Despite resource and logistical constraints, International Medical Corps cared for thousands at 5 Ebola treatment units in Liberia and Sierra Leone between 2014 and 2015 while collecting hundreds of data points on each patient. To facilitate data collection and global reporting in future humanitarian responses, standardized data forms and databases, with clear definitions of clinical and epidemiological variables, should be developed and adopted by the international community.

SummaryWe find no evidence to support a difference in the risk of death among pregnant women with suspected or confirmed Ebola virus disease (EVD) as compared to nonpregnant women. Limited data suggest poor fetal and neonatal outcomes in EVD-affected pregnancies.

IntroductionPrevious studies of Ebola Virus Disease (EVD) have focused on clinical symptoms and Ebola virus (EBOV) cycle threshold (CT) values recorded at patient triage. Our study explores EVD symptoms and EBOV CT values from onset of illness to recovery or death in a diverse population of patients.Methodology/Principal findingsWe analyzed clinical care data from EBOV positive patients admitted to five Ebola treatment units in West Africa from 2014–2015. Prevalence of clinical signs/symptoms and CT values were explored using descriptive statistics. Logistic regression was used to examine their association with mortality. Survival was analyzed using Kaplan-Meier estimators from symptom onset date to death. During the first week of illness, dyspnea (OR = 2.44, 95% CI: 1.07–5.85) and tachycardia (OR = 10.22, 95% CI: 2.20–56.71) were associated with higher odds of mortality. Dyspnea (OR = 2.33, 95% CI: 1.210–4.581), bleeding (OR = 2.51, 95% CI: 1.219–5.337), and diarrhoea (OR = 2.79, 95% CI: 1.171–6.970) at any point during the illness course were associated with higher odds of mortality. Higher initial (OR = 0.85, 95% CI: 0.81–0.89) and mean (OR = 0.60, 95% CI: 0.53–0.66) CT values were associated with lower odds of mortality. CT values reached their nadir after 3–5 days of illness and then rose in both survivors and non-survivors until recovery or death.Conclusions/SignificanceOur study demonstrates the population prevalence of clinical signs/symptoms and EBOV CT values over time in a large, diverse cohort of patients with EVD, as well as associations between symptoms/EBOV CT values and mortality. These findings have implications on surveillance, operational planning, and clinical care for future EVD outbreaks.

Introduction Information on immunization delivery costs (IDCs) is essential for better planning and budgeting for the sustainability and performance of national programs. However, delivery cost evidence is fragmented and of variable quality, making it difficult for policymakers, planners, and other stakeholders to understand and use. This study aimed to consolidate and summarize the evidence on delivery costs, answering the question: What are the unit costs of vaccine delivery across low- and middle-income countries (LMICs) and through a variety of delivery strategies? Methods We conducted a systematic review of over 15,000 published and unpublished resources from 2005 to 2018 that included IDCs in LMICs. We quality-rated and extracted data from 61 resources that contained 410 immunization delivery unit costs (e.g., cost per dose, cost per fully immunized child). We converted cost findings to a common year (2016) and currency (U.S. dollars) to ensure comparability across studies and settings. We performed a descriptive and gap analysis and developed immunization delivery cost ranges using comparable unit costs for single vaccines and schedules of vaccines. Results The majority of IDC evidence comes from low-income countries and Sub-Saharan Africa. Most unit costs are presented as cost per dose and represent health facility-based delivery. Discussion The cost ranges may be higher than current estimates used in many LMICs for budgeting: $0.16–$2.54 incremental cost per dose (including economic, financial, and fiscal costs) for single, newly introduced vaccines, and $0.75–$9.45 full cost per dose (economic costs) for schedules of four to eight vaccines delivered to children under one. Conclusions Despite increased attention on improving coverage and strengthening immunization delivery, evidence on the cost of delivery is nascent but growing. The cost ranges can inform planning and policymaking, but should be used with caution given their width and the few unit costs used in their development.

Highlights Poor practices and reporting oversights limit the understanding and use of immunization cost data. Our review identified reporting problems on the vaccines costed, types of costs, and data analysis. Our checklist offers a standard of practice for reporting on immunization costing studies. Reporting that adheres to this checklist will increase the interpretability and use of evidence.