A Modified Case Definition to Facilitate Essential Hospital Care During Ebola Outbreaks

Huizenga, Erdi; Ende, Jacob van der; Zwinkels, N.; Jimissa, Augustine S.; Ende-Bouwman, Carolien van der; Rooijen, Ruurd van; Kargbo, Brima; Agnandji, Selidji Todagbé; Hänscheid, Thomas; Goorhuis, Abraham; Grobusch, Martin P.

doi:10.1093/cid/ciy798

Cited by 7 publications

(10 citation statements)

References 24 publications

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“…Given these considerations, currently no EVD case definition is globally applied. Indeed, the EVD case defi nition can be reiterated during the course of an outbreak; such variations in case definition were used during the 2013-2016 Western African outbreak (for example, in Sierra Leone 61 ) as the outbreak evolved from a high incidence to a low incidence. Although novel case definitions are limited by variations in EVD prevalence during a particular outbreak and the intrinsic lack of specificity of case definitions compared with common endemic causes of acute febrile and diarrhoeal disease, their performance characteristics have been evaluated (box 4).…”

mentioning

confidence: 99%

Ebola virus disease

Jacob

Crozier

Fischer

et al. 2020

Nat Rev Dis Primers

374

345

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To date, 12 distinct filoviruses have been described 1. The seven filoviruses that have been found in humans belong either to the genus Ebolavirus (Bundibugyo virus (BDBV), Ebola virus (EBOV), Reston virus (RESTV), Sudan virus (SUDV) and Taï Forest virus (TAFV); Fig. 1) or to the genus Marburgvirus (Marburg virus (MARV) and Ravn virus (RAVV)) 2. The WHO International Classification of Diseases Revision 11 (ICD-11) of 2018 recognizes two major subcategories of filovirus disease (FVD): Ebola disease caused by BDBV, EBOV, SUDV or TAFV, and Marburg disease caused by MARV or RAVV. Ebola virus disease (EVD) is defined as a disease only caused by EBOV. This subcategorization of FVD is largely based on the increasing evidence of molecular differences between ebolaviruses and marburgviruses, differences that may influence virus-host reservoir tropism, pathogenesis and disease phenotype in accidental primate hosts 2. Since the discovery of filoviruses in 1967 (reF. 3), 43 FVD outbreaks (excluding at least five laboratoryacquired infections) have been recorded in or exported from Africa 4. The epidemiological definition of outbreak is one or more cases above the known endemic prevalence. For example, the single case of TAFV infection recorded in a setting in which FVD had never been reported before (Côte d'Ivoire) 5 is still considered an outbreak. All FVD outbreaks, with the exception of that caused by TAFV, were characterized by extremely high case-fatality rates (CFRs, also known as lethality). Until 2013, the most extensive outbreak, caused by SUDV, involved 425 cases and 224 deaths (CFR 52.7%) 6. The overall limited numbers of FVD cases (1967-2013: 2,886 cases including 1,982 deaths 4), the typical remote and rural locations of outbreaks and the often delayed announcement of new outbreaks to the international community 7 have prevented the systematic study of clinical FVD in humans. Thus, the commonly used description of FVD was derived either from observation of small groups of patients in care settings that were not well-equipped for diagnosis, treatment and disease characterization, or from observations of even smaller samples, such as individuals who were transferred from Equatorial Africa to Europe and the USA or who fell sick in Europe or the USA after contracting the virus elsewhere. Pathological characterization of FVD via autopsies has been rare 7,8. In the absence of extensive human clinical data, FVD could only be defined further via the use of experimental animal infections 9,10 .

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mentioning

confidence: 99%

Ebola virus disease

Jacob

Crozier

Fischer

et al. 2020

Nat Rev Dis Primers

374

345

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“…In Sierra Leone, measurements taken include training of healthcare professionals, establishing testing facilities, information campaigns and a partial lockdown. In many ways, there are parallels with the early phase of the West African Ebola outbreak 2013-2016including a steep decrease in in-and outpatients across health facilities [2].…”

Section: Dear Editormentioning

confidence: 99%

Primum non nocere: Potential indirect adverse effects of COVID-19 containment strategies in the African region

Wehrens

Bangura

Falama

et al. 2020

Travel Medicine and Infectious Disease

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“…Country-wide in 2013, only slightly more than half of the women gave birth in a health facility; 49.7% of women in rural areas versus 68.1% in urban areas (1). The West-African Ebola outbreak from 2013 to 2016 led to a further reduction in facility-based births as a consequence of a lack of possibilities to access the health system during the crisis (4,5).…”

Section: Introductionmentioning

confidence: 99%

Perceptions of health workers on the referral of women with obstetric complications: a qualitative study in rural Sierra Leone

Proos

Mathéron²,

Nunes³

et al. 2020

Preprint

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BackgroundSierra Leone has one of the highest maternal mortality ratios in the world. Timely and well-coordinated referrals are necessary to reduce delays in providing adequate care for women with obstetric complications. This study describes the perspectives of health workers in rural facilities in Sierra Leone concerning the referral of women with obstetric complications.MethodsWe conducted semi-structured group interviews with health care workers in nine peripheral health units in rural Sierra Leone regarding the referral of women with obstetric complications. Themes discussed were based on an interview guide. The data was analysed by systematic text condensation.ResultsPerspectives were grouped according to the following themes identified: 1) communication between health care workers; 2) underlying influences on decision-making; 3) women’s compliance to referral; 4) logistic constraints.ConclusionSeveral factors in rural Sierra Leone are perceived to complicate timely and adequate referral of women in need of emergency obstetric care. Notable among these factors are fear among women for being referred and fear among health care workers for having maternal deaths or severe obstetric complications at their own facilities. Furthermore, the decision-making of health care workers concerning referral is negatively influenced by an atmosphere of hierarchy between health care workers. Such factors must be considered in efforts to reduce maternal mortality.

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A Modified Case Definition to Facilitate Essential Hospital Care During Ebola Outbreaks

Cited by 7 publications

References 24 publications

Ebola virus disease

Ebola virus disease

Primum non nocere: Potential indirect adverse effects of COVID-19 containment strategies in the African region

Perceptions of health workers on the referral of women with obstetric complications: a qualitative study in rural Sierra Leone

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