Institutional policies and readiness in management of critical illness among patients with viral hemorrhagic fever

2021 ◽  
pp. 1-6
Author(s):  
Madeline A. DiLorenzo ◽  
Christoph A. Baker ◽  
Jocelyn J. Herstein ◽  
Laura Evans ◽  
John J. Lowe ◽  
...  
Keyword(s):  
Critical Care ◽  
Ebola Virus ◽  
Virus Disease ◽  
Disease Outbreaks ◽  
Hemorrhagic Fever ◽  
Viral Hemorrhagic Fever ◽  
Alternative Technologies ◽  
Infectious Disease Outbreaks ◽  
Care Policies ◽  
Us Government

Abstract Objective: In response to the 2013–2016 Ebola virus disease outbreak, the US government designated certain healthcare institutions as Ebola treatment centers (ETCs) to better prepare for future emerging infectious disease outbreaks. This study investigated ETC experiences and critical care policies for patients with viral hemorrhagic fever (VHF). Design: A 58-item questionnaire elicited information on policies for 9 critical care interventions, factors that limited care provision, and innovations developed to deliver care. Setting and participants: The questionnaire was sent to 82 ETCs. Methods: We analyzed ordinal and categorical data pertaining to the ETC characteristics and descriptive data about their policies and perceived challenges. Statistical analyses assessed whether ETCs with experience caring for VHF patients were more likely to have critical care policies than those that did not. Results: Of the 27 ETCs who responded, 17 (63%) were included. Among them, 8 (47%) reported experience caring for persons under investigation or confirmed cases of VHF. Most felt ready to provide intubation, chest compressions, and renal replacement therapy to these patients. The factors most cited for limiting care were staff safety and clinical futility. Innovations developed to better provide care included increased simulation training and alternative technologies for procedures and communication. Conclusions: There were broad similarities in critical care policies and limitations among institutions. There were several interventions, namely ECMO and cricothyrotomy, which few institutions felt ready to provide. Future studies could identify obstacles to providing these interventions and explore policy changes after increased experience with novel infectious diseases, such as COVID-19.

scholarly journals WHO guidance on ethics in outbreaks and the COVID-19 pandemic: a critical appraisal

2021 ◽  
pp. medethics-2020-106959
Author(s):  
Abha Saxena ◽  
Paul André Bouvier ◽  
Ehsan Shamsi-Gooshki ◽  
Johannes Köhler ◽  
Lisa J Schwartz
Keyword(s):  
Ebola Virus ◽  
Ethical Issues ◽  
Virus Disease ◽  
Disease Outbreaks ◽  
Guidance Document ◽  
Health Crisis ◽  
Infectious Disease Outbreaks ◽  
Ethical Implications ◽  
Political Crises ◽  
Starting Point

In 2016, following pandemic influenza threats and the 2014–2016 Ebola virus disease outbreaks, the WHO developed a guidance document for managing ethical issues in infectious disease outbreaks. In this article, we analyse some ethical issues that have had a predominant role in decision making in response to the current COVID-19 pandemic but were absent or not addressed in the same ways in the 2016 guidance document. A pandemic results in a health crisis and social and political crises both nationally and globally. The ethical implications of these global effects should be properly identified so that appropriate actions can be taken globally and not just in national isolation. Our analysis, which is a starting point to test the broader relevance of the 2016 WHO document that remains the only available guidance document applicable globally, concludes that the WHO guidance should be updated to provide reasoned and thoughtful comprehensive ethics advice for the sound management of the current and future pandemics.

Letter-to-Editor II

2014 ◽  
Vol 6 (2) ◽  
pp. 0-0
Author(s):  
Ayush Agarwal ◽  
Omkar Singh ◽  
VK Rastogi
Keyword(s):  
Ebola Virus ◽  
Virus Disease ◽  
Specific Treatment ◽  
Disease Outbreaks ◽  
Case Fatality ◽  
Hemorrhagic Fever ◽  
Physical Contact ◽  
Ebola Virus Disease ◽  
Human Beings ◽  
Ebola Hemorrhagic Fever

ABSTRACT • Ebola virus disease (EVD), also known as Ebola hemorrhagic fever, is a severe, often fatal illness of human beings having a case fatality rate of up to 90%. • Ebola virus disease outbreaks occur primarily in remote Central and West Africa, near the tropical rainforests. • The virus is transmitted to humans from wild animals and spreads in the human beings through physical contact. • It does not transmit through vectors or air-borne droplets. • Severely ill patients require intensive supportive care. No specific treatment or vaccine is available for use.

scholarly journals Core Minimal Datasets to Advance Clinical Research for Priority Epidemic Diseases

2019 ◽  
Author(s):  
Amanda M Rojek ◽  
James Moran ◽  
Peter W Horby
Keyword(s):  
Infectious Disease ◽  
Clinical Research ◽  
Ebola Virus ◽  
Virus Disease ◽  
Disease Outbreaks ◽  
Disease Outbreak ◽  
Significant Progress ◽  
Infectious Disease Outbreaks ◽  
Vaccine Trials ◽  
Epidemic Diseases

Abstract The Ebola virus disease outbreak in west Africa has prompted significant progress in responding to the clinical needs of patients affected by emerging infectious disease outbreaks. Among the noteworthy successes of vaccine trials, and the commendable efforts to implement clinical treatment trials during Ebola outbreaks, we should also focus on strengthening the collection and curation of epidemiological and observational data that can improve the conception and design of clinical research.

scholarly journals Addressing Disease-Related Stigma During Infectious Disease Outbreaks

2019 ◽  
Vol 13 (5-6) ◽  
pp. 989-994 ◽  
Author(s):  
Leah S. Fischer ◽  
Gordon Mansergh ◽  
Jonathan Lynch ◽  
Scott Santibanez
Keyword(s):  
Infectious Disease ◽  
Zika Virus ◽  
Ebola Virus ◽  
Virus Disease ◽  
Disease Outbreaks ◽  
Ebola Virus Disease ◽  
Effective Control ◽  
Infectious Disease Outbreaks ◽  
Influenza A H1n1 ◽  
Related Stigma

ABSTRACTOutbreaks of emerging infectious disease are a constant threat. In the last 10 years, there have been outbreaks of 2009 influenza A (H1N1), Ebola virus disease, and Zika virus. Stigma associated with infectious disease can be a barrier to adopting healthy behaviors, leading to more severe health problems, ongoing disease transmission, and difficulty controlling infectious disease outbreaks. Much has been learned about infectious disease and stigma in the context of nearly 4 decades of the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome pandemic. In this paper, we define stigma, discuss its relevance to infectious disease outbreaks, including how individuals and communities can be affected. Adapting lessons learned from the rich literature on HIV-related stigma, we propose a strategy for reducing stigma during infectious disease outbreaks such as Ebola virus disease and Zika virus. The implementation of brief, practical strategies such as the ones proposed here might help reduce stigma and facilitate more effective control of emerging infectious diseases.

scholarly journals A Quantitative Framework to Define the End of an Outbreak: Application to Ebola Virus Disease

2020 ◽  
Author(s):  
Bimandra A Djaafara ◽  
Natsuko Imai ◽  
Esther Hamblion ◽  
Benido Impouma ◽  
Christl A Donnelly ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Ebola Virus ◽  
Virus Disease ◽  
Disease Outbreaks ◽  
Reporting Rate ◽  
Ebola Virus Disease ◽  
World Health ◽  
Infectious Disease Outbreaks ◽  
Simulation Based ◽  
Health Organization

Abstract The end-of-outbreak declaration is an important step in controlling infectious disease outbreaks. An objective estimation of the confidence level that an outbreak is over is important to reduce the risk of post-declaration flare-ups. We developed a simulation-based model to quantify that confidence. We tested it on simulated Ebola Virus Disease data. We found these confidence estimates were most sensitive to the instantaneous reproduction number, the reporting rate, and the time between the symptom onset to death or recovery of the last detected case. For Ebola Virus Disease, our results suggest that the current World Health Organization criterion of 42 days since the recovery or death of the last detected case is too short and sensitive to underreporting. Therefore, we suggest a shift to a preliminary end-of-outbreak declaration after 63 days from the symptom onset day of the last detected case. This preliminary declaration should still be followed by 90 days of enhanced surveillance to capture potential flare-ups of cases, after which the official end-of-outbreak can be declared. This sequence corresponds to more than 95% confidence that an outbreak is over in most of the scenarios examined. Our framework is generic, and therefore could be adapted to estimate end-of-outbreak confidence for other infectious diseases.

scholarly journals Ethics of emerging infectious disease outbreak responses: Using Ebola virus disease as a case study of limited resource allocation

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246320
Author(s):  
Ariadne A. Nichol ◽  
Annick Antierens
Keyword(s):  
Infectious Disease ◽  
Ebola Virus ◽  
Virus Disease ◽  
Disease Outbreaks ◽  
Emerging Infectious Disease ◽  
Ethical Framework ◽  
Experimental Therapeutics ◽  
Ethical Challenges ◽  
Outbreak Response ◽  
Infectious Disease Outbreaks

Emerging infectious diseases such as Ebola Virus Disease (EVD), Nipah Virus Encephalitis and Lassa fever pose significant epidemic threats. Responses to emerging infectious disease outbreaks frequently occur in resource-constrained regions and under high pressure to quickly contain the outbreak prior to potential spread. As seen in the 2020 EVD outbreaks in the Democratic Republic of Congo and the current COVID-19 pandemic, there is a continued need to evaluate and address the ethical challenges that arise in the high stakes environment of an emerging infectious disease outbreak response. The research presented here provides analysis of the ethical challenges with regard to allocation of limited resources, particularly experimental therapeutics, using the 2013–2016 EVD outbreak in West Africa as a case study. In-depth semi-structured interviews were conducted with senior healthcare personnel (n = 16) from international humanitarian aid organizations intimately engaged in the 2013–2016 EVD outbreak response in West Africa. Interviews were recorded in private setting, transcribed, and iteratively coded using grounded theory methodology. A majority of respondents indicated a clear propensity to adopt an ethical framework of guiding principles for international responses to emerging infectious disease outbreaks. Respondents agreed that prioritization of frontline workers’ access to experimental therapeutics was warranted based on a principle of reciprocity. There was widespread acceptance of adaptive trial designs and greater trial transparency in providing access to experimental therapeutics. Many respondents also emphasized the importance of community engagement in limited resource allocation scheme design and culturally appropriate informed consent procedures. The study results inform a potential ethical framework of guiding principles based on the interview participants’ insights to be adopted by international response organizations and their healthcare workers in the face of allocating limited resources such as experimental therapeutics in future emerging infectious disease outbreaks to ease the moral burden of individual healthcare providers.

scholarly journals A quantitative framework to define the end of an outbreak: application to Ebola Virus Disease

2020 ◽  
Author(s):  
Bimandra A Djaafara ◽  
Natsuko Imai ◽  
Esther Hamblion ◽  
Benido Impouma ◽  
Christl A Donnelly ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Ebola Virus ◽  
Reproduction Number ◽  
Virus Disease ◽  
Disease Outbreaks ◽  
Reporting Rate ◽  
Ebola Virus Disease ◽  
Surveillance Period ◽  
Infectious Disease Outbreaks ◽  
Simulation Based

Declaring the end of an outbreak is an important step in controlling infectious disease outbreaks. An objective estimation of the probability of cases arising in the future is important to reduce the risk of post-declaration flare-ups. We developed a simulation-based model to quantify that probability. We tested it on simulated Ebola Virus Disease (EVD) data and found this probability was most sensitive to the instantaneous reproduction number, the reporting rate, and the delay between symptom onset and recovery or death of the last detected case. For EVD, our results suggest that the current WHO criterion of 42 days since the outcome of the last detected case is too short and very sensitive to underreporting. The 90 days of enhanced surveillance period after the end-of-outbreak declaration is therefore crucial to capture potential flare-ups of cases. Hence, we suggest a shift to a preliminary end-of-outbreak declaration after 63 days from the symptom onset day of the last detected case. This should be followed by a 90-day enhanced surveillance, after which the official end-of-outbreak can be declared. This corresponds to less than 5% probability of flare ups in most of the scenarios examined. Our quantitative framework could be adapted to define end-of-outbreak criteria for other infectious diseases.

scholarly journals Chainchecker: An application to visualise and explore transmission chains for Ebola virus disease

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247002
Author(s):  
Katy Gaythorpe ◽  
Aaron Morris ◽  
Natsuko Imai ◽  
Miles Stewart ◽  
Jeffrey Freeman ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Virus Disease ◽  
Data Entry ◽  
Hemorrhagic Fever ◽  
Ebola Virus Disease ◽  
Viral Hemorrhagic Fever ◽  
Link Type ◽  
R Shiny ◽  
Exposure Windows ◽  
Shiny Application

2020 saw the continuation of the second largest outbreak of Ebola virus disease (EVD) in history. Determining epidemiological links between cases is a key part of outbreak control. However, due to the large quantity of data and subsequent data entry errors, inconsistencies in potential epidemiological links are difficult to identify. We present chainchecker, an online and offline shiny application which visualises, curates and verifies transmission chain data. The application includes the calculation of exposure windows for individual cases of EVD based on user defined incubation periods and user specified symptom profiles. It has an upload function for viral hemorrhagic fever data and utility for additional entries. This data may then be visualised as a transmission tree with inconsistent links highlighted. Finally, there is utility for cluster analysis and the ability to highlight nosocomial transmission. chainchecker is a R shiny application which has an offline version for use with VHF (viral hemorrhagic fever) databases or linelists. The software is available at https://shiny.dide.imperial.ac.uk/chainchecker which is a web-based application that links to the desktop application available for download and the github repository, https://github.com/imperialebola2018/chainchecker.

scholarly journals Equine-Origin Immunoglobulin Fragments Protect Nonhuman Primates from Ebola Virus Disease

2018 ◽  
Vol 93 (5) ◽  
Author(s):  
Hualei Wang ◽  
Gary Wong ◽  
Wenjun Zhu ◽  
Shihua He ◽  
Yongkun Zhao ◽  
...  
Keyword(s):  
Large Scale ◽  
Nonhuman Primates ◽  
Ebola Virus ◽  
Virus Disease ◽  
Hemorrhagic Fever ◽  
West African ◽  
Clinical Testing ◽  
The Past ◽  
Over 40 Years

ABSTRACT Ebola virus (EBOV) infections result in aggressive hemorrhagic fever in humans, with fatality rates reaching 90% and with no licensed specific therapeutics to treat ill patients. Advances over the past 5 years have firmly established monoclonal antibody (MAb)-based products as the most promising therapeutics for treating EBOV infections, but production is costly and quantities are limited; therefore, MAbs are not the best candidates for mass use in the case of an epidemic. To address this need, we generated EBOV-specific polyclonal F(ab′)2 fragments from horses hyperimmunized with an EBOV vaccine. The F(ab′)2 was found to potently neutralize West African and Central African EBOV in vitro. Treatment of nonhuman primates (NHPs) with seven doses of 100 mg/kg F(ab′)2 beginning 3 or 5 days postinfection (dpi) resulted in a 100% survival rate. Notably, NHPs for which treatment was initiated at 5 dpi were already highly viremic, with observable signs of EBOV disease, which demonstrated that F(ab′)2 was still effective as a therapeutic agent even in symptomatic subjects. These results show that F(ab′)2 should be advanced for clinical testing in preparation for future EBOV outbreaks and epidemics. IMPORTANCE EBOV is one of the deadliest viruses to humans. It has been over 40 years since EBOV was first reported, but no cure is available. Research breakthroughs over the past 5 years have shown that MAbs constitute an effective therapy for EBOV infections. However, MAbs are expensive and difficult to produce in large amounts and therefore may only play a limited role during an epidemic. A cheaper alternative is required, especially since EBOV is endemic in several third world countries with limited medical resources. Here, we used a standard protocol to produce large amounts of antiserum F(ab′)2 fragments from horses vaccinated with an EBOV vaccine, and we tested the protectiveness in monkeys. We showed that F(ab′)2 was effective in 100% of monkeys even after the animals were visibly ill with EBOV disease. Thus, F(ab′)2 could be a very good option for large-scale treatments of patients and should be advanced to clinical testing.

Palliative care for children with communicable illnesses

2021 ◽  
pp. 304-322
Author(s):  
Michelle Meiring ◽  
Tonya Arscott-Mills
Keyword(s):  
Palliative Care ◽  
Ebola Virus ◽  
Virus Disease ◽  
Communicable Disease ◽  
Disease Outbreaks ◽  
Communicable Diseases ◽  
Humanitarian Response ◽  
Care Approach ◽  
Health Related ◽  
Communicable Illness

Whilst non-communicable diseases provided the impetus for the development of children’s palliative care (CPC) in the developed world, it was a single communicable illness human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) that was the catalyst for the development of many CPC programmes in the developing world. Whilst considerable gains have been made in preventing and controlling paediatric AIDS globally, there is still benefit to an integrated palliative care approach to the care of these children and especially for those living in countries without access to anti-retrovirals. Furthermore, there are many other communicable diseases associated with significant health-related suffering in children that could benefit from palliative care. This chapter proposes grouping these diseases using the well-known Association for Children with Terminal Conditions (ACT) categorization and discusses examples of important communicable diseases in each category. The need for improved CPC as part of the humanitarian response to acute communicable disease outbreaks such as Ebola virus disease is also explored.

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