Les enseignements de l’épidémie d’Ebola pour une meilleure préparation aux urgences

Fortin, Anne; Bi, Joseph Vroh Benié; Soulimane, Abdelkrim

doi:10.3917/spub.174.0465

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…Most EVD outbreaks have occurred in remote areas in which we note a lack of infrastructure and equipment, a few available diagnostic tools, and trained personnel. These conditions contribute to the further spread of the disease, compromising the outbreak control [6], and placing a heavy burden on the health systems and communities as well [7,8]. The control of EVD outbreaks relies on accurate and early detection of the pathogen to allow the rapid implementation of countermeasures [9].…”

Section: Introductionmentioning

confidence: 99%

Development of Ebola virus disease prediction scores: Screening tools for Ebola suspects at the triage-point during an outbreak

et al. 2022

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Background The control of Ebola virus disease (EVD) outbreaks relies on rapid diagnosis and prompt action, a daunting task in limited-resource contexts. This study develops prediction scores that can help healthcare workers improve their decision-making at the triage-point of EVD suspect-cases during EVD outbreaks. Methods We computed accuracy measurements of EVD predictors to assess their diagnosing ability compared with the reference standard GeneXpert® results, during the eastern DRC EVD outbreak. We developed predictive scores using the Spiegelhalter-Knill-Jones approach and constructed a clinical prediction score (CPS) and an extended clinical prediction score (ECPS). We plotted the receiver operating characteristic curves (ROCs), estimated the area under the ROC (AUROC) to assess the performance of scores, and computed net benefits (NB) to assess the clinical utility (decision-making ability) of the scores at a given cut-off. We performed decision curve analysis (DCA) to compare, at a range of threshold probabilities, prediction scores’ decision-making ability and to quantify the number of unnecessary isolation. Results The analysis was done on data from 10432 subjects, including 651 EVD cases. The EVD prevalence was 6.2% in the whole dataset, 14.8% in the subgroup of suspects who fitted the WHO Ebola case definition, and 3.2% for the set of suspects who did not fit this case definition. The WHO clinical definition yielded 61.6% sensitivity and 76.4% specificity. Fatigue, difficulty in swallowing, red eyes, gingival bleeding, hematemesis, confusion, hemoptysis, and a history of contact with an EVD case were predictors of EVD. The AUROC for ECPS was 0.88 (95%CI: 0.86–0.89), significantly greater than this for CPS, 0.71 (95%CI: 0.69–0.73) (p < 0.0001). At -1 point of score, the CPS yielded a sensitivity of 85.4% and specificity of 42.3%, and the ECPS yielded sensitivity of 78.8% and specificity of 81.4%. The diagnostic performance of the scores varied in the three disease contexts (the whole, fitting or not fitting the WHO case definition data sets). At 10% of threshold probability, e.g. in disease-adverse context, ECPS gave an NB of 0.033 and a net reduction of unnecessary isolation of 67.1%. Using ECPS as a joint approach to isolate EVD suspects reduces the number of unnecessary isolations by 65.7%. Conclusion The scores developed in our study showed a good performance as EVD case predictors since their use improved the net benefit, i.e., their clinical utility. These rapid and low-cost tools can help in decision-making to isolate EVD-suspicious cases at the triage point during an outbreak. However, these tools still require external validation and cost-effectiveness evaluation before being used on a large scale.

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Section: Introductionmentioning

confidence: 99%

Development of Ebola virus disease prediction scores: Screening tools for Ebola suspects at the triage-point during an outbreak

et al. 2022

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Preparedness and emergency response strategies for chemical, biological, radiological and nuclear emergencies in disaster management: A qualitative systematic review

Farhat,

Alinier,

Chaabna

et al. 2024

Contingencies & Crisis Mgmt

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Disaster management, mainly related to chemical, biological, radiological and nuclear (CBRN) incidents, is a critical field that requires constant evaluation to improve preparedness and response strategies. This review synthesises evidence on global health sector strategies for CBRN preparedness, gathering lessons to enhance policymaking for future response and readiness. This review included original English and French research addressing healthcare preparedness for CBRN threats. Database searches, such as EBSCO, ScienceDirect, PubMed, Ovid, Lissa, and Santécom, were conducted until November 2022. The Joanna Briggs Institute's tools were utilised to assess the risk of bias. Al‐Raayan® and Nvivo® version 12 software were employed for the review and analysis. 57 articles in English and 6 in French met the inclusion criteria. The analysis identified numerous strategies, concentrating on chemical and biological incidents (Chemical and biological bioterrorism: n = 27; Epidemics and Outbreak: n = 15). “Hospitals”, “responsibility”, and “health” emerged as prominent keywords, emphasising institutional roles and health outcomes in CBRN incidents preparedness. Key findings highlighted the need for a unified global definition of bioterrorism to align international efforts. Hospital‐level initiatives were emphasised as the foundation for national preparedness, emphasising specialised training, community engagement, and robust coordination mechanisms. Geographical variability in response strategies was noted, necessitating a harmonised global approach. Continuous research, epidemic management, and addressing radiological/nuclear threats emerged as crucial elements. Among others, strategies defined under “Emergency Response Preparedness” and “Intersectoral Policy Development” outlined comprehensive preparedness contexts for CBRN incidents. The review suggests an imperative shift towards building collaborative networks and enhancing health sector operational readiness to mitigate the impacts of CBRN incidents.

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Comment la résilience post-Ebola en Guinée contribue à la gestion de la COVID-19 ?

Maltais¹,

Brière²,

Yaya³

2022

Santé Publique

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Introduction : Le cas d’Ebola en Guinée (2013-2016) a été révélateur de faiblesses en matière de résilience du système de santé. Il a également permis de prendre la mesure d’un défi : pouvoir coordonner tous les acteurs de la réponse. Après l’épidémie, les autorités nationales et leurs partenaires internationaux ont amorcé un travail pour renforcer le système de santé. En 2021, la Guinée a fait face à la COVID-19 simultanément à la résurgence d’Ebola et d’autres maladies à potentiel épidémique. But de l’étude : L’objectif de cet article est d’analyser l’évolution des cinq caractéristiques de la résilience sanitaire de Kruk et al. dans le contexte guinéen. Pour ce faire, une triangulation des données a été effectuée grâce à une revue de littérature, 41 entretiens semi-dirigés avec des parties prenantes internationales, nationales et locales, et 37 événements observés dans la période post-Ebola. Résultats : Nos résultats montrent que la caractéristique de l’intégration a été la plus importante dans notre étude, grâce au renforcement de la coordination, de la communication et du partage d’informations entre les parties prenantes lors des crises. Ensuite, la diversité expose la nécessité de pouvoir faire face à plusieurs défis sanitaires en simultané. Les efforts avaient été concentrés sur Ebola pendant la première épidémie, mais depuis la pandémie de COVID-19, l’État est en mesure de faire face à plusieurs défis sanitaires. La conscience, quant à elle, suppose le besoin de connaître le contexte, ses forces et faiblesses. La Guinée a tiré les leçons d’Ebola et a mis en œuvre un programme de renforcement du système de réponse aux épidémies post-Ebola. Concernant l’autorégulation, le pays est désormais doté en ressources et possède des mécanismes de remontage de l’information et d’intervention qui ont fait leurs preuves. Enfin, l’adaptabilité constante en tenant compte des leçons apprises permet de rectifier le tir et de se préparer à d’autres crises potentielles et c’est ce qui est continuellement fait. Conclusions : Étant donné la fragilité ubiquiste de la Guinée, le système de santé n’est toujours pas pleinement résilient. Toutefois, les gains dans chacune des caractéristiques de la résilience améliorent certainement la riposte face à la COVID-19.

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Les enseignements de l’épidémie d’Ebola pour une meilleure préparation aux urgences

Cited by 3 publications

References 6 publications

Development of Ebola virus disease prediction scores: Screening tools for Ebola suspects at the triage-point during an outbreak

Development of Ebola virus disease prediction scores: Screening tools for Ebola suspects at the triage-point during an outbreak

Preparedness and emergency response strategies for chemical, biological, radiological and nuclear emergencies in disaster management: A qualitative systematic review

Comment la résilience post-Ebola en Guinée contribue à la gestion de la COVID-19 ?

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