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.




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.


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.


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).


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.



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.




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.


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.


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


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


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.


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.


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.


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


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


Keywords: Orthopoxvirus; Monkeypox; Human; West Africa.


#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.



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.


Quantifying the seasonal #drivers of #transmission for #Lassa fever in #Nigeria (Philos Transact Roy Soc B., abstract)

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

Philos Trans R Soc Lond B Biol Sci. 2019 Jun 24;374(1775):20180268. doi: 10.1098/rstb.2018.0268.

Quantifying the seasonal drivers of transmission for Lassa fever in Nigeria.

Akhmetzhanov AR1, Asai Y1, Nishiura H1.

Author information: 1 Graduate School of Medicine, Hokkaido University , Sapporo, Hokkaido , Japan.



Lassa fever (LF) is a zoonotic disease that is widespread in West Africa and involves animal-to-human and human-to-human transmission. Animal-to-human transmission occurs upon exposure to rodent excreta and secretions, i.e. urine and saliva, and human-to-human transmission occurs via the bodily fluids of an infected person. To elucidate the seasonal drivers of LF epidemics, we employed a mathematical model to analyse the datasets of human infection, rodent population dynamics and climatological variations and capture the underlying transmission dynamics. The surveillance-based incidence data of human cases in Nigeria were explored, and moreover, a mathematical model was used for describing the transmission dynamics of LF in rodent populations. While quantifying the case fatality risk and the rate of exposure of humans to animals, we explicitly estimated the corresponding contact rate of humans with infected rodents, accounting for the seasonal population dynamics of rodents. Our findings reveal that seasonal migratory dynamics of rodents play a key role in regulating the cyclical pattern of LF epidemics. The estimated timing of high exposure of humans to animals coincides with the time shortly after the start of the dry season and can be associated with the breeding season of rodents in Nigeria. This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’. This issue is linked with the subsequent theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control’.

KEYWORDS: Arenaviridae; Lassa haemorrhagic fever; multimammate rat; reservoir host; seasonality

PMID: 31056054 DOI: 10.1098/rstb.2018.0268

Keywords: Arenavirus; Lassa fever; West Africa.


Impact of #Intravenous #Fluid #Therapy on #Survival Among Patients with #Ebola Virus Disease: An #International Multisite Retrospective Cohort Study (Clin Infect Dis., abstract)

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

Clin Infect Dis. 2019 May 3. pii: ciz344. doi: 10.1093/cid/ciz344. [Epub ahead of print]

Impact of Intravenous Fluid Therapy on Survival Among Patients with Ebola Virus Disease: An International Multisite Retrospective Cohort Study.

Aluisio AR1, Yam D2, Peters JL3, Cho DK3, Perera SM4, Kennedy SB5, Massaquoi M5, Sahr F6, Smit MA7, Liu T2, Levine AC1.

Author information: 1 Department of Emergency Medicine, Brown University Alpert Medical School, Providence, RI, USA. 2 Center for Statistical Sciences, Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA. 3 Brown University, Providence, RI, USA. 4 International Medical Corps, Washington, DC, USA. 5 Ministry of Health, Monrovia, Liberia. 6 Sierra Leone Ministry of Defense, Freetown, Sierra Leone. 7 Division of Infectious Diseases, Children’s Hospital Los Angeles, Los Angeles, CA, USA.




Intravenous fluid (IVF) is a frequently recommended intervention in Ebola Virus Disease (EVD), yet its impact on patient outcomes remains unclear.


This retrospective cohort study evaluated patients with EVD admitted to five Ebola Treatment Units (ETU) in West Africa. The primary outcome was the difference in 28-day survival between cases treated and not treated with IVF. To control for demographic and clinical factors related to both IVF exposure and survival, cases were compared using propensity score matching. To control for time-varying patient and treatment factors over the course of ETU care, a marginal structural proportional hazards model (MSPHM) with inverse probability weighting was used to assess for 28-day survival differences.


Among 424 EVD positive cases with data for analysis, 354 (83.5%) were treated with IVF at some point during their ETU admission. Overall, 146 (41.3%) cases treated with IVF survived, while 31 (44.9%) cases not treated with any IVF survived (p=0.583). Matched propensity score analysis found no significant difference in 28-day survival between cases treated and not treated with IVF during their first 24 and 48 hours of care. Adjusted MSPHM survival analyses also found no significant difference in 28-day survival for cases treated with IVF (27.3%) compared to those not treated with IVF (26.9%) during their entire ETU admission (p=0.893).


After adjustment for patient and treatment-specific time varying factors, there was no significant difference in survival among patients with EVD treated with IVF as compared to those not treated with IVF.

© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

KEYWORDS: Ebola Virus Disease; West Africa; intravenous fluid; marginal structural models; survival

PMID: 31050703 DOI: 10.1093/cid/ciz344

Keywords: Ebola; West Africa.


#Determinants of #transmission #risk during the late stage of the West African #Ebola #epidemic (Am J Epidemiol., abstract)

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

Am J Epidemiol. 2019 Apr 3. pii: kwz090. doi: 10.1093/aje/kwz090. [Epub ahead of print]

Determinants of transmission risk during the late stage of the West African Ebola epidemic.

Robert A1, Edmunds WJ1, Watson CH1, Henao-Restrepo AM2, Gsell PS2, Williamson E3, Longini IM4, Sakoba K5, Kucharski AJ1, Touré A5, Nadlaou SD5, Diallo B6, Barry MS5, Fofana TO5, Camara L5, Kaba IL5, Sylla L5, Diaby ML5, Soumah O5, Diallo A5, Niare A5, Diallo A5, Eggo RM1.

Author information: 1 Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK. 2 World Health Organization, Geneva, Switzerland. 3 Department of Medical Statistics, London School of Hygiene &Tropical Medicine, UK. 4 Department of Biostatistics, University of Florida, USA. 5 WHO Ebola vaccination team, Guinea. 6 WHO Ebola vaccination team, Guinea, Ministry of Health, Guinea.



Understanding risk factors for Ebola transmission is key for effective prediction and design of interventions. We used data on 860 cases in 129 chains of transmission from the latter half of the 2013-16 Ebola outbreak in Guinea. Using negative binomial regression, we determined characteristics associated with the number of secondary cases resulting from each infected individual. We found that attending an Ebola Treatment Unit was associated with a 38% decrease in secondary cases (Incident rate ratio (IRR) 0.62, 95%CI: 0.38, 0.99) in individuals that did not survive. Unsafe burial was associated with a higher number of secondary cases (IRR 1.82, 95%CI: 1.10, 3.02). The average number of secondary cases was higher for the first generation of a transmission chain (mean = 1.77), compared with subsequent generations (mean = 0.70). Children were least likely to transmit (IRR 0.35 (95%CI: 0.21, 0.57) compared with adults, whereas older adults were associated with higher numbers of secondary cases. Men were less likely to transmit than women (IRR 0.71 (95%CI: 0.55, 0.93)). This detailed surveillance dataset provided an invaluable insight into transmission routes and risks. Our analysis highlights the key role that age, receiving treatment, and safe burial played in the spread of EVD.

© The Author(s) 2019. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

KEYWORDS: Ebola; Guinea; Multiple imputation; Regression analysis; Risk factors

PMID: 30941398 DOI: 10.1093/aje/kwz090

Keywords: Ebola; Ebola-Makona; West Africa.