is a common clinical feature of viral hemorrhagic fevers, including Ebola virus disease, Marburg hemorrhagic fever, and Lassa fever. These conditions are associated with high case fatality rates, and they carry a significant risk of infection for treating personnel. Optimized fluid therapy is the cornerstone of management of these diseases, but there are few data on the extent of fluid losses and the severity of the capillary leak in patients with VHFs, and no specific guidelines for fluid resuscitation and hemodynamic monitoring exist. We propose an innovative approach for monitoring VHF patients, in particular suited for low-resource settings, facilitating optimizing fluid therapy through remote-controlled and pulse pressure–guided fluid resuscitation. This strategy would increase the capacity for adequate supportive care, while decreasing the risk for virus transmission to health personnel.
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Affiliation(s)
- Marcus J Schultz
- 1Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,2Department of Intensive Care, Amsterdam University Medical Centres, Amsterdam, The Netherlands.,3Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jacqueline Deen
- 4Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
| | - Lorenz von Seidlein
- 1Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,3Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Chaisith Sivakorn
- 5Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Alex Kumar
- 6School of Population Health and Environmental Sciences, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Neill K J Adhikari
- 7Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Bridget Wills
- 3Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,8Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - Alexander S Kekulé
- 9Institute for Medical Microbiology, Martin Luther University, Halle-Wittenberg, Germany
| | - Nicholas P J Day
- 1Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,3Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Ben Cooper
- 1Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,3Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas J White
- 1Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,3Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Alex P Salam
- 3Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,10United Kingdom Public Health Rapid Support Team, London, United Kingdom
| | - Peter Horby
- 3Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,11ISARIC Global Support Centre, International Severe Acute Respiratory and Emerging Infection Consortium, Oxford, United Kingdom
| | - Piero Olliaro
- 3Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,11ISARIC Global Support Centre, International Severe Acute Respiratory and Emerging Infection Consortium, Oxford, United Kingdom
| | - Arjen M Dondorp
- 1Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,2Department of Intensive Care, Amsterdam University Medical Centres, Amsterdam, The Netherlands.,3Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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8
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Jain V, Charlett A, Brown CS. Meta-analysis of predictive symptoms for Ebola virus disease. PLoS Negl Trop Dis 2020; 14:e0008799. [PMID: 33095771 PMCID: PMC7641466 DOI: 10.1371/journal.pntd.0008799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 11/04/2020] [Accepted: 09/16/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION One of the leading challenges in the 2013-2016 West African Ebola virus disease (EVD) outbreak was how best to quickly identify patients with EVD, separating them from those without the disease, in order to maximise limited isolation bed capacity and keep health systems functioning. METHODOLOGY We performed a systematic literature review to identify all published data on EVD clinical symptoms in adult patients. Data was dual extracted, and random effects meta-analysis performed for each symptom to identify symptoms with the greatest risk for EVD infection. RESULTS Symptoms usually presenting late in illness that were more than twice as likely to predict a diagnosis of Ebola, were confusion (pOR 3.04, 95% CI 2.18-4.23), conjunctivitis (2.90, 1.92-4.38), dysphagia (1.95, 1.13-3.35) and jaundice (1.86, 1.20-2.88). Early non-specific symptoms of diarrhoea (2.99, 2.00-4.48), fatigue (2.77, 1.59-4.81), vomiting (2.69, 1.76-4.10), fever (1.97, 1.10-4.52), muscle pain (1.65, 1.04-2.61), and cough (1.63, 1.24-2.14), were also strongly associated with EVD diagnosis. CONCLUSIONS The existing literature fails to provide a unified position on the symptoms most predictive of EVD, but highlights some early and late stage symptoms that in combination will be useful for future risk stratification. Confirmation of these findings across datasets (or ideally an aggregation of all individual patient data) will aid effective future clinical assessment, risk stratification tools and emergency epidemic response planning.
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Affiliation(s)
- Vageesh Jain
- North East and North Central London Health Protection Team, Public Health England, London, United Kingdom
- Institute for Global Health, University College London (UCL), London, United Kingdom
- * E-mail:
| | - Andre Charlett
- National Infection Service, Public Health England, London, United Kingdom
| | - Colin S. Brown
- National Infection Service, Public Health England, London, United Kingdom
- King’s Sierra Leone Partnership, King’s Centre for Global Health, King’s Health Partners and King’s College London, London, United Kingdom
- Department of Infection, Royal Free London NHS Foundation Trust, London, United Kingdom
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Kiiza P, Mullin S, Teo K, Adhikari NKJ, Fowler RA. Treatment of Ebola-related critical illness. Intensive Care Med 2020; 46:285-297. [PMID: 32055888 PMCID: PMC7223059 DOI: 10.1007/s00134-020-05949-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/22/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To explore contemporary clincial case management of patients with Ebola virus disease. METHODS A narrative review from a clinical perspective of clinical features, diagnostic tests, treatments and outcomes of patients with Ebola virus disease. RESULTS Substantial advances have been made in the care of patients with Ebola virus disease (EVD), precipitated by the unprecedented extent of the 2014-2016 outbreak. There has been improved point-of-care diagnostics, improved characterization of the clinical course of EVD, improved patient-optimized standards of care, evaluation of effective anti-Ebola therapies, administration of effective vaccines, and development of innovative Ebola treatment units. A better understanding of the Ebola virus disease clinical syndrome has led to the appreciation of a central role for critical care clinicians-over 50% of patients have life-threatening complications, including hypotension, severe electrolyte imbalance, acute kidney injury, metabolic acidosis and respiratory failure. Accordingly, patients often require critical care interventions such as monitoring of vital signs, intravenous fluid resuscitation, intravenous vasoactive medications, frequent diagnostic laboratory testing, renal replacement therapy, oxygen and occasionally mechanical ventilation. CONCLUSION With advanced training and adherence to infection prevention and control practices, clinical interventions, including critical care, are feasible and safe to perform in critically ill patients. With specific anti-Ebola medications, most patients can survive Ebola virus infection.
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Affiliation(s)
- Peter Kiiza
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - S Mullin
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - K Teo
- Canadian Forces Health Services Group, Toronto, 10 Yukon Lane, North York, ON, M3K 0A1, Canada
| | - N K J Adhikari
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - R A Fowler
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. .,Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada. .,, 2075 Bayview Avenue, Room D478, Toronto, ON, M4N 3M5, Canada.
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Rojek AM, Moran J, Horby PW. Core Minimal Datasets to Advance Clinical Research for Priority Epidemic Diseases. Clin Infect Dis 2020; 70:696-697. [PMID: 31406989 PMCID: PMC7108131 DOI: 10.1093/cid/ciz760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 08/08/2019] [Indexed: 11/24/2022] Open
Abstract
The Ebola virus disease outbreak in west Africa has prompted significant progress in responding to the clinical needs of patients affected by emerging infectious disease outbreaks. Among the noteworthy successes of vaccine trials, and the commendable efforts to implement clinical treatment trials during Ebola outbreaks, we should also focus on strengthening the collection and curation of epidemiological and observational data that can improve the conception and design of clinical research.
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Affiliation(s)
- Amanda M Rojek
- Epidemic Diseases Research Group, University of Oxford, United Kingdom
| | - James Moran
- Epidemic Diseases Research Group, University of Oxford, United Kingdom
| | - Peter W Horby
- Epidemic Diseases Research Group, University of Oxford, United Kingdom
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Inungu J, Iheduru-Anderson K, Odio OJ. Recurrent Ebolavirus disease in the Democratic Republic of Congo: update and challenges. AIMS Public Health 2019; 6:502-513. [PMID: 31909070 PMCID: PMC6940573 DOI: 10.3934/publichealth.2019.4.502] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/18/2019] [Indexed: 12/31/2022] Open
Abstract
The current Ebolavirus disease (EVD) outbreak in the provinces of North Kivu and Ituri is the tenth outbreak affecting the Democratic Republic of Congo (DRC); the first outbreak occurring in a war context, and the second most deadly Ebolavirus outbreak on record following the 2014 outbreak in West Africa. The DRC government's response consisted of applying a package of interventions including detection and rapid isolation of cases, contact tracing, population mapping, and identification of high-risk areas to inform a coordinated effort. The coordinated effort was to screen, ring vaccinate, and conduct laboratory diagnoses using GeneXpert (Cepheid) polymerase chain reaction. The effort also included ensuring safe and dignified burials and promoting risk communication, community engagement, and social mobilization. Following the adoption of the “Monitored Emergency Use of Unregistered Products Protocol,” a randomized controlled trial of four investigational treatments (mAb114, ZMapp, and REGN-EB3 and Remdesivir) was carried out with all consenting patients with laboratory-confirmed EVD. REGN-EB3 and mAb114 showed promise as treatments for EVD. In addition, one investigational vaccine (rVSV-ZEBOV-GP) was used first, followed by a second prophylactic vaccine (Ad26.ZEBOV/MVA-BN-Filo) to reinforce the prevention. Although the provision of clinical supportive care remains the cornerstone of EVD outbreak management, the DRC response faced daunting challenges including general insecurity, violence and community resistance, appalling poverty, and entrenched distrust of authority. Ebolavirus remains a public health threat. A fully curative treatment is unlikely to be a game-changer given the settings of transmission, zoonotic nature, limits of effectiveness of any therapeutic intervention, and timing of presentation.
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Affiliation(s)
- Joseph Inungu
- Master of Public Health Program, College of Health Professions, Central Michigan University, Michigan, United States
| | | | - Ossam J Odio
- Department of Internal Medicine, Medical School Hospital, University of Kinshasa, Kinshasa, Congo
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