Factores pronósticos clínicos determinantes en la supervivencia de pacientes con el virus Ébola / Clinical prognostic factors determining the survival of patients with the Ebola virus

Introducción: La enfermedad por el virus del Ébola presenta una elevada letalidad, por lo cual resulta de gran interés la realización de investigaciones que aborden las manifestaciones clínicas que pudieran ser factores pronósticos de supervivencia. Objetivo: Evaluar factores pronósticos de los pacientes enfermos de ébola. Métodos: El universo lo constituyó la totalidad (n = 350) de pacientes ingresados. Se emplearon medidas de resumen para variables cualitativas, estimaciones puntuales y por intervalos para las cuantitativas, así como las pruebas de significación Kaplan-Meier, regresión de Cox y Odds Ratio. Se trabajó con un nivel de confiabilidad del 95 por ciento. Resultados: La supervivencia global fue del 42,5 por ciento. La media de supervivencia, de aproximadamente 10 días (IC: 9 - 11 días). Los pacientes que ingresaron en estado grave (OR = 3,76), que tuvieron dolor lumbar (OR = 2,24), que refirieron cefalea (OR = 2,22), que presentaron fiebre (OR=2,16), que aquejaron de dolor abdominal (OR=1,95) y a quienes se les constató inyección conjuntival (OR = 1,86), tuvieron mayor probabilidad de fallecer, que quienes ingresaron sin estos síntomas y signos. Conclusiones: La supervivencia fue elevada, pese a las complicaciones presentadas. Los síntomas y signos predictores de muerte en los pacientes fueron: la gravedad del paciente al momento del ingreso, la presencia de dolor lumbar, cefalea, fiebre, dolor abdominal e inyección conjuntival(AU)

Introduction: Ebola virus disease has a high lethality, which is why it is of great interest to carry out research that addresses clinical manifestations that could be prognostic factors for survival. Objective: To evaluate prognostic factors of Ebola patients. Methods: the universe was constituted by the totality (n = 350) of admitted patients. Summary measures were used for qualitative variables, point and interval estimates for quantitative variables, as well as Kaplan-Meier significance tests, Cox regression and Odds Ratio. We worked with a 95% level of reliability. Results: The overall survival was 42.5 por ciento. The average survival, approximately 10 days (CI: 9-11 days). Patients who were admitted in serious condition (OR = 3.76), who had low back pain (OR = 2.24), who reported headache (OR = 2.22), who presented fever (OR = 2.16), who they suffered from abdominal pain (OR = 1.95) and who were found to have conjunctival injection (OR = 1.86), were more likely to die than those who entered without these symptoms and signs. Conclusions: Survival was high, despite the complications presented. The symptoms and predictive signs of death in the patients were: the severity of the patient at admission, the presence of low back pain, headache, fever, abdominal pain and conjunctival injection(AU)

A comprehensive district-level laboratory intervention after the ebola epidemic in Sierra Leone

Background: The 2014­2016 Ebola outbreak exposed the poor laboratory systems in Sierra Leone. Immense needs were recognised across all areas, from facilities, diagnostic capacity, supplies, trained personnel to quality assurance mechanisms.Objective: We aimed to describe the first year of a comprehensive intervention, which started in 2015, in a public hospital's general laboratory serving a population of over 500 000 in a rural district.Methods: The intervention focused on (1)supporting local authorities and healthcare workers in policy implementation and developing procedures to enhance access to services, (2) addressing gaps by investing in infrastructure, supplies, and equipment, (3) development of quality assurance mechanisms via mentorship, bench-side training, and the introduction of quality control and information systems. All work was performed alongside counterparts from the Ministry of Health and Sanitation.Results: We observed a strong increase in patient visits and inpatient and outpatient testing volumes. Novel techniques and procedures were taken up well by staff, leading to improved and expanded service and safety, laying foundations for further improvements.Conclusion: This comprehensive approach was successful and the results suggest an increase in trust from patients and healthcare workers

Strengthening healthcare workforce capacity during and post Ebola outbreaks in Liberia : an innovative and effective approach to epidemic preparedness and response

Introduction: the 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017.Methods: data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained.Results: the ETU, SQS and RRT training were completed by a total of 21,248 participants. There were improvements in knowledge and confidence, an associated reduction in HCWs infection and reduced response time to subsequent public health events.Conclusion: no infections were reported by healthcare workers in Liberia since the completion of these training programs. HCW training programmes initiated during and post disease outbreak can boost public trust in the health system while providing an entry point for establishing an Epidemic Preparedness and Response (EPR) framework in resource-limited settings

Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017

Introduction: measles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia.Methods: we conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017.Results: from January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown.Conclusion: revitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible

Leçons apprises de la gestion des épidémies de la maladie à virus Ebola en République Démocratique du Congo de 2007 à 2017 / Lessons learned from the management of Ebola outbreaks in the Democratic Republic of Congo from 2007 to 2017

Contexte et objectifs. La RDC a un écosystème favorable à la survenue des maladies d'origine zoonotique à l'interface homme-animal dont la maladie à virus Ebola (MVE). Face à une létalité reconnue être élevée pour cette dernière, cette étude s'est focalisée sur les épidémies survenues à Mweka (2007 et 2008), à Isiro (2012), à Boende (2014) et à Likati (2017) afin de décrire les différents éléments de réponse mis en place lors de chacune de ces épidémies et identifier ceux qui ont une influence significative sur l'ampleur de l'épidémie. Méthodes. Une étude documentaire analytique sur les données secondaires recueillies lors de la gestion de ces cinq épidémies de la MVE survenues en RDC. Les statistiques descriptives ont été réalisées pour caractériser chaque épidémie. Les analyses univariées de chaque élément de réponse ont été menées en rapport avec la létalité. Résultats. Un total de 422 cas a été enregistré avec 282 décès soit 66,8 % de létalité. La grande majorité de cas se trouve dans la tranche d'âge de 15 à 49 ans. Le sexe féminin est le plus représenté. Parmi tous les éléments de la réponse, dans un modèle univarié, le déploiement du laboratoire mobile (p=0,002), la fonctionnalité des commissions (p=0,001), le déploiement d'une équipe multidisciplinaire et le système de surveillance performant (p=0,001) sont associés significativement à la létalité. Conclusion. Le déploiement rapide du laboratoire mobile sur le terrain, le déploiement des équipes multidisciplinaires, la bonne fonctionnalité des commissions et le système de surveillance fonctionnel ont permis de réduire significativement la létalité

Enfermedad por el virus del Ébola en el Centro de Tratamiento Coyah / Ebola virus disease at the Coyah Treatment Center

Introducción: la enfermedad por Ébola tiene elevada letalidad y no existe tratamiento efectivo. Es necesario su estudio y estar preparados para el enfrentamiento de futuras epidemias. Objetivo: describir la distribución espacio-temporal y relación con variables de persona, lugar y tiempo, de los pacientes con la enfermedad por el virus del Ébola atendido en el Centro de Tratamiento de Coyah. Métodos: se realizó un estudio descriptivo transversal. El universo lo constituyó los pacientes ingresados (N= 350) en este centro. La información se obtuvo de las historias clínicas. Resultados: se confirmaron casos con Ébola 244 pacientes (69,71 por ciento de positividad), 53,28 por ciento del sexo femenino; la media de edades fue de 30 años; 5 días promedio entre el inicio de los síntomas y el ingreso (mediana de 4 días). El 90,57 por ciento de los enfermos procedía de la región Kindia y 61,07 por ciento de la prefectura Forecariah. El número de pacientes ingresados, según semana estadística, presentó las fluctuaciones características de los brotes epidémicos. En el centro se registraron 133 fallecidos (tasa de letalidad de 54,5 por cada 100 enfermos confirmados). Conclusiones: la elevada confirmación de casos caracterizó la enfermedad, presente fundamentalmente en mujeres jóvenes, con ingreso alrededor de una semana, a partir de los primeros síntomas. La incidencia semanal de casos presentó fluctuaciones características de brotes epidémicos. La tasa de letalidad de la enfermedad fue baja(AU)

Introduction: Ebola disease has a high lethality and there is no effective treatment. It is necessary to study it and be prepared for dealing of future epidemics. Objective: To describe the spatio temporal distribution and relationship with variables of person, place and time of the patients treated at the Ebola Treatment Center in Coyah. Methods: A cross-sectional descriptive study was carried out. The universe were the admitted patients (N= 350) in this Center. The information was obtained from the medical records. Results: Ebola cases were confirmed in 244 patients (69.71 percent positivity), 53.28 percent in females; the average age was 30 years; 5 days average between the onset of symptoms and admission (median of 5 days). 90.57 percent of the patients came from the Kindia Region and 61.07 percent from the Forecariah prefecture. The number of patients admitted, according to statistical week, presented the characteristic fluctuations of epidemic outbreaks. In the center there were 133 deaths (case fatality rate of 54.5 per 100 confirmed patients). Conclusions: The high confirmation of cases characterized the disease, present mainly in young women, with admission around the week, from the first symptoms. The weekly incidence of cases showed characteristic fluctuations of epidemic outbreaks. The case fatality rate was low(AU)

Fear on the networks: analyzing the 2014 Ebola outbreak / El temor en las redes: Análisis del brote de ébola del 2014 / Temor nas redes: uma análise do surto de Ebola de 2014

ABSTRACT During the 2014 Ebola outbreak, information spread via multiple platforms, including social networks and Internet search engines. This report analyzes Twitter tweets, Facebook posts, and Google trends, as well as several other Internet resources, from March - November 2014. Understanding the types of discussions, social behaviors, feelings expressed, and information shared during the Ebola outbreak can help health organizations improve communication interventions and avert misinformation and panic during health emergencies. In all, 6 422 170 tweets, 83 Facebook posts, and Google search trends were integrated with 63 chronological Ebola-related events. Events that prompted a surge in tweets using #ebola were related to new cases of infection or the entry of the disease into a new geographic area. Most tweets were re-tweets of information provided by news agencies and official health organizations. Events related to new infections and deaths seemed to correlate with an increase of words that express fear. Google results concurred with Twitter and Facebook. Data from social media activity can be used to form hypotheses about how the public responds to and behaves during public health events, prompting health organizations to adopt new strategies for communications interventions. Furthermore, a spike in activity around a topic can be used as a surveillance technique to signal to health authorities that an outbreak may be underway. It is also recommended that news agencies, which engage with the public most often, consider content review by health experts as part of their health communications process.(AU)

RESUMEN Durante el brote de ébola del 2014, se difundió información por medio de varias plataformas, entre ellas las redes sociales y los motores de búsqueda de Internet. En este informe se analizan los tuits en Twitter, los mensajes publicados en Facebook y las tendencias de búsqueda en Google, así como varios recursos más en Internet, en el período comprendido entre marzo y noviembre del 2014. La comprensión de los tipos de conversaciones, el comportamiento social, los sentimientos expresados y la información transmitida durante el brote de ébola puede ayudar a las organizaciones de salud a mejorar sus intervenciones en materia de comunicación y evitar la información incorrecta y el pánico que se pueden propagar durante las emergencias de salud. En total, se integraron 6 422 170 tuits, 83 mensajes de Facebook y las tendencias de búsqueda en Google con 63 eventos cronológicos relacionados con ébola. Los eventos que dieron lugar a un incremento de los tuits con la etiqueta #ebola estaban relacionados con nuevos casos de infección o la entrada de la enfermedad en una nueva zona geográfica. La mayor parte de los tuits eran reenvíos de información suministrada por las agencias de noticias y las organizaciones de salud oficiales. Los eventos relacionados con nuevas infecciones y defunciones parecían guardar correlación con un aumento del uso de palabras que expresaban temor. Los resultados de Google coincidían con Twitter y Facebook. Se pueden emplear datos provenientes de la actividad de las redes sociales para formar hipótesis sobre el modo en que el público responde a los eventos de salud pública y en que se comporta durante ellos, e incitar a las organizaciones de salud a que adopten nuevas estrategias para las intervenciones en materia de comunicación. Además, se pueden usar los aumentos de la actividad en torno a un tema como técnica de vigilancia para señalar a las autoridades de salud que es posible que haya un brote. Se recomienda también que las agencias de noticias, que interactúan con el público con más frecuencia, consideren la posibilidad de contar con expertos en salud para examinar los contenidos en el marco de su proceso de comunicación para la salud.(AU)

RESUMO No transcurso do surto de Ebola de 2014, a informação se espalhou por diversas plataformas como as redes sociais e os mecanismos de busca da internet. Este artigo examina as mensagens no Twitter, postagens no Facebook e tendências no Google e outras mídias digitais no período de março a novembro de 2014. Entender as formas de discussões, comportamentos sociais, sentimentos expressos e informações partilhadas no decorrer do surto de Ebola pode contribuir para melhorar as intervenções em comunicação por parte das organizações de saúde e evitar a desinformação e o pânico em situações de emergência em saúde. Ao todo, 6.422.170 mensagens no Twitter, 83 postagens no Facebook e tendências de busca no Google foram correlacionadas a 63 eventos cronológicos relativos ao surto de Ebola. Os eventos que suscitaram um aumento no número de mensagens no Twitter com o hashtag #ebola foram a ocorrência de novos casos de infecção ou o surgimento da doença em outras áreas geográficas. Grande parte da atividade no Twitter consistiu no reenvio de mensagens com informações fornecidas pelas agências de notícias e organizações oficiais de saúde. Os eventos relacionados a novas infecções e mortes aparentemente se correlacionaram ao uso de um maior número de palavras que expressam temor. Os resultados do Google coincidiram com os do Twitter e Facebook. A análise da atividade nas mídias sociais permite formular hipóteses sobre a reação e o comportamento do público em situações de risco em saúde pública, motivando o uso de novas estratégias de comunicação por parte das organizações de saúde. Um pico de atividade em torno de um assunto pode ser um recurso de vigilância usado pelas autoridades sanitárias para sinalizar a possível ocorrência de um surto. Também se recomenda às agências de notícias, por estarem em contato constante com o público, integrar a análise do conteúdo por especialistas em saúde ao processo de comunicação de assuntos em saúde.(AU)

Ebola virus disease in DRC: need for enhanced preparedness and readlness measures in EMR

The World Health Organization [WHO] was notified, on 11 May 2017, by the Ministry of Health [MoH] of the Democratic Republic of Congo [DRC] of a laboratory-confirmed case of Ebola virus disease [EVD]. Since 22 April 2017, 9 suspected cases including 3 deaths [CFR: 33.3%] were reported in the northern part of the country. The current situation calls for stepping up preparedness and readiness measures in the countries of the Eastern Mediterranean Region of WHO to prevent any importation of cases

The strengths, weaknesses, opportunities, and threats (swots) analyses of the Ebola virus

Background: Owing to the extreme virulence and case fatality rate of ebola virus disease (EVD); there had been so much furore; panic and public health emergency about the possible pandemic from the recent West African outbreak of the disease; with attendant handful research; both in the past and most recently. The magnitude of the epidemic of ebola virus disease has prompted global interest and urgency in the discovery of measures to mitigate the impact of the disease. Researchers in the academia and the industry were pressured to only focus on the development of effective and safe ebola virus vaccines; without consideration of the other aspects to this virus; which may influence the success or otherwise of a potential vaccine. The objective of this review was to adopt the SWOT concept to elucidate the biological Strengths;Weaknesses; Opportunities; and Threats to Ebola virus as a pathogen; with a view to understanding and devising holistic strategies at combating and overcoming the scourge of EVD.Method: This systematic review and narrative synthesis utilized Medline; PubMed; Google and other databases to select about 150 publications on ebola and ebola virus disease using text word searches to generate the specific terms. Relevant publications were reviewed and compared; findings were synthesized using a narrative method and summarized qualitatively.Results: Some of the identified strengths of ebola virus include: Ebola virus is an RNA virus with inherent capability to mutate; reassort and recombine to generate mutant or reassortant virulent strains; Ebola virus has a broad cellular tropism; Natural Reservoir of ebola virus is unconfirmed but fruit bats; arthropods; and plants are hypothesized; Ebola virus primarily targets and selectively destroys the immune system; Ebola viruses possess accessory proteins that inhibits the host' immune responses; Secreted glycoprotein (sGP); a truncated soluble protein that triggers immune activation and increased vascular permeability is uniquely associated with Ebola virus only; Ability to effectively cross the species barrier and establish productive infection in humans; non human primates; and other mammals; Ebola virus attacks every part of the human body; The Weaknesses include: Ebola virus transmission and persistence is severely limited by its virulence; Ebola virus essentially requires host encoded protein Niemann-Pick C1 (NPC1) for host's cell' entry; Ebola virus essentially requires host encoded proteins (TIM-1) for cell' entry; Relative abundance of Ebolavirus Nucleoprotein than the other virion components; The Opportunities harnessed by ebola virus include: Lack of infection control practices in African health-care facilities and paucity of health infrastructures; especially in the endemic zones; Permissiveness of circulating Monocytes; Macrophages and dendritic cells in virus mobilization and dissemination; Collection; consumption and trade of wild games (bushmeats); Pertubation and drastic changes in forest ecosystems present opportunities for Ebola virus; Use of dogs in hunting predisposes man and animals to inter-species contact; Poverty; malnutrition; crowding; social disorder; mobility and political instability; Ease of travel and aviation as potentials for global spread; Possible mechanical transmission by arthropod vectors; No vaccines or therapeutics are yet approved for human treatment; The Threats to ebola virus include: Avoidance of direct contact with infected blood and other bodily fluids of infected patient; Appropriate and correct burial practices; Adoption of barrier Nursing; Improved surveillance to prevent potential spread of epidemic; Making Available Rapid laboratory equipment and procedures for prompt detection (ELISA; Western Blot; PCR); Sterilization or disinfection of equipment and safe disposal of instrument; Prompt hospitalization; isolation and quarantine of infected individual; Active contact tracing and monitoring; among others.Conclusion: The identified capacities and gaps presented in this study are inexhaustive framework to combat the ebola virus. To undermine and overcome the virus; focus should be aimed at strategically decreasing the identified strengths and opportunities; while increasing on the weaknesses of; and threats to the virus

Ébola: caracterización, historia y manifestaciones cutáneas; lo que debemos saber / Ebola: characterization, history and cutaneous manifestations

Ebola virus (EV) is one of the most virulent human pathogens. Fruits bats are its natural reservoir, the transmission to humans is across wild animals (especially primates) and the propagation in human populations is through bodily fluid contact. The actual outbreak started in December 2013 and crossed continental borders. Up to now, there are 17,145 suspected and confirmed cases with 6,070 deaths, resulting a total case fatality rate of 35%. Clinical manifestations can be divided in 3 phases. In phase I, symptoms are similar to flu, which may appear in a range of 2 to 21 days. In phase II which occurs in over 50% of cases, visceral symptoms and mucocutaneous manifestations appear within 4 and 5 days of the onset of symptoms. The main symptoms are a macular or maculopapular non-pruritic rash, desquamation and mucosal involvement of eyes, mouth and pharynx. In phase III, recovery or death occurs. The diagnosis is made on clinical grounds, epidemiological suspicion and a positive polymerase chain reaction (PCR) test. The treatment is supportive. If there is a suspected case, it should be notified immediately and all relevant safety measures should be instituted.

Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control

Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridae family, has become one of the world's most feared pathogens. The virus induces acute fever and death, often associated with hemorrhagic symptoms in up to 90% of infected patients. The known sub-types of the virus are Zaire, Sudan, Taï Forest, Bundibugyo and Reston Ebola viruses. In the past, outbreaks were limited to the East and Central African tropical belt with the exception of Ebola Reston outbreaks that occurred in animal facilities in the Philippines, USA and Italy. The on-going outbreak in West Africa that is causing numerous deaths and severe socio-economic challenges has resulted in widespread anxiety globally. This panic may be attributed to the intense media interest, the rapid spread of the virus to other countries like United States and Spain, and moreover, to the absence of an approved treatment or vaccine. Informed by this widespread fear and anxiety, we analyzed the commonly used strategies to manage and control Ebola outbreaks and proposed new approaches that could improve epidemic management and control during future outbreaks. We based our recommendations on epidemic management practices employed during recent outbreaks in East, Central and West Africa, and synthesis of peer-reviewed publications as well as published "field" information from individuals and organizations recently involved in the management of Ebola epidemics. The current epidemic management approaches are largely "reactive", with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to "reactive" interventions, "pre-emptive" strategies also need to be instituted. We conclude that emphasizing both "reactive" and "pre-emptive" strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks.

O risco da contaminação global: o combate à epidemia de Ebola na África como vetor de cooperação internacional / The global contamination risk: the battle against Ebola epidemic in Africa as a vector of international cooperation / /El riesgo de contaminación global: la lucha contra la epidemia por el virus del Ebola en África como un vector de la cooperación internacional

Considerada a maior epidemia de Ebola desde o primeiro surto em 1976, o oeste africano tem enfrentado grandes desafios, sobretudo endógenos, para conter a disseminação da doença. Objetiva-se analisar a atual epidemia de Ebola à luz do neoinstitucionalismo liberal e da lógica da ação coletiva, utilizando como metodologia a estratégia de nested analisys. Conclui-se que o risco de uma pandemia de Ebola tem funcionado como incentivo para que os atores envolvidos cooperem. Os resultados deslocam a discussão para uma área pouco explorada academicamente: a ética médica no âmbito das relações internacionais, que suscita indagações, tais como “por que africanos não têm prioridade no tratamento diferenciado contra o Ebola?” e “qual o verdadeiro papel da OMS ao lidar com grandes epidemias?”. O presente trabalho inova ao tratar lógicas por trás da cooperação internacional em matéria de saúde no continente africano e por agregar a infografia cartográfica à literatura sobre política internacional...

Considered the largest epidemic of Ebola since the first outbreak in 1976, West Africa has faced great challenges, especially endogenous, to contain the disease spreading. Our objective is to analyze the current epidemic of Ebola in the light of the neoliberal institutionalism and the logic of collective action, using as methodology the strategy of nested analysis. It is concluded that the risk of an Ebola pandemic has worked as an incentive for the involved actors want to cooperate. The results lead the discussion to an area little explored academically: the international medical ethics, which raises questions like: “why is not given priority to Africans in the differential treatment against Ebola?” and “what is the true role played by WHO when dealing with large epidemics?” The study breaks new ground when it deals with the logic behind the international cooperation concerning health in Africa and adds infographic maps to international politics literature...

Considerada la mayor epidemia por el virus del Ébola desde el primer brote en 1976, África Occidental ha enfrentado a grandes desafíos, en especial endógenos, para contener la propagación de la enfermedad. Este trabajo tiene como objetivo analizar la actual epidemia por el virus del Ébola de acuerdo con el neoinstitucionalismo liberal y la lógica de la acción colectiva, utilizando como metodología la estrategia de“nested analysis”. Se concluye que el riesgo de una pandemia por el virus del Ébola ha funcionado como un incentivo para que los actores interesados quieran cooperar. Los resultados llevan la discusión a una área poco trabajada en la academia: la ética médica en las relaciones internacionales, que suscita preguntas como: “¿por qué los africanos no tienen prioridad en el tratamiento diferenciado contra el virus del Ébola?”y “¿cuál es el verdadero papel de la OMS cuando trabaja contra grandes epidemias?”. El estudio abre nuevos caminos al tratar de la lógica detrás de la cooperación internacional en materia de salud en África y al agregar mapas infográficos a la literatura política internacional...

Post-exposure treatment of Ebola virus using passive immunotherapy: proposal for a new strategy

Background: Better treatments are urgently needed for the management of Ebola virus epidemics in Equatorial Africa. Methods: We conducted a systematic review of the literature on the use of passive immunotherapy for the treatment or prevention of Ebola virus disease. We placed findings from this review into the context of passive immunotherapy currently used for venom-induced disease, and recent improvements in manufacturing of polyvalent antivenom products. Results: Passive immunotherapy appears to be one of the most promising specific treatments for Ebola. However, its potential has been incompletely evaluated, considering the overall experience and recent improvement of immunotherapy. Development and use of heterologous serum derivatives could protect people exposed to Ebola viruses with reasonable cost and logistics. Conclusion: Hyperimmune equine IgG fragments and purified polyclonal whole IgG deserve further consideration as treatment for exposure to the Ebola virus.

Ebolavirus and haemorrhagic syndrome

The Ebola virus is a highly virulent, single-stranded ribonucleic acid virus which affects both humans and apes and has fast become one of the world's most feared pathogens. The virus induces acute fever and death, with haemorrhagic syndrome occurring in up to 90% of patients. The known species within the genus Ebolavirus are Bundibugyo, Sudan, Zaire, Reston and Tai Forest. Although endemic in Africa, Ebola has caused worldwide anxiety due to media hype and concerns about its international spread, including through bioterrorism. The high fatality rate is attributed to unavailability of a standard treatment regimen or vaccine. The disease is frightening since it is characterised by rapid immune suppression and systemic inflammatory response, causing multi-organ and system failure, shock and often death. Currently, disease management is largely supportive, with containment efforts geared towards mitigating the spread of the virus. This review describes the classification, morphology, infective process, natural ecology, transmission, epidemic patterns, diagnosis, clinical features and immunology of Ebola, including management and epidemic containment strategies

Ebola virus disease and the search for a cure

Ebola virus disease (EVD) was first identified in 1976 in Yambuku, Zaire (now the Democratic Republic of Congo), and is caused by an RNA virus in the filovirus family (Feldmann & Geisbert). The current strain circulation in West Africa is very similar to the original strain (>95% homology). The origin of the current outbreak remains unknown, but it is suspected to be from an animal reservoir with intermediary species (Fauci). Randomized clinical trials with adaptive design are ongoing to evaluate potential new therapies for EVD...

Ebola virus disease control in West Africa: an ecological, one health approach

The 2013-2015 Ebola Virus Disease outbreak in West Africa had similar nuances with the 1976 outbreaks in Central Africa; both were caused by the Zaire Ebola Virus strain and originated from rural forested communities. The definitive reservoir host of Ebola virus still remains unknown till date. However; from ecological perspective; it is known that the virus first emerged from forest ecotypes interfacing with human activities. As at March 2015; the outbreak has claimed over 9000 lives; which is unprecedented. Though it remains unproved; the primary sources of infection for past and present outbreaks are forest dwelling; human-hunted fauna. Understanding the ecological factors at play in these forest ecotypes where wild fauna interface with human and causing pathogen spill over is important. A broad based One Health approach incorporating these ecological concepts in the control of Ebola Virus Disease caneffectively ameliorate or forestall infection now and in the future