Outcome of transcutaneous edge-to-edge mitral valve repair in patients with diabetes mellitus: results from a real-world cohort

Background

Transcutaneous edge-to-edge repair (TEER) has become a treatment option for selected patients with severe mitral regurgitation (MR). Analysis of the COAPT trial indicated patients with diabetes mellitus to have higher death rates and a trend to higher rates of heart failure hospitalization (HFH) than those without diabetes. However, in that study only patients with secondary MR with specific criteria were included and there are only limited data on diabetes patients in real-world settings.

Purpose

This study sought to evaluate safety and efficacy of TEER in patients with diabetes mellitus in comparison to non-diabetics.

Methods

In this monocentric study 340 consecutive patients with severe primary and secondary MR who underwent TEER were included. Immediate results of the procedure, intrahospital as well as one-year outcome were compared between patients with and without diabetes.

Results

Diabetes was present in 109 patients (32%) of the study group. Patients with diabetes were younger (75±8 vs. 78±8 years; p=0.003), had more often ischemic cardiomyopathy (68% vs. 48%, p<0.001), previous coronary-artery bypass graft (35% vs. 20%; p=0.002) and arterial hypertension (89% vs. 75%; p<0.001) compared to those without diabetes. All other baseline clinical and imaging characteristics including NYHA class, left ventricular dimensions and function (ejection fraction: 38±13% vs. 41±14%; p=0.10) as well as severity of MR were not different between both patient groups (Table 1).

Success of the procedure was comparable between patients with and without diabetes (95% vs. 95%; p=0.84). There was no difference in intrahospital mortality between both groups (5.5% vs. 4.8%; p=0.98). At one-year follow up, there was no difference regarding all-cause mortality (24.2% vs. 23.0%; p=0.72), HFH (37.4% vs. 31.0%, p=0.23), NYHA class (p=0.11) or MR severity (p=0.20) between both groups (Table 2).

Conclusion

In contrast to previous published data on patients with diabetes and severe MR TEER seems to be similar safe and effective in a real-world setting compared to non-diabetics.

Funding Acknowledgement

Type of funding sources: None.

A novel IgG-based FLT3xCD3 bispecific antibody for the treatment of AML and B-ALL

BACKGROUND

In lymphoid malignancies, the introduction of chimeric antigen receptor T (CAR-T) cells and bispecific antibodies (bsAbs) has achieved remarkable clinical success. However, such immunotherapeutic strategies are not yet established for acute myeloid leukemia (AML), the most common form of acute leukemia in adults. Common targets in AML such as CD33, CD123, and CLEC12A are highly expressed on both AML blasts and on normal myeloid cells and hematopoietic stem cells (HSCs), thereby raising toxicity concerns. In B-cell acute lymphoblastic leukemia (B-ALL), bsAbs and CAR-T therapy targeting CD19 and CD22 have demonstrated clinical success, but resistance via antigen loss is common, motivating the development of agents focused on alternative targets. An attractive emerging target is FLT3, a proto-oncogene expressed in both AML and B-ALL, with low and limited expression on myeloid dendritic cells and HSCs.

METHODS

We developed and characterized CLN-049, a T cell-activating bsAb targeting CD3 and FLT3, constructed as an IgG heavy chain/scFv fusion. CLN-049 binds the membrane proximal extracellular domain of the FLT3 protein tyrosine kinase, which facilitates the targeting of leukemic blasts regardless of FLT3 mutational status. CLN-049 was evaluated for preclinical safety and efficacy in vitro and in vivo.

RESULTS

CLN-049 induced target-restricted activation of CD4+ and CD8+ T cells. AML cell lines expressing a broad range of surface levels of FLT3 were efficiently lysed on treatment with subnanomolar concentrations of CLN-049, whereas FLT3-expressing hematopoietic progenitor cells and dendritic cells were not sensitive to CLN-049 killing. Treatment with CLN-049 also induced lysis of AML and B-ALL patient blasts by autologous T cells at the low effector-to-target ratios typically observed in patients with overt disease. Lysis of leukemic cells was not affected by supraphysiological levels of soluble FLT3 or FLT3 ligand. In mouse xenograft models, CLN-049 was highly active against human leukemic cell lines and patient-derived AML and B-ALL blasts.

CONCLUSIONS

CLN-049 has a favorable efficacy and safety profile in preclinical models, warranting evaluation of its antileukemic activity in the clinic.

Endothelial progenitor cells modulate the phenotype of smooth muscle cells and increase their neointimal accumulation following vascular injury

Background

Smooth muscle cells (SMCs) are the main driver of neointima formation and restenosis following vascular injury. In animal models, endothelial progenitor cells (EPCs) accelerate endothelial regeneration and reduce neointima formation after arterial injury, however EPC-capture stents do not to reduce target vessel failure compared to conventional stents. Here we examined the influence of EPCs on features of SMCs pivotal for their impact on neointima formation including proliferation, migration and phenotype switch.

Methods and results

EPCs, their conditioned medium and EPC-derived microparticles induced proliferation of SMCs while limiting their apoptosis. In transwell membrane experiments and scratch assays EPCs stimulated migration of SMCs and accelerated their recovery from scratch-induced injury. Treatment of SMCs with EPC-derived conditioned medium or microparticles triggered transformation of SMCs towards a synthetic phenotype. However, co-cultivation of EPCs and SMCs enabling direct cell-cell contacts preserved their original phenotype and protected from the transformative effect of SMC cholesterol-loading. Adhesion of EPCs to SMCs was stimulated by SMC injury and reduced by blocking CXCR2 and CCR5. Interaction of EPCs with SMCs modulated their secretome and synergistically increased the release of selected chemokines. Following carotid wire injury in athymic mice, injection of EPCs resulted not only in reduced neointima formation but also in altered cellular composition of the neointima with augmented accumulation of SMCs.

Conclusion

EPCs stimulate proliferation and migration of SMCs and increase their neointimal accumulation following vascular injury. Furthermore, EPCs modify the SMC phenotype with protection from the transformative effect of cholesterol when direct cell-cell contact is established.

Funding Acknowledgement

Type of funding sources: None.

CD18 Antibody Application Blocks Unwanted Off-Target T Cell Activation Caused by Bispecific Antibodies

Simple Summary

Bispecific antibodies are a very effective immunotherapy against different types of cancer since they activate T cells in the presence of tumor cells. However, they can cause severe side effects, such as a systemic inflammation called cytokine release syndrome. We aimed to clarify an important mechanism that causes cytokine release syndrome. In cocultures of T cells with endothelial cells or lymphoid cells, application of bispecific antibodies can induce T cell activation and cytokine release in the absence of tumor cells. By blocking the adhesion molecule CD18, this interaction is interrupted and the unwanted T cell activation is diminished. CD18 blockade, however, does not interfere with T cell activation when tumor cells are present. Therefore, CD18 blockade could prevent side effects of bispecific antibodies without decreasing the anti-tumor effect.

Abstract

T cell-recruiting bispecific antibodies (bsAbs) are successfully used for the treatment of cancer. However, effective treatment with bsAbs is so far hampered by severe side effects, i.e., potentially life-threatening cytokine release syndrome. Off-target T cell activation due to binding of bispecific CD3 antibodies to T cells in the absence of target cells may contribute to excessive cytokine release. We report here, in an in vitro setting, that off-target T cell activation is induced by bsAbs with high CD3 binding affinity and increased by endothelial- or lymphoid cells that act as stimulating bystander cells. Blocking antibodies directed against the adhesion molecules CD18/CD54 or CD2/CD58 markedly reduced this type of off-target T cell activation. CD18 blockade—in contrast to CD2—did not affect the therapeutic activity of various bsAbs. Since CD18 antibodies have been shown to be safely applicable in patients, blockade of this integrin holds promise as a potential target for the prevention of unwanted off-target T cell activation and allows the application of truly effective bsAb doses.

Development of In Vitro Endothelialised Stents - Review

Endovascular treatment is prevalent as a primary treatment for coronary and peripheral arterial diseases. Although the introduction of drug-eluting stents (DES) dramatically reduced the risk of in-stent restenosis, stent thrombosis persists as an issue. Notwithstanding improvements in newer generation DES, they are yet to address the urgent clinical need to abolish the late stent complications that result from in-stent restenosis and are associated with late thrombus formation. These often lead to acute coronary syndromes with high mortality in coronary artery disease and acute limb ischemia with a high risk of limb amputation in peripheral arterial disease. Recently, a significant amount of research has focused on alternative solutions to improve stent biocompatibility by using tissue engineering. There are two types of tissue engineering endothelialisation methods: in vitro and in vivo. To date, commercially available in vivo endothelialised stents have failed to demonstrate antithrombotic or anti-stenosis efficacy in clinical trials. In contrast, the in vitro endothelialisation methods exhibit the advantage of monitoring cell type and growth prior to implantation, enabling better quality control. The present review discusses tissue-engineered candidate stents constructed by distinct in vitro endothelialisation approaches, with a particular focus on fabrication processes, including cell source selection, stent material composition, stent surface modifications, efficacy and safety evidence from in vitro and in vivo studies, and future directions.

An IgG-based bispecific antibody for improved dual targeting in PSMA-positive cancer

The prostate-specific membrane antigen (PSMA) has been demonstrated in numerous studies to be expressed specifically on prostate carcinoma cells and on the neovasculature of several other cancer entities. However, the simultaneous expression of PSMA on both, tumor cells as well as tumor vessels remains unclear, even if such "dual" expression would constitute an important asset to facilitate sufficient influx of effector cells to a given tumor site. We report here on the generation of a PSMA antibody, termed 10B3, which exerts superior dual reactivity on sections of prostate carcinoma and squamous cell carcinoma of the lung. 10B3 was used for the construction of T-cell recruiting bispecific PSMAxCD3 antibodies in Fab- and IgG-based formats, designated Fabsc and IgGsc, respectively. In vitro, both molecules exhibited comparable activity. In contrast, only the larger IgGsc molecule induced complete and durable elimination of established tumors in humanized mice due to favorable pharmacokinetic properties. Upon treatment of three patients with metastasized prostate carcinoma with the IgGsc reagent, marked activation of T cells and rapid reduction of elevated PSA levels were observed.

Valvular calcium load assessment for predicting postprocedural paravalvular leakage: a comparison between surgical aortic valve replacement versus transcatheter implantation

Background

Calcification of native aortic valve is a well known variable causing paravalvular leakage (PVL) following transcatheter aortic valve implantation (TAVI). However, there is currently no evidence to support the fact that patients with high calcium load could be better treated with surgical aortic valve replacement (SAVR).

Purpose

To assess the utility of preoperative assessment of valvular calcium load through computed tomography in patients affected by severe aortic valve stenosis undergoing SAVR or TAVI.

Methods

Between June 2016 and June 2018, 109 candidates for isolated SAVR through minimal invasive access underwent preoperative contrast enhanced multidetector computed tomography (MDCT) for the assessment of valve and aortic calcifications. Calcium load was quantitatively measured using a dedicated software in three regions on interest (aortic valve [AV], left ventricular outflow tract [LVOT] and device landing zone [DLZ], which is the sum of the earlier 2). Clinical, echocardiographic, and MDCT variables were collected and compared to a sample population of 107 patients that underwent TAVI (87 transfemoral, 20 transapical) for native aortic valve stenosis in the same period of time, in the same institution. A univariate and multivariate logistic regression analysis were performed on the whole study population to assess risk factors for the onset of postoperative PVL (any grade, defined as ≥ mild) at discharge.

Results

The two study groups were significantly different in terms of age (71.9±5 in SAVR; 81.5±6 in TAVI), gender (36% female in SAVR vs 51% in TAVI), Euroscore II (1.9%±0.8 in SAVR; 4.8%±2.7 in TAVI), annulus perimeter (79.5mm±8.2 in SAVR; 61.8mm±30.5 in TAVI), baseline ejection fraction (57%±8 in SAVR; 51%±12 in TAVI) and severe pulmonary hypertension (2%±13 in SAVR; 26%±44 in TAVI). Calcium load was not different between groups (DLZ 1066 mm3±716 vs 955mm3±639; total calcium in AV 987 mm3±678 vs 879 mm3±601; total calcium in LVOT 78 mm3±130 vs 77 mm3±100). 30-days-mortality was 1.8% in SAVR and 5.6% in TAVI group (p=0.17). At discharge, incidence of all grades PVL was 5.5% in SAVR (0.9% trace, 3.6% mild, 0.9% moderate) and 41% in TAVI group (12.1% trace, 25.2% mild, 3.7% moderate) (p<0.05). On logistic regression on the whole study population, DLZ calcium (OR 1.1, 95% CI 1–1.2 for 100 mm3, p=0.003) and the use of TAVI (OR 24, 95% CI 7.7–78, p<0.001) were identified as independently associated with the onset of PVL.

Conclusions

Aortic valve calcifications are a risk factor for the onset of PVL for both TAVI and SAVR. Nevertheless, the risk increases considerably with the use of TAVI. A deeper anatomical analysis of preoperative MDCT could improve the treatment selection and the outcome of patients affected by aortic valve stenosis.

Funding Acknowledgement

Type of funding source: None

Delay of transfer from the intensive care unit: a prospective observational analysis on economic effects of delayed in-house transfer

Background

Intensive care unit (ICU) capacity is a scant and precious resource in hospitals. Therefore, an optimal occupancy rate as well as detailed occupation planning is of great importance. Most literature deals with admission to the ICU, while only few discuss discharge from the ICU. Specifically, a delay of transfer from the ICU can cause a shortness of beds, jeopardize urgent patient treatment and lead to a decrease in treatment quality as well as economic downsides. This study examined the incidence, costs and reasons for delayed discharge from the ICU and analyzed the influence of the department the patient was admitted to.

Methods

Over the course of 12 months, the discharges of all 1643 patients of two surgical intensive care units of a large academic medical center were analyzed. Delay in minutes and reasons were recorded and translated into financial figures. A univariate logistic regression model was developed to evaluate the impact of length of stay at the ICU, age, gender, subspecialty and specific ICU on the delay of transfer. In a next step, significant factors of the univariate logistic regression were incorporated into a multivariate regression model.

Results

In 326 out of 1312 patients ready for discharge (24.8%), the transfer to the floor was delayed. Time of delay for all patients added up to a total of 265,691 min in 1 year. The application of the internal cost allocation, in which 1 min corresponds to 0.75 Euro cents, led to costs of 199,268 Euros (~ $240,000) for the study period. In 91.7% of the cases, the reason for the delay was the lack of an available or appropriate bed on the regular ward. Multivariate regression analysis revealed that the type of department the patient is admitted to poses a significantly influencing factor for delayed discharge from the ICU.

Conclusion

Delay in discharge from the ICU is a common problem of economic relevance. The main reason is a lack of appropriate floor beds. Patients from certain specific departments are at a higher risk to be discharged with delay. A solution to this problem lies in the focus on the downstream units. A proper use of the scarce resources is to be pursued because of ethical as well as economic reasons in an increasingly aging population.

Evaluation of Computer-assisted Image Enhancement in Minimal Invasive Endoscopic Surgery

Objectives: This paper focusses on the evaluation of the usage of computer-aided image processing methods for minimal invasive surgery. During video endoscopy of visceral cavities the images are displayed directly on the monitor without further processing. In the course of the operation the former good quality of the images decreases due to typical disturbances like bleeding, smoke or flying particles. These disturbances can be reduced by using image processing methods like color normalization, temporal filtering or equalization.

Methods: In this double-blinded analysis, 14 surgeons with different levels of experience evaluated 120 image pairs and 5 image sequences, directly comparing original and processed images or movies.

Results: Color normalization and equalization proved to significantly enhance video endoscopic images. With regard to temporal filtering, an improvement could be seen in the image sequences with filter size 5 being a greater enhancement than filter size 3. Comparing the state of experience and its influence on the results, it occurred that the experienced surgeons preferred the original color while altogether agreeing that the color-normalized images were better.

Conclusions: The results obtained in the present evaluation show that the image processing methods which were used can significantly improve the quality of video endoscopic images. As a result of this, necessary lavages of the operated area are reduced and a better overview and orientation for the surgeon can be reached.

Light Fields for Minimal Invasive Surgery Using an Endoscope Positioning Robot

Objectives: To generate a fast and robust 3-D visualization of the operation site during minimal invasive surgery.

Methods: Light fields are used to model and visualize the 3-D operation site during minimal invasive surgery. An endoscope positioning robot provides the position and orientation of the endoscope. The a priori unknown transformation from the endoscope plug to the endoscope tip (hand-eye transformation) can either be determined by a three-step algorithm, which includes measuring the endoscope length by hand or by using an automatic hand-eye calibration algorithm. Both methods are described in this paper and their respective computation times and accuracies are compared.

Results: Light fields were generated during real operations and in the laboratory. The comparison of the two methods to determine the unknown hand-eye transformation was done in the laboratory. The results which are being presented in this paper are: rendered images from the generated light fields, the calculated extrinsic camera parameters and their accuracies with respect to the applied hand-eye calibration method, and computation times.

Conclusion: Using an endoscope positioning robot and knowing the hand-eye transformation, the fast and robust generation of light fields for minimal invasive surgery is possible.

Letter to the Editor: Thrombocytopenia After Sutureless Aortic Valve Implantation: Does It Really Matter?

Despite the limited clinical relevance of thrombocytopenia after bioprosthetic aortic valve replacement (AVR), the postoperative depletion of platelet count continues to attract the attention of many authors. The development of thrombocytopenia has been evaluated either in patients receiving a sutureless bioprosthesis (1,2) or in those undergoing transcatheter aortic valve implantation, where cardiopulmonary bypass bears little or no relation to this phenomenon (3). Recently, Sánchez et al. (1) have published their findings on this topic, but their limited experience with the devices used makes their study of doubtful interest. Over three years, 27 patients were implanted with a sutureless bioprosthetic valve and were compared with 50 patients receiving a stented aortic valve. No risk factors that may have predisposed to platelet dysfunction were described in either group.Mortality and number of units of transfused red blood cells also seems to be extremely high for a patient population undergoing elective isolated AVR: it is not clear whether bleeding complications occurred in any patients and re-thoracotomy could not be performed, or whether more liberal transfusion protocols were used. In addition, platelet transfusions in patients from the sutureless group could represent a bias that renders the comparison of postoperative mean platelet volume and platelet distribution width between groups unreliable. It would have been more appropriate to consider postoperative echocardiographic findings because, in case of suboptimal placement of the prosthesis, paravalvular leakage may cause severe hemolysis and thrombocytopenia. At present, clinical data can be derived from other case series (4). At our Center, over a six-year period, AVR was performed using a sutureless, stentless, or stented bioprosthesis in 432, 193, and 180 patients, respectively, with all devices being supplied by the same manufacturer. Perioperative trends in platelet count after sutureless AVR did not show progression towards thrombocytopenia as occurs after stentless AVR (5), but compared favourably with conventional stented AVR (Fig. 1), where platelet depletion has no clinical relevance. Figure 1: Perioperative trends in platelet count after aorticvalve replacement with the sutureless Perceval, stentlessSolo, and stented Crown bioprosthetic valves.References1. Sánchez E, Corrales JA, Fantidis P, Tarhini IS, Khan I, Pineda T, González JR. Thrombocytopenia after aortic valve replacement with Perceval S sutureless bioprosthesis. J Heart Valve Dis 2016;25:75-812. Jiritano F, Cristodoro L, Malta E, Mastroroberto P. Thrombocytopenia after sutureless aortic valve implantation: Comparison between Intuity and Perceval bioprostheses. J Thorac Cardiovasc Surg 2016;152:1631-16333. McCabe JM, Huang PH, Riedl LA, et al. Incidence and implications of idiopathic thrombocytopenia following transcatheter aortic valve replacement with the Edwards Sapien® valves: A single center experience. Catheter Cardiovasc Interv 2014;83:633-6414. Santarpino G, Fischlein T, Pfeiffer S. A word of caution is needed before uttering a word of caution: Thrombocytopenia and sutureless valves. Heart Surg Forum 2016;19:E1695. Pozzoli A, De Maat GE, Hillege HL, Boogaard JJ, Natour E, Mariani MA. Severe thrombocytopenia and its clinical impact after implant of the stentless Freedom Solo bioprosthesis. Ann Thorac Surg 2013;96:1581-1586.

First experience with the new Sorin Crown PRT bioprosthetic aortic valve: early postoperative outcome and hemodynamic performance in 90 patients

AIM

The Crown PRT (The Phospholipid Reduction Treatment) is a new stent bovine bioprosthesis for aortic valve replacement (AVR). Aim of this paper is to report the postoperative clinical and hemodynamic results after ninety consecutive implants.

METHODS

After receiving CE mark in July 2014, two European university centers implanted the new Crown PRT (Sorin Group, Burnaby, Canada) for the first time. Up to now, ninety patients underwent aortic valve replacement, in isolated or combined procedures, for aortic stenosis or insufficiency. Intraoperative transesophageal echocardiogram was used to assess the prosthesis's function. In hospital outcomes and echocardiographic parameters were recorded.

RESULTS

Age and Log Euroscore were 71.8±7.9 years and 10.2%±4.5 respectively. In-hospital mortality for isolated AVR was 0%; one patient died after a multiple procedure (overall 30-days mortality 1.1%). No adverse device effects were recorded. Intensive Care Unit stay was 2±5.8 days. At discharge, echocardiogram showed no paravalvular leaks and normal postoperative gradients.

CONCLUSION

Our starting results showed that the Crown PRT is safe and reliable, with excellent hemodynamic performance. Further clinical results with a larger population and long term follow-up are needed to assess the versatility and the durability of this new device.

Characterization of a bispecific FLT3 X CD3 antibody in an improved, recombinant format for the treatment of leukemia

FLT3 is a receptor-tyrosine-kinase that is expressed on leukemic cells of the myeloid and lymphoid lineage rather specifically. We here report on the construction and selection of bispecific FLT3 X CD3 antibodies in a new recombinant format, termed Fabsc, that resembles the normal antibody structure more closely than the well-established bispecific single chain (bssc)-format. Our preferred antibody, which emerged from an initial selection procedure utilizing different FLT3- and CD3-antibodies, contains the FLT3-antibody 4G8 and the CD3-antibody UCHT1. The 4G8 X UCHT1 Fabsc-antibody was found to be superior to a bssc-antibody with identical specificities with respect to (i) affinity to the target antigen FLT3, (ii) production yield by transfected cells, and (iii) the diminished formation of aggregates. T-cell activation in the presence and absence of cultured leukemic cells and killing of these cells was comparable for both molecules. In addition, the 4G8 X UCHT1 Fabsc-antibody was found to induce T-cell activation and efficient killing of leukemic blasts in primary peripheral blood mononuclear cell (PBMC) cultures of acute myeloid leukemia (AML) patients. In these experiments, the bispecific molecule was clearly superior to an Fc-optimized monospecific FLT3-antibody described previously, indicating that within PBMC of AML patients the recruitment of T cells is more effective than that of natural killer cells.

γδ T Cell-Mediated Antibody-Dependent Cellular Cytotoxicity with CD19 Antibodies Assessed by an Impedance-Based Label-Free Real-Time Cytotoxicity Assay

γδ T cells are not MHC restricted, elicit cytotoxicity against various malignancies, are present in early post-transplant phases in novel stem cell transplantation strategies and have been shown to mediate antibody-dependent cellular cytotoxicity (ADCC) with monoclonal antibodies (mAbs). These features make γδ T cells promising effector cells for antibody-based immunotherapy in pediatric patients with B-lineage acute lymphoblastic leukemia (ALL). To evaluate combination of human γδ T cells with CD19 antibodies for immunotherapy of B-lineage ALL, γδ T cells were expanded after a GMP-compliant protocol and ADCC of both primary and expanded γδ T cells with an Fc-optimized CD19 antibody (4G7SDIE) and a bi-specific antibody with the specificities CD19 and CD16 (N19-C16) was evaluated in CD107a-degranulation assays and intracellular cytokine staining. CD107a, TNFα, and IFNγ expression of primary γδ T cells were significantly increased and correlated with CD16-expression of γδ T cells. γδ T cells highly expressed CD107a after expansion and no further increased expression by 4G7SDIE and N19-C16 was measured. Cytotoxicity of purified expanded γδ T cells targeting CD19-expressing cells was assessed in both europium-TDA release and in an impedance-based label-free method (using the xCELLigence system) measuring γδ T cell lysis in real-time. Albeit in the 2 h end-point europium-TDA release assay no increased lysis was observed, in real-time xCELLigence assays both significant antibody-independent cytotoxicity and ADCC of γδ T cells were observed. The xCELLigence system outperformed the end-point europium-TDA release assay in sensitivity and allows drawing of conclusions to lysis kinetics of γδ T cells over prolonged periods of time periods. Combination of CD19 antibodies with primary as well as expanded γδ T cells exhibits a promising approach, which may enhance clinical outcome of patients with pediatric B-lineage ALL and requires clinical evaluation.

Describing readmissions to an Ebola case management centre (CMC), Sierra Leone, 2014

Case management centres (CMCs) are part of the outbreak control plan for Ebola virus disease (EVD). A CMC in Sierra Leone had 33% (138/419) of primary admissions discharged as EVD negative (not a case). Fifteen of these were readmitted within 21 days, nine of which were EVD positive. All readmissions had contact with an Ebola case in the community in the previous 21 days indicating that the infection was likely acquired outside the CMC.

Describing readmissions to an Ebola case management centre (CMC), Sierra Leone, 2014

Case management centres (CMCs) are part of the outbreak control plan for Ebola virus disease (EVD). A CMC in Sierra Leone had 33% (138/419) of primary admissions discharged as EVD negative (not a case). Fifteen of these were readmitted within 21 days, nine of which were EVD positive. All readmissions had contact with an Ebola case in the community in the previous 21 days indicating that the infection was likely acquired outside the CMC.