Other > Journal Blog
BMJ Opinion (blog). 2019 May 24
Huster K, Healy J
BMJ Opinion (blog). 2019 May 24
Journal Article > ResearchFull Text
PLOS One. 2017 June 30; Volume 12 (Issue 6); DOI:10.1371/journal.pone.0180070
Ingelbeen B, Bah EI, Decroo T, Balde I, Nordenstedt H, et al.
PLOS One. 2017 June 30; Volume 12 (Issue 6); DOI:10.1371/journal.pone.0180070
Non-cases are suspect Ebola Virus Disease (EVD) cases testing negative by EVD RT-PCR after admission to an Ebola Treatment Centre (ETC). Admitting non-cases to an ETC prompts concerns on case- and workload in the ETC, risk for nosocomial EVD infection, and delays in diagnosis and disease-specific treatment. We retrospectively analysed characteristics, outcomes and determinants of death of EVD cases and non-cases admitted to the Conakry ETC in Guinea between 03/2014 and 09/2015. Of the 2362 admitted suspects who underwent full confirmatory PCR testing, 1540 (65.2%) were non-cases; among them 727 needed repeated confirmatory PCR testing resulting in 2.5 days (average) in the ETC isolation ward. Twenty-one patients tested positive on the repeat test, most in a period of flawed sampling for the initial test and none after introduction of PCR confirmation with geneXpert. No readmissions following nosocomial EVD infection were recorded. No combination of symptoms yielded acceptable sensitivity and specificity to allow differentiating confirmed from non-cases. Symptoms as ocular bleeding/redness have high specificity, but limited usefulness as not common. Admission delay and age distribution were not different for both groups. In total, 98 (20.6%) of 475 deaths in the ETC were non-cases. Most died within 24 hours after admission. Living in Conakry (aOR 1.78 (1.08-2.96)) was the strongest risk factor for death. Weeks with higher admission load had lower case fatality among non-cases, probably because more acute (and treatable) illnesses of contacts of known cases were admitted. These findings show high numbers of potentially critically ill non-cases need to be considered when setting up triage and referral of EVD suspect cases. Symptoms and risk factors alone do not allow differentiating the non-cases. Integration of highly-sensitive EVD diagnostic methods with short turnaround time in the triage of peripheral hospitals and dropping the systematic 2nd PCR for symptomatic early presenters could limit delays in access to adapted care of cases and seriously ill non-cases. Whether feasible without compromising outbreak control, and under which conditions, should be further assessed.
Journal Article > ResearchFull Text
Am J Trop Med Hyg. 2016 October 3; Volume 95 (Issue 6); 1389–1397 .; DOI:10.4269/ajtmh.16-0376
Tiffany A, Moundekeno FP, Traore A, Haile M, Sterk E, et al.
Am J Trop Med Hyg. 2016 October 3; Volume 95 (Issue 6); 1389–1397 .; DOI:10.4269/ajtmh.16-0376
Multiple community-based approaches can aid in quantifying mortality in the absence of reliable health facility data. Community-based sentinel site surveillance that was used to document mortality and the systems utility for outbreak detection was evaluated. We retrospectively analyzed data from 46 sentinel sites in three sous-préfectures with a reinforced malaria control program and one sous-préfecture without (Koundou) in Guinea. Deaths were recorded by key informants and classified as due to malaria or another cause. Malaria deaths were those reported as due to malaria or fever in the 3 days before death with no other known cause. Suspect Ebola virus disease (sEVD) deaths were those due to select symptoms in the EVD case definition. Deaths were aggregated by sous-préfecture and analyzed by a 6-month period. A total of 43,000 individuals were monitored by the surveillance system; 1,242 deaths were reported from July 2011-June 2014, of which 55.2% (N = 686) were reported as due to malaria. Malaria-attributable proportional mortality decreased by 26.5% (95% confidence interval [CI] = 13.9-33.1, P < 0.001) in the program area and by 6.6% (95% CI = -17.3-30.5, P = 0.589) in Koundou. Sixty-eight deaths were classified as sEVD and increased by 6.1% (95% CI = 1.3-10.8, P = 0.021). Seventeen sEVD deaths were reported from November 2013 to March 2014 including the first two laboratory-confirmed EVD deaths. Community surveillance can capture information on mortality in areas where data collection is weak, but determining causes of death remains challenging. It can also be useful for outbreak detection if timeliness of data collection and reporting facilitate real-time data analysis.
Journal Article > ResearchFull Text
Euro Surveill. 2014 October 9; Volume 19 (Issue 40); 20924.
Fitzpatrick G, Vogt F, Gbabai O, Black B, Santantonio M, et al.
Euro Surveill. 2014 October 9; Volume 19 (Issue 40); 20924.
Case management centres (CMCs) are part of the outbreak control plan for Ebola virus disease (EVD). A CMC in Sierra Leone had 33% (138/419) of primary admissions discharged as EVD negative (not a case). Fifteen of these were readmitted within 21 days, nine of which were EVD positive. All readmissions had contact with an Ebola case in the community in the previous 21 days indicating that the infection was likely acquired outside the CMC.
Journal Article > ResearchFull Text
J Infect Dis. 2016 May 25; Volume 215 (Issue 1); 64–69.; DOI:10.1093/infdis/jiw206
Muehlenbachs A, de la Rosa Vazquez O, Bausch DG, Schafer IJ, Paddock C, et al.
J Infect Dis. 2016 May 25; Volume 215 (Issue 1); 64–69.; DOI:10.1093/infdis/jiw206
Here we describe clinicopathologic features of EVD in pregnancy. One woman infected with Sudan virus in Gulu, Uganda in 2000 had a stillbirth and survived, and another woman with Bundibugyo virus had a livebirth with maternal and infant death in Isiro, the Democratic Republic of the Congo in 2012. Ebolavirus antigen was seen in the syncytiotrophoblast and placental maternal mononuclear cells by immunohistochemistry, and no antigen was seen in fetal placental stromal cells or fetal organs. In the Gulu case, ebolavirus antigen localized to malaria pigment-laden macrophages. These data suggest trophoblast infection may be a mechanism of transplacental ebolavirus transmission.
Journal Article > CommentaryFull Text
BMJ Glob Health. 2019 August 31; Volume 4 (Issue 4); e001593.; DOI:10.1136/
bmjgh-2019-001593
McDiarmid M, Crestani R
BMJ Glob Health. 2019 August 31; Volume 4 (Issue 4); e001593.; DOI:10.1136/
bmjgh-2019-001593
Health workers were differentially infected during the 2014 to 2016 Ebola outbreak with an incidence rate of 30 to 44/1000 depending on their job duties, compared to the wider population’s rate of 1.4/1000, according to the WHO.
Médecins Sans Frontières (MSF) health workers had a much lower incidence rate of 4.3/1000, explained as the result of MSF’s ‘duty of care’ toward staff safety.
Duty of care is defined as an obligation to conform to certain standards of conduct for the protection of others against an unreasonable risk of harm.
The duty of care was operationalised through four actions: performing risk assessments prior to deployment, organising work and work practices to minimise exposure, providing extensive risk communication and training of staff and providing medical follow-up for staff exposures.
Adopting and consistently enforcing these broader, duty of care safety policies in deployed teams augments and fortifies standard infection prevention practices, creating a more protective, comprehensive safety programme.
Prioritising staff safety by taking such actions will help avoid the catastrophic loss of the health work force and assist in building resilient health systems.
Médecins Sans Frontières (MSF) health workers had a much lower incidence rate of 4.3/1000, explained as the result of MSF’s ‘duty of care’ toward staff safety.
Duty of care is defined as an obligation to conform to certain standards of conduct for the protection of others against an unreasonable risk of harm.
The duty of care was operationalised through four actions: performing risk assessments prior to deployment, organising work and work practices to minimise exposure, providing extensive risk communication and training of staff and providing medical follow-up for staff exposures.
Adopting and consistently enforcing these broader, duty of care safety policies in deployed teams augments and fortifies standard infection prevention practices, creating a more protective, comprehensive safety programme.
Prioritising staff safety by taking such actions will help avoid the catastrophic loss of the health work force and assist in building resilient health systems.
Journal Article > Short ReportFull Text
Morbidity and Mortality Weekly Report. 2015 May 8
Christie A, Davies-Wayne GJ, Cordier-Lassalle T, Blackley DJ, Laney AS, et al.
Morbidity and Mortality Weekly Report. 2015 May 8
Journal Article > LetterFull Text
N Engl J Med. 2015 June 18; Volume 372 (Issue 25); DOI:10.1056/NEJMc1503275
Akerlund E, Prescott JB, Tampellini L
N Engl J Med. 2015 June 18; Volume 372 (Issue 25); DOI:10.1056/NEJMc1503275
Journal Article > ResearchAbstract Only
Anthropol Action. 2017 June 1; Volume 24 (Issue 2); 36-43.; DOI:10.3167/aia.2017.240205
Venables E
Anthropol Action. 2017 June 1; Volume 24 (Issue 2); 36-43.; DOI:10.3167/aia.2017.240205
Survivors of the Ebola virus have been widely profiled as the success stories of the outbreak, yet they still face challenges relating to their identity and reintegration. A survivor’s body takes on new meanings after experiencing Ebola, and the label ‘survivor’ is as problematic as it is celebratory. Using data conducted during fieldwork in Monrovia, Liberia, this article discusses the complex identities of Ebola survivors. In Monrovia, most of the stigma and discrimination relating to survivors was directed towards men, who were considered ‘atomic bombs’ because of concerns that they could transmit Ebola through sexual intercourse. Health promotion messages around sexual transmission were often misunderstood, and communities requested the quarantine of men to reduce what they felt was a threat to the wider community. Understanding the meanings and sources of such stigmatisation is necessary to be able to work with and support survivors through psychosocial care and health promotion activities.
Journal Article > ResearchFull Text
Front Public Health. 2016 July 4; Volume 4; 142.; DOI:10.3389/fpubh.2016.00142
Rabelo I, Lee VS, Fallah MP, Massaquoi M, Evlampidou I, et al.
Front Public Health. 2016 July 4; Volume 4; 142.; DOI:10.3389/fpubh.2016.00142
INTRODUCTION
A consequence of the West Africa Ebola outbreak 2014–2015 was the unprecedented number of Ebola survivors discharged from the Ebola Treatment Units (ETUs). Liberia alone counted over 5,000 survivors. We undertook a qualitative study in Monrovia to better understand the mental distress experienced by survivors during hospitalization and reintegration into their community.
METHODS
Purposively selected Ebola survivors from ELWA3, the largest ETU in Liberia, were invited to join focus group discussions. Verbal-informed consent was sought. Three focus groups with a total of 17 participants were conducted between February and April 2015. Thematic analysis approach was applied to analyze the data.
RESULTS
The main stressors inside the ETU were the daily exposure to corpses, which often remained several hours among the living; the patients’ isolation from their families and worries about their well-being; and sometimes, the perception of disrespect by ETU staff. However, most survivors reported how staff motivated patients to drink, eat, bathe, and walk. Additionally, employing survivors as staff fostered hope, calling patients by their name increased confidence and familiarity, and organizing prayer and singing activities brought comfort. When Ebola virus disease survivors returned home, the experience of being alive was both a gift and a burden. Flashbacks were common among survivors. Perceived as contagious, many were excluded from their family, professional, and social life. Some survivors faced divorce, were driven out of their houses, or lost their jobs. The subsequent isolation prevented survivors from picking up daily life, and the multiple losses affected their coping mechanisms. However, when available, the support of family, friends, and prayer enabled survivors to cope with their mental distress. For those excluded from society, psychosocial counseling and the survivor’s network were ways to give a meaning to life post-Ebola.
CONCLUSION
Exposure to death in the ETU and stigma in the communities induced posttraumatic stress reactions and symptoms of depression among Ebola survivors. Distress in the ETU can be reduced through timely management of corpses. Coping mechanisms can be strengthened through trust relationships, religion, peer/community support, and community-based psychosocial care. Mental health disorders need to be addressed with appropriate specialized care and follow-up.
A consequence of the West Africa Ebola outbreak 2014–2015 was the unprecedented number of Ebola survivors discharged from the Ebola Treatment Units (ETUs). Liberia alone counted over 5,000 survivors. We undertook a qualitative study in Monrovia to better understand the mental distress experienced by survivors during hospitalization and reintegration into their community.
METHODS
Purposively selected Ebola survivors from ELWA3, the largest ETU in Liberia, were invited to join focus group discussions. Verbal-informed consent was sought. Three focus groups with a total of 17 participants were conducted between February and April 2015. Thematic analysis approach was applied to analyze the data.
RESULTS
The main stressors inside the ETU were the daily exposure to corpses, which often remained several hours among the living; the patients’ isolation from their families and worries about their well-being; and sometimes, the perception of disrespect by ETU staff. However, most survivors reported how staff motivated patients to drink, eat, bathe, and walk. Additionally, employing survivors as staff fostered hope, calling patients by their name increased confidence and familiarity, and organizing prayer and singing activities brought comfort. When Ebola virus disease survivors returned home, the experience of being alive was both a gift and a burden. Flashbacks were common among survivors. Perceived as contagious, many were excluded from their family, professional, and social life. Some survivors faced divorce, were driven out of their houses, or lost their jobs. The subsequent isolation prevented survivors from picking up daily life, and the multiple losses affected their coping mechanisms. However, when available, the support of family, friends, and prayer enabled survivors to cope with their mental distress. For those excluded from society, psychosocial counseling and the survivor’s network were ways to give a meaning to life post-Ebola.
CONCLUSION
Exposure to death in the ETU and stigma in the communities induced posttraumatic stress reactions and symptoms of depression among Ebola survivors. Distress in the ETU can be reduced through timely management of corpses. Coping mechanisms can be strengthened through trust relationships, religion, peer/community support, and community-based psychosocial care. Mental health disorders need to be addressed with appropriate specialized care and follow-up.