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1.
MMWR Morb Mortal Wkly Rep ; 69(1): 14-19, 2020 Jan 10.
Artículo en Inglés | MEDLINE | ID: mdl-31917783

RESUMEN

On August 1, 2018, the Democratic Republic of the Congo (DRC) declared its 10th Ebola virus disease (Ebola) outbreak in an area with a high volume of cross-border population movement to and from neighboring countries. The World Health Organization (WHO) designated Rwanda, South Sudan, and Uganda as the highest priority countries for Ebola preparedness because of the high risk for cross-border spread from DRC (1). Countries might base their disease case definitions on global standards; however, historical context and perceived risk often affect why countries modify and adapt definitions over time, moving toward or away from regional harmonization. Discordance in case definitions among countries might reduce the effectiveness of cross-border initiatives during outbreaks with high risk for regional spread. CDC worked with the ministries of health (MOHs) in DRC, Rwanda, South Sudan, and Uganda to collect MOH-approved Ebola case definitions used during the first 6 months of the outbreak to assess concordance (i.e., commonality in category case definitions) among countries. Changes in MOH-approved Ebola case definitions were analyzed, referencing the WHO standard case definition, and concordance among the four countries for Ebola case categories (i.e., community alert, suspected, probable, confirmed, and case contact) was assessed at three dates (2). The number of country-level revisions ranged from two to four, with all countries revising Ebola definitions by February 2019 after a December 2018 peak in incidence in DRC. Case definition complexity increased over time; all countries included more criteria per category than the WHO standard definition did, except for the "case contact" and "confirmed" categories. Low case definition concordance and lack of awareness of regional differences by national-level health officials could reduce effectiveness of cross-border communication and collaboration. Working toward regional harmonization or considering systematic approaches to addressing country-level differences might increase efficiency in cross-border information sharing.


Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/epidemiología , Vigilancia en Salud Pública/métodos , República Democrática del Congo/epidemiología , Humanos , Rwanda/epidemiología , Sudán del Sur/epidemiología , Factores de Tiempo , Uganda/epidemiología
2.
BMC Infect Dis ; 19(1): 981, 2019 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-31752717

RESUMEN

BACKGROUND: The ninth outbreak of Ebola Virus Disease (EVD) in the Democratic Republic of the Congo occurred in Équateur Province from 8 May-24 July 2018. A system of health facility (HF)-based active case finding (ACF) was implemented in Mbandaka, a regional capital with four confirmed EVD cases, following completion of contact tracing. The goal of this HF-based ACF system was to look for undetected EVD cases among patients that visited HFs beginning one week prior to the system's implementation. METHODS: From 23 June - 24 July 2018, ACF teams visited HFs in Mbandaka and reviewed all medical records as far back as 17 June for any consultations meeting the suspected EVD case definition. The teams then assessed whether to validate these as suspected EVD cases based on factors such as recovery, epidemiological links, and their clinical judgement. ACF teams also assessed HFs' awareness of EVD symptoms and the process for alerting suspected cases. We calculated descriptive statistics regarding the characteristics of reviewed consultations, alert cases, and visited HFs. We also used univariate and multivariate random effects logistic regression models to evaluate the impact of repeated ACF visits to the same HF on the staff's awareness of EVD. RESULTS: ACF teams reviewed 37,746 consultations, of which 690 met the definition of a suspected case of EVD. Two were validated as suspected EVD cases and transferred to the Ebola Treatment Unit for testing; both tested negative. Repeated ACF visits to the same HF were significantly associated with improved EVD awareness (p < 0.001) in univariate and multivariate analyses. CONCLUSION: HF-based ACF during EVD outbreaks may improve EVD awareness and reveal many individuals meeting the suspected case definition. However, many who meet this definition may not have EVD, depending on the population size covered by ACF and amount of ongoing EVD transmission. Given the burdensome procedure of testing suspected EVD cases, future HF-based ACF systems would benefit from improved clarity on which patients require further testing.


Asunto(s)
Notificación de Enfermedades/métodos , Fiebre Hemorrágica Ebola/virología , República Democrática del Congo/epidemiología , Brotes de Enfermedades , Ebolavirus/genética , Ebolavirus/aislamiento & purificación , Ebolavirus/fisiología , Femenino , Instituciones de Salud/estadística & datos numéricos , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Modelos Logísticos , Masculino
3.
BMC Infect Dis ; 19(1): 810, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533659

RESUMEN

BACKGROUND: The 2014-2016 Ebola epidemic in West Africa was the largest Ebola epidemic to date. Contact tracing was a core surveillance activity. Challenges with paper-based contact tracing systems include incomplete identification of contacts, delays in communication and response, loss of contact lists, inadequate data collection and transcription errors. The aim of this study was to design and evaluate an electronic system for tracing contacts of Ebola cases in Port Loko District, Sierra Leone, and to compare this with the existing paper-based system. The electronic system featured data capture using a smartphone application, linked to an alert system to notify the District Ebola Response Centre of symptomatic contacts. METHODS: The intervention was a customised three-tier smartphone application developed using Dimagi's CommCare platform known as the Ebola Contact Tracing application (ECT app). Eligible study participants were all 26 Contact Tracing Coordinators (CTCs) and 86 Contact Tracers (CTs) working in the 11 Chiefdoms of Port Loko District during the study period (April-August 2015). Case detection was from 13th April to 17th July 2015. The CTCs and their CTs were provided with smartphones installed with the ECT app which was used to conduct contact tracing activities. Completeness and timeliness of contact tracing using the app were compared with data from April 13th-June 7th 2015, when the standard paper-based system was used. RESULTS: For 25 laboratory-confirmed cases for whom paper-based contact tracing was conducted, data for only 39% of 408 contacts were returned to the District, and data were often incomplete. For 16 cases for whom app-based contact tracing was conducted, 63% of 556 contacts were recorded as having been visited on the app, and the median recorded duration from case confirmation to first contact visit was 70 h. CONCLUSION: There were considerable challenges to conducting high-quality contact tracing in this setting using either the paper-based or the app-based system. However, the study demonstrated that it was possible to implement mobile health (mHealth) in this emergency setting. The app had the benefits of improved data completeness, storage and accuracy, but the challenges of using an app in this setting and epidemic context were substantial.


Asunto(s)
Trazado de Contacto/métodos , Fiebre Hemorrágica Ebola/diagnóstico , Adolescente , Adulto , África Occidental , Niño , Preescolar , Brotes de Enfermedades , Femenino , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles , Sierra Leona/epidemiología , Telemedicina , Adulto Joven
5.
Public Health Rep ; 134(5): 477-483, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31424330

RESUMEN

During 2014-2016, the largest outbreak of Ebola virus disease (EVD) in history occurred in West Africa. The New York City Department of Health and Mental Hygiene (DOHMH) worked with health care providers to prepare for persons under investigation (PUIs) for EVD in New York City. From July 1, 2014, through December 29, 2015, we classified as a PUI a person with EVD-compatible signs or symptoms and an epidemiologic risk factor within 21 days before illness onset. Of 112 persons who met PUI criteria, 74 (66%) sought medical care and 49 (44%) were hospitalized. The remaining 38 (34%) were isolated at home with daily contact by DOHMH staff members. Thirty-two (29%) PUIs received a diagnosis of malaria. Of 10 PUIs tested, 1 received a diagnosis of EVD. Home isolation minimized unnecessary hospitalization. This case study highlights the importance of developing competency among clinical and public health staff managing persons suspected to be infected with a high-consequence pathogen.


Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica Ebola/epidemiología , Administración en Salud Pública , Adolescente , Adulto , Niño , Preescolar , Femenino , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/fisiopatología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Vigilancia de la Población , Medición de Riesgo , Adulto Joven
6.
Pan Afr Med J ; 33(Suppl 2): 8, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31404295

RESUMEN

Introduction: Following a declaration by the World Health Organization that Liberia had successfully interrupted Ebola virus transmission on May 9th, 2015; the country entered a period of enhanced surveillance. The number of cases had significantly reduced prior to the declaration, leading to closure of eight out of eleven Ebola testing laboratories. Enhanced surveillance led to an abrupt increase in demand for laboratory services. We report interventions, achievements, lessons learned and recommendations drawn from enhancing laboratory capacity. Methods: Using archived data, we reported before and after interventions that aimed at increasing laboratory capacity. Laboratory capacity was defined by number of laboratories with Ebola Virus Disease (EVD) testing capacity, number of competent staff, number of specimens tested, specimen backlog, daily and surge testing capacity, and turnaround time. Using Stata 14 (Stata Corporation, College Station, TX, USA), medians and trends were reported for all continuous variables. Results: Between May and December 2015, interventions including recruitment and training of eight staff, establishment of one EVD laboratory facility, implementation of ten Ebola GeneXpert diagnostic platforms, and establishment of working shifts yielded an 8-fold increase in number of specimens tested, a reduction in specimens backlog to zero, and restoration of turn-around time to 24 hours. This enabled a more efficient surveillance system that facilitated timely detection and containment of two EVD clusters observed thereafter. Conclusion: Effective enhancement of laboratory services during high demand periods requires a combination of context-specific interventions. Building and ensuring sustainability of local capacity is an integral part of effective surveillance and disease outbreak response efforts.


Asunto(s)
Creación de Capacidad , Brotes de Enfermedades/prevención & control , Fiebre Hemorrágica Ebola/epidemiología , Laboratorios/organización & administración , Técnicas de Laboratorio Clínico , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/prevención & control , Humanos , Liberia/epidemiología
7.
Crit Care Clin ; 35(4): 697-710, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31445614

RESUMEN

Outbreaks of Ebola virus disease and high-risk transmissible infections are increasing and pose threats to health care workers and global health systems. Previous outbreaks offer lessons for health system preparedness and response, including establishment of hospital-based high-risk pathogen treatment units. Their creation demands early preparation and interprofessional coordination; infection prevention and control; case management training; prepositioning of supplies; conversion of existing structures to treatment units; and strengthening communication and research platforms. Hospital-based Ebola and high-risk pathogen treatment units may improve case detection, interrupt transmission, and improve staff safety and patient care.


Asunto(s)
Planificación en Desastres , Fiebre Hemorrágica Ebola/terapia , Unidades de Cuidados Intensivos/organización & administración , Cuidados Críticos/métodos , Cuidados Críticos/organización & administración , Brotes de Enfermedades , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/epidemiología , Humanos
8.
Sante Publique ; S1(HS): 107-114, 2019 May 13.
Artículo en Francés | MEDLINE | ID: mdl-31210471

RESUMEN

At a time when more than 5 million tonnes of bushmeat are harvested annually from tropical forests, and which account for a significant, but unrecorded, share of the gross domestic product of many forest countries, decision makers are encouraged, within conservation and food security policies, to understand the role that wildlife can play in the conservation of ecosystem services. In this article, we present an analysis of the problem, describing the role played by bushmeat in human diets, and the health risks linked to the consumption of bushmeat, in particular with regard to Ebola disease, to provide insights on the direction of possible strategies to manage the use of wildlife for meeting the needs of local populations and reducing risks to human health.


Asunto(s)
Ebolavirus , Abastecimiento de Alimentos , Fiebre Hemorrágica Ebola/transmisión , Bosque Lluvioso , Zoonosis , Animales , Ecosistema , Fiebre Hemorrágica Ebola/diagnóstico , Humanos
9.
Adv Mater ; 31(30): e1902331, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31168856

RESUMEN

Sensitive detection of pathogens is crucial for early disease diagnosis and quarantine, which is of tremendous need in controlling severe and fatal illness epidemics such as of Ebola virus (EBOV) disease. Serology assays can detect EBOV-specific antigens and antibodies cost-effectively without sophisticated equipment; however, they are less sensitive than reverse transcriptase polymerase chain reaction (RT-PCR) tests. Herein, a 3D plasmonic nanoantenna assay sensor is developed as an on-chip immunoassay platform for ultrasensitive detection of Ebola virus (EBOV) antigens. The EBOV sensor exhibits substantial fluorescence intensity enhancement in immunoassays compared to flat gold substrate. The nanoantenna-based biosensor successfully detects EBOV soluble glycoprotein (sGP) in human plasma down to 220 fg mL-1 , a significant 240 000-fold sensitivity improvement compared to the 53 ng mL-1 EBOV antigen detection limit of the existing rapid EBOV immunoassay. In a mock clinical trial, the sensor detects sGP-spiked human plasma samples at two times the limit of detection with 95.8% sensitivity. The results combined highlight the nanosensor's extraordinary capability of detecting EBOV antigen at ultralow concentration compared to existing immunoassay methods. It is a promising next-generation bioassay platform for early-stage disease diagnosis and pathogen detection for both public health and national security applications.


Asunto(s)
Antígenos Virales/sangre , Ebolavirus/inmunología , Fiebre Hemorrágica Ebola/diagnóstico , Nanoestructuras/química , Proteínas Virales de Fusión/sangre , Técnicas Biosensibles/métodos , Campos Electromagnéticos , Colorantes Fluorescentes/química , Oro/química , Humanos , Inmunoensayo , Límite de Detección , Sensibilidad y Especificidad , Dióxido de Silicio/química , Espectrometría de Fluorescencia , Propiedades de Superficie
10.
PLoS One ; 14(5): e0215642, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31071117

RESUMEN

The development of point-of-care (POC) diagnostic systems has received well-deserved attention in recent years in the scientific literature, and many experimental systems show great promise in real settings. However, in the case of an epidemic emergency (or a natural disaster), the first line of response should be based on commercially available and validated resources. Here, we compare the performance and ease of use of the miniPCR, a recently commercially available compact and portable PCR device, and a conventional thermocycler for the diagnostics of viral nucleic acids. We used both thermocyclers to detect and amplify Ebola and Zika DNA sequences of different lengths (in the range of 91 to 300 nucleotides) at different concentrations (in the range of ~50 to 4.0 x 108 DNA copies). Our results suggest that the performance of both thermocyclers is quite similar. Moreover, the portability, ease of use, and reproducibility of the miniPCR makes it a reliable alternative for point-of-care nucleic acid detection and amplification.


Asunto(s)
Fiebre Hemorrágica Ebola/diagnóstico , Reacción en Cadena de la Polimerasa/instrumentación , ARN Viral/genética , Infección por el Virus Zika/diagnóstico , Ebolavirus/genética , Ebolavirus/aislamiento & purificación , Humanos , Miniaturización/instrumentación , Sistemas de Atención de Punto , Virus Zika/genética , Virus Zika/aislamiento & purificación
11.
Semin Diagn Pathol ; 36(3): 197-202, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-31072653

RESUMEN

Infections are common during travel, and frontline physicians frequently must evaluate sick returned travelers. Sick travelers can be clinically challenging due to the wide range of endemic diseases in different geographic regions. To guide the diagnostic and treatment plan, consideration of endemic and emerging infections in the region of travel, as well as careful review of the travelers' exposures and preventative measures are necessary. Routine laboratory tests and cultures cannot confirm many tropical infections, and pathogen directed testing is typically required. Common tropical infections that can be severe, such as malaria, dengue, and enteric fever, should always be considered in the diagnostic evaluation. Providers should also be vigilant for rare but highly pathogenic emerging infections such as Ebola virus disease and Middle East respiratory syndrome (MERS).


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Dengue/diagnóstico , Fiebre Hemorrágica Ebola/diagnóstico , Malaria/diagnóstico , Fiebre Tifoidea/diagnóstico , Infecciones por Coronavirus/patología , Dengue/patología , Fiebre Hemorrágica Ebola/patología , Humanos , Malaria/patología , Viaje , Medicina Tropical , Fiebre Tifoidea/patología
12.
BMC Med Inform Decis Mak ; 19(1): 100, 2019 05 27.
Artículo en Inglés | MEDLINE | ID: mdl-31133075

RESUMEN

BACKGROUND: The 2014-2016 West Africa Ebola epidemic highlighted the difficulty of collecting patient information during emergencies, especially in highly infectious environments. Health information systems (HISs) appropriate for such settings were lacking prior to this outbreak. Here we describe our development and implementation of paper and electronic HISs at the Sierra Leone Kerry Town Ebola treatment centre (ETC) from 2014 to 2015. We share our approach, experiences, and recommendations for future health emergencies. METHODS: We developed eight fact-finding questions about data-related needs, priorities, and restrictions at the ETC ("inputs") to inform eight structural decisions ("outputs") across six core HIS components. Semi-structured interviews about the "inputs" were then conducted with HIS stakeholders, chosen based on their teams' involvement in ETC HIS-related activities. Their responses were used to formulate the "output" results to guide the HIS design. We implemented the HIS using an Agile approach, monitored system usage, and developed a structured questionnaire on user experiences and opinions. RESULTS: Some key "input" responses were: 1) data needs for priorities (patient care, mandatory reporting); 2) challenges around infection control, limited equipment, and staff clinical/language proficiencies; 3) patient/clinical flows; and 4) weak points from staff turnover, infection control, and changing protocols. Key outputs included: 1) determining essential data, 2) data tool design decisions (e.g. large font sizes, checkboxes/buttons), 3) data communication methods (e.g. radio, "collective memory"), 4) error reduction methods (e.g. check digits, pre-written wristbands), and 5) data storage options (e.g. encrypted files, accessible folders). Implementation involved building data collection tools (e.g. 13 forms), preparing the systems (e.g. supplies), training staff, and maintenance (e.g. removing old forms). Most patients had basic (100%, n = 456/456), drug (96.9%, n = 442/456), and additional clinical/epidemiological (98.9%, n = 451/456) data stored. The questionnaire responses highlighted the importance of usability and simplicity in the HIS. CONCLUSIONS: HISs during emergencies are often ad-hoc and disjointed, but systematic design and implementation can lead to high-quality systems focused on efficiency and ease of use. Many of the processes used and lessons learned from our work are generalizable to other health emergencies. Improvements should be started now to have rapidly adaptable and deployable HISs ready for the next health emergency.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Servicio de Urgencia en Hospital/organización & administración , Epidemias , Sistemas de Información en Salud , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/terapia , Recolección de Datos , Urgencias Médicas , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Almacenamiento y Recuperación de la Información , Sierra Leona/epidemiología
13.
BMC Public Health ; 19(1): 364, 2019 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-30940125

RESUMEN

BACKGROUND: The Ministry of Health and Sanitation (MOHS) in Sierra Leone partially rolled out the implementation of Integrated Disease Surveillance and Response (IDSR) in 2003. After the Ebola virus disease outbreak in 2014-2015, there was need to strengthen IDSR to ensure prompt detection and response to epidemic-prone diseases. We describe the processes, successes and challenges of revitalizing public health surveillance in a country recovering from a protracted Ebola virus disease outbreak. METHODS: The revitalization process began with adaptation of the revised IDSR guidelines and development of customized guidelines to suit the health care systems in Sierra Leone. Public health experts defined data flow, system operations, case definitions, frequency and channels of reporting and dissemination. Next, phased training of IDSR focal persons in each health facility and the distribution of data collection and reporting tools was done. Monitoring activities included periodic supportive supervision and data quality assessments. Rapid response teams were formed to investigate and respond to disease outbreak alerts in all districts. RESULTS: Submission of reports through the IDSR system began in mid-2015 and by the 35th epidemiologic week, all district health teams were submitting reports. The key performance indicators measuring the functionality of the IDSR system in 2016 and 2017 were achieved (WHO Africa Region target ≥80%); the annual average proportion of timely weekly health facility reports submitted to the next level was 93% in 2016 and 97% in 2017; the proportion of suspected outbreaks and public health events detected through the IDSR system was 96% (n = 87) in 2016 and 100% (n = 85) in 2017. CONCLUSION: With proper planning, phased implementation and adequate investment of resources, it is possible to establish a functional IDSR system in a country recovering from a public health crisis. A functional IDSR system requires well trained workforce, provision of the necessary tools and guidelines, information, communication and technology infrastructure to support data transmission, provision of timely feedback as well as logistical support.


Asunto(s)
Prestación de Atención de Salud , Planificación en Desastres , Brotes de Enfermedades , Instituciones de Salud , Fiebre Hemorrágica Ebola/prevención & control , Vigilancia en Salud Pública , Salud Pública , África/epidemiología , Recolección de Datos , Recursos en Salud , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Informe de Investigación , Sierra Leona/epidemiología
14.
Nurs Clin North Am ; 54(2): 169-180, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31027659

RESUMEN

The 2014 to 2016 Ebola outbreak response resulted in many lessons learned about biocontainment patient care, leading to enhanced domestic capabilities for highly infectious and hazardous communicable diseases. However, additional opportunities for improvement remain. The article identifies and describes key considerations and challenges for laboratory analysis, clinical management, transportation, and personnel management during the care of patients infected with Ebola or other special pathogens. Dedication to maintaining preparedness enables biocontainment patient care teams to perform at the highest levels of safety and confidence.


Asunto(s)
Contención de Riesgos Biológicos/normas , Brotes de Enfermedades/prevención & control , Guías como Asunto , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/terapia , Medidas de Seguridad/normas , África Occidental , Humanos , Estados Unidos
15.
Emerg Infect Dis ; 25(6): 1238-1240, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30900978

RESUMEN

Operating clinical analyzers within recommended parameters can be challenging during outbreak response. Using the Piccolo Xpress point-of-care blood chemistry analyzer on guinea pig blood, we found that values of many analytes are still readily comparable when samples and reagent discs are handled at various conditions outside of manufacturer recommendations.


Asunto(s)
Ebolavirus , Fiebre Hemorrágica Ebola/sangre , Fiebre Hemorrágica Ebola/diagnóstico , Pruebas Serológicas/métodos , Animales , Modelos Animales de Enfermedad , Femenino , Cobayas , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Masculino , Sistemas de Atención de Punto , Pruebas Serológicas/normas
16.
PLoS One ; 14(3): e0212113, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30845203

RESUMEN

BACKGROUND: Without an effective vaccine, as was the case early in the 2014-2016 Ebola Outbreak in West Africa, disease control depends entirely on interrupting transmission through early disease detection and prompt patient isolation. Lateral Flow Immunoassays (LFI) are a potential supplement to centralized reference laboratory testing for the early diagnosis of Ebola Virus Disease (EVD). The goal of this study was to assess the performance of commercially available simple and rapid antigen detection LFIs, submitted for review to the WHO via the Emergency Use Assessment and Listing procedure. The study was performed in an Ebola Treatment Centre laboratory involved in EVD testing in Sierra Leone. In light of the current Ebola outbreak in May 2018 in the Democratic Republic of Congo, which highlights the lack of clarity in the global health community about appropriate Ebola diagnostics, our findings are increasingly critical. METHODS: A cross-sectional study was conducted to assess comparative performance of four LFIs for detecting EVD. LFIs were assessed against the same 328 plasma samples and 100 whole EDTA blood samples, using the altona RealStar Filovirus Screen real-time RT-PCR as the bench mark assay. The performance of the Public Health England (PHE) in-house Zaire ebolavirus-specific real time RT-PCR Trombley assay was concurrently assessed. Statistical analysis using generalized estimating equations was conducted to compare LFI performance. FINDINGS: Sensitivity and specificity varied between the LFIs, with specificity found to be significantly higher for whole EDTA blood samples compared to plasma samples in at least 2 LFIs (P≤0.003). Using the altona RT-PCR assay as the bench mark, sensitivities on plasma samples ranged from 79.53% (101/127, 95% CI: 71.46-86.17%) for the DEDIATEST EBOLA (SD Biosensor) to 98.43% (125/127, 95% CI: 94.43-99.81%) for the One step Ebola test (Intec). Specificities ranged from 80.20% (158/197, 95% CI: 74.07-88.60%) for plasma samples using the ReEBOV Antigen test Kit (Corgenix) to 100.00% (98/98, 95% CI: 96.31-100.00%) for whole blood samples using the DEDIATEST EBOLA (SD Biosensor) and SD Ebola Zaire Ag (SD Biosensor). Results also showed the Trombley RT-PCR assay had a lower limit of detection than the altona assay, with some LFIs having higher sensitivity than the altona assay when the Trombley assay was the bench mark. INTERPRETATION: All of the tested EVD LFIs may be considered suitable for use in an outbreak situation (i.e. rule out testing in communities), although they had variable performance characteristics, with none possessing both high sensitivity and specificity. The non-commercial Trombley Zaire ebolavirus RT-PCR assay warrants further investigation, as it appeared more sensitive than the current gold standard, the altona Filovirus Screen RT-PCR assay.


Asunto(s)
Fiebre Hemorrágica Ebola/diagnóstico , Inmunoensayo/métodos , Adulto , Antígenos Virales/sangre , Estudios Transversales , Brotes de Enfermedades/prevención & control , Ebolavirus/genética , Epidemias , Femenino , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Pruebas Inmunológicas , Masculino , Sistemas de Atención de Punto , ARN Viral/sangre , Juego de Reactivos para Diagnóstico/virología , Sensibilidad y Especificidad , Sierra Leona
17.
Infect Dis Clin North Am ; 33(1): 247-264, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30712765

RESUMEN

The 2014 to 2016 Ebola virus disease outbreak underscored the threat posed by hemorrhagic fevers. Filoviral outbreaks have been identified since 1967, but data collection has remained sparse, limiting current knowledge of these illnesses. Documentation of objective physical signs and laboratory parameters and appropriate clinical management are connected and interdependent. Implementing both is necessary to improve outcomes. Clinical features include severe volume depletion due to diarrhea and vomiting, shock, rhabdomyolysis, and metabolic disturbances. Overt hemorrhage is uncommon. Point-of-care devices and inexpensive electronic equipment enable better monitoring and record keeping in resource-limited settings.


Asunto(s)
Manejo de la Enfermedad , Medicina Basada en la Evidencia , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/terapia , Diarrea/virología , Brotes de Enfermedades , Fiebre/virología , Humanos
18.
Br Med Bull ; 129(1): 79-89, 2019 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-30806466

RESUMEN

BACKGROUND: West African governments, the WHO and wider international community were caught unprepared for the world's largest Ebola outbreak of 2014-16. This was an unprecedented challenge to local services and international agencies, since the emergency required high-tech molecular diagnostic services operated by specialist staff and a coordinated emergency response in addition to humanitarian support, which was not available at the beginning of the outbreak. Public Health England (PHE), as a new national public health agency was well placed to provide support for these needs. After the outbreak, PHE supported reconstruction to ensure diagnostic and emergency planning capability remained in place in the immediate aftermath of the outbreak and build necessary public health infrastructure for the future. The article describes the role PHE played as a national public health agency supporting reconstruction and long-term development through the UK Government (Department for International Development) programme called 'Resilient Zero'. SOURCES OF DATA: Public Health England (PHE), UK Government's Department for International Development, WHO, US Centers for Communicable Diseases (CDC), China Centre for Communicable Diseases (China CDC). AREAS OF AGREEMENT: The need for reliable, sustainable, in country molecular diagnostics, together with a programme to strengthen in country Emergency Planning, Preparedness and Response (EPRR). AREAS OF CONTROVERSY: Providing high tech molecular capability in a resource-poor West African country with variable provision of basic diagnostic equipment, intermittent power supply, ineffective supply chains and maintaining training capacity for emergency planning in the long term. Emergency planning models from the West needed to be adapted for the countries' context. Short term aid projects as a model did not suite this development requirement. GROWING POINTS: PHE had strong local and international political support to reconstruct three Government regional laboratories and deploy molecular technology. Significant learning by PHE as a national public health agency and sharing this will be of benefit to other national public health agencies. UK staff reported increased levels of satisfaction and experience relevant to public health practice. The Sierra Leonean Government and officials requested long-term levels of commitment. It is important for agencies such as PHE to constantly learn, develop long-term institutional partnerships and play a bigger role with other similar agencies internationally. AREAS TIMELY FOR DEVELOPING RESEARCH: How best to support sustainable high-tech molecular technology in West Africa and modules for emergency planning relevant to the context; evidence for long term versus short-term support for highly complex diagnostic capabilities; relevance to maintaining individual country public health infrastructure to ensuring global health security; benefits of overseas work for employee of a national agency.


Asunto(s)
Fiebre Hemorrágica Ebola/epidemiología , Administración en Salud Pública , África Occidental/epidemiología , Planificación en Desastres/organización & administración , Brotes de Enfermedades , Urgencias Médicas , Fiebre Hemorrágica Ebola/diagnóstico , Humanos , Laboratorios/organización & administración , Técnicas de Diagnóstico Molecular/métodos
19.
Int J Gynaecol Obstet ; 145(1): 76-82, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30706470

RESUMEN

OBJECTIVES: To examine Ebola virus disease (EVD) symptom prevalence and EVD status among pregnant women in Ebola isolation units in Sierra Leone. METHODS: In an observational study, data were obtained for pregnant women admitted to Ebola isolation units across four districts in Sierra Leone from June 29, 2014, to December 20, 2014. Women were admitted to isolation units if they had suspected EVD exposures or fever (temperature >38°C) and three or more self-reported symptoms suggestive of EVD. Associations were examined between EVD status and each symptom using χ2 tests and logistic regression adjusting for age/labor status. RESULTS: Of 176 pregnant women isolated, 55 (32.5%) tested positive for EVD. Using logistic regression models adjusted for age, EVD-positive women were significantly more likely to have fever, self-reported fatigue/weakness, nausea/vomiting, headache, muscle/joint pain, chest pain, vaginal bleeding, unexplained bleeding, or sore throat upon admission. In models adjusted for age/labor, only women with fever or vaginal bleeding upon admission were significantly more likely to be EVD-positive. CONCLUSIONS: Several EVD symptoms and complications increased the odds of testing EVD-positive; some of these were also signs and symptoms of labor/pregnancy complications. The study results highlight the need to refine screening for pregnant women with EVD.


Asunto(s)
Fiebre Hemorrágica Ebola/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Adolescente , Adulto , Fatiga/etiología , Femenino , Fiebre/etiología , Cefalea , Hemorragia/etiología , Fiebre Hemorrágica Ebola/fisiopatología , Hospitalización , Humanos , Modelos Logísticos , Náusea/etiología , Aislamiento de Pacientes , Embarazo , Complicaciones Infecciosas del Embarazo/fisiopatología , Estudios Retrospectivos , Sierra Leona , Vómitos/etiología , Adulto Joven
20.
BMC Infect Dis ; 19(1): 81, 2019 Jan 24.
Artículo en Inglés | MEDLINE | ID: mdl-30678649

RESUMEN

BACKGROUND: The West Africa Ebola Virus Disease (EVD) outbreak in 2014-2016 was declared by the World Health Organization (WHO) a public health emergency of international concern. Most of the previous studies done in Sierra Leone relating to the clinical and epidemiological features of EVD during the 2014-2016 West African outbreak focused on adult EVD patients. There have been conflicting reports about the effects of EVD on children during previous outbreaks. METHODS: This is an observational retrospective analysis of medical data of all laboratory confirmed paediatric EVD patients below 15 years of age who were admitted at the 34 Military Hospital Ebola Treatment Center (ETC) in Wilberforce, Sierra Leone between June 2014 to April 2015. We analyzed the sociodemographic and clinical characteristics of paediatric EVD cases contained in case report forms that were collected by Ebola surveillance officers and clinicians at the 34 Military Hospital ETC. Both univariate and multivariate logistic regression models were used to determine the sociodemographic and clinical characteristics of paediatric EVD patients that were associated with EVD facility-based mortality. RESULTS: The majority of the paediatric EVD cases in this study were female (56.1%), pupils (51.1%), and 43.2% belonged to the age group between 10 years and below 15 years. The median age of the paediatric EVD cases was 9 years (interquartile range = 4 to 11 years). Adjusting for other covariates in the model, male paediatric EVD patient (AOR = 13.4, 95% CI = [2.07-156-18], p <  0.05), EVD patient with abdominal pain (AOR = 11.0, 95% CI = [1.30-161.81], p <  0.05), vomiting (AOR = 35.7, 95% CI = [3.43-833.73], p <  0.05), signs of conjunctivitis (AOR = 17.4, 95% CI = [1.53-342.21], p <  0.05) and difficulty in breathing (AOR = 23.3, 95% CI = [1.92-713.01], p <  0.05) at the time of admission had increased odds of dying during EVD treatment. CONCLUSIONS: We recommend the adoption of case definitions currently in vigour to cater for specific characteristics of paediatric patients. Subgroups that can be identified by applying the model developed in this study may require special attention and intensified care.


Asunto(s)
Fiebre Hemorrágica Ebola/tratamiento farmacológico , Adulto , Antivirales/administración & dosificación , Niño , Preescolar , Brotes de Enfermedades , Ebolavirus/fisiología , Femenino , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/virología , Hospitalización , Humanos , Modelos Logísticos , Masculino , Pediatría/estadística & datos numéricos , Estudios Retrospectivos , Sierra Leona/epidemiología , Resultado del Tratamiento
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