We report two cases of confirmed Ebola virus disease in pregnant women, who presented at the Médecins Sans Frontières Ebola treatment centre in Guéckédou. Despite the very high risk of death, both pregnant women survived. In both cases the critical decision was made to induce vaginal delivery. We raise a number of considerations regarding the management of Ebola virus-infected pregnant women, including the place of amniocentesis and induced delivery, and whether certain invasive medical acts are justified.We report two cases of confirmed Ebola virus disease (EVD) in pregnant patients who presented and were treated at the Médecins Sans Frontières (MSF) Ebola treatment centre in Guéckedou. We also raise a number of considerations regarding the role of amniocentesis and induced delivery in the management of pregnant women with EVD.

Introduction: The current Ebola outbreak represents the largest in history. Understanding psychological reactions among EVD survivors may provide relevant information about post-treatment adjustment and possible psychological preventative measures. We therefore studied the psychological reactions in Ebola Virus Disease survivors following their discharge from an Ebola treatment centre in Sierra Leone. Methods: Immediately following discharge, survivors met with the psychologist to discuss their experiences in the case management centre and the challenges they may face returning to their communities. Of 74 survivors discharged in the study period, 24 were followed up at home for a psychological consultation three to four weeks after discharge. During the home visit the psychologist applied an adaptation of the trauma screening questionnaire and explored number of family deaths from Ebola Virus Disease, stigma, the meaning they attached to the causation of their illness and general post illness adjustment. Results: All survivors had lost immediate family members to Ebola Virus Disease. Most (16; 67%) had also witnessed their deaths. Eight (32%) survivors had experienced stigma when returning to their communities. Seventeen (71%) survivors experienced arousal and re-experiencing reactions during the first two days post discharge. Five (21%) reported clinically important post traumatic reactions between three and four weeks post discharge predicting a risk of developing post-traumatic stress disorder. Conclusion: Although this study represents a snapshot of post-traumatic stress reactions observed in Ebola survivors, it does demonstrate the need to consider the likelihood of psychological sequelae in EVD survivors. Long term follow-up of is needed to understand psychological care needs of Ebola survivors.

In October 2012, a cluster of illnesses and deaths was reported in Uganda and was confirmed to be an outbreak of Marburg virus disease (MVD). Patients meeting the case criteria were interviewed using a standard investigation form, and blood specimens were tested for evidence of acute or recent Marburg virus infection by reverse transcription–polymerase chain reaction (RT-PCR) and antibody enzyme-linked immunosorbent assay. The total count of confirmed and probable MVD cases was 26, of which 15 (58%) were fatal. Four of 15 laboratory-confirmed cases (27%) were fatal. Case patients were located in 4 different districts in Uganda, although all chains of transmission originated in Ibanda District, and the earliest case detected had an onset in July 2012. No zoonotic exposures were identified. Symptoms significantly associated with being a MVD case included hiccups, anorexia, fatigue, vomiting, sore throat, and difficulty swallowing. Contact with a case patient and attending a funeral were also significantly associated with being a case. Average RT-PCR cycle threshold values for fatal cases during the acute phase of illness were significantly lower than those for nonfatal cases. Following the institution of contact tracing, active case surveillance, care of patients with isolation precautions, community mobilization, and rapid diagnostic testing, the outbreak was successfully contained 14 days after its initial detection.

Prevention of nosocomial Ebola virus (EBOV) infection among patients admitted to an Ebola management centre (EMC) is paramount. Current Médecins Sans Frontières (MSF) guidelines recommend classifying admitted patients at triage into suspect and highly-suspect categories pending laboratory confirmation. We investigated the performance of the MSF triage system to separate patients with subsequent EBOV-positive laboratory test (true-positive admissions) from patients who were initially admitted on clinical grounds but subsequently tested EBOV-negative (false-positive admissions). We calculated standard diagnostic test statistics for triage allocation into suspect or highly-suspect wards (index test) and subsequent positive or negative laboratory results (reference test) among 433 patients admitted into the MSF EMC Kailahun, Sierra Leone, between 1 July and 30 September 2014. 254 (59%) of admissions were classified as highly-suspect, the remaining 179 (41%) as suspect. 276 (64%) were true-positive admissions, leaving 157 (36.3%) false-positive admissions exposed to the risk of nosocomial EBOV infection. The positive predictive value for receiving a positive laboratory result after being allocated to the highly-suspect ward was 76%. The corresponding negative predictive value was 54%. Sensitivity and specificity were 70% and 61%, respectively. Results for accurate patient classification were unconvincing. The current triage system should be changed. Whenever possible, patients should be accommodated in single compartments pending laboratory confirmation. Furthermore, the initial triage step on whether or not to admit a patient in the first place must be improved. What is ultimately needed is a point-of-care EBOV diagnostic test that is reliable, accurate, robust, mobile, affordable, easy to use outside strict biosafety protocols, providing results with quick turnaround time.

CitationFavipiravir--a prophylactic treatment for Ebola contacts? 2015, 385 (9985):2350 Lancet

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