Factores pronósticos clínicos determinantes en la supervivencia de pacientes con el virus Ébola / Clinical prognostic factors determining the survival of patients with the Ebola virus

Introducción: La enfermedad por el virus del Ébola presenta una elevada letalidad, por lo cual resulta de gran interés la realización de investigaciones que aborden las manifestaciones clínicas que pudieran ser factores pronósticos de supervivencia. Objetivo: Evaluar factores pronósticos de los pacientes enfermos de ébola. Métodos: El universo lo constituyó la totalidad (n = 350) de pacientes ingresados. Se emplearon medidas de resumen para variables cualitativas, estimaciones puntuales y por intervalos para las cuantitativas, así como las pruebas de significación Kaplan-Meier, regresión de Cox y Odds Ratio. Se trabajó con un nivel de confiabilidad del 95 por ciento. Resultados: La supervivencia global fue del 42,5 por ciento. La media de supervivencia, de aproximadamente 10 días (IC: 9 - 11 días). Los pacientes que ingresaron en estado grave (OR = 3,76), que tuvieron dolor lumbar (OR = 2,24), que refirieron cefalea (OR = 2,22), que presentaron fiebre (OR=2,16), que aquejaron de dolor abdominal (OR=1,95) y a quienes se les constató inyección conjuntival (OR = 1,86), tuvieron mayor probabilidad de fallecer, que quienes ingresaron sin estos síntomas y signos. Conclusiones: La supervivencia fue elevada, pese a las complicaciones presentadas. Los síntomas y signos predictores de muerte en los pacientes fueron: la gravedad del paciente al momento del ingreso, la presencia de dolor lumbar, cefalea, fiebre, dolor abdominal e inyección conjuntival(AU)

Introduction: Ebola virus disease has a high lethality, which is why it is of great interest to carry out research that addresses clinical manifestations that could be prognostic factors for survival. Objective: To evaluate prognostic factors of Ebola patients. Methods: the universe was constituted by the totality (n = 350) of admitted patients. Summary measures were used for qualitative variables, point and interval estimates for quantitative variables, as well as Kaplan-Meier significance tests, Cox regression and Odds Ratio. We worked with a 95% level of reliability. Results: The overall survival was 42.5 por ciento. The average survival, approximately 10 days (CI: 9-11 days). Patients who were admitted in serious condition (OR = 3.76), who had low back pain (OR = 2.24), who reported headache (OR = 2.22), who presented fever (OR = 2.16), who they suffered from abdominal pain (OR = 1.95) and who were found to have conjunctival injection (OR = 1.86), were more likely to die than those who entered without these symptoms and signs. Conclusions: Survival was high, despite the complications presented. The symptoms and predictive signs of death in the patients were: the severity of the patient at admission, the presence of low back pain, headache, fever, abdominal pain and conjunctival injection(AU)

Association between multivitamin supplementation and mortality among patients with Ebola virus disease: an international multisite cohort study

Introduction: Micronutrient supplementation is recommended in Ebola Virus Disease (EVD) care; however, there is limited data on its therapeutic effects. Methods: This retrospective cohort study included patients with EVD admitted to five Ebola Treatment Units (ETU) in Sierra Leone and Liberia during September 2014 to December 2015. A uniform protocol was used to guide ETU care, however, due to supply limitations, only a subset of patients received multivitamins. Data on demographics, clinical characteristics, and laboratory testing was collected. The outcome of interest was facility based mortality and the primary predictor was multivitamin supplementation initiated within 48 h of admission. The multivitamin formulations included: thiamine, riboflavin, niacin and vitamins A, C, and D3. Propensity score models (PSM) were used to match patients based on covariates associated with multivitamin administration and mortality. Mortality between cases treated and untreated within 48 h of admission were compared using generalized estimating equations to calculate relative risk with bootstrap methods employed to assess statistical significance. Results: There were 424 patients with EVD who had sufficient treatment data for analysis, of which 261 (61.6%) had daily multivitamins initiated within 48 h of admission. The mean age of the cohort was 30.5 years and 59.4% were female. In the propensity score matched analysis, mortality was 53.5% among patients receiving multivitamins and 66.2% among patients not receiving multivitamins, resulting in a relative risk for mortality of 0.81 (p=0.03) for patients receiving multivitamins. Conclusion: Early multivitamin supplementation was associated with lower overall mortality. Further research on the impact of micronutrient supplementation in EVD is warranted

Leçons apprises de la gestion des épidémies de la maladie à virus Ebola en République Démocratique du Congo de 2007 à 2017 / Lessons learned from the management of Ebola outbreaks in the Democratic Republic of Congo from 2007 to 2017

Contexte et objectifs. La RDC a un écosystème favorable à la survenue des maladies d'origine zoonotique à l'interface homme-animal dont la maladie à virus Ebola (MVE). Face à une létalité reconnue être élevée pour cette dernière, cette étude s'est focalisée sur les épidémies survenues à Mweka (2007 et 2008), à Isiro (2012), à Boende (2014) et à Likati (2017) afin de décrire les différents éléments de réponse mis en place lors de chacune de ces épidémies et identifier ceux qui ont une influence significative sur l'ampleur de l'épidémie. Méthodes. Une étude documentaire analytique sur les données secondaires recueillies lors de la gestion de ces cinq épidémies de la MVE survenues en RDC. Les statistiques descriptives ont été réalisées pour caractériser chaque épidémie. Les analyses univariées de chaque élément de réponse ont été menées en rapport avec la létalité. Résultats. Un total de 422 cas a été enregistré avec 282 décès soit 66,8 % de létalité. La grande majorité de cas se trouve dans la tranche d'âge de 15 à 49 ans. Le sexe féminin est le plus représenté. Parmi tous les éléments de la réponse, dans un modèle univarié, le déploiement du laboratoire mobile (p=0,002), la fonctionnalité des commissions (p=0,001), le déploiement d'une équipe multidisciplinaire et le système de surveillance performant (p=0,001) sont associés significativement à la létalité. Conclusion. Le déploiement rapide du laboratoire mobile sur le terrain, le déploiement des équipes multidisciplinaires, la bonne fonctionnalité des commissions et le système de surveillance fonctionnel ont permis de réduire significativement la létalité

Enfermedad por el virus del Ébola en el Centro de Tratamiento Coyah / Ebola virus disease at the Coyah Treatment Center

Introducción: la enfermedad por Ébola tiene elevada letalidad y no existe tratamiento efectivo. Es necesario su estudio y estar preparados para el enfrentamiento de futuras epidemias. Objetivo: describir la distribución espacio-temporal y relación con variables de persona, lugar y tiempo, de los pacientes con la enfermedad por el virus del Ébola atendido en el Centro de Tratamiento de Coyah. Métodos: se realizó un estudio descriptivo transversal. El universo lo constituyó los pacientes ingresados (N= 350) en este centro. La información se obtuvo de las historias clínicas. Resultados: se confirmaron casos con Ébola 244 pacientes (69,71 por ciento de positividad), 53,28 por ciento del sexo femenino; la media de edades fue de 30 años; 5 días promedio entre el inicio de los síntomas y el ingreso (mediana de 4 días). El 90,57 por ciento de los enfermos procedía de la región Kindia y 61,07 por ciento de la prefectura Forecariah. El número de pacientes ingresados, según semana estadística, presentó las fluctuaciones características de los brotes epidémicos. En el centro se registraron 133 fallecidos (tasa de letalidad de 54,5 por cada 100 enfermos confirmados). Conclusiones: la elevada confirmación de casos caracterizó la enfermedad, presente fundamentalmente en mujeres jóvenes, con ingreso alrededor de una semana, a partir de los primeros síntomas. La incidencia semanal de casos presentó fluctuaciones características de brotes epidémicos. La tasa de letalidad de la enfermedad fue baja(AU)

Introduction: Ebola disease has a high lethality and there is no effective treatment. It is necessary to study it and be prepared for dealing of future epidemics. Objective: To describe the spatio temporal distribution and relationship with variables of person, place and time of the patients treated at the Ebola Treatment Center in Coyah. Methods: A cross-sectional descriptive study was carried out. The universe were the admitted patients (N= 350) in this Center. The information was obtained from the medical records. Results: Ebola cases were confirmed in 244 patients (69.71 percent positivity), 53.28 percent in females; the average age was 30 years; 5 days average between the onset of symptoms and admission (median of 5 days). 90.57 percent of the patients came from the Kindia Region and 61.07 percent from the Forecariah prefecture. The number of patients admitted, according to statistical week, presented the characteristic fluctuations of epidemic outbreaks. In the center there were 133 deaths (case fatality rate of 54.5 per 100 confirmed patients). Conclusions: The high confirmation of cases characterized the disease, present mainly in young women, with admission around the week, from the first symptoms. The weekly incidence of cases showed characteristic fluctuations of epidemic outbreaks. The case fatality rate was low(AU)

Ebola virus disease in DRC: need for enhanced preparedness and readlness measures in EMR

The World Health Organization [WHO] was notified, on 11 May 2017, by the Ministry of Health [MoH] of the Democratic Republic of Congo [DRC] of a laboratory-confirmed case of Ebola virus disease [EVD]. Since 22 April 2017, 9 suspected cases including 3 deaths [CFR: 33.3%] were reported in the northern part of the country. The current situation calls for stepping up preparedness and readiness measures in the countries of the Eastern Mediterranean Region of WHO to prevent any importation of cases

Ébolavirus: biología molecular y evasión de la respuesta inmune / Ebolavirus: molecular biology and immune response evasion

La actual epidemia de enfermedad por virus Ébola que azota al África Occidental ha cobrado la vida de alrededor de 9 000 personas con más de 22 000 infectados en seis países, y algunos casos aislados han llegado a ciudades de Europa y Estados Unidos. Aunque el curso clínico de la enfermedad es bien conocido, los mecanismos específicos que explican su patogenicidad no han sido completamente delineados. Los casos fatales de infección por Ébolavirus están marcados por un fallo catastrófico de las respuestas inmune innata y adaptativa, mediado por proteínas codificadas por el virus, así como por propiedades asociadas a su estructura. El genoma del Ébolavirus está constituido solamente por siete genes que codifican unas 10 proteínas, suficientes para desencadenar una enfermedad cuya letalidad varía del 40 al 90 por ciento. En el centro de la desregulación inducida por el Ébola se encuentra una temprana y coordinada actuación de las proteínas VP24, VP30 y VP35, que conduce a niveles elevados de replicación viral, a una inapropiada temporización de la cascada de liberación de linfocinas y a la muerte, tanto de células presentadoras de antígenos, como de células efectoras. Los complejos mecanismos del Ébola para regular selectivamente la respuesta inmune y su patogenicidad variable en diferentes especies hospederas, convierten a este virus en un adversario formidable, así como de un notable interés científico(AU)

The current Ebolavirus disease outbreak that strikes West Africa has claimed the life of around 9 000 people and has infected more than 22 000 in six countries, and some isolated cases have reached cities of Europe and the United States. Though the clinical course of the disease is well known, the specific mechanisms of its pathogenicity have not been fully delineated yet. Fatal cases of Ebolavirus disease are marked by a catastrophic failure of both innate and adaptive immune responses, mediated by virus-encoded proteins as well as properties associated with its structure. Ebolavirus genome comprises only seven genes encoding about 10 proteins, enough to cause a disease which fatality fluctuates from 40 to 90 percent. At the heart of Ebola-induced immune dysregulation is an early and coordinated disruption by VP24, VP30, and VP35 that leads to elevated levels of virus replication, a cascade of inappropriately timed cytokine release, and death of both antigen-presenting and responding immune cells. The complex mechanisms of Ebola to selectively regulate immune responses and its variable pathogenicity in different host species makes this virus both, a challenging foe and scientifically interesting(AU)

O risco da contaminação global: o combate à epidemia de Ebola na África como vetor de cooperação internacional / The global contamination risk: the battle against Ebola epidemic in Africa as a vector of international cooperation / /El riesgo de contaminación global: la lucha contra la epidemia por el virus del Ebola en África como un vector de la cooperación internacional

Considerada a maior epidemia de Ebola desde o primeiro surto em 1976, o oeste africano tem enfrentado grandes desafios, sobretudo endógenos, para conter a disseminação da doença. Objetiva-se analisar a atual epidemia de Ebola à luz do neoinstitucionalismo liberal e da lógica da ação coletiva, utilizando como metodologia a estratégia de nested analisys. Conclui-se que o risco de uma pandemia de Ebola tem funcionado como incentivo para que os atores envolvidos cooperem. Os resultados deslocam a discussão para uma área pouco explorada academicamente: a ética médica no âmbito das relações internacionais, que suscita indagações, tais como “por que africanos não têm prioridade no tratamento diferenciado contra o Ebola?” e “qual o verdadeiro papel da OMS ao lidar com grandes epidemias?”. O presente trabalho inova ao tratar lógicas por trás da cooperação internacional em matéria de saúde no continente africano e por agregar a infografia cartográfica à literatura sobre política internacional...

Considered the largest epidemic of Ebola since the first outbreak in 1976, West Africa has faced great challenges, especially endogenous, to contain the disease spreading. Our objective is to analyze the current epidemic of Ebola in the light of the neoliberal institutionalism and the logic of collective action, using as methodology the strategy of nested analysis. It is concluded that the risk of an Ebola pandemic has worked as an incentive for the involved actors want to cooperate. The results lead the discussion to an area little explored academically: the international medical ethics, which raises questions like: “why is not given priority to Africans in the differential treatment against Ebola?” and “what is the true role played by WHO when dealing with large epidemics?” The study breaks new ground when it deals with the logic behind the international cooperation concerning health in Africa and adds infographic maps to international politics literature...

Considerada la mayor epidemia por el virus del Ébola desde el primer brote en 1976, África Occidental ha enfrentado a grandes desafíos, en especial endógenos, para contener la propagación de la enfermedad. Este trabajo tiene como objetivo analizar la actual epidemia por el virus del Ébola de acuerdo con el neoinstitucionalismo liberal y la lógica de la acción colectiva, utilizando como metodología la estrategia de“nested analysis”. Se concluye que el riesgo de una pandemia por el virus del Ébola ha funcionado como un incentivo para que los actores interesados quieran cooperar. Los resultados llevan la discusión a una área poco trabajada en la academia: la ética médica en las relaciones internacionales, que suscita preguntas como: “¿por qué los africanos no tienen prioridad en el tratamiento diferenciado contra el virus del Ébola?”y “¿cuál es el verdadero papel de la OMS cuando trabaja contra grandes epidemias?”. El estudio abre nuevos caminos al tratar de la lógica detrás de la cooperación internacional en materia de salud en África y al agregar mapas infográficos a la literatura política internacional...

Overview of Sudan's Experience with Ebola Haemorrhagic Fever [1976]

A large outbreak of haemorrhagic fever [subsequently named Ebola Haemorrhagic Fever occurred in the Southern Sudan between June and November 1976. There were a total of 284 cases with 151 deaths: the overall case fatality rate was 53%. The outbreak appears to have originated in the workers of a cotton manufacturing factory in Nzara. Although the link was not well established, it appears that Nzara could have been the source of infection for a similar outbreak in the Bumba zone of Zaire or vice versa. This paper presents information on the history of Ebola haemorrhagic fever outbreak in Sudan and the experience learned from it as well as the future expectations based on the personal experience of one of the authors of this paper who was the Director of Epidemiology Department in the Central Ministry of Health Sudan [1976] and the head of the team from the Central Ministry of Health to investigate the outbreak. Literature review, of documents published teas also made and assisted in writing this paper. There are so mane challenges to answer the question that still remains as to the nature and origin of the responsible virus. With local and international collaboration a coordinated response will lead to successful containment of the disease