Epidemia de ébola en África: experiencia médica cubana en esta emergencia sanitaria internacional (VIII) / Ebola epidemic in Africa: Cuban medical experience in this international health emergency (VIII)

RESUMEN La misión de la brigada médica perteneciente al Contingente Internacional Especializado en Situaciones de Desastres y Graves Epidemias "Henry Reeve", que laboró en Sierra Leona, terminó el 1ro de abril de 2015, con sus objetivos cumplidos. Fueron atendidos 1589 pacientes y confirmados 619 con el ébola (38,9 %), se disminuyó el índice de mortalidad de 92 % a 43,3 % y se salvaron 351 vidas entre el 5 de noviembre de 2014 y el 10 de marzo de 2015. En total se trabajaron 377 días, con 6024 horas de estancia en el Centro de Tratamiento del Ébola y 2217 horas vistiendo el equipo de protección individual. Sus integrantes recibieron reconocimientos nacionales e internacionales y numerosas distinciones que avalaron el desempeño de tan exitosa encomienda.

ABSTRACT The mission of the medical brigade belonging to the "Henry Reeve "International Contingent Specialized in Situations of Disasters and Serious Epidemics, which worked in Sierra Leone, ended on April 1, 2015, with its objectives fulfilled. 1589 patients were treated and 619 confirmed with Ebola (38.9%), the death rate was reduced from 92% to 43.3% and 351 lives were saved from November 5, 2014 to March 10, 2015. they worked 377 days in all, with 6024 hours of stay in the Ebola Treatment Center and 2217 hours wearing the personal protection equipment. Its members received national and international recognition and numerous distinctions that endorsed the performance of such a successful mission.

Ébola, abordaje clínico integral / Ebola, comprehensive clinical approach

Resumen Introducción. El virus del Ébola, antes llamado fiebre hemorrágica del Ébola, es una enfermedad altamente contagiosa con mortalidad entre 50% y 90%, para la cual existen prometedoras opciones de tratamiento que se encuentran en fase de evaluación y uso compasional. Objetivos. Revisar la mejor evidencia médica publicada y analizar el comportamiento de las epidemias por virus del Ébola, sus manifestaciones clínicas, sus complicaciones, los elementos más significativos para su diagnóstico y las nuevas opciones terapéuticas disponibles, para así aprender y aplicar estas experiencias en nuevos brotes. Materiales y métodos. Se realizó una búsqueda sistemática en las bases de datos PubMed, ProQuest, Embase, Redalyc, Ovid, Medline, DynaMed y ClinicalKey durante el periodo 2009-2017 en el contexto internacional, regional y local. Resultados. La revisión sistemática de artículos aportó un total de 51 430 registros, de los cuales 772 eran elegibles; de estos, 722 no eran relevantes, por lo que quedaron incluidos 50. A punto de partida se pudieron precisar los aspectos objeto de esta revisión. Conclusión. La enfermedad causada por el virus del Ébola, a pesar de su alta mortalidad, puede ser prevenida, diagnosticada oportunamente y tratada con efectividad, lo cual permite evaluar su impacto epidemiológico en las áreas endémicas y a nivel mundial. Existe un potencial arsenal terapéutico en fase de experimentación con resultados prometedores.

Abstract Introduction: The Ebola virus, also known as Ebola hemorrhagic fever, is a highly contagious disease with mortality rates that range between 50% and 90%. There are promising treatment options that are currently under evaluation and compassionate use. Objectives: To review the best published medical material and analyze the behavior of Ebola virus outbreaks, clinical manifestations, complications, the most significant elements for diagnosis and new therapeutic options available, in order to learn and apply these experiences during new outbreaks. Materials and methods: A systematic search was carried out in the PubMed, ProQuest, Embase, Redalyc, Ovid, Medline, DynaMed and ClinicalKey databases during the 2009-2017 period in the international, regional and local context. Results: The systematic review yielded a total of 51 430 documents, of which 772 were eligible; of these, 722 were not relevant, and only 50 were included. Conclusion: Ebola virus disease, despite its high mortality, can be prevented, diagnosed promptly and treated effectively, which allows evaluating its epidemiological impact in endemic areas and worldwide. There are potential therapeutic tools under experimentation with promising results.

Enfoque clínico del síndrome febril agudo en Colombia / Clinical approach to acute febrile syndome in Colombia

El síndrome febril agudo se refiere a un conjunto de enfermedades que cursan con fiebre en el contexto de exposición en áreas tropicales y que constituyen un motivo de consulta frecuente en el servicio de urgencias. Este artículo revisa el enfoque clínico del síndrome febril agudo en Colombia y de las enfermedades más prevalentes o graves que lo causan. Se presenta el enfoque sindromático y se establece una revisión sucinta de los síntomas principales, signos de alarma, tratamiento, prevención y notificación en el sistema de vigilancia en salud pública.

Acute febrile syndrome refers to a group of diseases with fever as a main symptom, in a context of living in or having been exposed to tropical climates. It is a frequent cause for consultation in the emergency room. This paper reviews the clinical approach to acute febrile syndrome and the most prevalent or severe causes. We present the syndromatic approach to the patient and a short review of the main symptoms, alarm signs, treatment, prevention and notification to the public health surveillance system of the most frequent causes.

Fear on the networks: analyzing the 2014 Ebola outbreak / El temor en las redes: Análisis del brote de ébola del 2014 / Temor nas redes: uma análise do surto de Ebola de 2014

ABSTRACT During the 2014 Ebola outbreak, information spread via multiple platforms, including social networks and Internet search engines. This report analyzes Twitter tweets, Facebook posts, and Google trends, as well as several other Internet resources, from March - November 2014. Understanding the types of discussions, social behaviors, feelings expressed, and information shared during the Ebola outbreak can help health organizations improve communication interventions and avert misinformation and panic during health emergencies. In all, 6 422 170 tweets, 83 Facebook posts, and Google search trends were integrated with 63 chronological Ebola-related events. Events that prompted a surge in tweets using #ebola were related to new cases of infection or the entry of the disease into a new geographic area. Most tweets were re-tweets of information provided by news agencies and official health organizations. Events related to new infections and deaths seemed to correlate with an increase of words that express fear. Google results concurred with Twitter and Facebook. Data from social media activity can be used to form hypotheses about how the public responds to and behaves during public health events, prompting health organizations to adopt new strategies for communications interventions. Furthermore, a spike in activity around a topic can be used as a surveillance technique to signal to health authorities that an outbreak may be underway. It is also recommended that news agencies, which engage with the public most often, consider content review by health experts as part of their health communications process.(AU)

RESUMEN Durante el brote de ébola del 2014, se difundió información por medio de varias plataformas, entre ellas las redes sociales y los motores de búsqueda de Internet. En este informe se analizan los tuits en Twitter, los mensajes publicados en Facebook y las tendencias de búsqueda en Google, así como varios recursos más en Internet, en el período comprendido entre marzo y noviembre del 2014. La comprensión de los tipos de conversaciones, el comportamiento social, los sentimientos expresados y la información transmitida durante el brote de ébola puede ayudar a las organizaciones de salud a mejorar sus intervenciones en materia de comunicación y evitar la información incorrecta y el pánico que se pueden propagar durante las emergencias de salud. En total, se integraron 6 422 170 tuits, 83 mensajes de Facebook y las tendencias de búsqueda en Google con 63 eventos cronológicos relacionados con ébola. Los eventos que dieron lugar a un incremento de los tuits con la etiqueta #ebola estaban relacionados con nuevos casos de infección o la entrada de la enfermedad en una nueva zona geográfica. La mayor parte de los tuits eran reenvíos de información suministrada por las agencias de noticias y las organizaciones de salud oficiales. Los eventos relacionados con nuevas infecciones y defunciones parecían guardar correlación con un aumento del uso de palabras que expresaban temor. Los resultados de Google coincidían con Twitter y Facebook. Se pueden emplear datos provenientes de la actividad de las redes sociales para formar hipótesis sobre el modo en que el público responde a los eventos de salud pública y en que se comporta durante ellos, e incitar a las organizaciones de salud a que adopten nuevas estrategias para las intervenciones en materia de comunicación. Además, se pueden usar los aumentos de la actividad en torno a un tema como técnica de vigilancia para señalar a las autoridades de salud que es posible que haya un brote. Se recomienda también que las agencias de noticias, que interactúan con el público con más frecuencia, consideren la posibilidad de contar con expertos en salud para examinar los contenidos en el marco de su proceso de comunicación para la salud.(AU)

RESUMO No transcurso do surto de Ebola de 2014, a informação se espalhou por diversas plataformas como as redes sociais e os mecanismos de busca da internet. Este artigo examina as mensagens no Twitter, postagens no Facebook e tendências no Google e outras mídias digitais no período de março a novembro de 2014. Entender as formas de discussões, comportamentos sociais, sentimentos expressos e informações partilhadas no decorrer do surto de Ebola pode contribuir para melhorar as intervenções em comunicação por parte das organizações de saúde e evitar a desinformação e o pânico em situações de emergência em saúde. Ao todo, 6.422.170 mensagens no Twitter, 83 postagens no Facebook e tendências de busca no Google foram correlacionadas a 63 eventos cronológicos relativos ao surto de Ebola. Os eventos que suscitaram um aumento no número de mensagens no Twitter com o hashtag #ebola foram a ocorrência de novos casos de infecção ou o surgimento da doença em outras áreas geográficas. Grande parte da atividade no Twitter consistiu no reenvio de mensagens com informações fornecidas pelas agências de notícias e organizações oficiais de saúde. Os eventos relacionados a novas infecções e mortes aparentemente se correlacionaram ao uso de um maior número de palavras que expressam temor. Os resultados do Google coincidiram com os do Twitter e Facebook. A análise da atividade nas mídias sociais permite formular hipóteses sobre a reação e o comportamento do público em situações de risco em saúde pública, motivando o uso de novas estratégias de comunicação por parte das organizações de saúde. Um pico de atividade em torno de um assunto pode ser um recurso de vigilância usado pelas autoridades sanitárias para sinalizar a possível ocorrência de um surto. Também se recomenda às agências de notícias, por estarem em contato constante com o público, integrar a análise do conteúdo por especialistas em saúde ao processo de comunicação de assuntos em saúde.(AU)

Respuesta inmune en la infección por el virus del Ébola / Immune Response to Ebola Virus Infection

El virus del Ébola pertenece a la familia de los filovirus y produce una fiebre hemorrágica con una elevada letalidad. Los pacientes afectados muestran una respuesta inmune deteriorada como consecuencia de los mecanismos de evasión del virus. La catepsina es una enzima presente en los gránulos de los fagocitos que escinde las glicoproteínas de la superficie viral, permitiendo al virus la entrada a la célula anfitriona. Por otro lado, este virus es resistente a los efectos antivirales del interferón tipo I, promueve la síntesis de citoquinas proinflamatorias e induce la apoptosis de los monocitos y los linfocitos. Otros efectos del mismo son: inducir una activación incompleta de las células dendríticas con lo que evita la presentación de los antígenos virales. A pesar de que después de la primera semana se producen anticuerpos específicos, estos tienen una capacidad neutralizante dudosa. El virus evade la respuesta inmune y se replica de forma incontrolada en el hospedero. Se realizó este trabajo con el propósito de resumir los principales aspectos relacionados con las particularidades de la respuesta inmune durante la infección por el virus del Ébola.

Ebola virus belongs to the family Filoviridae and causes a highly lethal hemorrhagic fever. Affected patients show an impaired immune response as a result of the evasion mechanisms employed by the virus. Cathepsin is an enzyme present in the granules of phagocytes which cleaves viral surface glycoproteins, allowing virus entry into the host cell. In addition, this virus is resistant to the antiviral effects of type I interferon, promotes the synthesis of proinflammatory cytokines and induces apoptosis of monocytes and lymphocytes. It also induces an incomplete activation of dendritic cells, thus avoiding the presentation of viral antigens. Although specific antibodies are produced after the first week, their neutralizing capacity is doubtful. The virus evades the immune response and replicates uncontrollably in the host. This paper aims to summarize the main characteristics of the immune response to Ebola virus infection.

Five cases report of Ebola virus disease / 中华传染病杂志

Objective To analyze the clinical characteristics ,treatment and outcome of Ebola virus disease so as to provide early clinical recognition and treatment for this disease .Methods The clinical manifestations and treatment of 5 cases of Ebola virus disease in Ebola Holding Center of Sierra‐Leone China Friendship Hospital from 15 March 2015 to 15 May 2015 were retrospectively analyzed .And the clinical characteristics and possible effective treatment were discussed combined with related literature . Results Five patients were diagnosed with Ebola virus disease by polymerase chain reaction and 4 cases of 5 patients had confirmed contact history ,while 1 case had no clear contact history .All the 5 cases presented with low fever ,headache and joint pain .Three cases then progressed into severe gastrointestinal symptoms such as nausea ,vomiting ,diarrhea and hypovolemic shock .The patients presented with fast heart rate and shortness of breath and other inflammatory response syndrome in acute phase .One patient rapidly progressed to liver pain ,jaundice and anuria ,then died .Three severe cases recovered after treated with fluid resuscitation ,circulation maintenance and electrolyte balance in acute phase .Conclusions The early symptoms of Ebola virus disease are low fever ,joint pain and nausea .Frequent vomiting ,diarrhea , low blood pressure and electrolyte disorder indicate severe conditions .Shock and electrolyte disorder are deadly complications .Early recognition ,diagnosis and treatment are the key to improve the prognosis .

Laboratory diagnostic methods of Ebola virus diseases / 中华检验医学杂志

Etiological and serological testing, including virus genome, virus antigen, anti-virus antibodies, virus culture and identification, were the standard laboratory tests to confirm or exclude Ebola virus infections.Moreover, other laboratory tests, such as blood routine tests, liver and kidney function tests, serum electrolyte tests, and coagulation function tests, were very important to the clinical diagnosis and treatment of Ebola virus disease ( EVD) patients.Based on working experiences and practices in the China Ebola Treatment Center and available publications, opinions about the detailed clinical significance and associated key point of biosafty prevention and protection protocols of above described laboratory tests for the clinical diagnosis and treatment of EVD were provided.

Bibliometric analysis on research of Ebola virus and Ebola virus disease / 中华传染病杂志

Objective To get a knowledge of the current status of international research on Ebola virus and Ebola virus disease (EVD).Methods All the articles about EVD from PubMed database were retrieved and analyzed.After core subject headings had been identified by BICOMB,the co-occurrence matrix was established.Cluster analysis about co-occurrence matrix was performed by SPSS 19.0.The visualized network image was drawn by Ucinet 6.0.Results A total of 1 384 literatures were involved in the analysis,with the earliest one published in 1979.The number of literatures was increasing along with time and disease outbreaks.Totally 1 213 (87.6％) literatures were published by Europe and U.S.There were 27 core subjects and they were clustered into 3 research areas from 1979 to 2014,including Ebola virus genome structure and viral proteins,especially the envelope protein; immunology of Ebola virus and animal models; epidemiology,diagnosis and treatment of Ebola hemorrhagic fever.The visualized social network reflected that the prevention of EVD,the genome and immunology of Ebola were the major concerns.Conclusion It has been 35 years since the literatures on Ebola virus and EVD emerged.The United States and the United Kingdom are the top two countries in this field.The present studies have laid a crucial foundations for developing effective vaccines and diagnostic reagents.

Recomendações de prevenção e controle para o cuidado de pacientes com Ebola em instituições de saúde / Recommendations for prevention and control for the care of patients with Ebola in health institution / Recomendaciones para la prevención y el control de la atención de pacientes con ébola en las instituciones sanitarias

Estudo de revisão em base de dados nacionais e internacionais foi conduzido para identificar as melhores recomendações de prevenção e controle parao cuidado direto a pacientes com ebola. Para a pesquisa foram utilizados artigos de bases de dados nacionais e internacionais. A amostra do estudofoi constituída de 14 artigos. A febre hemorrágica ebola tem características epidêmicas e, portanto, a implementação de estratégias de prevençãoe controle influenciam diretamente o risco de infecção e transmissão da doença. A utilização de medidas de precauções-padrão, de prevenção porcontato e via perdigotos, além de cuidados com equipamentos e materiais médico-hospitalares, é imprescindível e deve ser adotada. A capacitaçãoe treinamento contínuo dos profissionais de saúde, bem como o fornecimento de recursos para o trabalho por parte das instituições de saúde, sãoformas éticas de garantir aos profissionais um atuar seguro com mínimos riscos de contaminação e propiciar aos pacientes o melhor cuidado.

A review studyof national and international databases was conducted to identify the best prevention and control recommendations for direct careof patients with Ebola. For the research articles from national and international databaseswere used. The study sample consisted of 14 articles. Ebolahemorrhagic fever has epidemic characteristics and therefore the implementation of prevention and control strategies directly influence the risk ofinfection and disease transmission. The use of standard precaution measures, contact prevention and droplets, as well as proper care of medicalequipment and materials are essential and should be adopted. Training of health professionals, as well as providing resources for the work by thehealth institutions are ethical ways to ensure that healthcare staff have a safe work environment with minimal risk of contamination and are ableto provide the best care to patients.

Se trata de una revisión de la literatura nacional e internacional para identificar las mejores recomendaciones sobre prevención y control en laatención directa de pacientes con Ébola. Para la investigación se utilizaron artículos de bases de datos nacionales y extranjeras. La muestra estuvocompuesta por 14 artículos. La fiebre hemorrágica del Ébola tiene características epidémicas y, por lo tanto, la implementación de estrategias deprevención y control influye directamente sobre el riesgo de infección y de transmisión de la enfermedad. Medidas de precauciones estándar, deprevención de contacto y del contagio a través de las gotas de saliva al toser, además del cuidado con equipos y material médico hospitalario, sonesenciales y deben ser adoptadas. La capacitación y formación continua de los profesionales de la salud, así como la provisión de recursos parael trabajo por parte de las instituciones sanitarias son formas éticas correctas para garantizar seguridad a los profesionales, con poco riesgo decontaminación, y mejor atención a los pacientes.