1
|
van Kesteren J, van Duinen AJ, Marah F, van Delft D, Spector AL, Cassidy LD, Groen RS, Jabbi SMBB, Bah S, Medo JA, Kamanda-Bongay A, van Leerdam D, Westendorp J, Mathéron HM, Mönnink GLE, Vas Nunes J, Lindenbergh KC, Hoel SK, Løvdal SM, Østensen MN, Solberg H, Boateng D, Klipstein-Grobusch K, van Herwaarden D, Martens JPJ, Bonjer HJ, Sankoh O, Grobusch MP, Bolkan HA. PREvalence Study on Surgical COnditions (PRESSCO) 2020: A Population-Based Cross-Sectional Countrywide Survey on Surgical Conditions in Post-Ebola Outbreak Sierra Leone. World J Surg 2022; 46:2585-2594. [PMID: 36068404 PMCID: PMC9529684 DOI: 10.1007/s00268-022-06695-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/27/2022]
Abstract
Background Understanding the burden of diseases requiring surgical care at national levels is essential to advance universal health coverage. The PREvalence Study on Surgical COnditions (PRESSCO) 2020 is a cross-sectional household survey to estimate the prevalence of physical conditions needing surgical consultation, to investigate healthcare-seeking behavior, and to assess changes from before the West African Ebola epidemic. Methods This study (ISRCTN: 12353489) was built upon the Surgeons Overseas Surgical Needs Assessment (SOSAS) tool, including expansions. Seventy-five enumeration areas from 9671 nationwide clusters were sampled proportional to population size. In each cluster, 25 households were randomly assigned and visited. Need for surgical consultations was based on verbal responses and physical examination of selected household members. Results A total of 3,618 individuals from 1,854 households were surveyed. Compared to 2012, the prevalence of individuals reporting one or more relevant physical conditions was reduced from 25 to 6.2% (95% CI 5.4–7.0%) of the population. One-in-five conditions rendered respondents unemployed, disabled, or stigmatized. Adult males were predominantly prone to untreated surgical conditions (9.7 vs. 5.9% women; p < 0.001). Financial constraints were the predominant reason for not seeking care. Among those seeking professional health care, 86.7% underwent surgery. Conclusion PRESSCO 2020 is the first surgical needs household survey which compares against earlier study data. Despite the 2013–2016 Ebola outbreak, which profoundly disrupted the national healthcare system, a substantial reduction in reported surgical conditions was observed. Compared to one-time measurements, repeated household surveys yield finer granular data on the characteristics and situations of populations in need of surgical treatment. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06695-7.
Collapse
Affiliation(s)
- Jurre van Kesteren
- Amsterdam UMC Location Vrije Universiteit, Department of Surgery, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Global Surgery Amsterdam, Amsterdam, The Netherlands.
| | - Alex J van Duinen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
| | - Foday Marah
- CapaCare, Trondheim, Norway
- Masanga Hospital, Tonkolili District, Masanga, Sierra Leone
| | - Diede van Delft
- CapaCare, Trondheim, Norway
- Masanga Hospital, Tonkolili District, Masanga, Sierra Leone
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
| | - Antoinette L Spector
- Institute for Health & Equity and Epidemiology Division, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Laura D Cassidy
- Institute for Health & Equity and Epidemiology Division, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Reinou S Groen
- Johns Hopkins School of Medicine, Baltimore, USA
- SOS - Surgeons OverSeas, New York, NY, USA
| | | | - Silleh Bah
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
| | - James A Medo
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
| | | | - Daniel van Leerdam
- CapaCare, Trondheim, Norway
- KIT, Royal Tropical Institute, Amsterdam, The Netherlands
| | - Josien Westendorp
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- CapaCare, Trondheim, Norway
| | - Hanna M Mathéron
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Giulia L E Mönnink
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Jonathan Vas Nunes
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
| | - Karel C Lindenbergh
- Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sara K Hoel
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sofie M Løvdal
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Mia N Østensen
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Helene Solberg
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Daniel Boateng
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | - H Jaap Bonjer
- Amsterdam UMC Location Vrije Universiteit, Department of Surgery, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Osman Sankoh
- Statistics Sierra Leone, Tower Hill, Freetown, Sierra Leone
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Health, University of Heidelberg Medical School, Heidelberg, Germany
| | - Martin P Grobusch
- Masanga Medical Research Unit, Tonkolili District, Masanga, Sierra Leone
- Amsterdam UMC location University of Amsterdam, AMC, Centre of Tropical Medicine and Travel Medicine, Amsterdam, The Netherlands
- Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany
- Centre de Recherches Médicales en Lambaréné (CERMEL), Lambaréné, Gabon
- Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Håkon A Bolkan
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Surgery, St. Olavs Hospital HF, Trondheim University Hospital, Trondheim, Norway
- CapaCare, Trondheim, Norway
| |
Collapse
|
2
|
Proos R, Mathéron H, Vas Nunes J, Falama A, Sery Kamal P, Grobusch MP, van den Akker T. Perspectives of health workers on the referral of women with obstetric complications: a qualitative study in rural Sierra Leone. BMJ Open 2020; 10:e041746. [PMID: 33303460 PMCID: PMC7733167 DOI: 10.1136/bmjopen-2020-041746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Sierra Leone has one of the highest maternal mortality ratios in the world. Timely and well-coordinated referrals are necessary to reduce delays in providing adequate care for women with obstetric complications. This study describes factors affecting timely and adequate referral of women with obstetric complications in rural areas of Sierra Leone as viewed by health workers in rural health facilities. DESIGN Qualitative research with semi-structured interviews using open-ended questions. Data were analysed by systematic text condensation. SETTING Interviews were held in nine peripheral health units in rural Sierra Leone. PARTICIPANTS 19 health workers including nurses, midwives and clinical health officers participated in nine interviews. RESULTS From the interviews, four major themes describing possible factors of delay in referral of women in need of emergency obstetric care emerged: (1) communication between healthcare workers; (2) underlying influences on decision-making; (3) women's compliance to referral and (4) logistic constraints.Several factors in rural Sierra Leone are perceived to complicate timely and adequate referral of women in need of emergency obstetric care. Notable among these factors are fear among women for being referred and fear among healthcare workers for having maternal deaths or severe obstetric complications occurring at their own facilities. Furthermore, decision-making of healthcare workers whether to refer a woman or not is negatively influenced by a hierarchical culture with high power distance between healthcare workers. CONCLUSION Factors identified that complicate timely and adequate referral of women in need of emergency obstetric care must be considered in efforts to reduce maternal mortality. Possible interventions that may reduce delay in referral include increased communication by mobile phones between health workers for advice and feedback regarding referrals, involvement of influential stakeholders to increase women's compliance to referral, and consistent use of standardised management protocols.
Collapse
Affiliation(s)
- Ryan Proos
- Masanga Medical Research Unit, Masanga, Sierra Leone
- Obstetrics and Gynaecology Department, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Abdul Falama
- Tonkolili District Health Management Team, Magburaka, Sierra Leone
| | | | - Martin Peter Grobusch
- Masanga Medical Research Unit, Masanga, Sierra Leone
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Thomas van den Akker
- Obstetrics and Gynaecology Department, Leiden University Medical Center, Leiden, The Netherlands
- Athena Institute, VU Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Dubbink JH, Branco TM, Kamara KB, Bangura JS, Wehrens E, Falama AM, Goorhuis A, Jørgensen PB, Sevalie SS, Hanscheid T, Grobusch MP. COVID-19 treatment in sub-Saharan Africa: If the best is not available, the available becomes the best. Travel Med Infect Dis 2020; 37:101878. [PMID: 32927051 PMCID: PMC7485546 DOI: 10.1016/j.tmaid.2020.101878] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Jan H Dubbink
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands
| | - Tiago Martins Branco
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Kelfala Bb Kamara
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - James S Bangura
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Erik Wehrens
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands; Capacare, Trondheim, Norway, and Freetown, Sierra Leone
| | - Abdul M Falama
- District Health Medical Team, District Medical Office, Magburaka, Tonkolili District, Sierra Leone
| | - Abraham Goorhuis
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands
| | - Peter B Jørgensen
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Stephen S Sevalie
- Joint Medical Unit, 34 Military Hospital, Republic of Sierra Leone Armed Forces, Free Town, Sierra Leone; National COVID-19 Emergency Response Team, National Emergency Operations Centre, Free Town, Sierra Leone
| | | | - Martin Peter Grobusch
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands.
| |
Collapse
|
4
|
Caleo G, Theocharaki F, Lokuge K, Weiss HA, Inamdar L, Grandesso F, Danis K, Pedalino B, Kobinger G, Sprecher A, Greig J, Di Tanna GL. Clinical and epidemiological performance of WHO Ebola case definitions: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2020; 20:1324-1338. [PMID: 32593318 PMCID: PMC9355392 DOI: 10.1016/s1473-3099(20)30193-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/07/2020] [Accepted: 03/06/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Ebola virus disease case definition is a crucial surveillance tool to detect suspected cases for referral and as a screening tool for clinicians to support admission and laboratory testing decisions at Ebola health facilities. We aimed to assess the performance of the WHO Ebola virus disease case definitions and other screening scores. METHODS In this systematic review and meta-analysis, we searched PubMed, Scopus, Embase, and Web of Science for studies published in English between June 13, 1978, and Jan 14, 2020. We included studies that estimated the sensitivity and specificity of WHO Ebola virus disease case definitions, clinical and epidemiological characteristics (symptoms at admission and contact history), and predictive risk scores against the reference standard (laboratory-confirmed Ebola virus disease). Summary estimates of sensitivity and specificity were calculated using bivariate and hierarchical summary receiver operating characteristic (when four or more studies provided data) or random-effects meta-analysis (fewer than four studies provided data). FINDINGS We identified 2493 publications, of which 14 studies from four countries (Sierra Leone, Guinea, Liberia, and Angola) were included in the analysis. 12 021 people with suspected disease were included, of whom 4874 were confirmed as positive for Ebola virus infection. Six studies explored the performance of WHO case definitions in non-paediatric populations, and in all of these studies, suspected and probable cases were combined and could not be disaggregated for analysis. The pooled sensitivity of the WHO Ebola virus disease case definitions from these studies was 81·5% (95% CI 74·1-87·2) and pooled specificity was 35·7% (28·5-43·6). History of contact or epidemiological link was a key predictor for the WHO case definitions (seven studies) and for risk scores (six studies). The most sensitive symptom was intense fatigue (79·0% [95% CI 74·4-83·0]), assessed in seven studies, and the least sensitive symptom was pain behind the eyes (1·0% [0·0-7·0]), assessed in three studies. The performance of fever as a symptom varied depending on the cutoff used to define fever. INTERPRETATION WHO Ebola virus disease case definitions perform suboptimally to identify cases at both community level and during triage at Ebola health facilities. Inclusion of intense fatigue as a key symptom and contact history could improve the performance of case definitions, but implementation of these changes will require effective collaboration with, and trust of, affected communities. FUNDING Médecins sans Frontières.
Collapse
Affiliation(s)
- Grazia Caleo
- Manson Unit, Médecins sans Frontières, London, UK; MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Foivi Theocharaki
- Centre for Longitudinal Studies, University College London, London, UK
| | - Kamalini Lokuge
- Manson Unit, Médecins sans Frontières, London, UK; National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | - Biagio Pedalino
- TEPHINET, Task Force for Global Health, Decatur, GA, USA; Istituto Superiore Di Sanita, Rome, Italy
| | - Gary Kobinger
- Département de Microbiologie-Infectiologie et d'Immunologie, Université Laval, Quebec City, QC, Canada
| | | | - Jane Greig
- Manson Unit, Médecins sans Frontières, London, UK
| | - Gian Luca Di Tanna
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
5
|
Wehrens E, Bangura JS, Falama AM, Kamara KBB, Dubbink JH, Bolkan HA, Grobusch MP. Primum non nocere: Potential indirect adverse effects of COVID-19 containment strategies in the African region. Travel Med Infect Dis 2020; 35:101727. [PMID: 32360422 PMCID: PMC7189182 DOI: 10.1016/j.tmaid.2020.101727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Erik Wehrens
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Capacare, Trondheim, Norway, and Freetown, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands
| | - James S Bangura
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Abdul M Falama
- District Medical Office, Masanga, Tonkolili District, Sierra Leone
| | - Kelfala B B Kamara
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Capacare, Trondheim, Norway, and Freetown, Sierra Leone
| | - Jan H Dubbink
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Capacare, Trondheim, Norway, and Freetown, Sierra Leone
| | - Håkon A Bolkan
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Capacare, Trondheim, Norway, and Freetown, Sierra Leone
| | - Martin P Grobusch
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, the Netherlands.
| |
Collapse
|
6
|
Jacob ST, Crozier I, Fischer WA, Hewlett A, Kraft CS, Vega MADL, Soka MJ, Wahl V, Griffiths A, Bollinger L, Kuhn JH. Ebola virus disease. Nat Rev Dis Primers 2020; 6:13. [PMID: 32080199 PMCID: PMC7223853 DOI: 10.1038/s41572-020-0147-3] [Citation(s) in RCA: 296] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 12/16/2022]
Abstract
Ebola virus disease (EVD) is a severe and frequently lethal disease caused by Ebola virus (EBOV). EVD outbreaks typically start from a single case of probable zoonotic transmission, followed by human-to-human transmission via direct contact or contact with infected bodily fluids or contaminated fomites. EVD has a high case-fatality rate; it is characterized by fever, gastrointestinal signs and multiple organ dysfunction syndrome. Diagnosis requires a combination of case definition and laboratory tests, typically real-time reverse transcription PCR to detect viral RNA or rapid diagnostic tests based on immunoassays to detect EBOV antigens. Recent advances in medical countermeasure research resulted in the recent approval of an EBOV-targeted vaccine by European and US regulatory agencies. The results of a randomized clinical trial of investigational therapeutics for EVD demonstrated survival benefits from two monoclonal antibody products targeting the EBOV membrane glycoprotein. New observations emerging from the unprecedented 2013-2016 Western African EVD outbreak (the largest in history) and the ongoing EVD outbreak in the Democratic Republic of the Congo have substantially improved the understanding of EVD and viral persistence in survivors of EVD, resulting in new strategies toward prevention of infection and optimization of clinical management, acute illness outcomes and attendance to the clinical care needs of patients.
Collapse
Affiliation(s)
- Shevin T Jacob
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Global Health Security Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Ian Crozier
- Integrated Research Facility at Fort Detrick, Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research supported by the National Cancer Institute, Frederick, MD, USA
| | - William A Fischer
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Chapel Hill, NC, USA
| | - Angela Hewlett
- Nebraska Biocontainment Unit, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Colleen S Kraft
- Microbiology Section, Emory Medical Laboratory, Emory University School of Medicine, Atlanta, GA, USA
| | - Marc-Antoine de La Vega
- Department of Microbiology, Immunology & Infectious Diseases, Université Laval, Quebec City, QC, Canada
| | - Moses J Soka
- Partnership for Ebola Virus Disease Research in Liberia, Monrovia Medical Units ELWA-2 Hospital, Monrovia, Liberia
| | - Victoria Wahl
- National Biodefense Analysis and Countermeasures Center, Fort Detrick, Frederick, MD, USA
| | - Anthony Griffiths
- Department of Microbiology and National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA, USA
| | - Laura Bollinger
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA.
| |
Collapse
|