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Ardiet DL, Nsio J, Komanda G, Coulborn RM, Grellety E, Grandesso F, Kitenge R, Ngwanga DL, Matady B, Manangama G, Mossoko M, Ngwama JK, Mbala P, Luquero F, Porten K, Ahuka-Mundeke S. Rapid Decision Algorithm for Patient Triage during Ebola Outbreaks. Emerg Infect Dis 2024; 30:1-11. [PMID: 39447210 PMCID: PMC11521189 DOI: 10.3201/eid3011.231650] [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] [Indexed: 10/26/2024] Open
Abstract
The low specificity of Ebola virus disease clinical signs increases the risk for nosocomial transmission to patients and healthcare workers during outbreaks. Reducing this risk requires identifying patients with a high likelihood of Ebola virus infection. Analyses of retrospective data from patients suspected of having Ebola virus infection identified 13 strong predictors and time from disease onset as constituents of a prediction score for Ebola virus disease. We also noted 4 highly predictive variables that could distinguish patients at high risk for infection, independent of their scores. External validation of this algorithm on retrospective data revealed the probability of infection continuously increased with the score.
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Affiliation(s)
| | | | - Gaston Komanda
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Rebecca M. Coulborn
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Emmanuel Grellety
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Francesco Grandesso
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Richard Kitenge
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Dolla L. Ngwanga
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Bibiche Matady
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Guyguy Manangama
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Mathias Mossoko
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - John K. Ngwama
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Placide Mbala
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Francisco Luquero
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Klaudia Porten
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
| | - Steve Ahuka-Mundeke
- Epicentre, Paris, France (D.-L. Ardiet, G. Komanda, R.M. Coulborn, E. Grellety, F. Grandesso, F. Luquero, K. Porten); Ministry of Health, Kinshasa, Democratic Republic of the Congo (J. Nsio, R. Kitenge, D.L. Ngwanga, B. Matady, M. Mossoko, J.K. Ngwama); Médecins Sans Frontières France, Paris (G. Manangama); Institut National de la Recherche Biomédicale, Kinshasa (P. Mbala, S. Ahuka-Mundeke); University of Kinshasa, Kinshasa (S. Ahuka-Mundeke)
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Adriaensen W, Oostvogels S, Levy Y, Leigh B, Kavunga-Membo H, Watson-Jones D. Urgent considerations for booster vaccination strategies against Ebola virus disease. THE LANCET. INFECTIOUS DISEASES 2024; 24:e647-e653. [PMID: 38734010 DOI: 10.1016/s1473-3099(24)00210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 05/13/2024]
Abstract
With two endorsed and prophylactic vaccines against Zaire ebolavirus (referred to hereafter as EBOV), the number of individuals vaccinated against EBOV worldwide is estimated to range between 500 000 and 1 000 000 individuals, increasing with every renewed EBOV threat and vaccination campaign. Therefore, re-exposure of previously vaccinated health-care workers, and possibly community members, could become more frequent. In the absence of long-term data on vaccine efficacy and duration of protection, we urgently need to understand revaccination strategies that could maximise the level of protection. In this Personal View, we highlight the scarcity of available evidence to guide revaccination recommendations for the accumulating groups of previously vaccinated communities or front-line health-care workers that could be redeployed or re-exposed in the next EBOV outbreak(s). This evidence base is crucial to identify optimal target populations and the frequency of booster doses, and guide vaccine interchangeability (especially in settings with limited or unpredictable vaccine supplies), while preventing vaccine mistrust, equity concerns, and exclusion of vulnerable populations. We discuss five priority gaps (to whom, when, and how frequently, to provide booster doses; long-term correlates and thresholds of protection; the effect of vector-directed immunity and viral variant protection; comparative research in mix-and-match schedules; and implementation concerns) that should be urgently tackled to adapt the initial EBOV prophylactic vaccination strategies considering potential booster dose vaccinations.
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Affiliation(s)
- Wim Adriaensen
- Clinical Immunology Unit, Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium.
| | - Selien Oostvogels
- Clinical Immunology Unit, Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Yves Levy
- Vaccine Research Institute, INSERM U955, Université Paris-Est Créteil, Créteil, France
| | - Bailah Leigh
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Hugo Kavunga-Membo
- Rodolphe Merieux Laboratory INRB-Goma, Goma, Democratic Republic of the Congo; University of Goma, Goma, Democratic Republic of the Congo
| | - Deborah Watson-Jones
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Mwanza Intervention Trials Unit, National Institute for Medical Research, Mwanza, Tanzania
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Kabami Z, Ario AR, Harris JR, Ninsiima M, Ahirirwe SR, Ocero JRA, Atwine D, Mwebesa HG, Kyabayinze DJ, Muruta AN, Kagirita A, Tegegn Y, Nanyunja M, Kizito SN, Kadobera D, Kwesiga B, Gidudu S, Migisha R, Makumbi I, Eurien D, Elyanu PJ, Ndyabakira A, Naiga HN, Zalwango JF, Agaba B, Kawungezi PC, Zalwango MG, King P, Simbwa BN, Akunzirwe R, Wanyana MW, Zavuga R, Kiggundu T. Ebola disease outbreak caused by the Sudan virus in Uganda, 2022: a descriptive epidemiological study. Lancet Glob Health 2024; 12:e1684-e1692. [PMID: 39222652 DOI: 10.1016/s2214-109x(24)00260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 06/04/2024] [Accepted: 06/10/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Uganda has had seven Ebola disease outbreaks, between 2000 and 2022. On Sept 20, 2022, the Ministry of Health declared a Sudan virus disease outbreak in Mubende District, Central Uganda. We describe the epidemiological characteristics and transmission dynamics. METHODS For this descriptive study, cases were classified as suspected, probable, or confirmed using Ministry of Health case definitions. We investigated all reported cases to obtain data on case-patient demographics, exposures, and signs and symptoms, and identified transmission chains. We conducted a descriptive epidemiological study and also calculated basic reproduction number (Ro) estimates. FINDINGS Between Aug 8 and Nov 27, 2022, 164 cases (142 confirmed, 22 probable) were identified from nine (6%) of 146 districts. The median age was 29 years (IQR 20-38), 95 (58%) of 164 patients were male, and 77 (47%) patients died. Symptom onsets ranged from Aug 8 to Nov 27, 2022. The case fatality rate was highest in children younger than 10 years (17 [74%] of 23 patients). Fever (135 [84%] of 160 patients), vomiting (93 [58%] patients), weakness (89 [56%] patients), and diarrhoea (81 [51%] patients) were the most common symptoms; bleeding was uncommon (21 [13%] patients). Before outbreak identification, most case-patients (26 [60%] of 43 patients) sought care at private health facilities. The median incubation was 6 days (IQR 5-8), and median time from onset to death was 10 days (7-23). Most early cases represented health-care-associated transmission (43 [26%] of 164 patients); most later cases represented household transmission (109 [66%]). Overall Ro was 1·25. INTERPRETATION Despite delayed detection, the 2022 Sudan virus disease outbreak was rapidly controlled, possibly thanks to a low Ro. Children (aged <10 years) were at the highest risk of death, highlighting the need for targeted interventions to improve their outcomes during Ebola disease outbreaks. Initial care-seeking occurred at facilities outside the government system, showing a need to ensure that private and public facilities receive training to identify possible Ebola disease cases during an outbreak. Health-care-associated transmission in private health facilities drove the early outbreak, suggesting gaps in infection prevention and control. FUNDING None.
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Affiliation(s)
- Zainah Kabami
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda.
| | - Alex R Ario
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Julie R Harris
- Division of Global Health Protection, Global Health Center, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Mackline Ninsiima
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Sherry R Ahirirwe
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Diana Atwine
- Office of the Permanent Secretary, Ministry of Health, Kampala, Uganda
| | - Henry G Mwebesa
- Office of the Director General Health Services, Ministry of Health, Kampala, Uganda
| | - Daniel J Kyabayinze
- Office of the Director of Public Health, Ministry of Health, Kampala, Uganda
| | - Allan N Muruta
- Department of Integrated Epidemiology, Surveillance and Public Health Emergencies, Ministry of Health, Kampala, Uganda
| | - Atek Kagirita
- Department of the National Health Laboratory And Diagnostic Services, Ministry of Health, Kampala, Uganda
| | - Yonas Tegegn
- Office of the Country Representative, WHO, Kampala, Uganda
| | - Miriam Nanyunja
- Emergency Preparedness and Response East and Southern Africa Hub, WHO AFRO Regional Office, Nairobi, Kenya
| | - Saudah N Kizito
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Samuel Gidudu
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Richard Migisha
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Issa Makumbi
- National Public Health Emergency Operations Center, Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Eurien
- Global Health Security, Baylor College of Medicine Children's Foundation, Kampala, Uganda
| | - Peter J Elyanu
- Global Health Security, Baylor College of Medicine Children's Foundation, Kampala, Uganda
| | - Alex Ndyabakira
- Directorate of Public Health and Environment, Kampala City Council Authority, Kampala, Uganda
| | - Helen Nelly Naiga
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Jane F Zalwango
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Brian Agaba
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Peter C Kawungezi
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Marie G Zalwango
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Patrick King
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Brenda N Simbwa
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Rebecca Akunzirwe
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Mercy W Wanyana
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Robert Zavuga
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Thomas Kiggundu
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
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Akunzirwe R, Carter S, Simbwa BN, Wanyana MW, Ahirirwe SR, Namubiru SK, Ninsiima M, Komakech A, Ario AR, Kadobera D, Kwesiga B, Migisha R, Bulage L, Naiga HN, Zalwango JF, Agaba B, Kabami Z, Zalwango MG, King P, Kiggundu T, Kawungezi PC, Gonahasa DN, Kyamwine IB, Atuhaire I, Asio A, Elayeete S, Nsubuga EJ, Masanja V, Migamba SM, Nakamya P, Nampeera R, Kwiringira A, Choi M, Lo T, Harris JR. Time to care and factors influencing appropriate Sudan virus disease care among case patients in Uganda, September to November 2022. Int J Infect Dis 2024; 145:107073. [PMID: 38670481 DOI: 10.1016/j.ijid.2024.107073] [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: 02/23/2024] [Revised: 04/22/2024] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES Early isolation and care for Ebola disease patients at Ebola Treatment Units (ETU) curb outbreak spread. We evaluated time to ETU entry and associated factors during the 2022 Sudan virus disease (SVD) outbreak in Uganda. METHODS We included persons with RT-PCR-confirmed SVD with onset September 20-November 30, 2022. We categorized days from symptom onset to ETU entry ("delays") as short (≤2), moderate (3-5), and long (≥6); the latter two were "delayed isolation." We categorized symptom onset timing as "earlier" or "later," using October 15 as a cut-off. We assessed demographics, symptom onset timing, and awareness of contact status as predictors for delayed isolation. We explored reasons for early vs late isolation using key informant interviews. RESULTS Among 118 case-patients, 25 (21%) had short, 43 (36%) moderate, and 50 (43%) long delays. Seventy-five (64%) had symptom onset later in the outbreak. Earlier symptom onset increased risk of delayed isolation (crude risk ratio = 1.8, 95% confidence interval (1.2-2.8]). Awareness of contact status and SVD symptoms, and belief that early treatment-seeking was lifesaving facilitated early care-seeking. Patients with long delays reported fear of ETUs and lack of transport as contributors. CONCLUSION Delayed isolation was common early in the outbreak. Strong contact tracing and community engagement could expedite presentation to ETUs.
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Affiliation(s)
| | - Simone Carter
- United Nations Children's Fund Public Health Emergencies, Geneva, Switzerland
| | | | | | | | | | | | - Allan Komakech
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Alex R Ario
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Benon Kwesiga
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Lilian Bulage
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Helen N Naiga
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Brian Agaba
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Zainah Kabami
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Patrick King
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | | | | | | | - Alice Asio
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Sarah Elayeete
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | | | | | - Rose Nampeera
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Mary Choi
- Centers for Disease Control and Prevention, Kampala, Uganda
| | - Terrence Lo
- Centers for Disease Control and Prevention, Kampala, Uganda
| | - Julie R Harris
- Centers for Disease Control and Prevention, Kampala, Uganda
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Bearnot CJ, Mbong EN, Muhayangabo RF, Laghari R, Butler K, Gainey M, Perera SM, Michelow IC, Tang OY, Levine AC, Colubri A, Aluisio AR. Derivation and Internal Validation of a Mortality Prognostication Machine Learning Model in Ebola Virus Disease Based on Iterative Point-of-Care Biomarkers. Open Forum Infect Dis 2024; 11:ofad689. [PMID: 38379568 PMCID: PMC10878059 DOI: 10.1093/ofid/ofad689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 02/22/2024] Open
Abstract
Background Although multiple prognostic models exist for Ebola virus disease mortality, few incorporate biomarkers, and none has used longitudinal point-of-care serum testing throughout Ebola treatment center care. Methods This retrospective study evaluated adult patients with Ebola virus disease during the 10th outbreak in the Democratic Republic of Congo. Ebola virus cycle threshold (Ct; based on reverse transcriptase polymerase chain reaction) and point-of-care serum biomarker values were collected throughout Ebola treatment center care. Four iterative machine learning models were created for prognosis of mortality. The base model used age and admission Ct as predictors. Ct and biomarkers from treatment days 1 and 2, days 3 and 4, and days 5 and 6 associated with mortality were iteratively added to the model to yield mortality risk estimates. Receiver operating characteristic curves for each iteration provided period-specific areas under curve with 95% CIs. Results Of 310 cases positive for Ebola virus disease, mortality occurred in 46.5%. Biomarkers predictive of mortality were elevated creatinine kinase, aspartate aminotransferase, blood urea nitrogen (BUN), alanine aminotransferase, and potassium; low albumin during days 1 and 2; elevated C-reactive protein, BUN, and potassium during days 3 and 4; and elevated C-reactive protein and BUN during days 5 and 6. The area under curve substantially improved with each iteration: base model, 0.74 (95% CI, .69-.80); days 1 and 2, 0.84 (95% CI, .73-.94); days 3 and 4, 0.94 (95% CI, .88-1.0); and days 5 and 6, 0.96 (95% CI, .90-1.0). Conclusions This is the first study to utilize iterative point-of-care biomarkers to derive dynamic prognostic mortality models. This novel approach demonstrates that utilizing biomarkers drastically improved prognostication up to 6 days into patient care.
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Affiliation(s)
- Courtney J Bearnot
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Eta N Mbong
- International Medical Corps, Goma, Democratic Republic of Congo
| | | | - Razia Laghari
- International Medical Corps, Goma, Democratic Republic of Congo
| | - Kelsey Butler
- Program in Bioinformatics and Integrative Biology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | | | | | - Ian C Michelow
- Division of Infectious Diseases and Immunology, Department of Pediatrics, School of Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Oliver Y Tang
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Adam C Levine
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Andrés Colubri
- Program in Bioinformatics and Integrative Biology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Adam R Aluisio
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Pare BC, Camara AM, Camara A, Kourouma M, Enogo K, Camara MS, Akilimali L, Sani S, de Sainte Fare EB, Lame P, Mouly N, Castro-Rial ML, Sivahera B, Cherif MS, Beavogui AH, Muamba D, Tamba JB, Moumié B, Kojan R, Lang HJ. Ebola outbreak in Guinea, 2021: Clinical care of patients with Ebola virus disease. S Afr J Infect Dis 2023; 38:454. [PMID: 36756241 PMCID: PMC9900378 DOI: 10.4102/sajid.v38i1.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/05/2022] [Indexed: 02/04/2023] Open
Abstract
Background Experience from the Zaire Ebolavirus epidemic in the eastern Democratic Republic of the Congo (2018-2020) demonstrates that early initiation of essential critical care and administration of Zaire Ebolavirus specific monoclonal antibodies may be associated with improved outcomes among patients with Ebola virus disease (EVD). Objectives This series describes 13 EVD patients and 276 patients with suspected EVD treated during a Zaire Ebolavirus outbreak in Guinea in 2021. Method Patients with confirmed or suspected EVD were treated in two Ebola treatment centres (ETC) in the region of N'zérékoré. Data were reviewed from all patients with suspected or confirmed EVD hospitalised in these two ETCs during the outbreak (14 February 2021 - 19 June 2021). Ebola-specific monoclonal antibodies, were available 2 weeks after onset of the outbreak. Results Nine of the 13 EVD patients (age range: 22-70 years) survived. The four EVD patients who died, including one pregnant woman, presented with multi-organ dysfunction and died within 48 h of admission. All eight patients who received Ebola-specific monoclonal antibodies survived. Four of the 13 EVD patients were health workers. Improvement of ETC design facilitated implementation of WHO-recommended 'optimized supportive care for EVD'. In this context, pragmatic clinical training was integrated in routine ETC activities. Initial clinical manifestations of 13 confirmed EVD patients were similar to those of 276 patients with suspected, but subsequently non confirmed EVD. These patients suffered from other acute infections (e.g. malaria in 183 of 276 patients; 66%). Five of the 276 patients with suspected EVD died. One of these five patients had Lassa virus disease and a coronavirus disease 2019 (COVID-19) co-infection. Conclusion Multidisciplinary outbreak response teams can rapidly optimise ETC design. Trained clinical teams can provide WHO-recommended optimised supportive care, including safe administration of Ebola-specific monoclonal antibodies. Pragmatic training in essential critical care can be integrated in routine ETC activities. Contribution This article describes clinical realities associated with implementation of WHO-recommended standards of 'optimized supportive care' and administration of Ebola virus specific treatments. In this context, the importance of essential design principles of ETCs is underlined, which allow continuous visual contact and verbal interaction of health workers and families with their patients. Elements that may contribute to further quality of care improvements for patients with confirmed or suspected EVD are discussed.
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Affiliation(s)
- Boyo C. Pare
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Alseny M. Camara
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Aminata Camara
- Ministry of Health, Agence Nationale de Sécurité Sanitaire, N’zérékoré, Guinea,Ministry of Health, Hôpital Régionale de N’zérékoré, N’zérékoré, Guinea
| | - Moussa Kourouma
- Ministry of Health, Agence Nationale de Sécurité Sanitaire, N’zérékoré, Guinea,Ministry of Health, Hôpital Régionale de N’zérékoré, N’zérékoré, Guinea
| | - Koivogui Enogo
- Ministry of Health, Agence Nationale de Sécurité Sanitaire, N’zérékoré, Guinea
| | | | | | - Sayadi Sani
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | | | - Papys Lame
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Nicolas Mouly
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | | | - Billy Sivahera
- Alliance for International Medical Action (ALIMA), Dakar, Senegal,World Health Organization (WHO), Geneva, Switzerland
| | - Mahamoud S. Cherif
- Centre National de Formation et de Recherche en Santé Rural de Maferinyah, Maferenya, Guinea
| | - Abdoul H. Beavogui
- Centre National de Formation et de Recherche en Santé Rural de Maferinyah, Maferenya, Guinea
| | - Dally Muamba
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Joachim B. Tamba
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Barry Moumié
- Ministry of Health, Agence Nationale de Sécurité Sanitaire, N’zérékoré, Guinea
| | - Richard Kojan
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Hans-Joerg Lang
- Alliance for International Medical Action (ALIMA), Dakar, Senegal,Witten/Herdecke- University, Global Child Health, Witten, Germany
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Lang HJ, Fontana L, Lado M, Kojan R. Triage of patients with Ebola virus disease. THE LANCET. INFECTIOUS DISEASES 2023; 23:10-12. [PMID: 36370718 DOI: 10.1016/s1473-3099(22)00721-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Hans-Joerg Lang
- Alliance for International Medical Action (ALIMA), Paris 75011, France; Alliance for International Medical Action (ALIMA), Dakar, Senegal; Global Child Health, Witten/Herdecke University, Witten, Germany.
| | - Luca Fontana
- Biomedical Department, University of Edinburgh, Edinburgh, UK
| | - Marta Lado
- Partners in Health, Freetown, Sierra Leone
| | - Richard Kojan
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
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