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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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Oguzie JU, Petros BA, Oluniyi PE, Mehta SB, Eromon PE, Nair P, Adewale-Fasoro O, Ifoga PD, Odia I, Pastusiak A, Gbemisola OS, Aiyepada JO, Uyigue EA, Edamhande AP, Blessing O, Airende M, Tomkins-Tinch C, Qu J, Stenson L, Schaffner SF, Oyejide N, Ajayi NA, Ojide K, Ogah O, Abejegah C, Adedosu N, Ayodeji O, Liasu AA, Okogbenin S, Okokhere PO, Park DJ, Folarin OA, Komolafe I, Ihekweazu C, Frost SDW, Jackson EK, Siddle KJ, Sabeti PC, Happi CT. Metagenomic surveillance uncovers diverse and novel viral taxa in febrile patients from Nigeria. Nat Commun 2023; 14:4693. [PMID: 37542071 PMCID: PMC10403498 DOI: 10.1038/s41467-023-40247-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/10/2023] [Indexed: 08/06/2023] Open
Abstract
Effective infectious disease surveillance in high-risk regions is critical for clinical care and pandemic preemption; however, few clinical diagnostics are available for the wide range of potential human pathogens. Here, we conduct unbiased metagenomic sequencing of 593 samples from febrile Nigerian patients collected in three settings: i) population-level surveillance of individuals presenting with symptoms consistent with Lassa Fever (LF); ii) real-time investigations of outbreaks with suspected infectious etiologies; and iii) undiagnosed clinically challenging cases. We identify 13 distinct viruses, including the second and third documented cases of human blood-associated dicistrovirus, and a highly divergent, unclassified dicistrovirus that we name human blood-associated dicistrovirus 2. We show that pegivirus C is a common co-infection in individuals with LF and is associated with lower Lassa viral loads and favorable outcomes. We help uncover the causes of three outbreaks as yellow fever virus, monkeypox virus, and a noninfectious cause, the latter ultimately determined to be pesticide poisoning. We demonstrate that a local, Nigerian-driven metagenomics response to complex public health scenarios generates accurate, real-time differential diagnoses, yielding insights that inform policy.
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Affiliation(s)
- Judith U Oguzie
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | - Brittany A Petros
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Harvard-MIT Program in Health Sciences and Technology, Cambridge, MA, 02139, USA
- Harvard/MIT MD-PhD Program, Boston, MA, 02115, USA
- Systems, Synthetic, and Quantitative Biology PhD Program, Department of Systems Biology, Harvard Medical School, Boston, MA, 02115, USA
| | - Paul E Oluniyi
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Samar B Mehta
- Department of Medicine, University of Maryland Medical Center, Baltimore, MA, USA
| | - Philomena E Eromon
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | - Parvathy Nair
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Opeoluwa Adewale-Fasoro
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | - Peace Damilola Ifoga
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | - Ikponmwosa Odia
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | | | - Otitoola Shobi Gbemisola
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | | | | | | | - Osiemi Blessing
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Michael Airende
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Christopher Tomkins-Tinch
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA
| | - James Qu
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Liam Stenson
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | | | - Nicholas Oyejide
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | - Nnenna A Ajayi
- Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Kingsley Ojide
- Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Onwe Ogah
- Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | | | | | | | | | | | | | - Daniel J Park
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Onikepe A Folarin
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | - Isaac Komolafe
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria
| | | | - Simon D W Frost
- Microsoft Premonition, Redmond, WA, USA
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Katherine J Siddle
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Department of Molecular Microbiology and Immunology, Brown University, Providence, RI, USA.
| | - Pardis C Sabeti
- Broad Institute of Harvard and MIT, Cambridge, MA, USA.
- Howard Hughes Medical Institute, Chevy Chase, MD, USA.
- Department of Organismic and Evolutionary Biology, Harvard University, Cambridge, MA, USA.
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
| | - Christian T Happi
- Department of Biological Sciences, Faculty of Natural Sciences, Redeemer's University, Ede, Osun State, Nigeria.
- African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer's University, Ede, Osun State, Nigeria.
- Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
- Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
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Topuz K, Davazdahemami B, Delen D. A Bayesian belief network-based analytics methodology for early-stage risk detection of novel diseases. ANNALS OF OPERATIONS RESEARCH 2023:1-25. [PMID: 37361089 PMCID: PMC10189691 DOI: 10.1007/s10479-023-05377-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/28/2023]
Abstract
During a pandemic, medical specialists have substantial challenges in discovering and validating new disease risk factors and designing effective treatment strategies. Traditionally, this approach entails several clinical studies and trials that might last several years, during which strict preventive measures are enforced to manage the outbreak and limit the death toll. Advanced data analytics technologies, on the other hand, could be utilized to monitor and expedite the procedure. This research integrates evolutionary search algorithms, Bayesian belief networks, and innovative interpretation techniques to provide a comprehensive exploratory-descriptive-explanatory machine learning methodology to assist clinical decision-makers in responding promptly to pandemic scenarios. The proposed approach is illustrated through a case study in which the survival of COVID-19 patients is determined using inpatient and emergency department (ED) encounters from a real-world electronic health record database. Following an exploratory phase in which genetic algorithms are used to identify a set of the most critical chronic risk factors and their validation using descriptive tools based on the concept of Bayesian Belief Nets, the framework develops and trains a probabilistic graphical model to explain and predict patient survival (with an AUC of 0.92). Finally, a publicly available online, probabilistic decision support inference simulator was constructed to facilitate what-if analysis and aid general users and healthcare professionals in interpreting model findings. The results widely corroborate intensive and expensive clinical trial research assessments.
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Affiliation(s)
- Kazim Topuz
- Collins College of Business, School of Finance and Operations Management, The University of Tulsa, Tulsa, USA
| | - Behrooz Davazdahemami
- Department of IT and Supply Chain Management, University of Wisconsin-Whitewater, 809 W. Starin Rd., Hyland Hall 1222, Whitewater, USA
| | - Dursun Delen
- Center for Health Systems Innovation, Spears School of Business, Oklahoma State University, Stillwater, USA
- Faculty of Engineering and Natural Sciences, Istinye University, Istanbul, Turkey
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4
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Dyal J, Kofman A, Kollie JZ, Fankhauser J, Orone R, Soka MJ, Glaybo U, Kiawu A, Freeman E, Giah G, Tony HD, Faikai M, Jawara M, Kamara K, Kamara S, Flowers B, Kromah ML, Desamu-Thorpe R, Graziano J, Brown S, Morales-Betoulle ME, Cannon DL, Su K, Linderman SL, Plucinski M, Rogier E, Bradbury RS, Secor WE, Bowden KE, Phillips C, Carrington MN, Park YH, Martin MP, Aguinaga MDP, Mushi R, Haberling DL, Ervin ED, Klena JD, Massaquoi M, Nyenswah T, Nichol ST, Chiriboga DE, Williams DE, Hinrichs SH, Ahmed R, Vonhm BT, Rollin PE, Purpura LJ, Choi MJ. Risk Factors for Ebola Virus Persistence in Semen of Survivors in Liberia. Clin Infect Dis 2023; 76:e849-e856. [PMID: 35639875 PMCID: PMC10169428 DOI: 10.1093/cid/ciac424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/08/2022] [Accepted: 05/24/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Long-term persistence of Ebola virus (EBOV) in immunologically privileged sites has been implicated in recent outbreaks of Ebola virus disease (EVD) in Guinea and the Democratic Republic of Congo. This study was designed to understand how the acute course of EVD, convalescence, and host immune and genetic factors may play a role in prolonged viral persistence in semen. METHODS A cohort of 131 male EVD survivors in Liberia were enrolled in a case-case study. "Early clearers" were defined as those with 2 consecutive negative EBOV semen test results by real-time reverse-transcription polymerase chain reaction (rRT-PCR) ≥2 weeks apart within 1 year after discharge from the Ebola treatment unit or acute EVD. "Late clearers" had detectable EBOV RNA by rRT-PCR >1 year after discharge from the Ebola treatment unit or acute EVD. Retrospective histories of their EVD clinical course were collected by questionnaire, followed by complete physical examinations and blood work. RESULTS Compared with early clearers, late clearers were older (median, 42.5 years; P < .001) and experienced fewer severe clinical symptoms (median 2, P = .006). Late clearers had more lens opacifications (odds ratio, 3.9 [95% confidence interval, 1.1-13.3]; P = .03), after accounting for age, higher total serum immunoglobulin G3 (IgG3) titers (P = .005), and increased expression of the HLA-C*03:04 allele (0.14 [.02-.70]; P = .007). CONCLUSIONS Older age, decreased illness severity, elevated total serum IgG3 and HLA-C*03:04 allele expression may be risk factors for the persistence of EBOV in the semen of EVD survivors. EBOV persistence in semen may also be associated with its persistence in other immunologically protected sites, such as the eye.
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Affiliation(s)
- Jonathan Dyal
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron Kofman
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Romeo Orone
- ELWA Hospital, Samaritan’s Purse, Monrovia, Liberia
| | - Moses J Soka
- ELWA Hospital, Samaritan’s Purse, Monrovia, Liberia
| | - Uriah Glaybo
- Men’s Health Screening Program, Monrovia, Liberia
| | - Armah Kiawu
- Men’s Health Screening Program, Monrovia, Liberia
| | - Edna Freeman
- Men’s Health Screening Program, Monrovia, Liberia
| | | | - Henry D Tony
- Men’s Health Screening Program, Monrovia, Liberia
| | | | - Mary Jawara
- Men’s Health Screening Program, Monrovia, Liberia
| | - Kuku Kamara
- Men’s Health Screening Program, Monrovia, Liberia
| | | | | | | | - Rodel Desamu-Thorpe
- Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Graziano
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shelley Brown
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maria E Morales-Betoulle
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deborah L Cannon
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kaihong Su
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Mateusz Plucinski
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric Rogier
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard S Bradbury
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - W Evan Secor
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katherine E Bowden
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Christi Phillips
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary N Carrington
- Basic Science Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
- Laboratory of Integrative Cancer Immunology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
- Ragon Institute of MGH, Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts, USA
| | - Yeon-Hwa Park
- Basic Science Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
| | - Maureen P Martin
- Basic Science Program, Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, Maryland, USA
| | - Maria del Pilar Aguinaga
- Department of Internal Medicine, Meharry Sickle Cell Center, Meharry Medical College, Nashville, Tennessee, USA
- Department of Obstetrics and Gynecology, Meharry Sickle Cell Center, Nashville, Tennessee, USA
| | - Robert Mushi
- Department of Internal Medicine, Meharry Sickle Cell Center, Meharry Medical College, Nashville, Tennessee, USA
| | - Dana L Haberling
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth D Ervin
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John D Klena
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - Stuart T Nichol
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David E Chiriboga
- University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Desmond E Williams
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Steven H Hinrichs
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Rafi Ahmed
- Emory Vaccine Center, Emory University, Atlanta, Georgia, USA
| | | | - Pierre E Rollin
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lawrence J Purpura
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary J Choi
- Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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5
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Jaspard M, Mulangu S, Juchet S, Serra B, Dicko I, Lang HJ, Baka BM, Komanda GM, Katsavara JM, Kabuni P, Mambu FM, Isnard M, Vanhecke C, Letord A, Dieye I, Patterson-Lomba O, Mbaya OT, Isekusu F, Mangala D, Biampata JL, Kitenge R, Kinda M, Anglaret X, Muyembe JJ, Kojan R, Ezzedine K, Malvy D. Development of the PREDS score to predict in-hospital mortality of patients with Ebola virus disease under advanced supportive care: Results from the EVISTA cohort in the Democratic Republic of the Congo. EClinicalMedicine 2022; 54:101699. [PMID: 36263398 PMCID: PMC9574409 DOI: 10.1016/j.eclinm.2022.101699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND As mortality remains high for patients with Ebola virus disease (EVD) despite new treatment options, the ability to level up the provided supportive care and to predict the risk of death is of major importance. This analysis of the EVISTA cohort aims to describe advanced supportive care provided to EVD patients in the Democratic Republic of the Congo (DRC) and to develop a simple risk score for predicting in-hospital death, called PREDS. METHODS In this prospective cohort (NCT04815175), patients were recruited during the 10th EVD outbreak in the DRC across three Ebola Treatment Centers (ETCs). Demographic, clinical, biological, virological and treatment data were collected. We evaluated factors known to affect the risk of in-hospital death and applied univariate and multivariate Cox proportional-hazards analyses to derive the risk score in a training dataset. We validated the score in an internal-validation dataset, applying C-statistics as a measure of discrimination. FINDINGS Between August 1st 2018 and December 31th 2019, 711 patients were enrolled in the study. Regarding supportive care, patients received vasopressive drug (n = 111), blood transfusion (n = 101), oxygen therapy (n = 250) and cardio-pulmonary ultrasound (n = 15). Overall, 323 (45%) patients died before day 28. Six independent prognostic factors were identified (ALT, creatinine, modified NEWS2 score, viral load, age and symptom duration). The final score range from 0 to 13 points, with a good concordance (C = 86.24%) and calibration with the Hosmer-Lemeshow test (p = 0.12). INTERPRETATION The implementation of advanced supportive care is possible for EVD patients in emergency settings. PREDS is a simple, accurate tool that could help in orienting early advanced care for at-risk patients after external validation. FUNDING This study was funded by ALIMA.
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Affiliation(s)
- Marie Jaspard
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
| | - Sabue Mulangu
- National Biomedical Research Institute (INRB), Kinshasa, Democratic Republic of the Congo
| | - Sylvain Juchet
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
| | - Beatrice Serra
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
| | - Ibrahim Dicko
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Hans-Joeg Lang
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | | | | | | | - Patricia Kabuni
- Kinshasa University Hospital, Democratic Republic of the Congo
| | - Fabrice Mbika Mambu
- National Biomedical Research Institute (INRB), Kinshasa, Democratic Republic of the Congo
| | | | | | - Alexia Letord
- Surgical Intensive Care Unit, Henri Mondor University Hospital, Créteil, France
| | | | | | - Olivier Tshiani Mbaya
- National Biomedical Research Institute (INRB), Kinshasa, Democratic Republic of the Congo
| | - Fiston Isekusu
- Kinshasa University Hospital, Democratic Republic of the Congo
| | | | - Jean Luc Biampata
- National Biomedical Research Institute (INRB), Kinshasa, Democratic Republic of the Congo
| | - Richard Kitenge
- Ministry of Health, National Emergency and Humanitarian Action Program, Democratic Republic of the Congo
| | - Moumouni Kinda
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Xavier Anglaret
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
| | - Jean Jacques Muyembe
- National Biomedical Research Institute (INRB), Kinshasa, Democratic Republic of the Congo
| | - Richard Kojan
- Alliance for International Medical Action (ALIMA), Dakar, Senegal
| | - Khaled Ezzedine
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, Créteil, France and Université Paris Est (UPEC), EpiDermE research unit, Paris, France
| | - Denis Malvy
- University of Bordeaux, National Institute for Health and Medical Research (Inserm), Research Institute for Sustainable Development (IRD), Bordeaux Population Health Center, UMR 1219, Bordeaux, France
- Department of Infectious Diseases and Tropical Medicine, Tropical Medicine and Clinical International Health Unit, Hôpital Pellegrin Bordeaux University Hospital, Bordeaux, France
- Corresponding author at: Department of Infectious Diseases and Tropical Medicine, Tropical Medicine and Clinical International Health Unit, Hôpital Pellegrin Bordeaux University Hospital, Bordeaux, France.
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6
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Constructing, validating, and updating machine learning models to predict survival in children with Ebola Virus Disease. PLoS Negl Trop Dis 2022; 16:e0010789. [PMID: 36223331 PMCID: PMC9555640 DOI: 10.1371/journal.pntd.0010789] [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: 02/22/2022] [Accepted: 09/05/2022] [Indexed: 11/07/2022] Open
Abstract
Background Ebola Virus Disease (EVD) causes high case fatality rates (CFRs) in young children, yet there are limited data focusing on predicting mortality in pediatric patients. Here we present machine learning-derived prognostic models to predict clinical outcomes in children infected with Ebola virus. Methods Using retrospective data from the Ebola Data Platform, we investigated children with EVD from the West African EVD outbreak in 2014–2016. Elastic net regularization was used to create a prognostic model for EVD mortality. In addition to external validation with data from the 2018–2020 EVD epidemic in the Democratic Republic of the Congo (DRC), we updated the model using selected serum biomarkers. Findings Pediatric EVD mortality was significantly associated with younger age, lower PCR cycle threshold (Ct) values, unexplained bleeding, respiratory distress, bone/muscle pain, anorexia, dysphagia, and diarrhea. These variables were combined to develop the newly described EVD Prognosis in Children (EPiC) predictive model. The area under the receiver operating characteristic curve (AUC) for EPiC was 0.77 (95% CI: 0.74–0.81) in the West Africa derivation dataset and 0.76 (95% CI: 0.64–0.88) in the DRC validation dataset. Updating the model with peak aspartate aminotransferase (AST) or creatinine kinase (CK) measured within the first 48 hours after admission increased the AUC to 0.90 (0.77–1.00) and 0.87 (0.74–1.00), respectively. Conclusion The novel EPiC prognostic model that incorporates clinical information and commonly used biochemical tests, such as AST and CK, can be used to predict mortality in children with EVD. Although case fatality rates remain high, there are limited data on predicting mortality in children with Ebola Virus Disease (EVD). Furthermore, challenges in predicting EVD outcomes using clinical and laboratory data highlight the need for the development and validation of pediatric predictive models. The novel EVD Prognosis in Children (EPiC) model uses clinical and biochemical information, such as AST and CK, to predict mortality in infected children. While few prognostic models or scoring systems have been developed to predict clinical outcomes of EVD, the majority of them were limited in geographical and temporal scope having been derived using data from one location. As such, the EPiC model is the first externally validated model for the prognosis of pediatric EVD using diverse datasets from geographically and temporally separate outbreaks. This model can be easily applied by bedside clinicians to assess pediatric patients at risk for death and help to allocate resources accordingly.
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Hohl HT, Froeschl G, Hoelscher M, Heumann C. Modelling of a triage scoring tool for SARS-COV-2 PCR testing in health-care workers: data from the first German COVID-19 Testing Unit in Munich. BMC Infect Dis 2022; 22:664. [PMID: 35915394 PMCID: PMC9341161 DOI: 10.1186/s12879-022-07627-5] [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: 03/15/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022] Open
Abstract
Background Numerous scoring tools have been developed for assessing the probability of SARS-COV-2 test positivity, though few being suitable or adapted for outpatient triage of health care workers. Methods We retrospectively analysed 3069 patient records of health care workers admitted to the COVID-19 Testing Unit of the Ludwig-Maximilians-Universität of Munich between January 27 and September 30, 2020, for real-time polymerase chain reaction analysis of naso- or oropharyngeal swabs. Variables for a multivariable logistic regression model were collected from self-completed case report forms and selected through stepwise backward selection. Internal validation was conducted by bootstrapping. We then created a weighted point-scoring system from logistic regression coefficients. Results 4076 (97.12%) negative and 121 (2.88%) positive test results were analysed. The majority were young (mean age: 38.0), female (69.8%) and asymptomatic (67.8%). Characteristics that correlated with PCR-positivity included close-contact professions (physicians, nurses, physiotherapists), flu-like symptoms (e.g., fever, rhinorrhoea, headache), abdominal symptoms (nausea/emesis, abdominal pain, diarrhoea), less days since symptom onset, and contact to a SARS-COV-2 positive index-case. Variables selected for the final model included symptoms (fever, cough, abdominal pain, anosmia/ageusia) and exposures (to SARS-COV-positive individuals and, specifically, to positive patients). Internal validation by bootstrapping yielded a corrected Area Under the Receiver Operating Characteristics Curve of 76.43%. We present sensitivity and specificity at different prediction cut-off points. In a subgroup with further workup, asthma seems to have a protective effect with regard to testing result positivity and measured temperature was found to be less predictive than anamnestic fever. Conclusions We consider low threshold testing for health care workers a valuable strategy for infection control and are able to provide an easily applicable triage score for the assessment of the probability of infection in health care workers in case of resource scarcity. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07627-5.
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Affiliation(s)
- Hannah Tuulikki Hohl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802, Munich, Germany.
| | - Guenter Froeschl
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, 80802, Munich, Germany
| | - Michael Hoelscher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstr. 5, 80802, Munich, Germany.,German Center for Infection Research (DZIF), Partner Site Munich, 80802, Munich, Germany
| | - Christian Heumann
- Department of Statistics, University of Munich (LMU), Ludwigstr. 33, 80539, Munich, Germany
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Melnik LI, Garry RF. Enterotoxigenic Escherichia coli Heat-Stable Toxin and Ebola Virus Delta Peptide: Similarities and Differences. Pathogens 2022; 11:pathogens11020170. [PMID: 35215114 PMCID: PMC8878840 DOI: 10.3390/pathogens11020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 01/27/2023] Open
Abstract
Enterotoxigenic Escherichia coli (ETEC) STb toxin exhibits striking structural similarity to Ebola virus (EBOV) delta peptide. Both ETEC and EBOV delta peptide are enterotoxins. Comparison of the structural and functional similarities and differences of these two toxins illuminates features that are important in induction of pathogenesis by a bacterial and viral pathogen.
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Affiliation(s)
- Lilia I. Melnik
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA 70112, USA;
- Viral Hemorrhagic Fever Consortium, New Orleans, LA 70112, USA
- Correspondence: ; Tel.: +1-(504)988-3818
| | - Robert F. Garry
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA 70112, USA;
- Viral Hemorrhagic Fever Consortium, New Orleans, LA 70112, USA
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9
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The impact of malaria coinfection on Ebola virus disease outcomes: A systematic review and meta-analysis. PLoS One 2021; 16:e0251101. [PMID: 34029352 PMCID: PMC8143409 DOI: 10.1371/journal.pone.0251101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/13/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction Viral outbreaks present a particular challenge in countries in Africa where there is already a high incidence of other infectious diseases, including malaria which can alter immune responses to secondary infection. Ebola virus disease (EVD) is one such problem; understanding how Plasmodium spp. and Ebolavirus (EBOV) interact is important for future outbreaks. Methods We conducted a systematic review in PubMed and Web of Science to find peer-reviewed papers with primary data literature to determine 1) prevalence of EBOV/Plasmodium spp. coinfection, 2) effect of EBOV/Plasmodium spp. coinfection on EVD pathology and the immune response, 3) impact of EBOV/Plasmodium spp. coinfection on the outcome of EVD-related mortality. Random effects meta-analyses were conducted with the R package meta to produce overall proportion and effect estimates as well as measure between-study heterogeneity. Results From 322 peer-reviewed papers, 17 were included in the qualitative review and nine were included in a meta-analysis. Prevalence of coinfection was between 19% and 72%. One study reported significantly lower coagulatory response biomarkers in coinfected cases but no difference in inflammatory markers. Case fatality rates were similar between EBOV(+)/Pl(+) and EBOV(+)/Pl(-) cases (62.8%, 95% CI 49.3–74.6 and 56.7%, 95% CI 53.2–60.1, respectively), and there was no significant difference in risk of mortality (RR 1.09, 95% CI 0.90–1.31) although heterogeneity between studies was high. One in vivo mouse model laboratory study found no difference in mortality by infection status, but another found prior acute Plasmodium yoeli infection was protective against morbidity and mortality via the IFN-γ signalling pathway. Conclusion The literature was inconclusive; studies varied widely and there was little attempt to adjust for confounding variables. Laboratory studies may present the best option to answer how pathogens interact within the body but improvement in data collection and analysis and in diagnostic methods would aid patient studies in the future.
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Yitao Z, Mu C, Ling Z, Shiyao C, Jiaojie X, Zhichong C, Huajing P, Maode O, Kanglin C, Mao OY, Xiaoneng M, Weijie Z. Predictors of clinical deterioration in non-severe patients with COVID-19: a retrospective cohort study. Curr Med Res Opin 2021; 37:385-391. [PMID: 33459077 PMCID: PMC7876670 DOI: 10.1080/03007995.2021.1876005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains pandemic with considerable morbidity and mortality around the world. The aim of this study was to identify the predictors for clinical deterioration in patients with COVID-19 who did not show clinical deterioration upon hospital admission. METHODS Two hundred fifty-seven patients with confirmed COVID-19 pneumonia admitted to Guangzhou Eighth People's Hospital between 23 January and 21 March 2020 were retrospectively enrolled. Demographic data, symptoms, laboratory values, comorbidities and treatments were all collected. The study endpoint was clinical deterioration within 20 days from hospital admission. Univariate and multivariable logistic regression methods were used to explore the risk factors associated with clinical deterioration. RESULTS A total of 49 (19%) patients showed clinical deterioration after admission. Compared with patients that did not experience clinical deterioration, clinically deteriorated patients had more dyspnea, cough and myalgia (65.3% versus 29.3%) symptoms and more had comorbidities (89.8% versus 36.1%). Clinical and laboratory characteristics at admission that were associated with clinical deterioration included senior age, diabetes, hypertension, myalgia, higher temperature, systolic blood pressure, C-reactive protein (CRP), procalcitonin, activated partial thromboplastin time, aspartate aminotransferase, alanine transaminase, direct bilirubin, plasma creatinine, lymphocytopenia, thrombocytopenia, decreased albumin and bicarbonate concentration. Medical history of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, calcium channel blockers and metformin were also risk factors. CONCLUSION The four best predictors for clinical deterioration were CRP, procalcitonin, age and albumin. A "best" multivariable prediction model, resulting from using a variable selection procedure, included senior age, presentation with myalgia, and higher level of CRP and serum creatinine (bias-corrected c-statistic = 0.909). Sensitivity and specificity corresponding to a cut point of CRP ≥18.45 mg/L for predicting clinical deterioration were 85% and 74%, respectively.
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Affiliation(s)
- Zhang Yitao
- The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chen Mu
- Department of Pulmonology, Guangzhou Eighth People’s Hospital, Guangzhou, China
| | - Zhou Ling
- The First Clinical Medical College, Jinan University, Guangzhou, China
- Ultrasonic Department, Hospital of South China University of Technology, Guangzhou, China
| | - Cheng Shiyao
- The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xue Jiaojie
- The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chen Zhichong
- The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Peng Huajing
- The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ou Maode
- The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Cheng Kanglin
- The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ou Yang Mao
- The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- CONTACT Zeng Weijie ; Ou Yang Mao The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, No.26, Erheng Road, Yuan Village, Tianhe District, Guangzhou510655, China
| | - Mo Xiaoneng
- Department of Pulmonology, Guangzhou Eighth People’s Hospital, Guangzhou, China
- Mo Xiaoneng Department of Pulmonology, Guangzhou Eighth People’s Hospital, 13, Guangyuan Xi Road, Baiyun District, Guangzhou510060, China
| | - Zeng Weijie
- The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- CONTACT Zeng Weijie ; Ou Yang Mao The Cardiovascular Department, the Sixth Affiliated Hospital of Sun Yat-sen University, No.26, Erheng Road, Yuan Village, Tianhe District, Guangzhou510655, China
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Characterization of Ebola Virus Risk to Bedside Providers in an Intensive Care Environment. Microorganisms 2021; 9:microorganisms9030498. [PMID: 33652895 PMCID: PMC7996731 DOI: 10.3390/microorganisms9030498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/20/2021] [Accepted: 02/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The 2014–2016 Ebola outbreak in West Africa recapitulated that nosocomial spread of Ebola virus could occur and that health care workers were at particular risk including notable cases in Europe and North America. These instances highlighted the need for centers to better prepare for potential Ebola virus cases; including understanding how the virus spreads and which interventions pose the greatest risk. Methods: We created a fully equipped intensive care unit (ICU), within a Biosafety Level 4 (BSL4) laboratory, and infected multiple sedated non-human primates (NHPs) with Ebola virus. While providing bedside care, we sampled blood, urine, and gastric residuals; as well as buccal, ocular, nasal, rectal, and skin swabs, to assess the risks associated with routine care. We also assessed the physical environment at end-point. Results: Although viral RNA was detectable in blood as early as three days post-infection, it was not detectable in the urine, gastric fluid, or swabs until late-stage disease. While droplet spread and fomite contamination were present on a few of the surfaces that were routinely touched while providing care in the ICU for the infected animal, these may have been abrogated through good routine hygiene practices. Conclusions: Overall this study has helped further our understanding of which procedures may pose the highest risk to healthcare providers and provides temporal evidence of this over the clinical course of disease.
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Miller EH, Zucker J, Castor D, Annavajhala MK, Sepulveda JL, Green DA, Whittier S, Scherer M, Medrano N, Sobieszczyk ME, Yin MT, Kuhn L, Uhlemann AC. Pretest Symptom Duration and Cycle Threshold Values for Severe Acute Respiratory Syndrome Coronavirus 2 Reverse-Transcription Polymerase Chain Reaction Predict Coronavirus Disease 2019 Mortality. Open Forum Infect Dis 2021; 8:ofab003. [PMID: 33604401 PMCID: PMC7798567 DOI: 10.1093/ofid/ofab003] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/02/2021] [Indexed: 12/13/2022] Open
Abstract
Background The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and patient symptom duration in both in- and outpatients, and the impact of these factors on patient outcomes, are currently unknown. Understanding these associations is important to clinicians caring for patients with coronavirus disease 2019 (COVID-19). Methods We conducted an observational study between March 10 and May 30, 2020 at a large quaternary academic medical center in New York City. Patient characteristics, laboratory values, and clinical outcomes were abstracted from the electronic medical records. Of all patients tested for SARS-CoV-2 during this time (N = 16 384), there were 5467 patients with positive tests, 4254 of which had available cycle threshold (Ct) values and were included in further analysis. Univariable and multivariable logistic regression models were used to test associations between Ct values, duration of symptoms before testing, patient characteristics, and mortality. The primary outcome is defined as death or discharge to hospice. Results Lower Ct values at diagnosis (ie, higher viral load) were associated with significantly higher mortality among both in- and outpatients. It is interesting to note that patients with a shorter time since the onset of symptoms to testing had a worse prognosis, with those presenting less than 3 days from symptom onset having 2-fold increased odds of death. After adjusting for time since symptom onset and other clinical covariates, Ct values remained a strong predictor of mortality. Conclusions Severe acute respiratory syndrome coronavirus 2 reverse-transcription polymerase chain reaction Ct value and duration of symptoms are strongly associated with mortality. These 2 factors add useful information for clinicians to risk stratify patients presenting with COVID-19.
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Affiliation(s)
- Emily Happy Miller
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Jason Zucker
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Delivette Castor
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Medini K Annavajhala
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Jorge L Sepulveda
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Daniel A Green
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Susan Whittier
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Matthew Scherer
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Nicola Medrano
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Magdalena E Sobieszczyk
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Michael T Yin
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
| | - Louise Kuhn
- Gertrude H. Sergievsky Center, Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Anne-Catrin Uhlemann
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, New York, USA
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Kangbai JB, Heumann C, Hoelscher M, Sahr F, Froeschl G. Severity score for predicting in-facility Ebola treatment outcome. Ann Epidemiol 2020; 49:68-74. [PMID: 32763341 DOI: 10.1016/j.annepidem.2020.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/13/2020] [Accepted: 07/24/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Sierra Leone recorded the highest incidence rate for the 2013-2016 West African Ebola outbreak. In this investigation, we used the medical records of Ebola patients with different sociodemographic and clinical features to determine the factors that are associated with Ebola treatment outcome during the 2013-2016 West African Ebola outbreak in Sierra Leone and constructed a predictive in-facility mortality score. METHODS We used the anonymized medical records of 1077 laboratory-confirmed pediatric and adult patients with EVD who received treatment at the 34 Military Hospital and the Police Training School Ebola Treatment Centers in Sierra Leone between the period of June 2014 and April 2015. We later determined the in-facility case fatality rates for Ebola, the odds of dying during Ebola treatment, and later constructed a predictive in-facility mortality score for these patients based on their clinical and sociodemographic characteristics. RESULTS We constructed a model that partitioned the study population into three mortality risk groups of equal patient numbers, based on risk scoring: low (score ≤ -5), medium (score -4 to 1), and high-risk group (score ≥ 2). The CFR of patients with EVD belonging to the low- (≤-5), medium (-4 to 1), and high- (≥2) risk groups were 0.56%, 9.75%, and 67.41%, respectively. CONCLUSIONS We succeeded in designing an in-facility mortality risk score that reflects EVD clinical severity and can assist in the clinical prioritization of patients with EVD.
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Affiliation(s)
- Jia Bainga Kangbai
- Center for International Health, University of Munich (LMU), Munich, Germany; Department of Environmental Health Sciences, Njala University, Bo, Sierra Leone.
| | - Christian Heumann
- Department of Statistics, University of Munich (LMU), Munich, Germany
| | - Michael Hoelscher
- Center for International Health, University of Munich (LMU), Munich, Germany; Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Foday Sahr
- Department of Microbiology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; The 34 Military Hospital, Wilberforce, Sierra Leone
| | - Guenter Froeschl
- Center for International Health, University of Munich (LMU), Munich, Germany; Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
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Abbate JL, Becquart P, Leroy E, Ezenwa VO, Roche B. Exposure to Ebola Virus and Risk for Infection with Malaria Parasites, Rural Gabon. Emerg Infect Dis 2020; 26:229-237. [PMID: 31829919 PMCID: PMC6986822 DOI: 10.3201/eid2602.181120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
An association between malaria and risk for death among patients with Ebola virus disease has suggested within-host interactions between Plasmodium falciparum parasites and Ebola virus. To determine whether such an interaction might also influence the probability of acquiring either infection, we used a large snapshot surveillance study from rural Gabon to test if past exposure to Ebola virus is associated with current infection with Plasmodium spp. during nonepidemic conditions. We found a strong positive association, on population and individual levels, between seropositivity for antibodies against Ebola virus and the presence of Plasmodium parasites in the blood. According to a multiple regression model accounting for other key variables, antibodies against Ebola virus emerged as the strongest individual-level risk factor for acquiring malaria. Our results suggest that within-host interactions between malaria parasites and Ebola virus may underlie epidemiologic associations.
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Junaid A, Tang H, van Reeuwijk A, Abouleila Y, Wuelfroth P, van Duinen V, Stam W, van Zonneveld AJ, Hankemeier T, Mashaghi A. Ebola Hemorrhagic Shock Syndrome-on-a-Chip. iScience 2019; 23:100765. [PMID: 31887664 PMCID: PMC6941864 DOI: 10.1016/j.isci.2019.100765] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 01/12/2023] Open
Abstract
Ebola virus, for which we lack effective countermeasures, causes hemorrhagic fever in humans, with significant case fatality rates. Lack of experimental human models for Ebola hemorrhagic fever is a major obstacle that hinders the development of treatment strategies. Here, we model the Ebola hemorrhagic syndrome in a microvessel-on-a-chip system and demonstrate its applicability to drug studies. Luminal infusion of Ebola virus-like particles leads to albumin leakage from the engineered vessels. The process is mediated by the Rho/ROCK pathway and is associated with cytoskeleton remodeling. Infusion of Ebola glycoprotein (GP1,2) generates a similar phenotype, indicating the key role of GP1,2 in this process. Finally, we measured the potency of a recently developed experimental drug FX06 and a novel drug candidate, melatonin, in phenotypic rescue. Our study confirms the effects of FX06 and identifies melatonin as an effective, safe, inexpensive therapeutic option that is worth investigating in animal models and human trials.
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Affiliation(s)
- Abidemi Junaid
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden 2333 CC, Netherlands; Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden 2333 ZA, Netherlands; Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden 2333 ZA, Netherlands
| | - Huaqi Tang
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden 2333 CC, Netherlands
| | - Anne van Reeuwijk
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden 2333 CC, Netherlands
| | - Yasmine Abouleila
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden 2333 CC, Netherlands
| | | | - Vincent van Duinen
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden 2333 CC, Netherlands; Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden 2333 ZA, Netherlands; Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden 2333 ZA, Netherlands
| | - Wendy Stam
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden 2333 ZA, Netherlands; Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden 2333 ZA, Netherlands
| | - Anton Jan van Zonneveld
- Department of Internal Medicine (Nephrology), Leiden University Medical Center, Leiden 2333 ZA, Netherlands; Einthoven Laboratory for Vascular and Regenerative Medicine, Leiden University Medical Center, Leiden 2333 ZA, Netherlands
| | - Thomas Hankemeier
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden 2333 CC, Netherlands
| | - Alireza Mashaghi
- Division of Systems Biomedicine and Pharmacology, Leiden Academic Centre for Drug Research, Leiden University, Leiden 2333 CC, Netherlands.
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Rojek AM, Salam A, Ragotte RJ, Liddiard E, Elhussain A, Carlqvist A, Butler M, Kayem N, Castle L, Odondi L', Stepniewska K, Horby PW. A systematic review and meta-analysis of patient data from the West Africa (2013-16) Ebola virus disease epidemic. Clin Microbiol Infect 2019; 25:1307-1314. [PMID: 31284032 PMCID: PMC7116468 DOI: 10.1016/j.cmi.2019.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/25/2019] [Accepted: 06/28/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Over 28 000 individuals were infected with Ebola virus during the West Africa (2013-2016) epidemic, yet there has been criticism of the lack of robust clinical descriptions of Ebola virus disease (EVD) illness from that outbreak. OBJECTIVES To perform a meta-analysis of published data from the epidemic to describe the clinical presentation, evolution of disease, and predictors of mortality in individuals with EVD. To assess the quality and utility of published data for clinical and public health decision-making. DATA SOURCES Primary articles available in PubMed and published between January 2014 and May 2017. ELIGIBILITY Studies that sequentially enrolled individuals hospitalized for EVD and that reported acute clinical outcomes. METHODS We performed meta-analyses using random-effect models and assessed heterogeneity using the I2 method. We assessed data representativeness by comparing meta-analysis estimates with WHO aggregate data. We examined data utility by examining the availability and compatibility of data sets. RESULTS In all, 3653 articles were screened and 34 articles were included, representing 16 independent cohorts of patients (18 overlapping cohorts) and at least 6168 individuals. The pooled estimate for case fatality rate was 51% (95% CI 46%-56%). However, pooling of estimates for clinical presentation, progression, and predictors of mortality in individuals with EVD were hampered by significant heterogeneity, and inadequate data on clinical progression. Our assessment of data quality found that heterogeneity was largely unexplained, and data availability and compatibility were poor. CONCLUSIONS We have quantified a missed opportunity to generate reliable estimates of the clinical manifestations of EVD during the West Africa epidemic. Clinical data standards and data capture platforms are urgently needed.
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Affiliation(s)
- A M Rojek
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK.
| | - A Salam
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK; United Kingdom Public Health Rapid Support Team, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - R J Ragotte
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - E Liddiard
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - A Elhussain
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - A Carlqvist
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - M Butler
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - N Kayem
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - L Castle
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - L 'o Odondi
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
| | - K Stepniewska
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK; WorldWide Antimalarial Resistance Network, Oxford, UK
| | - P W Horby
- Epidemic Diseases Research Group, University of Oxford, Oxford, UK
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17
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Lanini S, Portella G, Vairo F, Di Caro A, Kobinger G, Zumla A, Ippolito G. Reply to Reisler et al. Clin Infect Dis 2019; 66:1480-1481. [PMID: 29272344 DOI: 10.1093/cid/cix1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Simone Lanini
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome
| | | | - Francesco Vairo
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome
| | - Antonino Di Caro
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome
| | - Gary Kobinger
- Research Centre on Infectious Diseases, Faculty of Medicine, Université Laval, Québec, Canada
| | - Alimmudin Zumla
- Division of Infection and Immunity, University College London (UCL), United Kingdom
- National Institute for Health Research Biomedical Research Centre at UCL Hospitals NHS Foundation Trust, United Kingdom
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome
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18
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Affiliation(s)
- Patricia C Henwood
- From the Division of Emergency Ultrasound, Department of Emergency Medicine, Brigham and Women's Hospital, and Harvard Medical School - both in Boston
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19
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Colubri A, Hartley MA, Siakor M, Wolfman V, Felix A, Sesay T, Shaffer JG, Garry RF, Grant DS, Levine AC, Sabeti PC. Machine-learning Prognostic Models from the 2014-16 Ebola Outbreak: Data-harmonization Challenges, Validation Strategies, and mHealth Applications. EClinicalMedicine 2019; 11:54-64. [PMID: 31312805 PMCID: PMC6610774 DOI: 10.1016/j.eclinm.2019.06.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 05/02/2019] [Accepted: 06/07/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Ebola virus disease (EVD) plagues low-resource and difficult-to-access settings. Machine learning prognostic models and mHealth tools could improve the understanding and use of evidence-based care guidelines in such settings. However, data incompleteness and lack of interoperability limit model generalizability. This study harmonizes diverse datasets from the 2014-16 EVD epidemic and generates several prognostic models incorporated into the novel Ebola Care Guidelines app that provides informed access to recommended evidence-based guidelines. METHODS Multivariate logistic regression was applied to investigate survival outcomes in 470 patients admitted to five Ebola treatment units in Liberia and Sierra Leone at various timepoints during 2014-16. We generated a parsimonious model (viral load, age, temperature, bleeding, jaundice, dyspnea, dysphagia, and time-to-presentation) and several fallback models for when these variables are unavailable. All were externally validated against two independent datasets and compared to further models including expert observational wellness assessments. Models were incorporated into an app highlighting the signs/symptoms with the largest contribution to prognosis. FINDINGS The parsimonious model approached the predictive power of observational assessments by experienced clinicians (Area-Under-the-Curve, AUC = 0.70-0.79, accuracy = 0.64-0.74) and maintained its performance across subcohorts with different healthcare seeking behaviors. Age and viral load contributed > 5-fold the weighting of other features and including them in a minimal model had a similar AUC, albeit at the cost of specificity. INTERPRETATION Clinically guided prognostic models can recapitulate clinical expertise and be useful when such expertise is unavailable. Incorporating these models into mHealth tools may facilitate their interpretation and provide informed access to comprehensive clinical guidelines. FUNDING Howard Hughes Medical Institute, US National Institutes of Health, Bill & Melinda Gates Foundation, International Medical Corps, UK Department for International Development, and GOAL Global.
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Affiliation(s)
- Andres Colubri
- Harvard University, Department of Organismic and Evolutionary Biology, Cambridge, USA
- Broad Institute of MIT and Harvard, Cambridge, USA
- Howard Hughes Medical Institute, Chevy Chase, USA
- Correspondence to: A. Colubri, Harvard University, Department of Organismic and Evolutionary Biology, Cambridge, USA.
| | - Mary-Anne Hartley
- University of Lausanne, Faculty of Biology and Medicine, Lausanne, Switzerland
- GOAL Global, Dublin, Ireland
| | | | | | - August Felix
- Broad Institute of MIT and Harvard, Cambridge, USA
| | - Tom Sesay
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Jeffrey G. Shaffer
- Tulane University, School of Public Health and Tropical Medicine, New Orleans, USA
| | - Robert F. Garry
- Tulane University, Department of Microbiology and Immunology, New Orleans, USA
| | - Donald S. Grant
- Viral Hemorrhagic Fever Program, Kenema Government Hospital, Kenema, Sierra Leone
| | - Adam C. Levine
- International Medical Corps, Los Angeles, USA
- Brown University, Warren Alpert School of Medicine, Providence, USA
- Correspondence to: A. C. Levine, International Medical Corps, Los Angeles, USA.
| | - Pardis C. Sabeti
- Harvard University, Department of Organismic and Evolutionary Biology, Cambridge, USA
- Broad Institute of MIT and Harvard, Cambridge, USA
- Howard Hughes Medical Institute, Chevy Chase, USA
- Harvard School of Public Health, Boston, USA
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20
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Abstract
The clinical management of Ebola created a significant challenge during the outbreak in West Africa, due to the paucity of previous research conducted into the optimum treatment regimen. That left many centres, to some extent, having to ‘work out’ best practice as they went along, and attempting to conduct real time prospective research. Médecins Sans Frontières (MSF) [1] were the only organization to have provided relatively in depth practical guidance prior to the outbreak and this manual was the basis of further planning between the WHO, national Ministry of Health and Sanitation in Sierra Leone, and other relevant stakeholders. Additionally, guidance changed over the epidemic as experience grew. This chapter will describe four key areas in the management of Ebola in West Africa. Firstly, it outlines the most recent WHO guidance; secondly, it looks back at how Ebola was managed in differing low and high resource settings; thirdly it outlines possible and optimal options for managing complications, paying particular attention to some of the controversies faced; fourthly it describes recent and ongoing studies into potential novel therapies that may shape future practice.
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Affiliation(s)
- Marta Lado
- King’s Sierra Leone Partnership, Freetown, Sierra Leone
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21
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Malvy D, McElroy AK, de Clerck H, Günther S, van Griensven J. Ebola virus disease. Lancet 2019; 393:936-948. [PMID: 30777297 DOI: 10.1016/s0140-6736(18)33132-5] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/12/2018] [Accepted: 11/28/2018] [Indexed: 12/17/2022]
Abstract
Ebolaviruses are pathogenic agents associated with a severe, potentially fatal, systemic disease in man and great apes. Four species of ebolaviruses have been identified in west or equatorial Africa. Once the more virulent forms enter the human population, transmission occurs primarily through contact with infected body fluids and can result in major epidemics in under-resourced settings. These viruses cause a disease characterised by systemic viral replication, immune suppression, abnormal inflammatory responses, major fluid and electrolyte losses, and high mortality. Despite recent progress on vaccines, and with no licensed prophylaxis or treatment available, case management is essentially supportive with management of severe multiple organ failure resulting from immune-mediated cell damage. The 2013-16 outbreak was classified by WHO as a Public Health Emergency of International Concern, which drew attention to the challenges of diseases caused by infections with ebolaviruses and questioned scientific, clinical, and societal preparation to handle future epidemics.
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Affiliation(s)
- Denis Malvy
- Department for Infectious and Tropical Diseases, University Hospital Centre of Bordeaux, Bordeaux, France; INSERM 1219, University of Bordeaux, Bordeaux, France.
| | - Anita K McElroy
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Stephan Günther
- Department of Virology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany
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22
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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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23
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Dickson SJ, Clay KA, Adam M, Ardley C, Bailey MS, Burns DS, Cox AT, Craig DG, Espina M, Ewington I, Fitchett G, Grindrod J, Hinsley DE, Horne S, Hutley E, Johnston AM, Kao RLC, Lamb LE, Lewis S, Marion D, Moore AJ, Nicholson-Roberts TC, Phillips A, Praught J, Rees PS, Schoonbaert I, Trinick T, Wilson DR, Simpson AJ, Wang D, O'Shea MK, Fletcher TE. Enhanced case management can be delivered for patients with EVD in Africa: Experience from a UK military Ebola treatment centre in Sierra Leone. J Infect 2018; 76:383-392. [PMID: 29248587 PMCID: PMC5903873 DOI: 10.1016/j.jinf.2017.12.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/28/2017] [Accepted: 12/10/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Limited data exist describing supportive care management, laboratory abnormalities and outcomes in patients with Ebola virus disease (EVD) in West Africa. We report data which constitute the first description of the provision of enhanced EVD case management protocols in a West African setting. METHODS Demographic, clinical and laboratory data were collected by retrospective review of clinical and laboratory records of patients with confirmed EVD admitted between 5 November 2014 and 30 June 2015. RESULTS A total of 44 EVD patients were admitted (median age 37 years (range 17-63), 32/44 healthcare workers), and excluding those evacuated, the case fatality rate was 49% (95% CI 33%-65%). No pregnant women were admitted. At admission 9/44 had stage 1 disease (fever and constitutional symptoms only), 12/44 had stage 2 disease (presence of diarrhoea and/or vomiting) and 23/44 had stage 3 disease (presence of diarrhoea and/or vomiting with organ failure), with case fatality rates of 11% (95% CI 1%-58%), 27% (95% CI 6%-61%), and 70% (95% CI 47%-87%) respectively (p = 0.009). Haemorrhage occurred in 17/41 (41%) patients. The majority (21/40) of patients had hypokalaemia with hyperkalaemia occurring in 12/40 patients. Acute kidney injury (AKI) occurred in 20/40 patients, with 14/20 (70%, 95% CI 46%-88%) dying, compared to 5/20 (25%, 95% CI 9%-49%) dying who did not have AKI (p = 0.01). Ebola virus (EBOV) PCR cycle threshold value at baseline was mean 20.3 (SD 4.3) in fatal cases and 24.8 (SD 5.5) in survivors (p = 0.007). Mean national early warning score (NEWS) at admission was 5.5 (SD 4.4) in fatal cases and 3.0 (SD 1.9) in survivors (p = 0.02). Central venous catheters were placed in 37/41 patients and intravenous fluid administered to 40/41 patients (median duration of 5 days). Faecal management systems were inserted in 21/41 patients, urinary catheters placed in 27/41 and blood component therapy administered to 20/41 patients. CONCLUSIONS EVD is commonly associated life-threatening electrolyte imbalance and organ dysfunction. We believe that the enhanced levels of protocolized care, scale and range of medical interventions we report, offer a blueprint for the future management of EVD in resource-limited settings.
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Affiliation(s)
- S J Dickson
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - K A Clay
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - M Adam
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - C Ardley
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - M S Bailey
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D S Burns
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A T Cox
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D G Craig
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - M Espina
- Royal Canadian Medical Services, Ottawa, Canada
| | - I Ewington
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - G Fitchett
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - J Grindrod
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D E Hinsley
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - S Horne
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - E Hutley
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A M Johnston
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - R L C Kao
- Royal Canadian Medical Services, Ottawa, Canada
| | - L E Lamb
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - S Lewis
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D Marion
- Royal Canadian Medical Services, Ottawa, Canada
| | - A J Moore
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - T C Nicholson-Roberts
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A Phillips
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - J Praught
- Royal Canadian Medical Services, Ottawa, Canada
| | - P S Rees
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | | | - T Trinick
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - D R Wilson
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - A J Simpson
- Rare and Imported Pathogens Laboratory, Public Health England, Porton, United Kingdom
| | - D Wang
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom
| | - M K O'Shea
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - T E Fletcher
- U.K. Defence Medical Services EVD Group, Royal Centre for Defence Medicine, Birmingham, United Kingdom; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, United Kingdom.
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25
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Cherif MS, Camara F, Diallo MP, Koné A, Cissé M, Dumre SP, Diakité M, Hirayama K, Kassé D, Le Gall E, Karbwang J, Cherif F. Prognostic and Predictive Factors of Ebola Virus Disease Outcome in Elderly People during the 2014 Outbreak in Guinea. Am J Trop Med Hyg 2018; 98:198-202. [DOI: 10.4269/ajtmh.17-0372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Mahamoud Sama Cherif
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
- Faculty of Medicine Pharmacy and Odontostomatology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Facely Camara
- Faculty of Medicine Pharmacy and Odontostomatology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Mamadou Pathé Diallo
- Faculty of Medicine Pharmacy and Odontostomatology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Alpha Koné
- Faculty of Medicine Pharmacy and Odontostomatology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Mohamed Cissé
- Faculty of Medicine Pharmacy and Odontostomatology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Shyam Prakash Dumre
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Mandiou Diakité
- Faculty of Medicine Pharmacy and Odontostomatology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Kenji Hirayama
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Diénaba Kassé
- Faculty of Medicine Pharmacy and Odontostomatology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Edouard Le Gall
- Pôle Régional de Cancérologie Bretagne, Rennes, France
- Faculty of Medicine Pharmacy and Odontostomatology, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Juntra Karbwang
- Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
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26
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Abstract
The West African outbreak of 2013 to 2016 was the largest Ebola epidemic in history. With tens of thousands of patients treated during this outbreak, much was learned about how to optimize clinical care for children with Ebola. In anticipation of inevitable future outbreaks, a firsthand summary of the major aspects of pediatric Ebola case management in austere settings is presented. Emphasis is on early and aggressive critical care, including fluid resuscitation, electrolyte repletion, antimicrobial therapy, and nutritional supplementation.
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Affiliation(s)
- Indi Trehan
- Lao Friends Hospital for Children, Luang Prabang, Lao PDR; Department of Pediatrics, One Children's Place, Campus Box 8116, St Louis, MO 63110, USA; Maforki Ebola Holding and Treatment Centre, Port Loko, Sierra Leone.
| | - Stephanie C De Silva
- Department of Pediatrics, One Children's Place, Campus Box 8116, St Louis, MO 63110, USA
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27
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Structure based virtual screening of the Ebola virus trimeric glycoprotein using consensus scoring. Comput Biol Chem 2017; 72:170-180. [PMID: 29361403 DOI: 10.1016/j.compbiolchem.2017.11.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 11/11/2017] [Accepted: 11/19/2017] [Indexed: 01/12/2023]
Abstract
Ebola virus (EBOV) causes zoonotic viral infection with a potential risk of global spread and a highly fatal effect on humans. Till date, no drug has gotten market approval for the treatment of Ebola virus disease (EVD), and this perhaps allows the use of both experimental and computational approaches in the antiviral drug discovery process. The main target of potential vaccines that are recently undergoing clinical trials is trimeric glycoprotein (GP) of the EBOV and its exact crystal structure was used in this structure based virtual screening study, with the aid of consensus scoring to select three possible hit compounds from about 36 million compounds in MCULE's database. Amongst these three compounds, (5R)-5-[[5-(4-chlorophenyl)-1,2,4-oxadiazol-3-yl]methyl]-N-[(4-methoxyphenyl)methyl]-4,5-dihydroisoxazole-3-carboxamide (SC-2, C21H19ClN4O4) showed good features with respect to drug likeness, ligand efficiency metrics, solubility, absorption and distribution properties and non-carcinogenicity to emerge as the most promising compound that can be optimized to lead compound against the GP EBOV. The binding mode showed that SC-2 is well embedded within the trimeric chains of the GP EBOV with molecular interactions with some amino acids. The SC-2 hit compound, upon its optimization to lead, might be a good potential candidate with efficacy against the EBOV pathogen and subsequently receive necessary approval to be used as antiviral drug for the treatment of EVD.
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28
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Recent advances in vaccine development against Ebola threat as bioweapon. Virusdisease 2017; 28:242-246. [PMID: 29291209 DOI: 10.1007/s13337-017-0398-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/29/2017] [Indexed: 12/19/2022] Open
Abstract
With the increasing rate of Ebola virus appearance, with multiple natural outbreaks of Ebola hemorrhagic fever, it is worthy of consideration as bioweapon by anti-national groups. Further, with the non-availability of the vaccines against Ebola virus, concerns about the public health emerge. In this regard, this review summarizes the structure, genetics and potential of Ebola virus to be used as a bioweapon. We highlight the recent advances in the treatment strategies and vaccine development against Ebola virus. The understanding of these aspects might lead to effective treatment practices which can be applied during the future outbreaks of Ebola.
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