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. 2015 May 22; Volume 212 (Issue 11); DOI:10.1093/infdis/jiv304
Fitzpatrick G, Vogt F, Gbabai O, Decroo T, Keane M, et al.
J Infect Dis. 2015 May 22; Volume 212 (Issue 11); DOI:10.1093/infdis/jiv304
This paper describes patient characteristics, including Ebola viral load, associated with mortality in an MSF Ebola case management centre. Out of 780 admissions between June and October 2014, 525 (67%) were positive for Ebola with a known outcome. The crude mortality rate was 51% (270/525). Ebola viral load (whole blood sample) data was available on 76% (397/525) of patients. Univariate analysis indicated viral load at admission, age, symptom duration prior to admission and distance travelled to the CMC were associated with mortality (p value<0.05). The multivariable model predicted mortality in those with a viral load at admission greater than 10 million copies per millilitre (p value<0.05, Odds Ratio>10), aged 50 years or more (p value=0.08, Odds Ratio=2) and symptom duration prior to admission less than 5 days (p value=0.14). The presence of confusion, diarrhoea and conjunctivitis were significantly higher (p value<0.05) in Ebola patients who died. These findings highlight the importance viral load at admission has on mortality outcomes and could be used to cohort cases with viral loads greater than 10 million copies into dedicated wards with more intensive medical support to further reduce mortality.
Journal Article > CommentaryFull Text
Public Health Action. 2017 June 21; Volume 7 (Issue 1); DOI:10.5588/pha.17.0029
Decroo T, Fitzpatrick G, Amone J
Public Health Action. 2017 June 21; Volume 7 (Issue 1); DOI:10.5588/pha.17.0029
Journal Article > ResearchFull Text
Emerg Med (Los Angel). 2015 October 13; Volume 05 (Issue 06); DOI:10.4172/2165-7548.1000285
Hugo M, Declerck H, Fitzpatrick G, Severy N, Gbabai O, et al.
Emerg Med (Los Angel). 2015 October 13; Volume 05 (Issue 06); DOI:10.4172/2165-7548.1000285
Journal Article > ResearchFull Text
Euro Surveill. 2014 October 9
Fitzpatrick G, Vogt F, Gbabai O, Black B, Santantonio M, et al.
Euro Surveill. 2014 October 9
Journal Article > CommentaryFull Text
Emerg Infect Dis. 2017 July 1; Volume 23 (Issue 7); 1057-62.; DOI:10.3201/eid2307.161389
Fitzpatrick G, Decroo T, Draguez B, Crestani R, Ronsse A, et al.
Emerg Infect Dis. 2017 July 1; Volume 23 (Issue 7); 1057-62.; DOI:10.3201/eid2307.161389
Operational research aims to identify interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programs where the research is taking place. Médecins Sans Frontières admitted ≈5,200 patients with confirmed Ebola virus disease during the Ebola outbreak in West Africa and from the beginning nested operational research within its emergency response. This research covered critical areas, such as understanding how the virus spreads, clinical trials, community perceptions, challenges within Ebola treatment centers, and negative effects on non-Ebola healthcare. Importantly, operational research questions were decided to a large extent by returning volunteers who had first-hand knowledge of the immediate issues facing teams in the field. Such a method is appropriate for an emergency medical organization. Many challenges were also identified while carrying out operational research across 3 different countries, including the basic need for collecting data in standardized format to enable comparison of findings among treatment centers.
Journal Article > ResearchFull Text
Euro Surveill. 2015 December 17; Volume 20 (Issue 50); DOI:10.2807/1560-7917.ES.2015.20.50.30097
Vogt F, Fitzpatrick G, Patten GE, Van der Bergh R, Stinson K, et al.
Euro Surveill. 2015 December 17; Volume 20 (Issue 50); DOI:10.2807/1560-7917.ES.2015.20.50.30097
Prevention of nosocomial Ebola virus (EBOV) infection among patients admitted to an Ebola management centre (EMC) is paramount. Current Médecins Sans Frontières (MSF) guidelines recommend classifying admitted patients at triage into suspect and highly-suspect categories pending laboratory confirmation. We investigated the performance of the MSF triage system to separate patients with subsequent EBOV-positive laboratory test (true-positive admissions) from patients who were initially admitted on clinical grounds but subsequently tested EBOV-negative (false-positive admissions). We calculated standard diagnostic test statistics for triage allocation into suspect or highly-suspect wards (index test) and subsequent positive or negative laboratory results (reference test) among 433 patients admitted into the MSF EMC Kailahun, Sierra Leone, between 1 July and 30 September 2014. 254 (59%) of admissions were classified as highly-suspect, the remaining 179 (41%) as suspect. 276 (64%) were true-positive admissions, leaving 157 (36.3%) false-positive admissions exposed to the risk of nosocomial EBOV infection. The positive predictive value for receiving a positive laboratory result after being allocated to the highly-suspect ward was 76%. The corresponding negative predictive value was 54%. Sensitivity and specificity were 70% and 61%, respectively. Results for accurate patient classification were unconvincing. The current triage system should be changed. Whenever possible, patients should be accommodated in single compartments pending laboratory confirmation. Furthermore, the initial triage step on whether or not to admit a patient in the first place must be improved. What is ultimately needed is a point-of-care EBOV diagnostic test that is reliable, accurate, robust, mobile, affordable, easy to use outside strict biosafety protocols, providing results with quick turnaround time.