After Ebola in West Africa — Unpredictable Risks, Preventable Epidemics

Agua-Agum, Junerlyn; Allegranzi, Benedetta; Ariyarajah, Archchun; Aylward, R. Bruce; Blake, Isobel M.; Barboza, P; Bausch, Daniel G.; Brennan, Richard; Clement, Peter; Coffey, Pasqualina; Cori, Anne; Donnelly, Christl A.; Dorigatti, Ilaria; Drury, Patrick; Durski, Kara; Dye, Christopher; Eckmanns, Tim; Ferguson, Neil; Fraser, Christophe; Garcia, Erika; Garske, Tini; Gasasira, Alex; Gurry, Céline; Hamblion, Esther; Hinsley, Wes; Holden, Robert W.; Holmes, David; Hugonnet, Stéphane; Gutierrez, Giovanna Jaramillo; Jombart, Thibaut; Kelley, Edward; Santhana, Ravi; Mahmoud, Nuha; Mills, Harriet L.; Mohamed, Yasmine; Musa, Emmanuel; Naidoo, Dhamari; Nedjati-Gilani, Gemma; Newton, Emily; Norton, Ian; Nouvellet, Pierre; Perkins, Devin; Perkins, Mark D.; Riley, Steven; Schumacher, Dirk; Shah, Anita; Tang, Minh; Varsaneux, Olivia; Kerkhove, Maria D. Van

doi:10.1056/nejmsr1513109

Cited by 221 publications

(113 citation statements)

References 28 publications

(27 reference statements)

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“…Healthcare provision measures included: health infrastructure improvements, such as the construction of new clinics, treatment centres, or hospitals [20, 24, 28, 30, 34, 38, 39, 45, 48] ( n = 9, 29%); improved case management [21, 27, 30, 33, 34, 36, 41] ( n = 7, 23%); appointment of public health officers and reorientation of specialists [19, 22, 24, 28, 36, 48] ( n = 6, 19%); training of doctors, community health workers, and other professionals [22, 28, 38, 39] ( n = 4, 13%); provision of pre- or post-exposure prophylaxis [21, 30, 37] ( n = 3, 10%); reactive vaccination campaigns [29, 41, 47] ( n = 3, 10%); introduction of treatment beds [24, 46] ( n = 2, 6%); use of new technology for diagnosis and treatment [24, 27] ( n = 2, 6%); timely hospital admission and effective triage of patients [40] ( n = 1, 3%), and safe transfer of identified cases [40] ( n = 1, 3%). Psychosocial support was also provided in one study [25] ( n = 1, 3%).…”

Section: Resultsmentioning

confidence: 99%

Containment measures for emerging and re-emerging vector-borne and other infectious diseases of poverty in urban settings: a scoping review

et al. 2018

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BackgroundThe emergence and re-emergence of vector-borne and other infectious diseases of poverty pose a threat to the health of populations living in urban and low-income settings. A detailed understanding of intervention strategies, including effectiveness of past outbreak containment, is necessary to improve future practices. The objective was to determine what is known about the effectiveness of containment measures for emerging and re-emerging vector-borne and other infectious diseases of poverty in urban settings and identify research gaps and implications for public health practice.Main bodyWe conducted a scoping review and systematically searched peer-reviewed and grey literature published between 2000 and 2016. Different data extraction tools were used for data coding and extraction, and data on implementation process and transferability were extracted from all studies. A quality assessment was conducted for each included study.We screened 205 full-text articles and reports for a total of 31 articles included in the review. The quality of the studies was generally low to moderate. The largest body of evidence concerned control activities for Ebola virus and dengue fever. The majority of interventions (87%) relied on multiple types of measures, which were grouped into four categories: 1) healthcare provision; 2) epidemiological investigation and/or surveillance; 3) environmental or sanitary interventions; and 4) community-based interventions. The quality of the majority of studies (90%) was poor or moderate, and one-third of the studies did not provide a clear description of the outcomes and of the procedures and/or tools used for the intervention.ConclusionsOur results highlight the difficulty of establishing causation when assessing the effect of containment measures. Studies that extend beyond solely reporting on effectiveness and take into account the complexity of real-world settings are urgently needed. We recommend the allocation of research efforts to the evaluation of the implementation processes of interventions as well as their comprehensive and systematic description using validated checklists.Electronic supplementary materialThe online version of this article (10.1186/s40249-018-0478-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Containment measures for emerging and re-emerging vector-borne and other infectious diseases of poverty in urban settings: a scoping review

et al. 2018

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“…1,2 More than 28,000 cases were reported; of those, more than 11,000 died. The overwhelming majority of cases and deaths occurred in Guinea, Liberia, and Sierra Leone.…”

Section: Purposementioning

confidence: 99%

“…An additional 36 travel-related cases were reported in 6 other countries, including the United States. 1 This challenging global public health emergency led to the largest emergency response in CDC’s history and included participation of ~4000 CDC staff members in both international and domestic efforts. 2 …”

Section: Purposementioning

confidence: 99%

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Addressing Maternal Health During CDC's Ebola Response in the United States

Ellington

Perez

Morof

et al. 2017

Journal of Women's Health

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Previous outbreaks suggest that pregnant women with Ebola virus disease (EVD) are at increased risk for severe disease and death. Healthcare workers who treat pregnant women with EVD are at increased risk of body fluid exposure. Despite the absence of pregnant women with EVD in the United States, CDC activated the Maternal Health Team (MHT), a functional unit dedicated to emergency preparedness and response issues, on October 18, 2014. We describe major activities of the MHT. A high-priority MHT activity was to publish guiding principles early in the response. The MHT also prepared guidance documents, provided guidance and technical support for hospital preparedness, and addressed inquiries. We analyzed maternal health inquiries received through CDC-INFO, MHT, and CDC’s Medical Investigations Team from August 2014 to December 2015. Internal call logs used to capture, monitor, and track inquiries for the three data sources were merged. Inquiries not related to maternal health issues and duplicates were removed. Each inquiry was categorized by route (email/phone), inquirer type, and topic. In total, 201 inquiries were received from clinicians, public health professionals, and the public. The predominant topic was related to infection control for high-risk situations such as labor and delivery. During the Ebola response, most inquiries were received via email rather than telephone, a notable shift compared to the H1N1 emergency response. Lessons learned during the H1N1 and Ebola responses are currently informing CDC’s Zika Response, an unprecedented emergency response primarily focused on reproductive health issues.

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“…The outbreak led to a broader understanding of Ebola epidemiology and heightened recognition of the need to respond rapidly to interrupt transmission early [1]. Considerable progress has also been made on vaccine development [2–6], but there is still limited knowledge on EVD pathophysiology [7] and therapeutic yielded inconclusive findings [8–13].…”

Section: Introductionmentioning

confidence: 99%

Intensive care support and clinical outcomes of patients with Ebola virus disease (EVD) in West Africa

Langer

Portella²,

Finazzi

et al. 2018

Intensive Care Med

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PurposeWe investigate the impact on outcome of different levels of supportive treatment in Ebola virus disease (EVD). The NGO EMERGENCY delivered care sequentially at two Ebola Treatment Centres (ETC) in Sierra Leone: first at Lakka (fluids, symptomatic, antibiotic, antimalaria treatment, and hospital level medical care), and thereafter in Goderich, adding organ support in the only African ETC with an equipped and staffed intensive care unit (ETC-ICU).MethodsThe primary outcome in this retrospective cohort study was in-ETC mortality. Secondarily, we used multivariable logistic regression to investigate the independent impact of the IC on mortality by comparing patients in two ETCs, adjusting for potential confounders, including the viral load (base-10 logarithm in copies/ml) (LVL), modelled as a piecewise linear function. Mortality was plotted versus LVL. Confidence bands were constructed by a bootstrap technique. The number of hospital-free days within 28 was computed to assess the burden of EVD.ResultsData from 229 EVD patients were analysed (123 in Lakka, 106 in Goderich). Crude analysis showed a non-statistically significant difference in mortality (57.7% in Lakka vs 50.0% in Goderich; p = 0.19). Age and LVL were associated with mortality. Adjusted mortality was lower at the Goderich ICU-ETC (p = 0.055). This difference was observed with 80% confidence for patients with LVL between 7.5 and 8.5 copies/ml. Hospital-free days (of 28 days) were greater (7.7 vs 5.5; p = 0.03) for patients treated in the ICU-ETC.ConclusionsProvision of critical care to patients with EVD is feasible in resource-limited settings and was associated with improved survival and less time in hospital.Electronic supplementary materialThe online version of this article (10.1007/s00134-018-5308-4) contains supplementary material, which is available to authorized users.

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After Ebola in West Africa — Unpredictable Risks, Preventable Epidemics

Cited by 221 publications

References 28 publications

Containment measures for emerging and re-emerging vector-borne and other infectious diseases of poverty in urban settings: a scoping review

Containment measures for emerging and re-emerging vector-borne and other infectious diseases of poverty in urban settings: a scoping review

Addressing Maternal Health During CDC's Ebola Response in the United States

Intensive care support and clinical outcomes of patients with Ebola virus disease (EVD) in West Africa

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