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Mandizadza OO, Phebeni RT, Ji C. Prevalence of somatic symptoms among Ebola Virus Disease (EVD) survivors in Africa: a systematic review and meta-analysis. BMC Public Health 2024; 24:1511. [PMID: 38840082 PMCID: PMC11155043 DOI: 10.1186/s12889-024-19013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Many Ebola virus disease (EVD) survivors have reported somatic and neuropsychological symptoms after discharge from the Ebola Treatment Unit (ETU). Since the 2014-2016 Ebola epidemic in West Africa, various studies have investigated and identified these symptoms. Evidence on somatic symptoms is widely available in the literature, however, there is no concise overview of the prevalence across different time intervals. METHODS This meta-analysis was conducted following the (PRISMA) guidelines. A database search was conducted to identify original studies that reported the prevalence of symptoms. The primary outcome measure was the prevalence rate of several somatic symptoms. Results were pooled, and prevalence rates were assessed over time, to elucidate any particular trends. RESULTS We included 23 studies (5,714 participants). The pooled prevalence was: arthralgia 50% (95% CI: 41%-59%); headache 44% (95% CI: 36%-52%); myalgia 32% (95% CI: 26%-38%); abdominal pain 27% (95% CI: 15%-39%); fatigue 25% (95% CI: 19%-31%); numbness of feet 16% (95% CI: 14%-18%); numbness of hands 12% (95% CI: 10%-14%) and hearing loss 9% (95% CI: 5%-12%). Prevalence across different time intervals revealed significant patterns. All the symptoms persisted for more than 2 years after discharge except for abdominal pain. CONCLUSION The pooled prevalence rates of somatic symptoms are notably high. Arthralgia and headache are the most prevalent of the symptoms, with hearing loss and numbness in hands and feet being the least. We found that arthralgia, myalgia, and abdominal pain decreased over time. However, headache, fatigue, numbness of hands and feet, and hearing loss increased over time.
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Affiliation(s)
| | | | - Conghua Ji
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China.
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2
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Lee HN, Xu B, Lewkowicz AP, Engel K, Kelley-Baker L, McWilliams IL, Ireland DDC, Kielczewski JL, Li J, Fariss RN, Campos MM, Baum A, Kyratsous C, Pascal K, Chan CC, Caspi RR, Manangeeswaran M, Verthelyi D. Ebola virus-induced eye sequelae: a murine model for evaluating glycoprotein-targeting therapeutics. EBioMedicine 2024; 104:105170. [PMID: 38823088 PMCID: PMC11169960 DOI: 10.1016/j.ebiom.2024.105170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/17/2024] [Accepted: 05/14/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Ebola virus disease (EVD) survivors experience ocular sequelae including retinal lesions, cataracts, and vision loss. While monoclonal antibodies targeting the Ebola virus glycoprotein (EBOV-GP) have shown promise in improving prognosis, their effectiveness in mitigating ocular sequelae remains uncertain. METHODS We developed and characterized a BSL-2-compatible immunocompetent mouse model to evaluate therapeutics targeting EBOV-GP by inoculating neonatal mice with vesicular stomatitis virus expressing EBOV-GP (VSV-EBOV). To examine the impact of anti-EBOV-GP antibody treatment on acute retinitis and ocular sequelae, VSV-EBOV-infected mice were treated with polyclonal antibodies or monoclonal antibody preparations with antibody-dependent cellular cytotoxicity (ADCC-mAb) or neutralizing activity (NEUT-mAb). FINDINGS Treatment with all anti-EBOV-GP antibodies tested dramatically reduced viremia and improved survival. Further, all treatments reduced the incidence of cataracts. However, NEUT-mAb alone or in combination with ADCC-mAb reduced viral load in the eyes, downregulated the ocular immune and inflammatory responses, and minimized retinal damage more effectively. INTERPRETATION Anti-EBOV-GP antibodies can improve survival among EVD patients, but improved therapeutics are needed to reduce life altering sequelae. This animal model offers a new platform to examine the acute and long-term effect of the virus in the eye and the relative impact of therapeutic candidates targeting EBOV-GP. Results indicate that even antibodies that improve systemic viral clearance and survival can differ in their capacity to reduce acute ocular inflammation, and long-term retinal pathology and corneal degeneration. FUNDING This study was partly supported by Postgraduate Research Fellowship Awards from ORISE through an interagency agreement between the US DOE and the US FDA.
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Affiliation(s)
- Ha-Na Lee
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, 20993, USA
| | - Biying Xu
- Laboratory of Immunology, National Eye Institute, NIH, Bethesda, MD, 20892, USA
| | - Aaron P Lewkowicz
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, 20993, USA
| | - Kaliroi Engel
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, 20993, USA
| | - Logan Kelley-Baker
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, 20993, USA
| | - Ian L McWilliams
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, 20993, USA
| | - Derek D C Ireland
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, 20993, USA
| | | | - Jinbo Li
- Biological Imaging Core, National Eye Institute, NIH, Bethesda, MD, 20892, USA
| | - Robert N Fariss
- Biological Imaging Core, National Eye Institute, NIH, Bethesda, MD, 20892, USA
| | - Mercedes M Campos
- Biological Imaging Core, National Eye Institute, NIH, Bethesda, MD, 20892, USA
| | - Alina Baum
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, 10591, USA
| | | | - Kristen Pascal
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, 10591, USA
| | - Chi-Chao Chan
- Laboratory of Immunology, National Eye Institute, NIH, Bethesda, MD, 20892, USA
| | - Rachel R Caspi
- Laboratory of Immunology, National Eye Institute, NIH, Bethesda, MD, 20892, USA
| | - Mohanraj Manangeeswaran
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, 20993, USA
| | - Daniela Verthelyi
- Division of Biotechnology Review and Research-III, Office of Biotechnology Products, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, 20993, USA.
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3
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Ahmad F, Deshmukh N, Webel A, Johnson S, Suleiman A, Mohan RR, Fraunfelder F, Singh PK. Viral infections and pathogenesis of glaucoma: a comprehensive review. Clin Microbiol Rev 2023; 36:e0005723. [PMID: 37966199 PMCID: PMC10870729 DOI: 10.1128/cmr.00057-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023] Open
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide, caused by the gradual degeneration of retinal ganglion cells and their axons. While glaucoma is primarily considered a genetic and age-related disease, some inflammatory conditions, such as uveitis and viral-induced anterior segment inflammation, cause secondary or uveitic glaucoma. Viruses are predominant ocular pathogens and can impose both acute and chronic pathological insults to the human eye. Many viruses, including herpes simplex virus, varicella-zoster virus, cytomegalovirus, rubella virus, dengue virus, chikungunya virus, Ebola virus, and, more recently, Zika virus (ZIKV) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), have been associated with sequela of either primary or secondary glaucoma. Epidemiological and clinical studies suggest the association between these viruses and subsequent glaucoma development. Despite this, the ocular manifestation and sequela of viral infections are not well understood. In fact, the association of viruses with glaucoma is considered relatively uncommon in part due to underreporting and/or lack of long-term follow-up studies. In recent years, literature on the pathological spectrum of emerging viral infections, such as ZIKV and SARS-CoV-2, has strengthened this proposition and renewed research activity in this area. Clinical studies from endemic regions as well as laboratory and preclinical investigations demonstrate a strong link between an infectious trigger and development of glaucomatous pathology. In this article, we review the current understanding of the field with a particular focus on viruses and their association with the pathogenesis of glaucoma.
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Affiliation(s)
- Faraz Ahmad
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Nikhil Deshmukh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Aaron Webel
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Sandra Johnson
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Ayman Suleiman
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Rajiv R. Mohan
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
- Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri, USA
- Departments of Veterinary Medicine & Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri, USA
| | - Frederick Fraunfelder
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Pawan Kumar Singh
- Department of Ophthalmology, Mason Eye Institute, University of Missouri School of Medicine, Columbia, Missouri, USA
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ACENG JANERUTH, BOSA HENRYKYOBE, KAMARA NEEMA, ATWINE DIANA, MWEBESA HENRY, NYIKA HOWARD, MAUREEN KATUSIIME, OLARO CHARLES, KAGIRITA ATEK, LARMODE MOHAMMED, RIEK LULPOUT, TEMFACK ELVIS, SALYER STEPHANIE, ALIDDEKI DATIVA, MACHINGAIDZE SHINGAI, MAZUGUNI FESTO, KIRENGA BRUCE, MUTTAMBA WINTERS, WAYENGERA MISAKI, BBUYE MUDASHIR, KASAMBULA ARTHUR, EURIEN DANIEL, GRACE AKELLO, AMPAIRE INGRID, HERBERT ISABIRYE, TUT MATHEW, BANGURE DONEWELL, MANKOULA WESSAM, SONKO IBRAHIMA, KOKOU ALINONNOUWAME, MAGODI SIMON, MHIRAF ADDIS, BULWADDA DANIEL, KYABAYINZE DANIEL, KABAMI ZAINAH, MURUTA ALLAN, BAHATUNGIRE RONY, GEORGE UPENTHO, NABADDA SUSAN, BIRUNGI GLORIA, RICHARD KABANDA, ARAGAW MERAWI, OUMA AHMEDOGWELL. Continental concerted efforts to control the seventh outbreak of Ebola Virus disease in Uganda: The first 90 days of the response. J Public Health Afr 2023; 14:2735. [PMID: 37881727 PMCID: PMC10594597 DOI: 10.4081/jphia.2023.2735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
On 20th September 2022, Uganda declared the 7th outbreak of Ebola virus disease (EVD) caused by the Sudan Ebola strain following the confirmation of a case admitted at Mubende Regional Referral Hospital. Upon confirmation, the Government of Uganda immediately activated the national incident management system to initiate response activities. Additionally, a multi-country emergency stakeholder meeting was held in Kampala; convening Ministers of Health from neighbouring Member States to undertake cross-border preparedness and response actions. The outbreak spanned 69 days and recorded 164 cases (142 confirmed, 22 probable), 87 recoveries and 77 deaths (case fatality ratio of 47%). Nine out of 136 districts were affected with transmission taking place in 5 districts but spilling over in 4 districts without secondary transmission. As part of the response, the Government galvanised robust community mobilisation and initiated assessment of medical counter measures including therapeutics, new diagnostics and vaccines. This paper highlights the response actions that contributed to the containment of this outbreak in addition to the challenges faced with a special focus on key recommendations for better control of future outbreaks.
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Affiliation(s)
| | | | - NEEMA KAMARA
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | | | - HOWARD NYIKA
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | | | | | - MOHAMMED LARMODE
- Makerere University Institute of Infectious Diseases, Kampala, Uganda
| | - LUL POUT RIEK
- Africa Centres for Disease Control and Prevention, Nairobi, Kenya
| | - ELVIS TEMFACK
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - STEPHANIE SALYER
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - DATIVA ALIDDEKI
- Africa Centres for Disease Control and Prevention, Nairobi, Kenya
| | | | - FESTO MAZUGUNI
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | | | | | | | | | | | | | | | | | - MATHEW TUT
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - DONEWELL BANGURE
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - WESSAM MANKOULA
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - IBRAHIMA SONKO
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - SIMON MAGODI
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - ADDIS MHIRAF
- Africa Centres for Disease Control and Prevention, Nairobi, Kenya
| | - DANIEL BULWADDA
- Makerere University Institute of Infectious Diseases, Kampala, Uganda
| | | | | | | | | | | | | | | | | | - MERAWI ARAGAW
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - AHMED OGWELL OUMA
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
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Rishi E, Thomas J, Fashina T, Kim L, Yeh S. Emerging Pathogenic Viral Infections of the Eye. Annu Rev Vis Sci 2023; 9:71-89. [PMID: 37018917 DOI: 10.1146/annurev-vision-100820-010504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Global health security threats and the public health impact resulting from emerging infectious diseases including the ongoing COVID-19 pandemic and recent Ebola virus disease outbreaks continuously emphasize the need for a comprehensive approach to preparedness, management of disease outbreaks, and health sequelae associated with emergent pathogens. A spectrum of associated ophthalmic manifestations, along with the potential persistence of emerging viral pathogens in ocular tissues, highlight the importance of an ophthalmic approach to contributing to efforts in the response to public health emergencies from disease outbreaks. This article summarizes the ophthalmic and systemic findings, epidemiology, and therapeutics for emerging viral pathogens identified by the World Health Organization as high-priority pathogens with epidemic potential.
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Affiliation(s)
- Ekta Rishi
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA; , ,
| | | | - Tolulope Fashina
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA; , ,
| | - Lucas Kim
- Mercer University School of Medicine, Augusta, Georgia, USA;
| | - Steven Yeh
- Department of Ophthalmology and Visual Sciences, Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA; , ,
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Okeibunor J, Diarra T, Onyeneho N, Diallo B, Yao MNK, Djingarey MH, Yoti Z, Fall S, Chamla D, Gueye AS. Survivors and the Response to the Ebola Virus Disease in the Provinces of North Kivu and Ituri in the Democratic Republic of Congo. JOURNAL OF IMMUNOLOGICAL SCIENCES 2023; Suppl 3:31-43. [PMID: 38333359 PMCID: PMC7615617 DOI: 10.29245/2578-3009/2023/s3.1105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
We explored issues around the integration of survivors in communities and the implications for the Ebola Virus Disease (EVD) response in the Democratic Republic of Congo (DRC). We conducted a survey with 800 randomly selected respondents using a structured questionnaire. Respondents were persons aged 18 years and above. Focus group discussions (FGDs) and in-depth interviews (IDIs) were employed to obtain contextual data on the issues. Community leaders, health workers, and response pillar leads engaged in IDIs, while community members were involved in FGDs. The results revealed that the survivors suffered stigmatization and, upon return to the communities, were avoided by the community members due to fear of contamination. Some thought that the survivors should be supported in adjusting to the community, while some recommended engaging the survivors in EVD response activities.
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Guetiya Wadoum RE, Sevalie S, Baimba Kargbo M, Clarke A, Bangura S, Kargbo M, Sesay HM, Kamara AH, Bangura J, Kamara AF, Allieu S, Rogers H, Mattei M, Colizzi V, Montesano C, Momoh EJJ. Identification of Laboratory Biomarkers for Early Detection and Clinical Management of Post-Acute Syndrome Among Survivors of the 2013-2016 West Africa Ebola Outbreak in Sierra Leone. J Blood Med 2023; 14:119-132. [PMID: 36817368 PMCID: PMC9930681 DOI: 10.2147/jbm.s371239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Abstract
Background The clinical management of persistent medical conditions affecting Ebola survivors, generally described as a post-Ebola syndrome, remains a public health concern. We aimed to analyze Ebola survivors' laboratory biomarkers as compared to their non-infected household relatives to identify biomarkers that could guide the identification of survivors at increased risk of developing severe at odds with the non-severe post-Ebola syndrome. Materials and Methods Data were extracted from medical records of the Ebola survivors clinic, and we included only Ebola survivor's parameters recorded during the first baseline follow-up visit 2 weeks interval after their second negative PCR result. Moreover, household non-infected family contacts of survivors visiting the clinic during the same period were recruited as community control. Results The mean age of survivors was 32.65 (IQR: 15.5, 38.25) years, and Ebola IgG immunoglobulin was detected in all, thus confirming their status. The statistical significance (all p < 0.05) observed in monocyte percentage (MONO%), cluster of differentiation 4 percentage (CD4%), alanine aminotransferase (ALT), creatinine (CREA), and creatinine kinase (C-kinase) proved to be clinically significant as compared to the household relatives' group. Interestingly, the linear regression analysis indicated that the duration at ETU was negatively associated with lymphocyte percentage with a 5% lymphocyte decrease per day spent at ETU. Finally, there was a significant (p < 0.05) association between hematological (Hb, PCV, MCV, MCH), biochemical (ALT, CREA, C-kinase, T-cholesterol, triglycerides) parameters and the risk of developing severe complications. Conclusion We recommend clinicians closely monitor Hb, PCV, MCV, MCH, ALT, CREA, C-kinase, T-cholesterol, triglycerides and lymphocytes as clinically relevant laboratory biomarkers to identify survivors at higher risk of developing severe post-acute syndrome upon discharge from Ebola treatment unit including headache, abdominal pain, chest pain, ocular complication, arthralgia, hearing difficulty and erectile dysfunction which can impact health-related quality of life among Ebola survivors.
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Affiliation(s)
- Raoul Emeric Guetiya Wadoum
- Department of Public Health, Microbiology and Immunology, Ernest Bai Koroma University of Science and Technology, Makeni, Sierra Leone,Correspondence: Raoul Emeric Guetiya Wadoum; Edwin JJ Momoh, Email ; ;
| | - Stephen Sevalie
- 34th Military Hospital, The Republic of Sierra Leone Armed Forces, Freetown, Sierra Leone
| | - Maurice Baimba Kargbo
- Department of Agriculture and Food Security; Ernest Bai Koroma University of Science and Technology, Makeni, Sierra Leone
| | - Andrew Clarke
- Global Programs Division, Save the Children UK, London, UK,Department/Division of Health Research, Lancaster University, Lancaster, UK
| | - Sherry Bangura
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | - Mariatu Kargbo
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | | | - Abdul H Kamara
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | - Jamil Bangura
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | - Alie F Kamara
- Sierra Leone Association of Ebola Survivors, Freetown, Sierra Leone
| | - Sophie Allieu
- Department of Public Health, Microbiology and Immunology, Ernest Bai Koroma University of Science and Technology, Makeni, Sierra Leone
| | - Hassan Rogers
- Department of Public Health, Microbiology and Immunology, Ernest Bai Koroma University of Science and Technology, Makeni, Sierra Leone
| | - Maurizio Mattei
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Vittorio Colizzi
- Department of Sciences and Technology, Evangelical University of Cameroon, Bandjoun, Cameroon
| | - Carla Montesano
- Department of Biology, University of Rome Tor Vergata, Rome, Italy
| | - Edwin J J Momoh
- Department of Public Health, Microbiology and Immunology, Ernest Bai Koroma University of Science and Technology, Makeni, Sierra Leone,Department of Agriculture and Food Security; Ernest Bai Koroma University of Science and Technology, Makeni, Sierra Leone
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Wohl DA, Fischer WA, Mei W, Zou F, Tozay S, Reeves E, Pewu K, Demarco J, Schieffelin J, Johnson H, Conneh T, Williams G, McMillian D, Brown J. Post-Ebola Symptoms 7 Years After Infection: The Natural History of Long Ebola. Clin Infect Dis 2023; 76:e835-e840. [PMID: 36065768 PMCID: PMC10169389 DOI: 10.1093/cid/ciac732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/25/2022] [Accepted: 09/01/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lingering symptoms have been reported by survivors of Ebola virus disease (EVD). There are few data describing the persistence and severity of these symptoms over time. METHODS Symptoms of headache, fatigue, joint pain, muscle pain, hearing loss, visual loss, numbness of hands or feet were longitudinally assessed among participants in the Liberian Ebola Survivors Cohort study. Generalized linear mixed effects models, adjusted for sex and age, were used to calculate the odds of reporting a symptom and it being rated as highly interfering with life. RESULTS From June 2015 to June 2016, 326 survivors were enrolled a median of 389 days (range 51-614) from acute EVD. At baseline 75.2% reported at least 1 symptom; 85.8% were highly interfering with life. Over a median follow-up of 5.9 years, reporting of any symptom declined (odds ratio for each 90 days of follow-up = 0.96, 95% confidence interval [CI]: .95, .97; P < .0001) with all symptoms declining except for numbness of hands or feet. Rating of any symptom as highly interfering decreased over time. Among 311 with 5 years of follow-up, 52% (n = 161) reported a symptom and 29% (n = 47) of these as highly interfering with their lives. CONCLUSIONS Major post-EVD symptoms are common early during convalescence and decline over time along with severity. However, even 5 years after acute infection, a majority continue to have symptoms and, for many, these continue to greatly impact their lives. These findings call for investigations to identify the mechanisms of post-EVD sequelae and therapeutic interventions to benefit the thousands of effected EVD survivors.
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Affiliation(s)
- David Alain Wohl
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William A Fischer
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wenwen Mei
- Department of Biostatistics, Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Fei Zou
- Department of Biostatistics, Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel Tozay
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Edwin Reeves
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Korto Pewu
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jean Demarco
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - John Schieffelin
- Section of Infectious Disease, Department of Pediatrics, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Henrietta Johnson
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Tonia Conneh
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Gerald Williams
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Darrius McMillian
- Institute of Global Health and Infectious Diseases, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jerry Brown
- John F. Kennedy Memorial Medical Center, Monrovia, Liberia
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Huang Y, Mustapha J, Harrison-Williams L, Fashina T, Randleman C, Ifantides C, Shantha JG, Yeh S. Global Ophthalmic Health Initiatives in Ebola and Emerging Infectious Disease Outbreaks: Implications for Vision Health Systems, Program Implementation, and Disease Surveillance. Int Ophthalmol Clin 2023; 63:79-89. [PMID: 36598835 PMCID: PMC9819215 DOI: 10.1097/iio.0000000000000443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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10
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Worwa G, Cooper TK, Yeh S, Shantha JG, Hischak AMW, Klim SE, Byrum R, Kurtz JR, Anthony SM, Aiosa NM, Ragland D, Lee JH, Claire MS, Davis C, Ahmed R, Holbrook MR, Kuhn JH, Saphire EO, Crozier I. Persistent intraocular Ebola virus RNA is associated with severe uveitis in a convalescent rhesus monkey. Commun Biol 2022; 5:1204. [PMID: 36352100 PMCID: PMC9644391 DOI: 10.1038/s42003-022-04158-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
Despite increasing evidence that uveitis is common and consequential in survivors of Ebola virus disease (EVD), the host-pathogen determinants of the clinical phenotype are undefined, including the pathogenetic role of persistent viral antigen, ocular tissue-specific immune responses, and histopathologic characterization. Absent sampling of human intraocular fluids and tissues, these questions might be investigated in animal models of disease; however, challenges intrinsic to the nonhuman primate model and the animal biosafety level 4 setting have historically limited inquiry. In a rhesus monkey survivor of experimental Ebola virus (EBOV) infection, we observed and documented the clinical, virologic, immunologic, and histopathologic features of severe uveitis. Here we show the clinical natural history, resultant ocular pathology, intraocular antigen-specific antibody detection, and persistent intraocular EBOV RNA detected long after clinical resolution. The association of persistent EBOV RNA as a potential driver of severe immunopathology has pathophysiologic implications for understanding, preventing, and mitigating vision-threatening uveitis in EVD survivors.
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Affiliation(s)
- Gabriella Worwa
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA.
| | - Timothy K Cooper
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Steven Yeh
- Emory Eye Center, Emory University, Atlanta, GA, 30322, USA
- Truhlsen Eye Institute, University of Nebraska Medical Center, Omaha, NE, 68105, USA
| | | | - Amanda M W Hischak
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Sarah E Klim
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Russell Byrum
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Jonathan R Kurtz
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Scott M Anthony
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Nina M Aiosa
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Danny Ragland
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Ji Hyun Lee
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Marisa St Claire
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Carl Davis
- Emory Vaccine Center, Emory University, Atlanta, GA, 30322, USA
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University, Atlanta, GA, 30322, USA
| | - Michael R Holbrook
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA
| | - Erica Ollmann Saphire
- Center for Infectious Disease and Vaccine Discovery, La Jolla Institute for Immunology, La Jolla, CA, 92065, USA
| | - Ian Crozier
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health; Fort Detrick, Frederick, MD, 21702, USA.
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, 21702, USA.
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11
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Ficenec SC, Grant DS, Sumah I, Alhasan F, Yillah MS, Brima J, Konuwa E, Gbakie MA, Kamara FK, Bond NG, Engel EJ, Shaffer JG, Fischer WA, Wohl DA, Emmett SD, Schieffelin JS. The prevalence of Post-Ebola Syndrome hearing loss, Sierra Leone. BMC Infect Dis 2022; 22:624. [PMID: 35850699 PMCID: PMC9290210 DOI: 10.1186/s12879-022-07604-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, hearing loss is the second leading cause of disability, affecting approximately 18.7% of the world's population. However, the burden of hearing loss is unequally distributed, with the majority of affected individuals located in Asia or Sub-Saharan Africa. Following the 2014 West African Ebola Outbreak, disease survivors began to describe hearing loss as part of the constellation of symptoms known as Post-Ebola Syndrome. The goal of this study was to more fully characterize hearing loss among Ebola Virus Disease (EVD) survivors. METHODOLOGY AND PRINCIPAL FINDINGS EVD survivors and their household contacts were recruited (n = 1,12) from Eastern Sierra Leone. Each individual completed a symptom questionnaire, physical exam, and a two-step audiometry process measuring both air and bone conduction thresholds. In comparison to contacts, EVD survivors were more likely to have complaints or abnormal findings affecting every organ system. A significantly greater percentage of EVD survivors were found to have hearing loss in comparison to contacts (23% vs. 9%, p < 0.001). Additionally, survivors were more likely to have bilateral hearing loss of a mixed etiology. Logistic regression revealed that the presence of any symptoms of middle or inner ear (p < 0.001), eye (p = 0.005), psychiatric (p = 0.019), and nervous system (p = 0.037) increased the odds of developing hearing loss. CONCLUSIONS AND SIGNIFICANCE This study is the first to use an objective and standardized measurement to report hearing loss among EVD survivors in a clinically meaningful manner. In this study it was found that greater than 1/5th of EVD survivors develop hearing loss. The association between hearing impairment and symptoms affecting the eye and nervous system may indicate a similar mechanism of pathogenesis, which should be investigated further. Due to the quality of life and socioeconomic detriments associated with untreated hearing loss, a greater emphasis must be placed on understanding and mitigating hearing loss following survival to aid in economic recovery following infectious disease epidemics.
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Affiliation(s)
- Samuel C Ficenec
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA.
| | - Donald S Grant
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Ibrahim Sumah
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Foday Alhasan
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Mohamed S Yillah
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Jenneh Brima
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Edwin Konuwa
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Michael A Gbakie
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Fatima K Kamara
- Kenema Government Hospital, Ministry of Health and Sanitation, Kenema, Sierra Leone
| | - Nell G Bond
- Department of Immunology and Microbiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Emily J Engel
- Department of Pediatrics, Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jeffrey G Shaffer
- Department of Biostatistics and Data Science, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - William A Fischer
- Department of Internal Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - David A Wohl
- Department of Internal Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Susan D Emmett
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Department of Otolaryngology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - John S Schieffelin
- Department of Pediatrics, Section of Infectious Diseases, Tulane University School of Medicine, New Orleans, LA, USA
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12
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Shantha JG, Canady D, Hartley C, Cassedy A, Miller C, Angeles-Han ST, Harrison-Williams LC, Vandy MJ, Weil N, Bastien G, Yeh S. Ophthalmic sequelae and psychosocial impact in pediatric ebola survivors. EClinicalMedicine 2022; 49:101483. [PMID: 35747182 PMCID: PMC9167858 DOI: 10.1016/j.eclinm.2022.101483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
Background Ebola virus disease (EVD) outbreaks in West Africa (2013-2016) and the Democratic Republic of Congo (2018-2020) have resulted in thousands of EVD survivors who remain at-risk for survivor sequelae. While EVD survivorship has been broadly reported in adult populations, pediatric EVD survivors are under-represented. In this cross-sectional study, we investigated the prevalence of eye disease, health-related quality-of-life, vision-related quality-of-life, and the burden of mental illness among pediatric EVD survivors in Sierra Leone. Methods Twenty-three pediatric EVD survivors and 58 EVD close contacts were enrolled. Participants underwent a comprehensive ophthalmic examination and completed the following surveys: Pediatric Quality of Life Inventory Version 4.0, Effect of Youngsters Eyesight on Quality-of-Life, and the Revised Child Anxiety and Depression Scale. Findings A higher prevalence of uveitis was observed in EVD survivor eyes (10·8%) cohort compared to close contacts eyes (1·7%, p=0·03). Overall, 47·8% of EVD survivor eyes and 31·9% of close contact eyes presented with an eye disease at the time of our study (p=0·25). Individuals diagnosed with an ocular complication had poorer vision-related quality-of-life (p=0·02). Interpretation Both health related quality-of-life and vision-related quality-of-life were poor among EVD survivors and close contacts. The high prevalence of eye disease associated with reduced vision health, suggests that cross-disciplinary approaches are needed to address the unmet needs of EVD survivors. Funding National Institutes of Health R01 EY029594, K23 EY030158; National Eye Institute; Research to Prevent Blindness (Emory Eye Center); Marcus Foundation Combating Childhood Illness; Emory Global Health Institute; Stanley M. Truhlsen Family Foundation.
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Affiliation(s)
- Jessica G. Shantha
- University of California San Francisco, F.I. Proctor Foundation, San Francisco, CA, United States
| | | | - Caleb Hartley
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Amy Cassedy
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, United States
| | - Chris Miller
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheila T. Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, United States
| | | | - Matthew J. Vandy
- Ministry of Health and Sanitation Sierra Leone, Freetown, Sierra Leone
| | - Natalie Weil
- Children's Hospital New Orleans, New Orleans, LA, United States
| | | | - Steven Yeh
- Truhlsen Eye Institute, Department of Ophthalmology, University of Nebraska Medical Center, Omaha, NE, United States
- Child Health Research Institute, University of Nebraska Medical Center, Omaha, NE, United States
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
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13
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Choutka J, Jansari V, Hornig M, Iwasaki A. Unexplained post-acute infection syndromes. Nat Med 2022; 28:911-923. [PMID: 35585196 DOI: 10.1038/s41591-022-01810-6] [Citation(s) in RCA: 198] [Impact Index Per Article: 99.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/01/2022] [Indexed: 02/06/2023]
Abstract
SARS-CoV-2 is not unique in its ability to cause post-acute sequelae; certain acute infections have long been associated with an unexplained chronic disability in a minority of patients. These post-acute infection syndromes (PAISs) represent a substantial healthcare burden, but there is a lack of understanding of the underlying mechanisms, representing a significant blind spot in the field of medicine. The relatively similar symptom profiles of individual PAISs, irrespective of the infectious agent, as well as the overlap of clinical features with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), suggest the potential involvement of a common etiopathogenesis. In this Review, we summarize what is known about unexplained PAISs, provide context for post-acute sequelae of SARS-CoV-2 infection (PASC), and delineate the need for basic biomedical research into the underlying mechanisms behind this group of enigmatic chronic illnesses.
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Affiliation(s)
- Jan Choutka
- Department of Chemistry of Natural Compounds, University of Chemistry and Technology, Prague, Czech Republic.
| | - Viraj Jansari
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA
| | - Mady Hornig
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Akiko Iwasaki
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, USA. .,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA. .,Department of Molecular, Cellular and Developmental Biology, Yale University, New Haven, CT, USA. .,Howard Hughes Medical Institute, Chevy Chase, MD, USA.
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14
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Yan LD, Matuja SS, Pain KJ, McNairy ML, Etyang AO, Peck RN. Emerging Viral Infections, Hypertension, and Cardiovascular Disease in Sub-Saharan Africa: A Narrative Review. Hypertension 2022; 79:898-905. [PMID: 35272495 PMCID: PMC9010372 DOI: 10.1161/hypertensionaha.121.17949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sub-Saharan Africa (SSA) has the highest age-adjusted burden of hypertension and cardiovascular disease (CVD). SSA also experiences many viral infections due to unique environmental and societal factors. The purpose of this narrative review is to examine evidence around how hypertension, CVD, and emerging viral infections interact in SSA. METHODS In September 2021, we conducted a search in MEDLINE, Embase, and Scopus, limited to English language studies published since 1990, and found a total of 1169 articles. Forty-seven original studies were included, with 32 on COVID-19 and 15 on other emerging viruses. RESULTS Seven articles, including those with the largest sample size and most robust study design, found an association between preexisting hypertension or CVD and COVID-19 severity or death. Ten smaller studies found no association, and 17 did not calculate statistics to compare groups. Two studies assessed the impact of COVID-19 on incident CVD, with one finding an increase in stroke admissions. For other emerging viruses, 3 studies did not find an association between preexisting hypertension or CVD on West Nile and Lassa fever mortality. Twelve studies examined other emerging viral infections and incident CVD, with 4 finding no association and 8 not calculating statistics. CONCLUSIONS Growing evidence from COVID-19 suggests viruses, hypertension, and CVD interact on multiple levels in SSA, but research gaps remain especially for other emerging viral infections. SSA can and must play a leading role in the study and control of emerging viral infections, with expansion of research and public health infrastructure to address these interactions.
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Affiliation(s)
- Lily D Yan
- Center for Global Health and Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sarah S Matuja
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
| | - Kevin J Pain
- Samuel J. Wood Library and C. V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, USA
| | - Margaret L McNairy
- Center for Global Health and Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Robert N Peck
- Center for Global Health and Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medicine, Weill Bugando School of Medicine, Mwanza, Tanzania
- Mwanza Interventions Trial Unit, Mwanza, Tanzania
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15
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Adenovirus-based vaccines - a platform for pandemic preparedness against emerging viral pathogens. Mol Ther 2022; 30:1822-1849. [PMID: 35092844 PMCID: PMC8801892 DOI: 10.1016/j.ymthe.2022.01.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/24/2022] Open
Abstract
Zoonotic viruses continually pose a pandemic threat. Infection of humans with viruses for which we typically have little or no prior immunity can result in epidemics with high morbidity and mortality. These epidemics can have public health and economic impact and can exacerbate civil unrest or political instability. Changes in human behavior in the past few decades—increased global travel, farming intensification, the exotic animal trade, and the impact of global warming on animal migratory patterns, habitats, and ecosystems—contribute to the increased frequency of cross-species transmission events. Investing in the pre-clinical advancement of vaccine candidates against diverse emerging viral threats is crucial for pandemic preparedness. Replication-defective adenoviral (Ad) vectors have demonstrated their utility as an outbreak-responsive vaccine platform during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Ad vectors are easy to engineer; are amenable to rapid, inexpensive manufacturing; are relatively safe and immunogenic in humans; and, importantly, do not require specialized cold-chain storage, making them an ideal platform for equitable global distribution or stockpiling. In this review, we discuss the progress in applying Ad-based vaccines against emerging viruses and summarize their global safety profile, as reflected by their widespread geographic use during the SARS-CoV-2 pandemic.
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16
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Cénat JM, Rousseau C, Bukaka J, Dalexis RD, Guerrier M. Severe Anxiety and PTSD Symptoms Among Ebola Virus Disease Survivors and Healthcare Workers in the Context of the COVID-19 Pandemic in Eastern DR Congo. Front Psychiatry 2022; 13:767656. [PMID: 35599776 PMCID: PMC9120641 DOI: 10.3389/fpsyt.2022.767656] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/01/2022] [Indexed: 11/13/2022] Open
Abstract
Ebola virus disease (EVD) survivors and healthcare workers (HCWs) face stress, fear, and stigma during the COVID-19 pandemic that can induce severe symptoms of anxiety and post-traumatic stress disorder (PTSD). We examined the prevalence and factors related to severe PTSD and anxiety symptoms, using a representative sample of survivors of the 2018-2020 EVD epidemic in DR Congo in comparison HCWs. Five hundred sixty-three participants (55.25% women, 309 survivors, 202 HCWs, and 52 HCWs and survivors) completed questionnaires assessing anxiety, PTSD, exposure to EVD and COVID-19, stigmatization related to EVD and COVID-19, interpersonal traumas, social support. During the COVID-19 pandemic, 45.6 and 75.0% of survivors and HCWs reported severe symptoms of PTSD and anxiety. Significant difference was observed among the three groups for both PTSD (53.7% survivors, 37.1% HCWs, and 30.8% HCWs-survivors, χ2= 18.67, p < 0.0001) and anxiety (88.3% survivors, 56.9% HCWs, and 65.4% HCWs- survivors, χ2= 67.03, p < 0.0001). Comorbidity of severe PTSD and anxiety symptoms was 42.3% between the three groups. Results revealed that exposure to EVD (b = 0.53; p = 0.001; b = 0.12; p = 0.042), EVD-related stigmatization (b = 0.14; p = 0.018; b = 0.07; p = 0.006), COVID-19-related stigmatization (b = 0.22; p < 0.0001; b = 0.08; p = 0.0001) and social support (b = -0.30; p < 0.0001; b = -0.14; p < 0.0001) predicted severe PTSD and anxiety symptoms. The last models explained 63.8 and 56.4% of the variance of PTSD and anxiety. Symptoms of PTSD and anxiety are common among EVD survivors and HCWs during the COVID-19 pandemic. Culturally-sensitive programs that address stigma are necessary to mitigate the cumulative effects of EVD and the COVID-19 pandemic on EVD survivors and HCWs.
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Affiliation(s)
- Jude Mary Cénat
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Cécile Rousseau
- Division of Social and Transcultural Psychiatry, McGill University, Montreal, QC, Canada
| | - Jacqueline Bukaka
- Department of Psychology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Rose Darly Dalexis
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
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17
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Diallo MSK, Toure A, Sow MS, Kpamou C, Keita AK, Taverne B, Peeters M, Msellati P, Barry TA, Etard JF, Ecochard R, Delaporte E. Understanding Long-term Evolution and Predictors of Sequelae of Ebola Virus Disease Survivors in Guinea: A 48-Month Prospective, Longitudinal Cohort Study (PostEboGui). Clin Infect Dis 2021; 73:2166-2174. [PMID: 33621316 PMCID: PMC8677527 DOI: 10.1093/cid/ciab168] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Indexed: 11/29/2022] Open
Abstract
Background Longitudinal analyses are needed to better understand long-term Ebola virus disease (EVD) sequelae. We aimed to estimate the prevalence, incidence, and duration of sequelae and to identify risk factors associated with symptom occurrence among EVD survivors in Guinea. Methods We followed 802 EVD survivors over 48 months and recorded clinical symptoms with their start/end dates. Prevalence, incidence, and duration of sequelae were calculated. Risk factors associated with symptom occurrence were assessed using an extended Cox model for recurrent events. Results Overall, the prevalence and incidence of all symptoms decreased significantly over time, but sequelae remained present 48 months after Ebola treatment center discharge with a prevalence of 30.68% (95% confidence interval [CI] 21.40–39.96) for abdominal, 30.55% (95% CI 20.68–40.41) for neurologic, 5.80% (95% CI 1.96–9.65) for musculoskeletal, and 4.24% (95% CI 2.26–6.23) for ocular sequelae. Half of all patients (50.70%; 95% CI 47.26–54.14) complained of general symptoms 2 years’ postdischarge and 25.35% (95% CI 23.63–27.07) 4 years’ post-discharge. Hemorrhage (hazard ratio [HR], 2.70; P = .007), neurologic (HR 2.63; P = .021), and general symptoms (HR 0.34; P = .003) in the EVD acute phase were significantly associated with the further occurrence of ocular sequelae, whereas hemorrhage (HR 1.91; P = .046) and abdominal (HR 2.21; P = .033) symptoms were significantly associated with musculoskeletal sequelae. Conclusions Our findings provide new insight into the long-term clinical complications of EVD and their significant association with symptoms in the acute phase, thus reinforcing the importance of regular, long-term follow-up for EVD survivors.
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Affiliation(s)
- Mamadou Saliou Kalifa Diallo
- IRD/INSERM/Montpellier University, Montpellier, France
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Abdoulaye Toure
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
- Institut National de Santé Publique, Conakry, Guinea
| | | | - Cécé Kpamou
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Alpha Kabinet Keita
- IRD/INSERM/Montpellier University, Montpellier, France
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | | | | | | | - Thierno Alimou Barry
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | | | - René Ecochard
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
- CNRS UMR 5558 Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
- Université de Lyon, Lyon, France
- Université Lyon 1, Villeurbanne, France
| | - Eric Delaporte
- IRD/INSERM/Montpellier University, Montpellier, France
- Correspondence: E. Delaporte, IRD UMI233-INSERM U1175, Montpellier University, Délégation Régionale Occitanie, 911 avenue Agropolis, BP 64501, Montpellier Montpellier, France ()
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18
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Dose-Dependent Response to Infection with Ebola Virus in the Ferret Model and Evidence of Viral Evolution in the Eye. J Virol 2021; 95:e0083321. [PMID: 34586862 PMCID: PMC8610581 DOI: 10.1128/jvi.00833-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Filoviruses cause high-consequence infections with limited approved medical countermeasures (MCMs). MCM development is dependent upon well-characterized animal models for the assessment of antiviral agents and vaccines. Following large-scale Ebola virus (EBOV) disease outbreaks in Africa, some survivors are left with long-term sequelae and persistent virus in immune-privileged sites for many years. We report the characterization of the ferret as a model for Ebola virus infection, reproducing disease and lethality observed in humans. The onset of clinical signs is rapid, and EBOV is detected in the blood, oral, and rectal swabs and all tissues studied. We identify viral RNA in the eye (a site of immune privilege) and report on specific genomic changes in EBOV present in this structure. Thus, the ferret model has utility in testing MCMs that prevent or treat long-term EBOV persistence in immune-privileged sites. IMPORTANCE Recent reemergence of Ebola in Guinea that caused over 28,000 cases between 2013 and 2016 has been linked to the original virus from that region. It appears the virus has remained in the region for at least 5 years and is likely to have been maintained in humans. Persistence of Ebola in areas of the body for extended periods of time has been observed, such as in the eye and semen. Despite the importance of reintroduction of Ebola from this route, such events are rare in the population, which makes studying medical interventions to clear persistent virus difficult. We studied various doses of Ebola in ferrets and detected virus in the eyes of most ferrets. We believe this model will enable the study of medical interventions that promote clearance of Ebola virus from sites that promote persistence.
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19
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Amuzu C, James PB, Bah AJ, Bayoh AVS, Singer SR. Post-Ebola sequelae among Ebola child survivors in Sierra Leone. BMC Pediatr 2021; 21:482. [PMID: 34717580 PMCID: PMC8556876 DOI: 10.1186/s12887-021-02957-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are limited data regarding the long-term health effects of child survivors of the 2013-2016 West African Ebola virus disease (EVD) outbreak. Here, we assess post-Ebola sequelae among EVD child survivors by comparing the self-reported symptoms between EVD child survivors and their close household contacts over one year after the end of the outbreak. Methods EVD child survivors(n=159) and their close contacts(n=303) were enrolled in Western and Eastern Sierra Leone. Demographics and self-reported symptoms data were collected using an interviewer-administered questionnaire. We compared a list of self-reported symptoms between EVD child survivors and their close household contacts using backward stepwise logistic regression. Results EVD child survivors were more likely to be orphans compared to their close contacts. Musculoskeletal, ocular, auditory and neurological symptoms were more prevalent among Ebola child survivors than their close contacts (p<0.001). Joint pain and headache were the most common self-reported symptoms in EVD child survivors and their close contacts. Joint pain (AOR=2.633; 95 % CI:1.31-5.28, p=0.006), eye pain (AOR=4.56;95 %CI: 2.16-9.64, p<0.001), hearing loss (AOR=3.85; 95 %CI: 1.15-12.87, p=0.029), memory impairment (AOR=7.76;0.95 %CI: 1.34-45.01 p=0.022), mood changes (AOR=5.07; 95 %CI: 2.35-10.94, p<0.001) were more common among survivors than their contacts. Conclusions Our data suggest that EVD child survivors have higher odds than their close contacts of suffering from musculoskeletal, ophthalmic, auditory and neurological impairment more than a year after the end of the EVD outbreak. Routine screening, treatment and monitoring of these symptoms is required to prevent long-term disability among EVD child survivors. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02957-w.
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Affiliation(s)
- Claudette Amuzu
- Braun School of Public Health, Hadassah/Hebrew University, Jerusalem, Israel
| | - Peter Bai James
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, Australia. .,Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.,Queen Margaret University Edinburgh, Musselburgh, Scotland, UK
| | | | - Shepherd Roee Singer
- Braun School of Public Health, Hadassah/Hebrew University, Jerusalem, Israel.,Israel Ministry of Health, Jerusalem, Israel
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20
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Bond NG, Grant DS, Himmelfarb ST, Engel EJ, Al-Hasan F, Gbakie M, Kamara F, Kanneh L, Mustapha I, Okoli A, Fischer W, Wohl D, Garry RF, Samuels R, Shaffer JG, Schieffelin JS. Post-Ebola Syndrome Presents With Multiple Overlapping Symptom Clusters: Evidence From an Ongoing Cohort Study in Eastern Sierra Leone. Clin Infect Dis 2021; 73:1046-1054. [PMID: 33822010 PMCID: PMC8442780 DOI: 10.1093/cid/ciab267] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Following the 2013-2016 West African Ebola outbreak, distinct, persistent health complaints were recognized in Ebola virus disease (EVD) survivors. Here we provide an in-depth characterization of post-Ebola syndrome >2.5 years after resolution of disease. Additionally, we report subphenotypes of post-Ebola syndrome with overlapping symptom clusters in survivors from Eastern Sierra Leone. METHODS Participants in Eastern Sierra Leone were identified by the Sierra Leone Association of Ebola survivors. Survivors and their contacts were administered a questionnaire assessing self-reported symptoms and a physical examination. Comparisons between survivors and contacts were conducted using conditional logistic regression. Symptom groupings were identified using hierarchical clustering approaches. Simplified presentation of incredibly complex evaluations (SPICE), correlation analysis, logistic regression, and principal component analysis (PCA) were performed to explore the relationships between symptom clusters. RESULTS Three hundred seventy-five EVD survivors and 1040 contacts were enrolled into the study. At enrollment, EVD survivors reported significantly more symptoms than their contacts in all categories (P < .001). Symptom clusters representing distinct organ systems were identified. Correlation and logistic regression analysis identified relationships between symptom clusters, including stronger relationships between clusters including musculoskeletal symptoms (r = 0.63, P < .001; and P < .001 for correlation and logistic regression, respectively). SPICE and PCA further highlighted subphenotypes with or without musculoskeletal symptoms. CONCLUSIONS This study presents an in-depth characterization of post-Ebola syndrome in Sierra Leonean survivors >2.5 years after disease. The interrelationship between symptom clusters indicates that post-Ebola syndrome is a heterogeneous disease. The distinct musculoskeletal and non-musculoskeletal phenotypes identified likely require targeted therapies to optimize long-term treatment for EVD survivors.
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Affiliation(s)
- Nell G Bond
- Tulane University, New Orleans, Louisiana, USA
| | | | | | | | | | | | | | | | | | | | - William Fischer
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Wohl
- University of North Carolina, Chapel Hill, North Carolina, USA
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21
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Parihar S, Kaur RJ, Singh S. Flashback and lessons learnt from history of pandemics before COVID-19. J Family Med Prim Care 2021; 10:2441-2449. [PMID: 34568118 PMCID: PMC8415662 DOI: 10.4103/jfmpc.jfmpc_2320_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/16/2021] [Accepted: 03/17/2021] [Indexed: 12/24/2022] Open
Abstract
With an increasing frequency of infectious disease outbreaks, the COVID-19 pandemic causing mortality around the world and the threat of similar future events looming large, mankind is faced with the herculean task of counteracting such threats with the best possible strategies and public health decisions. It is key that such decisions should be guided by previous examples of similar health emergencies. Here we review some of the significant infectious disease outbreaks, including epidemics and pandemics occurring worldwide in the past including their impact at population and global levels, unique challenges presented by each and the measures taken by authorities worldwide as well as the crucial lessons each epidemic or pandemic provided. This review highlights that throughout history measures such as contact tracing, quarantine and isolation have been incredibly effective in limiting an outbreak in its severity, thus ensuring accurate information flow to the public is as essential as limiting the spread of misinformation. With global populations rising, surveillance for emerging and re-emerging pathogens will play an immense role in preventing future epidemics or pandemics. And finally that even though for novel strains or pathogens, although vaccines are thought to be an irreplaceable defense, but their development and distribution in time to curb an epidemic has seldom been witnessed and remains an important challenge for the future. Hence, we conclude that looking at these past examples not only highlights the important knowledge gained for the strategies to devise, but also the mistakes that can be avoided in the way forward.
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Affiliation(s)
| | | | - Surjit Singh
- Department of Pharmacology, AIIMS, Jodhpur, Rajasthan, India
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22
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Tozay S, Fischer WA, Wohl DA, Kilpatrick K, Zou F, Reeves E, Pewu K, DeMarco J, Loftis AJ, King K, Grant D, Schieffelin J, Gorvego G, Johnson H, Conneh T, Williams G, Nelson JAE, Hoover D, McMillian D, Merenbloom C, Hawks D, Dube K, Brown J. Long-term Complications of Ebola Virus Disease: Prevalence and Predictors of Major Symptoms and the Role of Inflammation. Clin Infect Dis 2021; 71:1749-1755. [PMID: 31693114 DOI: 10.1093/cid/ciz1062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/29/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cohort studies have reported a high prevalence of musculoskeletal, neurologic, auditory, and visual complications among Ebola virus disease (EVD) survivors. However, little is known about the host- and disease-related predictors of these symptoms and their etiological mechanisms. METHODS The presence and patterns of 8 cardinal symptoms that are most commonly reported following EVD survival were assessed in the 326 EVD survivors who participated in the ongoing longitudinal Liberian EVD Survivor Study. At quarterly study visits, symptoms that developed since acute EVD were recorded and blood was collected for biomarkers of inflammation and immune activation. RESULTS At baseline (mean 408 days from acute EVD), 75.5% of survivors reported at least 1 new cardinal symptom since surviving EVD, which in 85.8% was rated as highly interfering with life. Two or more incident symptoms were reported by 61.0% of survivors, with pairings of joint pain, headache, or fatigue the most frequent. Women were significantly more likely than men to report headache, while older age was significantly associated with musculoskeletal and visual symptoms. In analyses adjusted for multiple comparisons, no statistically significant association was found between any symptom and 26 markers of inflammation and immune activation. Symptom frequency remained largely unchanged during study follow-up. CONCLUSIONS Post-EVD complications occur in a majority of survivors and remain present more than 4 years after acute infection. An association between markers of inflammation and immune activation and individual symptoms was not found, suggesting an alternative etiology for persistent post-EVD symptomatology.
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Affiliation(s)
- Sam Tozay
- Eternal Love Winning Africa Hospital, Paynesville, Liberia
| | - William A Fischer
- Division of Pulmonary and Critical Care Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.,Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David A Wohl
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kayla Kilpatrick
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Fei Zou
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Edwina Reeves
- Eternal Love Winning Africa Hospital, Paynesville, Liberia
| | - Korto Pewu
- Eternal Love Winning Africa Hospital, Paynesville, Liberia
| | - Jean DeMarco
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amy James Loftis
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA.,Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katie King
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Donald Grant
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - John Schieffelin
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | | - Tonia Conneh
- Eternal Love Winning Africa Hospital, Paynesville, Liberia
| | | | - Julie A E Nelson
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Hoover
- ICON Government and Public Health Solutions (formerly Clinical RM), Leopardstown, Dublin, Ireland
| | - Darrius McMillian
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Carson Merenbloom
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Darrell Hawks
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Karine Dube
- Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jerry Brown
- Eternal Love Winning Africa Hospital, Paynesville, Liberia
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23
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Venkatesh A, Patel R, Goyal S, Rajaratnam T, Sharma A, Hossain P. Ocular manifestations of emerging viral diseases. Eye (Lond) 2021; 35:1117-1139. [PMID: 33514902 PMCID: PMC7844788 DOI: 10.1038/s41433-020-01376-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/02/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
Emerging infectious diseases (EIDs) are an increasing threat to public health on a global scale. In recent times, the most prominent outbreaks have constituted RNA viruses, spreading via droplets (COVID-19 and Influenza A H1N1), directly between humans (Ebola and Marburg), via arthropod vectors (Dengue, Zika, West Nile, Chikungunya, Crimean Congo) and zoonotically (Lassa fever, Nipah, Rift Valley fever, Hantaviruses). However, specific approved antiviral therapies and vaccine availability are scarce, and public health measures remain critical. Patients can present with a spectrum of ocular manifestations. Emerging infectious diseases should therefore be considered in the differential diagnosis of ocular inflammatory conditions in patients inhabiting or returning from endemic territories, and more general vigilance is advisable in the context of a global pandemic. Eye specialists are in a position to facilitate swift diagnosis, improve clinical outcomes, and contribute to wider public health efforts during outbreaks. This article reviews those emerging viral diseases associated with reports of ocular manifestations and summarizes details pertinent to practicing eye specialists.
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Affiliation(s)
- Ashwin Venkatesh
- grid.5335.00000000121885934School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ravi Patel
- grid.439257.e0000 0000 8726 5837Moorfields Eye Hospital, London, UK
| | - Simran Goyal
- grid.5335.00000000121885934School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Timothy Rajaratnam
- grid.5335.00000000121885934School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anant Sharma
- grid.439257.e0000 0000 8726 5837Moorfields Eye Hospital, London, UK
| | - Parwez Hossain
- grid.430506.4Eye Unit, University Hospitals Southampton NHS Foundation Trust, Southampton, UK ,grid.5491.90000 0004 1936 9297Clinical Experimental Sciences, Faculty of Medicine, Univeristy of Southampton, Southampton, UK
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24
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Medina‐Rivera M, Centeno‐Tablante E, Finkelstein JL, Rayco‐Solon P, Peña‐Rosas JP, Garcia‐Casal MN, Rogers L, Ridwan P, Martinez SS, Andrade J, Layden AJ, Chang J, Zambrano MP, Ghezzi‐Kopel K, Mehta S. Presence of Ebola virus in breast milk and risk of mother-to-child transmission: synthesis of evidence. Ann N Y Acad Sci 2021; 1488:33-43. [PMID: 33113592 PMCID: PMC8048832 DOI: 10.1111/nyas.14519] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/16/2020] [Accepted: 10/08/2020] [Indexed: 12/28/2022]
Abstract
To help inform global guidelines on infant feeding, this systematic review synthesizes evidence related to the presence of the Ebola virus (EBOV) in breast milk and its potential risk of viral transmission to the infant when breastfeeding. We relied on a comprehensive search strategy to identify studies including women with suspected, probable, or confirmed EBOV infection, intending to breastfeed or give breast milk to an infant. Our search identified 10,454 records, and after deduplication and screening, we assessed 148 full texts. We included eight studies reporting on 10 breastfeeding mothers and their children (one mother with twins), who provided breast milk samples for assessment. EBOV was detected via RT-PCR or viral culture in seven out of ten breast milk samples. Four out of the five-breastfed infants with EBOV-positive breast milk were found positive for EBOV infection, and all of these EBOV-positive infants died. Since previous reports have detected EBOV in tears, saliva, sweat, and contaminated surfaces, with the current evidence, it is not possible to conclude with certainty that breast milk was the main route of EBOV transmission.
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Affiliation(s)
| | | | | | - Pura Rayco‐Solon
- Department of Maternal, Newborn, Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
| | | | | | - Lisa Rogers
- Department of Nutrition and Food SafetyWorld Health OrganizationGenevaSwitzerland
| | - Pratiwi Ridwan
- Division of Nutritional SciencesCornell UniversityIthacaNew York
| | - Sabrina Sales Martinez
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social WorkFlorida International UniversityMiamiFlorida
| | - Joyce Andrade
- Hospital de Niños Roberto Gilbert ElizaldeGuayaquilEcuador
| | | | - Juan Chang
- Hospital de Niños Roberto Gilbert ElizaldeGuayaquilEcuador
| | | | | | - Saurabh Mehta
- Division of Nutritional SciencesCornell UniversityIthacaNew York
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25
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Radosavljevic A, Agarwal M, Chee SP, Zierhut M. Epidemiology of Viral Induced Anterior Uveitis. Ocul Immunol Inflamm 2021; 30:297-309. [PMID: 33617392 DOI: 10.1080/09273948.2020.1853177] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: Viral agents are the most common cause of infectious anterior uveitis worldwide. The purpose of this review is to analyze the frequency, gender and racial differences of viral anterior uveitis (VAU) in various populations.Methods: Systematized literature review of epidemiological reports of VAU cited in PubMed, EMBASE and the Cochrane Library database published until June 30th, 2020.Results: A total of 12 clinical studies on epidemiology of definite VAU and 36 clinical studies of presumed VAU were identified. Members of Herpesviridae family represent the most common causes of VAU. Other less frequently reported causes, such as rubella and endemic viruses (HTLV-1, Chikungunya, Dengue, Ebola, Zika virus) were also analyzed.Conclusion: HSV, VZV are prevalent worldwide. CMV is more frequent in Asia, and rubella in the West. However, due to globalization and air travel, HTLV-1, Chikungunya, Dengue and Ebola may become important causes of VAU across the world.
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Affiliation(s)
| | - Mamta Agarwal
- Uveitis & Cornea Services, Sankara Nethralaya, Chennai, India
| | - Soon Phaik Chee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Duke-NUS Medical School, Singapore
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tubingen, Tubingen, Germany
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26
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Assessing anxiety, depression and insomnia symptoms among Ebola survivors in Africa: A meta-analysis. PLoS One 2021; 16:e0246515. [PMID: 33544772 PMCID: PMC7864444 DOI: 10.1371/journal.pone.0246515] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background During health disaster events such as the current devastating havoc being inflicted on countries globally by the SARS-CoV-19 pandemic, mental health problems among survivors and frontline workers are likely concerns. However, during such health disaster events, stakeholders tend to give more precedence to the socio-economic and biomedical health consequences at the expense of mental health. Meanwhile, studies show that regardless of the kind of disaster/antecedent, all traumatic events trigger similar post-traumatic stress symptoms among survivors, families, and frontline workers. Thus, our study investigated the prevalence of anxiety, depression and insomnia symptoms among survivors of the 2014–2016 Ebola virus disease that plagued the West African sub-region. Methods We systematically retrieved peer-reviewed articles published between 1970 and 2019 from seven electronic databases, including Google Scholar, MEDLINE, PsychInfo, PubMed, Scopus, Springer Link, Web of Science on Ebola and post-traumatic stress disorder symptoms. A comprehensive hand search complemented this literature search. Of the 87 articles retrieved, only 13 met the inclusion criteria for this meta-analysis. Results After heterogeneity, influence, and publication bias analysis, our meta-analysis pooled proportion effects estimates showed a moderate to a high prevalence of anxiety (14%; 99% CI: 0.05–0.30), depression (15%; 99% CI: 0.11–0.21), and insomnia (22%; 99% CI: 0.13–0.36). Effect estimates ranging from (0.13; 99% CI: 0.05, 0.28) through to (0.11; 99% CI: 0.05–0.22), (0.15; 99% CI: 0.09–0.25) through to (0.13; 99% CI: 0.08–0.21) and (0.23; 99% CI: 0.11–0.41) to (0.23; 99% CI: 0.11–0.41) were respectively reported for anxiety, depression and insomnia symptoms. These findings suggest a significant amount of EVD survivors are struggling with anxiety, depression and insomnia symptoms. Conclusion Our study provided the first-ever meta-analysis evidence of anxiety, depression, and insomnia symptoms among EVD survivors, and suggest that the predominant biomedical health response to regional and global health disasters should be complemented with trauma-related mental health services.
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27
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Berry DE, Bavinger JC, Fernandes A, Mattia JG, Mustapha J, Harrison-Williams L, Teshome M, Vandy MJ, Shantha JG, Yeh S. Posterior Segment Ophthalmic Manifestations in Ebola Survivors, Sierra Leone. Ophthalmology 2021; 128:1371-1373. [PMID: 33561480 DOI: 10.1016/j.ophtha.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Duncan E Berry
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia
| | - J Clay Bavinger
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia
| | - Alcides Fernandes
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia
| | - John G Mattia
- Lowell and Ruth Gess Kissy Eye Hospital, Freetown, Sierra Leone
| | - Jalikatu Mustapha
- Ministry of Health and Sanitation, National Eye Program, Freetown, Sierra Leone
| | | | - Moges Teshome
- Lowell and Ruth Gess Kissy Eye Hospital, Freetown, Sierra Leone
| | - Matthew J Vandy
- Ministry of Health and Sanitation, National Eye Program, Freetown, Sierra Leone
| | - Jessica G Shantha
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia.
| | - Steven Yeh
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, Atlanta, Georgia; Emory Global Health Institute, Emory University School of Medicine, Atlanta, Georgia.
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28
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[The latest research findings on Ebola virus]. Uirusu 2021; 71:137-150. [PMID: 37245976 DOI: 10.2222/jsv.71.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
013-2016 Ebola virus disease (EVD) outbreak was the largest EVD outbreak ever documented that started earlier in Guinea and later widely spread throughout West Africa, ending up a total of > 28,000 human infections. In this review, we outline research findings on Ebola virus (EBOV) variant Makona, a new EBOV variant isolated from the 2013-2016 EVD outbreak, and introduce the unique biological and pathogenic characteristics of Makona variant. We also discuss about the relevance of persistent infection of EBOV in EVD survivors with resurgence of EVD outbreak in Guinea in 2021. Moreover, this review covers a recent case report of EVD relapse and deliberates new interpretations of EBOV biology and EVD outbreak.
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29
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Miyazato Y, Morioka S, Tsuzuki S, Akashi M, Osanai Y, Tanaka K, Terada M, Suzuki M, Kutsuna S, Saito S, Hayakawa K, Ohmagari N. Prolonged and Late-Onset Symptoms of Coronavirus Disease 2019. Open Forum Infect Dis 2020; 7:ofaa507. [PMID: 33230486 PMCID: PMC7665672 DOI: 10.1093/ofid/ofaa507] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/14/2020] [Indexed: 12/13/2022] Open
Abstract
Some patients who recover from coronavirus disease 2019 (COVID-19) have prolonged symptoms such as dyspnea, fatigue, cough, and dysosmia for longer than 120 days after symptom onset. In addition, some patients who recovered from COVID-19 reported hair loss a few months after the onset of the disease. Alopecia is a late-onset symptom of COVID-19. The cause of alopecia is unknown; however, androgenic alopecia and telogen effluvium are possible causes.
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Affiliation(s)
- Yusuke Miyazato
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Shinichiro Morioka
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan.,Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan.,AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Shinya Tsuzuki
- AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Masako Akashi
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Yasuyo Osanai
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Keiko Tanaka
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Mari Terada
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Michiyo Suzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan.,Emerging and Reemerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan.,AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan.,AMR Clinical Reference Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
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30
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Abstract
PURPOSE OF REVIEW Given the growing body of critical care clinical research publications, core outcome sets (COSs) are important to help mitigate heterogeneity in outcomes assessed and measurement instruments used, and have potential to reduce research waste. This article provides an update on COS projects in critical care medicine, and related resources and tools for COS developers. RECENT FINDINGS We identified 28 unique COS projects, of which 15 have published results as of May 2020. COS topics relevant to critical care medicine include mechanical ventilation, cardiology, stroke, rehabilitation, and long-term outcomes (LTOs) after critical illness. There are four COS projects for coronavirus disease 2019 (COVID-19), with a 'meta-COS' summarizing common outcomes across these projects. To help facilitate COS development, there are existing resources, standards, guidelines, and tools available from the Core Outcome Measures in Effectiveness Trials Initiative (www.comet-initiative.org/) and the National Institutes of Health-funded Improve LTO project (www.improvelto.com/). SUMMARY Many COS projects have been completed in critical care, with more on-going COS projects, including foci from across the spectrum of acute critical care, COVID-19, critical care rehabilitation, and patient recovery and LTOs. Extensive resources are accessible to help facilitate rigorous COS development.
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31
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Bothra A, Maheswari A, Singh M, Pawar M, Jodhani K. Cutaneous manifestations of viral outbreaks. Australas J Dermatol 2020; 62:27-36. [PMID: 32895964 DOI: 10.1111/ajd.13421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022]
Abstract
As the world tries to grapple with the COVID-19 pandemic, dermatologists are left in a lurch as there is a lacuna in dermatologic literature as well as training regarding the cutaneous manifestations of varied viral agents capable of causing epidemics/pandemics or the potential to be bio-weaponised. Such outbreaks have the potential to become a pandemic given this age of globalisation. The quote by George Santayana stands true 'Those who cannot remember the past are condemned to repeat it'. Thus, this article lends a perspective to the recent viral outbreaks and is aimed at summarising these agents and their clinical features to serve as a quick reference for dermatologists.
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Affiliation(s)
- Atul Bothra
- Department of Dermatology, Gauhati Medical College & Hospital, Guwahati, India
| | - Anshu Maheswari
- Consultant Dermatologist, Private Practice, New Delhi, India
| | - Mehak Singh
- Department of Dermatology, JK Medical College & LN Hospital, Bhopal, India
| | - Manoj Pawar
- Department of Dermatology, MVP's Dr.V.P Medical College & Hospital & Research center, Nashik, India
| | - Kirti Jodhani
- Department of Dermatology, Gauhati Medical College & Hospital, Guwahati, India
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32
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Cooper TK, Logue J, Liu DX, Perry DL, Hart RJ, Hischak AMW, Bernbaum JG, Gerhardt DM, Rojas O, Bohannon JK, Hagen KR, Johnson RF, Crozier I, Jahrling PB, Hensley LE, Bennett RS. Filoviruses Infect Rhesus Macaque Synoviocytes in Vivo and Primary Human Synoviocytes in Vitro. THE AMERICAN JOURNAL OF PATHOLOGY 2020; 190:1867-1880. [PMID: 32479821 PMCID: PMC7456742 DOI: 10.1016/j.ajpath.2020.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 11/18/2022]
Abstract
The most commonly reported symptom of post-Ebola virus disease syndrome in survivors is arthralgia, yet involvement of the joints in acute or convalescent Ebola virus infection is not well characterized in human patients or animal models. Through immunohistochemistry, we found that the lining synovial intima of the stifle (knee) is a target for acute infection by Ebola virus/Kikwit, Ebola virus/Makona-C05, and Marburg virus/Angola in the rhesus macaque model. Furthermore, histologic analysis, immunohistochemistry, RNAscope in situ hybridization, and transmission electron microscopy showed that synoviocytes of the stifle, shoulder, and hip are a target for mouse-adapted Ebola virus/Yambuku-Mayinga infection during acute disease in rhesus macaques. A time course of infection study with Ebola virus/Kikwit found that the large joint synovium became immunopositive beginning on postinfection day 6. In total, the synovium of 28 of 30 rhesus macaques with terminal filovirus disease had evidence of infection (64 of 96 joints examined). On the basis of immunofluorescence, infected cell types included CD68+ type A (macrophage-like) synoviocytes and CD44+ type B (fibroblast-like) synoviocytes. Cultured primary human fibroblast-like synoviocytes were permissive to infection with Ebola and Marburg viruses in vitro. Because synovial joints include immune privileged sites, these findings are significant for future investigations of filovirus pathogenesis and persistence as well as arthralgias in acute and convalescent filovirus disease.
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Affiliation(s)
- Timothy K Cooper
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland.
| | - James Logue
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - David X Liu
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Donna L Perry
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Randy J Hart
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Amanda M W Hischak
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - John G Bernbaum
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Dawn M Gerhardt
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Oscar Rojas
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - J Kyle Bohannon
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Katie R Hagen
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Reed F Johnson
- Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Ian Crozier
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland
| | - Peter B Jahrling
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
| | - Lisa E Hensley
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland.
| | - Richard S Bennett
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, Maryland
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Canady D, Weil NC, Miller C, Shantha JG, Bastien G, Yeh S. Ophthalmic and psychosocial sequelae in Ebola virus disease survivors: ongoing need for health systems strengthening across disciplines. Expert Rev Anti Infect Ther 2020; 19:117-119. [PMID: 32772594 DOI: 10.1080/14787210.2020.1808461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Natalie C Weil
- Department of Ophthalmology, Emory University School of Medicine , Atlanta, GA, USA
| | - Christopher Miller
- Department of Ophthalmology, Emory University School of Medicine , Atlanta, GA, USA
| | - Jessica G Shantha
- Morehouse School of Medicine , Atlanta, GA, USA.,Department of Ophthalmology, Emory University School of Medicine , Atlanta, GA, USA
| | | | - Steven Yeh
- Department of Ophthalmology, Emory University School of Medicine , Atlanta, GA, USA.,Emory Global Health Institute, Emory University , Atlanta, GA, USA
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Rowen RJ. Ozone and oxidation therapies as a solution to the emerging crisis in infectious disease management: a review of current knowledge and experience. Med Gas Res 2020; 9:232-237. [PMID: 31898609 PMCID: PMC7802416 DOI: 10.4103/2045-9912.273962] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Medicine faces crisis with emerging “super bugs,” lethal viruses (Ebola), and stealth pathogens such as tick-borne infections. Thousands are dying worldwide of once easily treatable diseases. Ozone therapy, extensively studied, may be a valuable adjunctive or stand-alone therapy. Ebola again ravages Africa with over 2000 already dead, carrying a 65% mortality rate. The world desperately needs safe, inexpensive and effective anti-infective therapy to which microbes will not develop resistance. Oxidation therapies have shown an extremely high safety profile, lacking credible reports of significant injury beyond vein irritation. Ozone therapy, the most studied and least expensive to perform, is in itself a germicide, not an antibiotic, and improves several physiological parameters essential for infection defense. Recent reports indicate very favorable responses to both bacterial and viral disease, inclusive of Ebola. Despite lack of commercial profitability (not patentable), medicine would do well to revisit its pre-antibiotic era oxidation therapy roots, especially ozone in the current crisis.
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Landry MD, Geddes L, Park Moseman A, Lefler JP, Raman SR, Wijchen JV. Early reflection on the global impact of COVID19, and implications for physiotherapy. Physiotherapy 2020; 107:A1-A3. [PMID: 32312528 PMCID: PMC7194933 DOI: 10.1016/j.physio.2020.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Michel D Landry
- Duke Global Health Institute (DGHI), Duke University, 184 Durham, USA; Western Norway University of Applied Sciences, Bergen, 186 Norway.
| | | | | | | | - Sudha R Raman
- Department of Population Health Sciences, Duke University, Durham, USA
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Landry MD, Geddes L, Park Moseman A, Lefler JP, Raman SR, Wijchen JV. Early reflection on the global impact of COVID19, and implications for physiotherapy. Physiotherapy 2020. [PMID: 32312528 DOI: 10.1016/j.physio.2020.03.003)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Affiliation(s)
- Michel D Landry
- Duke Global Health Institute (DGHI), Duke University, 184 Durham, USA; Western Norway University of Applied Sciences, Bergen, 186 Norway.
| | | | | | | | - Sudha R Raman
- Department of Population Health Sciences, Duke University, Durham, USA
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Foeller ME, Carvalho Ribeiro do Valle C, Foeller TM, Oladapo OT, Roos E, Thorson AE. Pregnancy and breastfeeding in the context of Ebola: a systematic review. THE LANCET. INFECTIOUS DISEASES 2020; 20:e149-e158. [PMID: 32595045 DOI: 10.1016/s1473-3099(20)30194-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 12/31/2022]
Abstract
The outbreaks of Ebola virus between 2014 and 2020 have drawn attention to knowledge gaps related to Ebola virus disease in pregnant women. The aim of this study was to systematically evaluate available data on pregnant and lactating women with acute Ebola virus disease or following recovery. We searched MEDLINE, Embase, Cochrane Library (CENTRAL), Web of Science Core Collection, CINAHL, POPLINE, Global Health, and WHO Global Index Medicus, in addition to grey literature, for relevant articles. Studies of all types and published between database inception and Aug 19, 2019, were eligible (PROSPERO 129335). We identified 1060 records, of which 52 studies met our inclusion criteria. Overall, mortality in 274 pregnant women with Ebola virus disease was 72% (197 women died); mortality for pregnant women with Ebola virus disease were not higher than those in the general population of patients with Ebola virus disease. Nearly all women with Ebola virus disease had adverse pregnancy outcomes. Among survivors, Ebola virus RNA was detected by RT-PCR in amniotic fluid up to 32 days after maternal clearance of Ebola virus from the blood and in breastmilk 26 days after symptom onset. A risk of transmission of Ebola virus from pregnancy-related fluids and breastmilk probably exists, and precautions should be taken.
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Affiliation(s)
- Megan E Foeller
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Obstetrics and Gynecology, Stanford University, Stanford, CA, USA; Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO, USA
| | | | - Timothy M Foeller
- Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - Olufemi T Oladapo
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Elin Roos
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna E Thorson
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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Pathogenesis of Uveitis in Ebola Virus Disease Survivors: Evolving Understanding from Outbreaks to Animal Models. Microorganisms 2020; 8:microorganisms8040594. [PMID: 32325950 PMCID: PMC7232169 DOI: 10.3390/microorganisms8040594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/05/2020] [Accepted: 04/13/2020] [Indexed: 01/24/2023] Open
Abstract
Ebola virus disease (EVD) and emerging infectious disease threats continue to threaten life, prosperity and global health security. To properly counteract EVD, an improved understanding of the long-term impact of recent EVD outbreaks in West Africa and the Democratic Republic of Congo are needed. In the wake of recent outbreaks, numerous health sequelae were identified in EVD survivors. These findings include joint pains, headaches, myalgias, and uveitis, a vision-threatening inflammatory condition of the eye. Retrospective and more recent prospective studies of EVD survivors from West Africa have demonstrated that uveitis may occur in 13–34% of patients with an increase in prevalence from baseline to 12-month follow-up. The clinical spectrum of disease ranges from mild, anterior uveitis to severe, sight-threatening panuveitis. Untreated inflammation may ultimately lead to secondary complications of cataract and posterior synechiae, with resultant vision impairment. The identification of Ebola virus persistence in immune privileged organs, such as the eye, with subsequent tissue inflammation and edema may lead to vision loss. Non-human primate models of EVD have demonstrated tissue localization to the eye including macrophage reservoirs within the vitreous matter. Moreover, in vitro models of Ebola virus have shown permissiveness in retinal pigment epithelial cells, potentially contributing to viral persistence. Broad perspectives from epidemiologic studies of the outbreak, animal modeling, and immunologic studies of EVD survivors have demonstrated the spectrum of the eye disease, tissue specificity of Ebola virus infection, and antigen-specific immunologic response. Further studies in these areas will elucidate the mechanisms of this highly prevalent disease with the potential for improved therapeutics for Ebola virus in immune-privileged sites.
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Ficenec SC, Schieffelin JS, Emmett SD. A Review of Hearing Loss Associated with Zika, Ebola, and Lassa Fever. Am J Trop Med Hyg 2020; 101:484-490. [PMID: 31333155 PMCID: PMC6726950 DOI: 10.4269/ajtmh.18-0934] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The neglected tropical diseases Zika, Ebola, and Lassa fever (LF) have all been noted to cause some degree of hearing loss (HL). Hearing loss is a chronic disability that can lead to a variety of detrimental effects, including speech and language delays in children, decreased economic productivity in adults, and accelerated cognitive decline in older adults. The objective of this review is to summarize what is known regarding HL secondary to these viruses. Literature for this review was gathered using the PubMed database. Articles were excluded if there were no data of the respective viruses, postinfectious complications, or conditions related to survivorship. A total of 50 articles were included in this review. Fourteen articles discussing Zika virus and subsequent complications were included. Across these studies, 56 (21.2%) of 264 Zika-infected individuals were found to have HL. Twenty-one articles discussing Ebola virus and subsequent complications were included, with 190 (5.7%) of 3,350 Ebola survivors found to have HL. Fifteen additional articles discussing LF and subsequent complications were included. Of 926 individuals with LF, 79 (8.5%) were found to have HL. These results demonstrate a relationship between HL and infection. The true prevalence is likely underestimated, however, because of lack of standardization of reporting and measurement. Future studies of viral sequelae would benefit from including audiometric evaluation. This information is critical to understanding pathophysiology, preventing future cases of this disability, and improving quality of life after survival of infection.
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Affiliation(s)
| | | | - Susan D Emmett
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina.,Duke Global Health Institute, Durham, North Carolina.,Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina
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Jacob ST, Crozier I, Fischer WA, Hewlett A, Kraft CS, Vega MADL, Soka MJ, Wahl V, Griffiths A, Bollinger L, Kuhn JH. Ebola virus disease. Nat Rev Dis Primers 2020; 6:13. [PMID: 32080199 PMCID: PMC7223853 DOI: 10.1038/s41572-020-0147-3] [Citation(s) in RCA: 272] [Impact Index Per Article: 68.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 12/16/2022]
Abstract
Ebola virus disease (EVD) is a severe and frequently lethal disease caused by Ebola virus (EBOV). EVD outbreaks typically start from a single case of probable zoonotic transmission, followed by human-to-human transmission via direct contact or contact with infected bodily fluids or contaminated fomites. EVD has a high case-fatality rate; it is characterized by fever, gastrointestinal signs and multiple organ dysfunction syndrome. Diagnosis requires a combination of case definition and laboratory tests, typically real-time reverse transcription PCR to detect viral RNA or rapid diagnostic tests based on immunoassays to detect EBOV antigens. Recent advances in medical countermeasure research resulted in the recent approval of an EBOV-targeted vaccine by European and US regulatory agencies. The results of a randomized clinical trial of investigational therapeutics for EVD demonstrated survival benefits from two monoclonal antibody products targeting the EBOV membrane glycoprotein. New observations emerging from the unprecedented 2013-2016 Western African EVD outbreak (the largest in history) and the ongoing EVD outbreak in the Democratic Republic of the Congo have substantially improved the understanding of EVD and viral persistence in survivors of EVD, resulting in new strategies toward prevention of infection and optimization of clinical management, acute illness outcomes and attendance to the clinical care needs of patients.
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Affiliation(s)
- Shevin T Jacob
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Global Health Security Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Ian Crozier
- Integrated Research Facility at Fort Detrick, Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research supported by the National Cancer Institute, Frederick, MD, USA
| | - William A Fischer
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Chapel Hill, NC, USA
| | - Angela Hewlett
- Nebraska Biocontainment Unit, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Colleen S Kraft
- Microbiology Section, Emory Medical Laboratory, Emory University School of Medicine, Atlanta, GA, USA
| | - Marc-Antoine de La Vega
- Department of Microbiology, Immunology & Infectious Diseases, Université Laval, Quebec City, QC, Canada
| | - Moses J Soka
- Partnership for Ebola Virus Disease Research in Liberia, Monrovia Medical Units ELWA-2 Hospital, Monrovia, Liberia
| | - Victoria Wahl
- National Biodefense Analysis and Countermeasures Center, Fort Detrick, Frederick, MD, USA
| | - Anthony Griffiths
- Department of Microbiology and National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA, USA
| | - Laura Bollinger
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA.
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41
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Nelson AN, Lin WHW, Shivakoti R, Putnam NE, Mangus L, Adams RJ, Hauer D, Baxter VK, Griffin DE. Association of persistent wild-type measles virus RNA with long-term humoral immunity in rhesus macaques. JCI Insight 2020; 5:134992. [PMID: 31935196 DOI: 10.1172/jci.insight.134992] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/08/2020] [Indexed: 01/21/2023] Open
Abstract
Recovery from measles results in life-long protective immunity. To understand induction of long-term immunity, rhesus macaques were studied for 6 months after infection with wild-type measles virus (MeV). Infection caused viremia and rash, with clearance of infectious virus by day 14. MeV RNA persisted in PBMCs for 30-90 days and in lymphoid tissue for 6 months most often in B cells but was rarely detected in BM. Antibody with neutralizing activity and binding specificity for MeV nucleocapsid (N), hemagglutinin (H), and fusion proteins appeared with the rash and avidity matured over 3-4 months. Lymph nodes had increasing numbers of MeV-specific antibody-secreting cells (ASCs) and germinal centers with late hyalinization. ASCs appeared in circulation with the rash and continued to appear along with peripheral T follicular helper cells for the study duration. ASCs in lymph nodes and PBMCs produced antibody against both H and N, with more H-specific ASCs in BM. During days 14-21, 20- to 100-fold more total ASCs than MeV-specific ASCs appeared in circulation, suggesting mobilization of preexisting ASCs. Therefore, persistence of MeV RNA in lymphoid tissue was accompanied by continued germinal center formation, ASC production, avidity maturation, and accumulation of H-specific ASCs in BM to sustain neutralizing antibody and protective immunity.
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Affiliation(s)
- Ashley N Nelson
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wen-Hsuan W Lin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rupak Shivakoti
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nicole E Putnam
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lisa Mangus
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert J Adams
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Debra Hauer
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Victoria K Baxter
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Diane E Griffin
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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42
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Piot P, Soka MJ, Spencer J. Emergent threats: lessons learnt from Ebola. Int Health 2019; 11:334-337. [PMID: 31385587 DOI: 10.1093/inthealth/ihz062] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 06/05/2019] [Accepted: 07/29/2019] [Indexed: 11/13/2022] Open
Abstract
Recent disease outbreaks have demonstrated the severe health, economic and political crises that epidemics can trigger. The rate of emergence of infectious diseases is accelerating and, with deepening globalisation, pathogens are increasingly mobile. Yet the 2014-2015 West African Ebola epidemic exposed major gaps in the world's capacity to prevent and respond to epidemics. In the midst of the world's second largest ever recorded Ebola outbreak in the Democratic Republic of the Congo, we reflect on six of the many lessons learnt from the epidemic in West Africa, focusing on progress made and the challenges ahead in preparing for future threats. While Ebola and other emerging epidemics will remain a challenge in the years to come, by working in partnership with affected communities and across sectors, and by investing in robust health systems, it is within our power to be better prepared when they strike.
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Affiliation(s)
- Peter Piot
- London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Moses J Soka
- Ministry of Health, Box, Congo Town, Monrovia, Liberia
| | - Julia Spencer
- London School of Hygiene & Tropical Medicine, Keppel St, London WC1E 7HT, UK
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43
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Ebola virus disease: An emerging and re-emerging viral threat. J Autoimmun 2019; 106:102375. [PMID: 31806422 DOI: 10.1016/j.jaut.2019.102375] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 12/21/2022]
Abstract
The genus Ebolavirus from the family Filoviridae is composed of five species including Sudan ebolavirus, Reston ebolavirus, Bundibugyo ebolavirus, Taï Forest ebolavirus, and Ebola virus (previously known as Zaire ebolavirus). These viruses have a large non-segmented, negative-strand RNA of approximately 19 kb that encodes for glycoproteins (i.e., GP, sGP, ssGP), nucleoproteins, virion proteins (i.e., VP 24, 30,40) and an RNA dependent RNA polymerase. These viruses have become a global health concern because of mortality, their rapid dissemination, new outbreaks in West-Africa, and the emergence of a new condition known as "Post-Ebola virus disease syndrome" that resembles inflammatory and autoimmune conditions such as rheumatoid arthritis, systemic lupus erythematosus and spondyloarthritis with uveitis. However, there are many gaps in the understanding of the mechanisms that may induce the development of such autoimmune-like syndromes. Some of these mechanisms may include a high formation of neutrophil extracellular traps, an uncontrolled "cytokine storm", and the possible formation of auto-antibodies. The likely appearance of autoimmune phenomena in Ebola survivors suppose a new challenge in the management and control of this disease and opens a new field of research in a special subgroup of patients. Herein, the molecular biology, pathogenesis, clinical manifestations, and treatment of Ebola virus disease are reviewed and some strategies for control of disease are discussed.
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Pascal KE, Dudgeon D, Trefry JC, Anantpadma M, Sakurai Y, Murin CD, Turner HL, Fairhurst J, Torres M, Rafique A, Yan Y, Badithe A, Yu K, Potocky T, Bixler SL, Chance TB, Pratt WD, Rossi FD, Shamblin JD, Wollen SE, Zelko JM, Carrion R, Worwa G, Staples HM, Burakov D, Babb R, Chen G, Martin J, Huang TT, Erlandson K, Willis MS, Armstrong K, Dreier TM, Ward AB, Davey RA, Pitt MLM, Lipsich L, Mason P, Olson W, Stahl N, Kyratsous CA. Development of Clinical-Stage Human Monoclonal Antibodies That Treat Advanced Ebola Virus Disease in Nonhuman Primates. J Infect Dis 2019; 218:S612-S626. [PMID: 29860496 PMCID: PMC6249601 DOI: 10.1093/infdis/jiy285] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background For most classes of drugs, rapid development of therapeutics to treat emerging infections is challenged by the timelines needed to identify compounds with the desired efficacy, safety, and pharmacokinetic profiles. Fully human monoclonal antibodies (mAbs) provide an attractive method to overcome many of these hurdles to rapidly produce therapeutics for emerging diseases. Methods In this study, we deployed a platform to generate, test, and develop fully human antibodies to Zaire ebolavirus. We obtained specific anti-Ebola virus (EBOV) antibodies by immunizing VelocImmune mice that use human immunoglobulin variable regions in their humoral responses. Results Of the antibody clones isolated, 3 were selected as best at neutralizing EBOV and triggering FcγRIIIa. Binding studies and negative-stain electron microscopy revealed that the 3 selected antibodies bind to non-overlapping epitopes, including a potentially new protective epitope not targeted by other antibody-based treatments. When combined, a single dose of a cocktail of the 3 antibodies protected nonhuman primates (NHPs) from EBOV disease even after disease symptoms were apparent. Conclusions This antibody cocktail provides complementary mechanisms of actions, incorporates novel specificities, and demonstrates high-level postexposure protection from lethal EBOV disease in NHPs. It is now undergoing testing in normal healthy volunteers in preparation for potential use in future Ebola epidemics.
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Affiliation(s)
| | - Drew Dudgeon
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - John C Trefry
- Virology Division, US Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - Manu Anantpadma
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio
| | - Yasuteru Sakurai
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio
| | - Charles D Murin
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California
| | - Hannah L Turner
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California
| | | | | | | | - Ying Yan
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Ashok Badithe
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Kevin Yu
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Terra Potocky
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Sandra L Bixler
- Virology Division, US Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - Taylor B Chance
- Pathology Division, US Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - William D Pratt
- Virology Division, US Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - Franco D Rossi
- Center for Aerobiological Sciences, US Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - Joshua D Shamblin
- Virology Division, US Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - Suzanne E Wollen
- Virology Division, US Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - Justine M Zelko
- Virology Division, US Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - Ricardo Carrion
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio
| | - Gabriella Worwa
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio
| | - Hilary M Staples
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio
| | - Darya Burakov
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Robert Babb
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Gang Chen
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Joel Martin
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Tammy T Huang
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Karl Erlandson
- Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC
| | - Melissa S Willis
- Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC
| | - Kimberly Armstrong
- Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC
| | - Thomas M Dreier
- Biomedical Advanced Research and Development Authority, Office of the Assistant Secretary for Preparedness and Response, US Department of Health and Human Services, Washington, DC
| | - Andrew B Ward
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, California
| | - Robert A Davey
- Department of Virology and Immunology, Texas Biomedical Research Institute, San Antonio
| | - Margaret L M Pitt
- Office of the Commander, US Army Medical Research Institute of Infectious Diseases, Ft. Detrick, Maryland
| | - Leah Lipsich
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Peter Mason
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - William Olson
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
| | - Neil Stahl
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York
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45
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Huber C, Finelli L, Stevens W. The Economic and Social Burden of the 2014 Ebola Outbreak in West Africa. J Infect Dis 2019; 218:S698-S704. [PMID: 30321368 DOI: 10.1093/infdis/jiy213] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The 2014 Ebola virus disease (EVD) outbreak in West Africa was more devastating than all previous EVD outbreaks combined; however, many estimates of its economic burden did not capture its significant social costs. This study aimed to review all currently available estimates, identify social components missed by these estimates, and generate a comprehensive cost of the 2014 EVD outbreak. Methods We conducted a systematic review of the grey (reports produced by nonprofit or nongovernmental organizations, government, or industry) and published literature to identify current estimates of the burden of the outbreak. Based on the findings of this review, we identified 6 key areas absent or underestimated from previous estimates and calculated the underestimated social costs using estimates from the literature and extrapolation. Results Current estimates of the economic burden of the outbreak range from $2.8 to $32.6 billion in lost gross domestic product. We estimated the comprehensive economic and social burden from the 2014 EVD outbreak to be $53.19 billion (2014 USD). The most significant component, $18.8 billion, was deaths from non-Ebola causes. Conclusions A more complete understanding of the burden of the 2014 EVD outbreak underscores the value of interventions that can mitigate or reduce the severity of future outbreaks.
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Affiliation(s)
- Caroline Huber
- Health Policy Value, and Innovation Practice, Precision Health Economics, Los Angeles, California
| | - Lyn Finelli
- Center for Observational and Real-World Evidence, Merck & Co., Inc. Kenilworth, New Jersey
| | - Warren Stevens
- Health Economics, Parexel International, Durham, North Carolina
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Oliver GF, Orang AV, Appukuttan B, Marri S, Michael MZ, Marsh GA, Smith JR. Expression of microRNA in human retinal pigment epithelial cells following infection with Zaire ebolavirus. BMC Res Notes 2019; 12:639. [PMID: 31570108 PMCID: PMC6771106 DOI: 10.1186/s13104-019-4671-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/19/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Survivors of Ebola virus disease (EVD) are at risk of developing blinding intraocular inflammation-or uveitis-which is associated with retinal pigment epithelial (RPE) scarring and persistence of live Zaire ebolavirus (EBOV) within the eye. As part of a large research project aimed at defining the human RPE cell response to being infected with EBOV, this work focused on the microRNAs (miRNAs) associated with the infection. RESULTS Using RNA-sequencing, we detected 13 highly induced and 2 highly repressed human miRNAs in human ARPE-19 RPE cells infected with EBOV, including hsa-miR-1307-5p, hsa-miR-29b-3p and hsa-miR-33a-5p (up-regulated), and hsa-miR-3074-3p and hsa-miR-27b-5p (down-regulated). EBOV-miR-1-5p was also found in infected RPE cells. Through computational identification of putative miRNA targets, we predicted a broad range of regulatory activities, including effects on innate and adaptive immune responses, cellular metabolism, cell cycle progression, apoptosis and autophagy. The most highly-connected molecule in the miR-target network was leucine-rich repeat kinase 2, which is involved in neuroinflammation and lysosomal processing. Our findings should stimulate new studies on the impact of miRNA changes in EBOV-infected RPE cells to further understanding of intraocular viral persistence and the pathogenesis of uveitis in EVD survivors.
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Affiliation(s)
- Genevieve F Oliver
- Flinders University College of Medicine and Public Health, Flinders Medical Centre Room 4E-431, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - Ayla V Orang
- Flinders University College of Medicine and Public Health, Flinders Medical Centre Room 4E-431, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - Binoy Appukuttan
- Flinders University College of Medicine and Public Health, Flinders Medical Centre Room 4E-431, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - Shashikanth Marri
- Flinders University College of Medicine and Public Health, Flinders Medical Centre Room 4E-431, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - Michael Z Michael
- Flinders University College of Medicine and Public Health, Flinders Medical Centre Room 4E-431, Flinders Drive, Bedford Park, SA, 5042, Australia
| | - Glenn A Marsh
- Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, 5 Portarlington Rd, Newcomb, VIC, 3219, Australia
| | - Justine R Smith
- Flinders University College of Medicine and Public Health, Flinders Medical Centre Room 4E-431, Flinders Drive, Bedford Park, SA, 5042, Australia.
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Jagadesh S, Sevalie S, Fatoma R, Sesay F, Sahr F, Faragher B, Semple MG, Fletcher TE, Weigel R, Scott JT. Disability Among Ebola Survivors and Their Close Contacts in Sierra Leone: A Retrospective Case-Controlled Cohort Study. Clin Infect Dis 2019; 66:131-133. [PMID: 29020205 PMCID: PMC5833946 DOI: 10.1093/cid/cix705] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 08/09/2017] [Indexed: 12/05/2022] Open
Abstract
Ebola survivors (21/27 [77.8%]) suffered more disability than their close contacts (6/54 [11.1%]) (adjusted odds ratio, 23.5 [95% confidence interval, 6.5–85.7]; P < .001) when measured by the Washington Group Disability Extended Questionnaire. Major limitations in vision, mobility, cognition, and affect were observed in survivors 1 year following the 2014–2016 Ebola outbreak, highlighting the need for long-term rehabilitation.
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Affiliation(s)
| | | | | | - Foday Sesay
- 34 Military Hospital, Freetown, Sierra Leone
| | - Foday Sahr
- 34 Military Hospital, Freetown, Sierra Leone
| | | | - Malcolm G Semple
- University of Liverpool Institute of Translational Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, United Kingdom
| | - Tom E Fletcher
- University of Liverpool Institute of Translational Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, United Kingdom.,Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University Hospital, Samsun, Turkey
| | - Ralf Weigel
- Liverpool School of Tropical Medicine, United Kingdom
| | - Janet T Scott
- University of Liverpool Institute of Translational Medicine and National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, United Kingdom
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James PB, Wardle J, Steel A, Adams J. Pattern of health care utilization and traditional and complementary medicine use among Ebola survivors in Sierra Leone. PLoS One 2019; 14:e0223068. [PMID: 31560708 PMCID: PMC6764668 DOI: 10.1371/journal.pone.0223068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022] Open
Abstract
Background It is well established that Ebola Survivors experience a myriad of physical and psychological sequelae. However, little is known about how they seek care to address their health needs. Our study determines the current healthcare seeking behaviour among Ebola survivors and determines the prevalence, pattern of use and correlates of traditional and complementary medicine (T&CM) use among Ebola survivors in Sierra Leone. Methods We conducted a nationwide questionnaire survey among a cross-sectional sample of Ebola Survivors in Sierra Leone between January and August 2018. We employed descriptive statistics, chi-square test, Fisher exact two-tailed test and backward stepwise binary regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant. Results Ebola Survivors who participated in our study (n = 358), visited a healthcare provider (n = 308, 86.0%), self-medicated with conventional medicines (n = 255, 71.2%) and visited a private pharmacy outlet (n = 141, 39.4%). Survivors also self-medicated with T&CM products (n = 107, 29.9%), concurrently self-medicated with conventional and T&CM products (n = 62, 17.3%), and visited a T&CM practitioner (n = 41, 11.5%). Almost half of (n = 163, 45.5%) Ebola survivors reported using T&CM treatments for post ebola related symptoms and non-Ebola related symptoms since their discharge from an Ebola treatment centre. Ebola survivors who considered their health to be fair or poor (AOR = 4.08; 95%CI: 2.22–7.50; p<0.01), presented with arthralgia (AOR = 2.52; 95%CI: 1.11–5.69, p = 0.026) and were discharged three years or less (AOR = 3.14; 95%CI: 1.13–8.73, p = 0.028) were more likely to use T&CM. Family (n = 101,62.0%) and friends (n = 38,23.3%) were the common sources of T&CM information. Abdominal pain (n = 49, 30.1%) followed by joint pain (n = 46, 28.2%) and back pain (n = 43, 26.4%) were the most cited post–Ebola indications for T&CM use. More than three-quarters of T&CM users (n = 135, 82.8%) failed to disclose their use of T&CM to their healthcare providers. Conclusion Ebola survivors in Sierra Leone employ a myriad of healthcare options including T&CM in addressing their healthcare needs. Researchers, health policy makers and healthcare providers should be aware of the substantial role of T&CM in the health seeking of survivors, and this topic that should be factored into future research, policy formulation and implementation as well as routine practice regarding Ebola survivors.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre inw Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Sydney, Australia
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- * E-mail:
| | - Jon Wardle
- Australian Research Centre inw Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Sydney, Australia
| | - Amie Steel
- Australian Research Centre inw Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Sydney, Australia
| | - Jon Adams
- Australian Research Centre inw Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Sydney, Australia
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Schuchat A, Seward JF, Goldstein ST, Mahon BE. Comment: The Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE). J Infect Dis 2019; 217:S1-S5. [PMID: 29788344 DOI: 10.1093/infdis/jix665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anne Schuchat
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jane F Seward
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Barbara E Mahon
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Affiliation(s)
- Daniel S Chertow
- Critical Care Medicine Department, National Institutes of Health Clinical Center and Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA.
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