Learning from the #Epidemiological #Response to the 2014/15 #Ebola Virus Disease #Outbreak (J Epidemiol Globa Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Epidemiol Glob Health. 2019 Sep;9(3):169-175. doi: 10.2991/jegh.k.190808.002.

Learning from the Epidemiological Response to the 2014/15 Ebola Virus Disease Outbreak.

Holding M1,2,3, Ihekweazu C4,5, Stuart JM1,6, Oliver I1,2.

Author information: 1 NIHR Health Protection Research Unit on Evaluation of Interventions, University of Bristol, Bristol, UK. 2 Field Service, National Infection Service, Public Health England, Bristol, UK. 3 NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK. 4 Nigeria Centre for Disease Control, Abuja, Nigeria. 5 ECOWAS Regional Centre for Surveillance and Disease Control, Abuja, Nigeria. 6 School of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.

 

Abstract

A large international response was needed to bring the 2014/15 West African Ebola virus disease outbreak under control. This study sought to learn lessons from this epidemic to strengthen the response to future outbreaks of international significance by identifying priorities for future epidemiology training and response. Epidemiologists who were deployed to West Africa were recruited through a snowball sampling method and surveyed using an online anonymous questionnaire. Associations between demographics, training, qualifications, and role while in-country were explored alongside respondents’ experience during deployment. Of 128 responses, 105 met the inclusion criteria. Respondents originated from 25 countries worldwide, for many (62%), this was their first deployment abroad. The most common tasks carried out while deployed were surveillance, training, contact tracing, and cluster investigation. Epidemiologists would value more detailed predeployment briefings including organizational aspects of the response. Gaps in technical skills reported were mostly about geographical information systems; however, epidemiologists identified the need for those deployed in future to have greater knowledge about roles and responsibilities of organizations involved in the response, better cultural awareness, and leadership and management skills. Respondents felt that the public health community must improve the timeliness of the response in future outbreaks and strengthen collaboration and coordination between organizations.

© 2019 Atlantis Press International B.V.

KEYWORDS: Ebola virus; West Africa; FETP; epidemiologist; international deployment; outbreak response

PMID: 31529934 DOI: 10.2991/jegh.k.190808.002

Keywords: Ebola; West Africa; Public Health.

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Increased #mortality in #survivors of #Ebola virus disease (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Summary, edited.]

Increased mortality in survivors of Ebola virus disease

Hugues Fausther-Bovendo, Gary Kobinger

Published: September 04, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30429-3

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Long-term sequelae of Ebola virus disease—including myalgia, arthralgia, ocular diseases, and mental confusion—have come to light in survivors of the 2014–16 Ebola outbreak in west Africa. The frequency and duration of these sequelae, which are collectively referred to as post-Ebola virus disease syndrome, have since been reported. 1 However, information about subsequent mortality in survivors of Ebola is scarce. Anecdotal reports and one previous study 2  have documented the unexpected death of survivors of Ebola virus disease after viral clearance and discharge from Ebola treatment units, suggesting that the acute phase of the disease can lead to protracted death in some survivors, but no systematic investigations of increased mortality in survivors have previously been published.

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Keywords: Ebola; West Africa; Ebola-Makona.

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#CFR #estimates for the 2013 – 2016 West #African #Ebola #epidemic: application of Boosted Regression Trees for imputation (Clin Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Clin Infect Dis. 2019 Jul 22. pii: ciz678. doi: 10.1093/cid/ciz678. [Epub ahead of print]

Case fatality ratio estimates for the 2013 – 2016 West African Ebola epidemic: application of Boosted Regression Trees for imputation.

Forna A1, Nouvellet P1,2, Dorigatti I1, Donnelly CA1,3.

Author information: 1 MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom. 2 School of Life Sciences, University of Sussex, Brighton, UK. 3 Department of Statistics, University of Oxford, Oxford, UK.

 

Abstract

BACKGROUND:

The 2013-2016 West African Ebola epidemic has been the largest to date with more than 11,000 deaths in the affected countries. The data collected have provided more insight than ever before into the case fatality ratio (CFR) and how it varies with age and other characteristics. However, the accuracy and precision of the naïve CFR remain limited because 44% of survival outcomes were unreported.

METHODS:

Using a Boosted Regression Tree (BRT) model, we imputed survival outcomes (i.e. survival or death) when unreported, corrected for model imperfection to estimate the CFR without imputation, with imputation and adjusted with imputation. The method allowed us to further identify and explore relevant clinical and demographic predictors of the CFR.

RESULTS:

The out-of-sample performances of our model were good: sensitivity=69.7% (95% CI 52.5%-75.6%), specificity=69.8% (95% CI 54.1%-75.6%), percentage correctly classified=69.9% (95% CI 53.7%-75.5%) and area under the ROC curve= 76.0% (95% CI 56.8%-82.1%). The adjusted CFR estimates for the 2013-2016 West African epidemic were 82.8% (95% CI 45%.6-85.6%) overall and 89.1% (95% CI 40.8%-91.6%) , 65.6% (95% CI 61.3%-69.6%) and 79.2% (95% CI 45.4-84.1) for Sierra Leone, Guinea and Liberia, respectively. We found that district, hospitalisation status, age, case classification and quarter explained 93.6% of the variance in the naïve CFR.

CONCLUSIONS:

The adjusted CFR estimates improved the naïve CFR estimates obtained without imputation and were more representative. Used in conjunction with other resources, adjusted estimates will inform public health contingency planning for future Ebola epidemic, and help better allocate resources and evaluate the effectiveness of future inventions.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.

KEYWORDS: Imputation; Infectious Disease Epidemiology; Machine Learning; Survival; Viral Haemorrhagic Disease

PMID: 31328221 DOI: 10.1093/cid/ciz678

Keywords: Ebola; West Africa.

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Effect of Mass #Artesunate-Amodiaquine #Distribution on #Mortality of #Patients With #Ebola Virus Disease During West #African #Outbreak (Open Forum Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Open Forum Infect Dis. 2019 May 24;6(7):ofz250. doi: 10.1093/ofid/ofz250. eCollection 2019 Jul.

Effect of Mass Artesunate-Amodiaquine Distribution on Mortality of Patients With Ebola Virus Disease During West African Outbreak.

Garbern SC1, Yam D2, Aluisio AR1, Cho DK3, Kennedy SB4, Massaquoi M4, Sahr F5, Perera SM6, Levine AC1, Liu T2.

Author information: 1 Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island. 2 Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island. 3 Brown University, Providence, Rhode Island. 4 Ministry of Health, Monrovia, Liberia. 5 Sierra Leone Ministry of Defense, Freetown, Sierra Leone. 6 International Medical Corps, Washington, DC.

 

Abstract

BACKGROUND:

Experiments in vitro have shown that the drug amodiaquine may inhibit Ebola virus activity. During the Ebola virus disease (EVD) epidemic in West Africa in 2014-2016, 2 mass drug administrations (MDAs) of artesunate-amodiaquine (ASAQ) were implemented to decrease the burden of malaria. The objective of this study was to assess the effect of the ASAQ MDAs on the mortality of patients with EVD.

METHODS:

A retrospective cohort design was used to analyze mortality data for patients with EVD admitted to 5 Ebola treatment units in Liberia and Sierra Leone. Patients admitted to the ETUs during the time period of ASAQ’s therapeutic effect from areas where the MDA was implemented were matched to controls not exposed to ASAQ, using a range of covariates, including malaria co-infection status, and a logistic regression analysis was performed. The primary outcome was Ebola treatment unit mortality.

RESULTS:

A total of 424 patients with EVD had sufficient data for analysis. Overall, the mortality of EVD patients was 57.5%. A total of 22 EVD patients were exposed to ASAQ during the MDAs and were found to have decreased risk of death compared with those not exposed in a matched analysis, but this did not reach statistical significance (relative risk, 0.63; 95% confidence interval, 0.37-1.07; P = .086).

CONCLUSIONS:

There was a non-statistically significantly decreased risk of mortality in EVD patients exposed to ASAQ during the 2 MDAs as compared with EVD patients not exposed to ASAQ. Further prospective trials are needed to determine the direct effect of ASAQ on EVD mortality.

KEYWORDS: Ebola virus disease; amodiaquine; epidemic; mass drug administration; mortality

PMID: 31281856 PMCID: PMC6602760 DOI: 10.1093/ofid/ofz250

Keywords: Ebola; Malaria; West Africa; Artesunate; Amodiquinine.

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A systematic #review and meta-analysis of #patient #data from the west #Africa (2013-16) #Ebola virus disease #epidemic (Clin Microbiol Infect., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Clin Microbiol Infect. 2019 Jul 5. pii: S1198-743X(19)30387-8. doi: 10.1016/j.cmi.2019.06.032. [Epub ahead of print]

A systematic review and meta-analysis of patient data from the west Africa (2013-16) Ebola virus disease epidemic.

Rojek AM1, Salam A2, Ragotte RJ3, Liddiard E3, Elhussain A3, Carlqvist A3, Butler M3, Kayem N3, Castle L3, Odondi L3, Stepniewska K4, Horby PW3.

Author information: 1 Epidemic Diseases Research Group, University of Oxford, Oxford, United Kingdom. Electronic address: amanda.rojek@ndm.ox.ac.uk. 2 Epidemic Diseases Research Group, University of Oxford, Oxford, United Kingdom; United Kingdom Public Health Rapid Support Team. 3 Epidemic Diseases Research Group, University of Oxford, Oxford, United Kingdom. 4 Epidemic Diseases Research Group, University of Oxford, Oxford, United Kingdom; WorldWide Antimalarial Resistance Network, Oxford, United Kingdom.

 

Abstract

BACKGROUND:

Over 28,000 patients were infected with Ebola virus disease (EVD) during the west Africa (2013-16) epidemic, yet there has been criticism of the lack of robust clinical descriptions of illness from that outbreak.

OBJECTIVES:

To perform a meta-analysis of published data from the epidemic in order to describe the clinical presentation, evolution of disease, and predictors of mortality in patients with EVD. To assess the quality and utility of published data for clinical and public health decision making.

DATA SOURCES:

Primary articles available in PubMed and published between January 2014 and May 2017.

ELIGIBILITY:

Studies that sequentially enrolled patients hospitalised for EVD and that reported acute clinical outcomes.

METHODS:

We performed meta-analyses using random-effect models and assessed heterogeneity using the I2 method. We assessed data representativeness by comparing meta-analysis estimates to World Health Organization aggregate data. We examined data utility by examining the availability and compatibility of data sets.

RESULTS:

We screened 3653 articles and included 34 articles, representing 16 independent cohorts of patients (18 overlapping cohorts) and at least 6168 patients. The pooled estimate for case fatality rate was 51% (CI 46% to 56%). However, pooling of estimates for clinical presentation, and predictors of mortality in patients with EVD was hampered by significant heterogeneity, and inadequate data on clinical progression. Our assessment of data quality found that heterogeneity was largely unexplained, and data availability and compatibility were poor.

CONCLUSIONS:

We have quantified a missed opportunity to generate reliable estimates of the clinical manifestations of EVD during the west Africa epidemic. Clinical data standards and data capture platforms are urgently needed.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Ebola; Ebola Virus Disease; Emerging infection; Epidemic; Outbreak; Viral Haemorrhagic Fever; Viral hemorrhagic fever

PMID: 31284032 DOI: 10.1016/j.cmi.2019.06.032

Keywords: Ebola; West Africa.

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Emergence of #human #monkeypox in west #Africa (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Summary, edited.]

Emergence of human monkeypox in west Africa

Giovanni Rezza

Published: July 05, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30281-6

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Human monkeypox is a zoonotic disease that is endemic to central and western Africa. It is caused by an orthopoxvirus that was first identified in captive monkeys in 1958, and in a child from DR Congo in 1970. There are two variants of the virus: the Congo Basin clade and the west African clade. Unlike the variola virus, the monkeypox virus has a wide range of hosts and a reservoir in wild animals. 1

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Keywords: Orthopoxvirus; Monkeypox; Human; West Africa.

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#Conceptions within #misconceptions: #Pluralisms in an #Ebola #vaccine #trial in West Africa (Glob Public Health., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Glob Public Health. 2019 Jun 25:1-9. doi: 10.1080/17441692.2019.1632368. [Epub ahead of print]

Conceptions within misconceptions: Pluralisms in an Ebola vaccine trial in West Africa.

Alenichev A1,2, Peeters Grietens K3, Gerrets R1.

Author information: 1a Department of Anthropology , University of Amsterdam , Amsterdam , Netherlands. 2b The Barcelona Institute for Global Health , Barcelona , Spain. 3c Department of Public Health , Institute of Tropical Medicine , Antwerp , Belgium.

 

Abstract

Ensuring that biomedical information about research procedures is adequately understood by participants and their communities is key for conducting ethical research. This article explores participants’ understanding of trial procedures for an experimental vaccine against Ebola virus disease (EVD) in a West African context. We found that some trial participants believed there was a chance of contracting Ebola and other sicknesses from the vaccine, and others believed both the vaccine and the placebo control would be able to prevent other illnesses than EVD. While these beliefs might be understood as misconceptions about the vaccine trial, this paper shows that such a conclusion is problematic because it excludes local explanatory health models and logics of causality. The paper invites bioethicists to work with anthropologists to take seriously different models of health knowledge in global health research. Investigating and addressing such differences could be the key to understanding human subjects’ motives for participation, and to creating space for studies of empirical ethics.

KEYWORDS: Ebola; clinical trial; misconceptions; pluralism

PMID: 31237180 DOI: 10.1080/17441692.2019.1632368

Keywords: Ebola; Vaccines; Society; Africa region; Bioethics.

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