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Delport D, Sanderson B, Sacks-Davis R, Vaccher S, Dalton M, Martin-Hughes R, Mengistu T, Hogan D, Abeysuriya R, Scott N. A Framework for Assessing the Impact of Outbreak Response Immunization Programs. Diseases 2024; 12:73. [PMID: 38667531 PMCID: PMC11048879 DOI: 10.3390/diseases12040073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
The impact of outbreak response immunization (ORI) can be estimated by comparing observed outcomes to modelled counterfactual scenarios without ORI, but the most appropriate metrics depend on stakeholder needs and data availability. This study developed a framework for using mathematical models to assess the impact of ORI for vaccine-preventable diseases. Framework development involved (1) the assessment of impact metrics based on stakeholder interviews and literature reviews determining data availability and capacity to capture as model outcomes; (2) mapping investment in ORI elements to model parameters to define scenarios; (3) developing a system for engaging stakeholders and formulating model questions, performing analyses, and interpreting results; and (4) example applications for different settings and pathogens. The metrics identified as most useful were health impacts, economic impacts, and the risk of severe outbreaks. Scenario categories included investment in the response scale, response speed, and vaccine targeting. The framework defines four phases: (1) problem framing and data sourcing (identification of stakeholder needs, metrics, and scenarios); (2) model choice; (3) model implementation; and (4) interpretation and communication. The use of the framework is demonstrated by application to two outbreaks, measles in Papua New Guinea and Ebola in the Democratic Republic of the Congo. The framework is a systematic way to engage with stakeholders and ensure that an analysis is fit for purpose, makes the best use of available data, and uses suitable modelling methodology.
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Affiliation(s)
- Dominic Delport
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Ben Sanderson
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
| | - Rachel Sacks-Davis
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- School of Population and Global Health, The University of Melbourne, Parkville, VIC 3010, Australia
| | - Stefanie Vaccher
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
| | - Milena Dalton
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
| | - Rowan Martin-Hughes
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
| | - Tewodaj Mengistu
- Gavi, The Vaccine Alliance, 1218 Geneva, Switzerland; (T.M.); (D.H.)
| | - Dan Hogan
- Gavi, The Vaccine Alliance, 1218 Geneva, Switzerland; (T.M.); (D.H.)
| | - Romesh Abeysuriya
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Nick Scott
- Burnet Institute, Melbourne, VIC 3004, Australia; (B.S.); (R.S.-D.); (S.V.); (M.D.); (R.M.-H.); (R.A.); (N.S.)
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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2
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Šulejová K, Líška D, Liptáková E, Szántová M, Patarák M, Koller T, Batalik L, Makara M, Skladaný Ľ. Relationship between alcohol consumption and adverse childhood experiences in college students–A cross-sectional study. Front Psychol 2022; 13:1004651. [PMID: 36312134 PMCID: PMC9605734 DOI: 10.3389/fpsyg.2022.1004651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 09/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Alcohol consumption is an important issue. Adverse childhood experiences (ACEs) can affect alcohol consumption later in life. Therefore, the main objective of this study was to test the association between ACE and the alcohol consumption in college students. Materials and methods A cross-sectional study on college students was conducted during December 2021 and January 2022, Through the school web system, students received a standard questionnaire on alcohol consumption (AUDIT) and ACEs. The study involved 4,044 participants from three universities in Slovakia. Result Compared to men, the incidence of emotional abuse by a parent, physical abuse by a parent, and sexual abuse was significantly higher in women (p < 0.001). Furthermore, women reported greater emotional and physical neglect (p < 0.001). The incidence of a high or very high AUDIT score in college students with ACE-0, ACE-1, ACE-2, ACE-3, and ACE-4+ was 3.8, 4.7, 4.1, 6.4, and 9.3%, respectively. Conclusion More adverse childhood experiences were associated with increased alcohol consumption in both male and female university students. Baseline drinking was higher in male students, but increased drinking in relation to an increase in ACEs was higher in female students. These results point to gender-specific driving forces and targets for intervention.
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Affiliation(s)
- Karolína Šulejová
- 2nd Department of Internal Medicine, Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology and Liver Transplant), F. D. Roosevelt Teaching Hospital, Slovak Medical University, Banská Bystrica, Slovakia
| | - Dávid Líška
- Faculty of Arts, Department of Physical Education and Sports, Matej Bel University, Banská Bystrica, Slovakia
- *Correspondence: Dávid Líška,
| | - Erika Liptáková
- Faculty of Economics, Technical University of Košice, Košice, Slovakia
| | - Mária Szántová
- 3rd Department of Internal Medicine, Medical Faculty of Comenius University Bratislava, University Hospital, Bratislava, Slovakia
| | - Michal Patarák
- Psychiatric Clinic, F. D. Roosevelt Teaching Hospital, Slovak Medical University, Banská Bystrica, Slovakia
| | - Tomáš Koller
- Gastroenterology and Hepatology Subdivision, 5th Department of Internal Medicine, Comenius University Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Ladislav Batalik
- Central Hospital of Southern Pest, Budapest, Hungary
- Department of Rehabilitation, University Hospital Brno, Brno, Czechia
| | - Michael Makara
- Department of Public Health, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Ľubomír Skladaný
- 2nd Department of Internal Medicine, Faculty of Medicine, HEGITO (Div Hepatology, Gastroenterology and Liver Transplant), F. D. Roosevelt Teaching Hospital, Slovak Medical University, Banská Bystrica, Slovakia
- 2nd Department of Internal Medicine, Faculty of Medicine, P. J. Safarik University, Košice, Slovakia
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3
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Kunal S, Madan M, Tarke C, Gautam DK, Kinkar JS, Gupta K, Agarwal R, Mittal S, Sharma SM. Emerging spectrum of post-COVID-19 syndrome. Postgrad Med J 2021; 98:633-643. [PMID: 34880080 DOI: 10.1136/postgradmedj-2020-139585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 11/13/2021] [Indexed: 12/16/2022]
Abstract
'Post-COVID-19 syndrome' refers to symptoms in the convalescent phase following initial COVID-19 infection. This term encompasses a wide array of presentation involving lungs, heart and the neuromuscular system. Pulmonary manifestations include post-COVID-19 fibrosis, which is akin to post acute respiratory distress syndrome fibrosis and may reflect the permanent damage to the lungs following an initial bout of infection. Cardiovascular system is often involved, and the presentation can be in terms of acute coronary syndrome, myocarditis and heart failure. Clinical manifestations are often varied and non-specific, which entails a detailed workup and a multidisciplinary approach. Post-COVID-19 syndrome adds to the overall disease morbidity and leads to a prolonged hospital stay, greater healthcare utilisation and loss of productivity marring the country's dwindling economy. Thus, it is imperative that post-COVID-19 syndrome be prevented and identified early followed by a prompt treatment.
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Affiliation(s)
- Shekhar Kunal
- Department of Cardiology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Manu Madan
- Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Chandrakant Tarke
- Department of Pulmonology, Apollo Hospital, Hyderabad, Telangana, India
| | - Dinesh Kumar Gautam
- Department of Cardiology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Jiwan Shriram Kinkar
- Department of Neurology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Kashish Gupta
- Department of Medicine, SG Diabetes Centre, Delhi, India
| | - Ritu Agarwal
- Department of Radiodiagnosis, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Shruti Mittal
- Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Shashi Mohan Sharma
- Department of Cardiology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
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4
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Cumpstey AF, Clark AD, Santolini J, Jackson AA, Feelisch M. COVID-19: A Redox Disease-What a Stress Pandemic Can Teach Us About Resilience and What We May Learn from the Reactive Species Interactome About Its Treatment. Antioxid Redox Signal 2021; 35:1226-1268. [PMID: 33985343 DOI: 10.1089/ars.2021.0017] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Significance: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19), affects every aspect of human life by challenging bodily, socioeconomic, and political systems at unprecedented levels. As vaccines become available, their distribution, safety, and efficacy against emerging variants remain uncertain, and specific treatments are lacking. Recent Advances: Initially affecting the lungs, COVID-19 is a complex multisystems disease that disturbs the whole-body redox balance and can be long-lasting (Long-COVID). Numerous risk factors have been identified, but the reasons for variations in susceptibility to infection, disease severity, and outcome are poorly understood. The reactive species interactome (RSI) was recently introduced as a framework to conceptualize how cells and whole organisms sense, integrate, and accommodate stress. Critical Issues: We here consider COVID-19 as a redox disease, offering a holistic perspective of its effects on the human body, considering the vulnerability of complex interconnected systems with multiorgan/multilevel interdependencies. Host/viral glycan interactions underpin SARS-CoV-2's extraordinary efficiency in gaining cellular access, crossing the epithelial/endothelial barrier to spread along the vascular/lymphatic endothelium, and evading antiviral/antioxidant defences. An inflammation-driven "oxidative storm" alters the redox landscape, eliciting epithelial, endothelial, mitochondrial, metabolic, and immune dysfunction, and coagulopathy. Concomitantly reduced nitric oxide availability renders the sulfur-based redox circuitry vulnerable to oxidation, with eventual catastrophic failure in redox communication/regulation. Host nutrient limitations are crucial determinants of resilience at the individual and population level. Future Directions: While inflicting considerable damage to health and well-being, COVID-19 may provide the ultimate testing ground to improve the diagnosis and treatment of redox-related stress diseases. "Redox phenotyping" of patients to characterize whole-body RSI status as the disease progresses may inform new therapeutic approaches to regain redox balance, reduce mortality in COVID-19 and other redox diseases, and provide opportunities to tackle Long-COVID. Antioxid. Redox Signal. 35, 1226-1268.
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Affiliation(s)
- Andrew F Cumpstey
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Anna D Clark
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jérôme Santolini
- Institute for Integrative Biology of the Cell (I2BC), Biochemistry, Biophysics and Structural Biology, CEA, CNRS, Université Paris-Sud, Universite Paris-Saclay, Gif-sur-Yvette, France
| | - Alan A Jackson
- Human Nutrition, University of Southampton and University Hospital Southampton, Southampton, United Kingdom
| | - Martin Feelisch
- Respiratory and Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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5
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Ebola virus antibody decay-stimulation in a high proportion of survivors. Nature 2021; 590:468-472. [PMID: 33505020 PMCID: PMC7839293 DOI: 10.1038/s41586-020-03146-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/18/2020] [Indexed: 11/29/2022]
Abstract
Neutralizing antibody function provides a foundation for the efficacy of vaccines and therapies1–3. Here, using a robust in vitro Ebola virus (EBOV) pseudo-particle infection assay and a well-defined set of solid-phase assays, we describe a wide spectrum of antibody responses in a cohort of healthy survivors of the Sierra Leone EBOV outbreak of 2013–2016. Pseudo-particle virus-neutralizing antibodies correlated with total anti-EBOV reactivity and neutralizing antibodies against live EBOV. Variant EBOV glycoproteins (1995 and 2014 strains) were similarly neutralized. During longitudinal follow-up, antibody responses fluctuated in a ‘decay–stimulation–decay’ pattern that suggests de novo restimulation by EBOV antigens after recovery. A pharmacodynamic model of antibody reactivity identified a decay half-life of 77–100 days and a doubling time of 46–86 days in a high proportion of survivors. The highest antibody reactivity was observed around 200 days after an individual had recovered. The model suggests that EBOV antibody reactivity declines over 0.5–2 years after recovery. In a high proportion of healthy survivors, antibody responses undergo rapid restimulation. Vigilant follow-up of survivors and possible elective de novo antigenic stimulation by vaccine immunization should be considered in order to prevent EBOV viral recrudescence in recovering individuals and thereby to mitigate the potential risk of reseeding an outbreak. In many survivors of Ebola virus infection, antibody responses show long-term patterns of decline followed by restimulation, possibly owing to recrudescence of persisting virus.
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6
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Alva S, Davis N, Stan L, Pivato I, Sanderson J. Conducting mixed-methods research with Ebola survivors in a complex setting in Sierra Leone. BMC Public Health 2020; 20:1346. [PMID: 32883281 PMCID: PMC7470604 DOI: 10.1186/s12889-020-09469-9] [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: 03/31/2020] [Accepted: 08/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In late 2015, the Sierra Leone government established the Comprehensive Program for Ebola Survivors (CPES) to improve the well-being of 3466 registered Ebola virus disease (EVD) survivors. This case analysis outlines the challenges of conducting research studies on the health situation of these EVD survivors in a complicated, post-Ebola context. It outlines strategies to address these challenges without compromising research quality. The mixed-methods study sought to determine EVD survivors' access to health services offered through CPES, their health and disability status, and psychosocial and mental health issues faced. Qualitative data from survivors and stakeholders at multiple levels complemented and contextualized the survey results to help understand the unique health and associated socioeconomic challenges that EVD survivors face, which could be applied to other crisis settings. Study findings indicated that CPES had lasting impacts on Sierra Leone's health system, enabling it to respond to EVD survivors, who increasingly accessed health services and showed lower levels of disability after receiving care. DISCUSSION Understanding the health service needs of this specialized population in a country with an overloaded health system after the Ebola epidemic makes this research study important and timely. The study faced several challenges, including working in a low-resource and low-capacity setting marked by constantly changing priorities and activities of CPES donors and implementers. Further, the study aimed to measure sensitive topics, such as mental health and disability, with standardized tools that required careful contextualization for accurate reporting of findings. Strategies to overcome these challenges included utilizing a mixed-methods approach to contextualize and validate survey results. The study also enabled capacity building of local research teams to ensure that they could follow lines of inquiry and navigate the complex post-Ebola context. CONCLUSIONS Flexibility is paramount when conducting high-quality research for representative and useful results. Timely research and ongoing sharing of the findings with stakeholders is critical to ensure that they benefit study subjects. Furthermore, in such settings, there is a need to balance engagement of stakeholders with maintaining independence and impartiality in the research design and subsequent data produced.
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7
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Chen D, Hou Z, Jiang D, Zheng M, Li G, Zhang Y, Li R, Lin H, Chang J, Zeng H, Guo JT, Zhao X. GILT restricts the cellular entry mediated by the envelope glycoproteins of SARS-CoV, Ebola virus and Lassa fever virus. Emerg Microbes Infect 2020; 8:1511-1523. [PMID: 31631785 PMCID: PMC6818130 DOI: 10.1080/22221751.2019.1677446] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Interferons (IFNs) control viral infections by inducing expression of IFN-stimulated genes (ISGs) that restrict distinct steps of viral replication. We report herein that gamma-interferon-inducible lysosomal thiol reductase (GILT), a lysosome-associated ISG, restricts the infectious entry of selected enveloped RNA viruses. Specifically, we demonstrated that GILT was constitutively expressed in lung epithelial cells and fibroblasts and its expression could be further induced by type II interferon. While overexpression of GILT inhibited the entry mediated by envelope glycoproteins of SARS coronavirus (SARS-CoV), Ebola virus (EBOV) and Lassa fever virus (LASV), depletion of GILT enhanced the entry mediated by these viral envelope glycoproteins. Furthermore, mutations that impaired the thiol reductase activity or disrupted the N-linked glycosylation, a posttranslational modification essential for its lysosomal localization, largely compromised GILT restriction of viral entry. We also found that the induction of GILT expression reduced the level and activity of cathepsin L, which is required for the entry of these RNA viruses in lysosomes. Our data indicate that GILT is a novel antiviral ISG that specifically inhibits the entry of selected enveloped RNA viruses in lysosomes via disruption of cathepsin L metabolism and function and may play a role in immune control and pathogenesis of these viruses.
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Affiliation(s)
- Danying Chen
- Institute of Infectious disease, Beijing Ditan Hospital, Capital Medical University , Beijing , People's Republic of China.,Beijing Key Laboratory of Emerging Infectious Disease , Beijing , People's Republic of China
| | - Zhifei Hou
- Institute of Infectious disease, Beijing Ditan Hospital, Capital Medical University , Beijing , People's Republic of China.,Beijing Key Laboratory of Emerging Infectious Disease , Beijing , People's Republic of China.,Department of Pulmonary and Critical Care Medicine, General Hospital of Datong Coal Mine Group Co., Ltd. , People's Republic of China
| | - Dong Jiang
- Institute of Infectious disease, Beijing Ditan Hospital, Capital Medical University , Beijing , People's Republic of China.,Beijing Key Laboratory of Emerging Infectious Disease , Beijing , People's Republic of China
| | - Mei Zheng
- Institute of Infectious disease, Beijing Ditan Hospital, Capital Medical University , Beijing , People's Republic of China.,Beijing Key Laboratory of Emerging Infectious Disease , Beijing , People's Republic of China
| | - Guoli Li
- Institute of Infectious disease, Beijing Ditan Hospital, Capital Medical University , Beijing , People's Republic of China.,Beijing Key Laboratory of Emerging Infectious Disease , Beijing , People's Republic of China
| | - Yue Zhang
- Institute of Infectious disease, Beijing Ditan Hospital, Capital Medical University , Beijing , People's Republic of China.,Beijing Key Laboratory of Emerging Infectious Disease , Beijing , People's Republic of China
| | - Rui Li
- Institute of Infectious disease, Beijing Ditan Hospital, Capital Medical University , Beijing , People's Republic of China.,Beijing Key Laboratory of Emerging Infectious Disease , Beijing , People's Republic of China
| | - Hanxin Lin
- Department of Pathology and Laboratory Medicine, Western University , London , Ontario , Canada
| | - Jinhong Chang
- Baruch S. Blumberg Institute, Hepatitis B Foundation , Doylestown , PA , USA
| | - Hui Zeng
- Institute of Infectious disease, Beijing Ditan Hospital, Capital Medical University , Beijing , People's Republic of China.,Beijing Key Laboratory of Emerging Infectious Disease , Beijing , People's Republic of China
| | - Ju-Tao Guo
- Baruch S. Blumberg Institute, Hepatitis B Foundation , Doylestown , PA , USA
| | - Xuesen Zhao
- Institute of Infectious disease, Beijing Ditan Hospital, Capital Medical University , Beijing , People's Republic of China.,Beijing Key Laboratory of Emerging Infectious Disease , Beijing , People's Republic of China
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8
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Wing K, Oza S, Houlihan C, Glynn JR, Irvine S, Warrell CE, Simpson AJH, Boufkhed S, Sesay A, Vandi L, Sebba SC, Shetty P, Cummings R, Checchi F, McGowan CR. Surviving Ebola: A historical cohort study of Ebola mortality and survival in Sierra Leone 2014-2015. PLoS One 2018; 13:e0209655. [PMID: 30589913 PMCID: PMC6307710 DOI: 10.1371/journal.pone.0209655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022] Open
Abstract
Background While a number of predictors for Ebola mortality have been identified, less is known about post-viral symptoms. The identification of acute-illness predictors for post-viral symptoms could allow the selection of patients for more active follow up in the future, and those in whom early interventions may be beneficial in the long term. Studying predictors of both mortality and post-viral symptoms within a single cohort of patients could also further our understanding of the pathophysiology of survivor sequelae. Methods/Principal findings We performed a historical cohort study using data collected as part of routine clinical care from an Ebola Treatment Centre (ETC) in Kerry Town, Sierra Leone, in order to identify predictors of mortality and of post-viral symptoms. Variables included as potential predictors were sex, age, date of admission, first recorded viral load at the ETC and symptoms (recorded upon presentation at the ETC). Multivariable logistic regression was used to identify predictors. Of 263 Ebola-confirmed patients admitted between November 2014 and March 2015, 151 (57%) survived to ETC discharge. Viral load was the strongest predictor of mortality (adjusted OR comparing high with low viral load: 84.97, 95% CI 30.87–345.94). We did not find evidence that a high viral load predicted post-viral symptoms (ocular: 1.17, 95% CI 0.35–3.97; musculoskeletal: 1.07, 95% CI 0.28–4.08). Ocular post-viral symptoms were more common in females (2.31, 95% CI 0.98–5.43) and in those who had experienced hiccups during the acute phase (4.73, 95% CI 0.90–24.73). Conclusions/Significance These findings may add epidemiological support to the hypothesis that post-viral symptoms have an immune-mediated aspect and may not only be a consequence of high viral load and disease severity.
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Affiliation(s)
- Kevin Wing
- Save the Children International, Kerry Town, Sierra Leone
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Shefali Oza
- Save the Children International, Kerry Town, Sierra Leone
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine Houlihan
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Judith R. Glynn
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sharon Irvine
- Save the Children International, Kerry Town, Sierra Leone
| | | | - Andrew J. H. Simpson
- Rare and Imported Pathogens Laboratory, Public Health England, Porton, Wilts, United Kingdom
| | - Sabah Boufkhed
- Save the Children International, Kerry Town, Sierra Leone
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alieu Sesay
- Save the Children International, Kerry Town, Sierra Leone
| | - Lahai Vandi
- Save the Children International, Kerry Town, Sierra Leone
| | | | - Pranav Shetty
- Humanitarian Public Health Technical Unit, Save the Children, London, United Kingdom
| | - Rachael Cummings
- Humanitarian Public Health Technical Unit, Save the Children, London, United Kingdom
| | - Francesco Checchi
- Save the Children International, Kerry Town, Sierra Leone
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine R. McGowan
- Save the Children International, Kerry Town, Sierra Leone
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Humanitarian Public Health Technical Unit, Save the Children, London, United Kingdom
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9
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Stawicki SP, Sharpe RP, Galwankar SC, Sweeney J, Martins N, Papadimos TJ, Jeanmonod D, Firstenberg MS, Paladino L, Hansoti B, Garg M. Reflections on the Ebola Public Health Emergency of International Concern, Part 1: Post-Ebola Syndrome: The Silent Outbreak. J Glob Infect Dis 2017; 9:41-44. [PMID: 28584453 PMCID: PMC5452549 DOI: 10.4103/jgid.jgid_20_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stanislaw P Stawicki
- Department of Research and Innovation, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Richard P Sharpe
- St. Luke's International Surgical Studies, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Sagar C Galwankar
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
| | - Joan Sweeney
- Department of Neurology, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Noel Martins
- Department of Gastroenterology, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Donald Jeanmonod
- Department of Emergency Medicine, St. Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Michael S Firstenberg
- Department of Surgery and Integrative Medicine, Northeast Ohio Medical University, Akron, Ohio, USA
| | - Lorenzo Paladino
- Department of Emergency Medicine, SUNY Downstate Medical Center, New York, USA
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Manish Garg
- Department of Emergency Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
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