Other > Journal Blog
BMJ Opinion (blog). 2019 May 24
Huster K, Healy J
BMJ Opinion (blog). 2019 May 24
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
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 > LetterFull Text
Nature. 2015 June 17; Volume 524 (Issue 7563); 97-101.; DOI:10.1038/nature14594
Carroll MW, Matthews DA, Hiscox JA, Elmore MJ, Pollakis G, et al.
Nature. 2015 June 17; Volume 524 (Issue 7563); 97-101.; DOI:10.1038/nature14594
West Africa is currently witnessing the most extensive Ebola virus (EBOV) outbreak so far recorded. Until now, there have been 27,013 reported cases and 11,134 deaths. The origin of the virus is thought to have been a zoonotic transmission from a bat to a twoyear-old boy in December 2013 (ref. 2). From this index case the virus was spread by human-to-human contact throughout Guinea, Sierra Leone and Liberia. However, the origin of the particular virus in each country and time of transmission is not known and currently relies on epidemiological analysis, which may be unreliable owing to the difficulties of obtaining patient information. Here we trace the genetic evolution of EBOV in the current outbreak that has resulted in multiple lineages. Deep sequencing of 179 patient samples processed by the European Mobile Laboratory, the first diagnostics unit to be deployed to the epicentre of the outbreak in Guinea, reveals an epidemiological and evolutionary history of the epidemic from March 2014 to January 2015. Analysis of EBOV genome evolution has also benefited from a similar sequencing effort of patient samples from Sierra Leone. Our results confirm that the EBOV from Guinea moved into Sierra Leone, most likely in April or early May. The viruses of the Guinea/Sierra Leone lineage mixed around June/July 2014. Viral sequences covering August, September and October 2014 indicate that this lineage evolved independently within Guinea. These data can be used in conjunction with epidemiological information to test retrospectively the effectiveness of control measures, and provides an unprecedented window into the evolution of an ongoing viral haemorrhagic fever outbreak.
Journal Article > Short ReportFull Text
Morbidity and Mortality Weekly Report. 2014 November 14; Volume 63; 1067-71.
Sharma A, Heijenberg N, Peter C, Bolongei J, Reeder B, et al.
Morbidity and Mortality Weekly Report. 2014 November 14; Volume 63; 1067-71.
WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?
Lofa County in Liberia has one of the highest numbers of reported cases of Ebola virus disease (Ebola) in West Africa. Government health offices, nongovernmental organizations, and technical agencies coordinated response activities to reduce transmission of Ebola in Lofa County. The intensity and thoroughness of activities increased in response to the resurgence of Ebola in early June.
WHAT IS ADDED BY THIS REPORT?
Trends in new reported cases, admissions to the dedicated Ebola treatment unit in the town of Foya, and test results of community decedents evaluated for Ebola virus suggest transmission of Ebola virus decreased in Lofa County as early as August 17, 2014, following rapid scale-up of response activities after a resurgence of Ebola in early June.
WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?
A comprehensive Ebola response strategy developed with participation from the local community and rapidly scaled up following resurgence of Ebola might have reduced the spread of Ebola virus in Lofa County. The strategy implemented in Lofa County might serve as a model for reducing transmission of Ebola virus in other affected areas.
Lofa County in Liberia has one of the highest numbers of reported cases of Ebola virus disease (Ebola) in West Africa. Government health offices, nongovernmental organizations, and technical agencies coordinated response activities to reduce transmission of Ebola in Lofa County. The intensity and thoroughness of activities increased in response to the resurgence of Ebola in early June.
WHAT IS ADDED BY THIS REPORT?
Trends in new reported cases, admissions to the dedicated Ebola treatment unit in the town of Foya, and test results of community decedents evaluated for Ebola virus suggest transmission of Ebola virus decreased in Lofa County as early as August 17, 2014, following rapid scale-up of response activities after a resurgence of Ebola in early June.
WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?
A comprehensive Ebola response strategy developed with participation from the local community and rapidly scaled up following resurgence of Ebola might have reduced the spread of Ebola virus in Lofa County. The strategy implemented in Lofa County might serve as a model for reducing transmission of Ebola virus in other affected areas.
Conference Material > Abstract
Meakin S
Epicentre Scientific Day 2024. 2024 May 23
BACKGROUND
The recombinant vesicular stomatitis virus–Zaire Ebola virus (rVSV-ZEBOV) vaccine is the only vaccine recommended for use to respond to Zaire ebolavirus outbreaks by SAGE. A single ring vaccination trial found the efficacy to be 100%; however, no estimates of real-world effectiveness have yet been published.
METHODS
We conducted a retrospective test-negative case-control analysis to estimate effectiveness of rVSV-ZEBOV vaccination against Ebola virus disease (EVD) during the 2018 - 2020 epidemic in the Democratic Republic of the Congo (DRC), using data on suspected cases collected at Ebola treatment centres. Missing data were imputed using multivariate imputation. Among those who reported contact with an Ebola case before symptom onset, each EVD-positive case was matched to one EVD-negative control by sex, age, health zone and month of symptom onset. Effectiveness was then estimated from the odds ratio of being vaccinated vs. unvaccinated among cases and controls, after adjusting for the matching factors.
RESULTS
The primary study population contained 309 cases and controls each, on average, of which between 11 and 23 cases (3.6– 7.4%) and between 48 and 80 controls (16 – 26%) were recorded as vaccinated at least ten days before symptom onset. We found rVSV-ZEBOV vaccination at least ten days before symptom onset was 84% effective against developing EVD (95% credible interval [70%, 92%]). There was no apparent difference in effectiveness by sex, age, or due to a change in vaccination protocol.
CONCLUSION
This study is the first to estimate real-world effectiveness of rVSV-ZEBOV vaccination EVD during the second largest EVD outbreak ever recorded. Our findings confirm that rVSV-ZEBOV vaccination is highly protective against developing EVD and support its reactive, targeted use in at-risk people during future outbreaks.
The recombinant vesicular stomatitis virus–Zaire Ebola virus (rVSV-ZEBOV) vaccine is the only vaccine recommended for use to respond to Zaire ebolavirus outbreaks by SAGE. A single ring vaccination trial found the efficacy to be 100%; however, no estimates of real-world effectiveness have yet been published.
METHODS
We conducted a retrospective test-negative case-control analysis to estimate effectiveness of rVSV-ZEBOV vaccination against Ebola virus disease (EVD) during the 2018 - 2020 epidemic in the Democratic Republic of the Congo (DRC), using data on suspected cases collected at Ebola treatment centres. Missing data were imputed using multivariate imputation. Among those who reported contact with an Ebola case before symptom onset, each EVD-positive case was matched to one EVD-negative control by sex, age, health zone and month of symptom onset. Effectiveness was then estimated from the odds ratio of being vaccinated vs. unvaccinated among cases and controls, after adjusting for the matching factors.
RESULTS
The primary study population contained 309 cases and controls each, on average, of which between 11 and 23 cases (3.6– 7.4%) and between 48 and 80 controls (16 – 26%) were recorded as vaccinated at least ten days before symptom onset. We found rVSV-ZEBOV vaccination at least ten days before symptom onset was 84% effective against developing EVD (95% credible interval [70%, 92%]). There was no apparent difference in effectiveness by sex, age, or due to a change in vaccination protocol.
CONCLUSION
This study is the first to estimate real-world effectiveness of rVSV-ZEBOV vaccination EVD during the second largest EVD outbreak ever recorded. Our findings confirm that rVSV-ZEBOV vaccination is highly protective against developing EVD and support its reactive, targeted use in at-risk people during future outbreaks.
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 > 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 > 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.