scholarly journals Vitamin A Supplementation Was Associated with Reduced Mortality in Patients with Ebola Virus Disease during the West African Outbreak

2019 ◽  
Vol 149 (10) ◽  
pp. 1757-1765 ◽  
Author(s):  
Adam R Aluisio ◽  
Shiromi M Perera ◽  
Derrick Yam ◽  
Stephanie Garbern ◽  
Jillian L Peters ◽  
...  
Keyword(s):  
Vitamin A ◽  
Ebola Virus ◽  
Propensity Scores ◽  
Resource Constraints ◽  
Clinical Symptoms ◽  
Virus Disease ◽  
Ebola Virus Disease ◽  
Threshold Values ◽  
Vitamin A Supplementation ◽  
Cycle Threshold

ABSTRACT Background Micronutrient supplementation is recommended in Ebola virus disease (EVD); however, there are limited data on therapeutic impacts of specific micronutrients. Objective To evaluate the association between vitamin A supplementation and mortality in EVD. Methods This retrospective cohort included patients with EVD admitted to 5 International Medical Corps Ebola Treatment Units (ETUs) in 2 countries during 2014–2015. Protocolized treatments with micronutrients were used at all ETUs: however, because of resource constraints, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola viral loads (cycle threshold values) were collected. The outcome of interest was mortality between cases treated with 200,000 IU of vitamin A on care days 1 and/or 2, and those not. Propensity scores based on the first 48 h of care were derived using covariates of age, ETU duration, malaria status, cycle threshold values, and clinical symptoms. Patients were matched 1:1 using nearest neighbors with replacement. Mortality between cases treated and not treated with vitamin A was compared using generalized estimating equations to calculate RR with associated 95% CI. Results There were 424 cases analyzed, of which 330 (77.8%) were treated with vitamin A. The mean age was 30.5 y and 40.3% were men. The most common symptoms were diarrhea (85.6%), anorexia (80.7%), and abdominal pain (76.9%). Mortality proportions among cases treated and not treated with vitamin A were 55.0% and 71.9%, respectively. In the propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77, 95% CI: 0.59, 0.99; P = 0.041). In a subgroup analysis of patients treated with multivitamins already containing vitamin A, additional vitamin A supplementation did not impact mortality. Conclusion Early vitamin A supplementation was associated with reduced mortality in patients with EVD, and should be further studied and considered for use in future epidemics.

scholarly journals Association Between Vitamin A Supplementation and Mortality Among Patients with Ebola Virus Disease: An International Multisite Cohort Study

2019 ◽  
Vol 34 (s1) ◽  
pp. s15-s16
Author(s):  
Adam Aluisio ◽  
Derrick Yam ◽  
Jillian L. Peters ◽  
Daniel K. Cho ◽  
Shiromi M. Perera ◽  
...  
Keyword(s):  
Cohort Study ◽  
Vitamin A ◽  
Ebola Virus ◽  
Propensity Scores ◽  
Virus Disease ◽  
Ebola Virus Disease ◽  
Vitamin A Supplementation ◽  
Resource Limitations ◽  
Covariate Balance ◽  
Relative Risks

Introduction:Micronutrient supplementation is recommended in Ebola Virus Disease (EVD). However, there is limited data on its therapeutic impacts. This study evaluated the association between vitamin A supplementation and mortality outcomes in EVD patients.Methods:This retrospective cohort study accrued patients with EVD admitted to five International Medical Corps run Ebola Treatment Units (ETU) in two countries from 2014-2015. Protocolized treatments with antimicrobials and micronutrients were used at all ETUs. However, due to resource limitations and care variations, only a subset of patients received vitamin A. Standardized data on demographics, clinical characteristics, malaria status, and Ebola virus RT-PCR cycle threshold (CT) values were collected. The outcome of interest was mortality compared between cases treated with 200,000 International Units of vitamin A on care days one and two and those not. Propensity scores (PS) based on the first 48-hours of care were derived using the covariates of age, duration of ETU function, malaria status, CT values, symptoms of confusion, hemorrhage, diarrhea, dysphagia, and dyspnea. Treated and non-treated cases were matched 1:1 based on nearest neighbors with replacement. Covariate balance met predefined thresholds. Mortality proportions between cases treated and untreated with vitamin A were compared using generalized estimating equations to calculate relative risks (RR) with associated 95% confidence intervals (CI).Results:There were 424 cases analyzed, with 330 (77.8%) being vitamin A-treated cases. The mean age was 30.5 years and 57.0% were female. The most common symptoms were diarrhea (86%), anorexia (81%), and vomiting (77%). Mortality proportions among cases untreated and treated with vitamin A were 71.9% and 55.0%, respectively. In a propensity-matched analysis, mortality was significantly lower among cases receiving vitamin A (RR = 0.77 95%; CI:0.59-0.99; p = 0.041).Discussion:Early vitamin A supplementation was associated with reduced mortality in EVD patients and should be provided routinely during future epidemics.

scholarly journals IN VITRO DIAGNOSIS FOR EBOLA VIRUS DISEASE. A COMPARISON OF CURRENT TECHNIQUES AND DIAGNOSTIC ASSAYS

2019 ◽  
Vol 1 (3) ◽  
pp. 105-116
Author(s):  
A. O. Sementsova ◽  
V. G. Dedkov ◽  
V. A. Ternovoy ◽  
E. V. Chub ◽  
S. A. Pyankov ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Clinical Symptoms ◽  
Virus Disease ◽  
Hemorrhagic Fever ◽  
Multiple Organ ◽  
Ebola Virus Disease ◽  
Diagnostic Assays ◽  
Natural Foci ◽  
Forested Areas

Ebola virus disease is dangerous viral infection, occurring in the form of hemorrhagic fever, characterized by acute clinical symptoms and high mortality rate due to multiple organ failure. Ebola virus natural foci are located in forested areas of the central and western parts of Africa. It was believed for many years, the incidence of Ebola virus disease has been sporadic and the burden of it is true only in endemic areas. However, the unprecedented Ebola epidemic caused by Zaire virus in 2013 — 2016, has significantly changed our understanding of this disease and the patterns of its distribution. We have also identified weaknesses in the organization of anti-epidemic measures, the effectiveness of which was not very effective at the onset of the epidemic, in particular due to weak development of in vitro diagnostics (IVD). However, during the elimination of the epidemic in West Africa, anti-epidemic system has been modified substantially, largely due to quickly developed IVD kits. This review is devoted to analysis of trends in IVD for Ebola virus disease based on the experience obtained in the course of the West-African epidemic in 2013 — 2016.

scholarly journals Long-lasting severe immune dysfunction in Ebola virus disease survivors

2019 ◽  
Author(s):  
Aurélie Wiedemann ◽  
M.Sc. Emile Foucat ◽  
Hakim Hocini ◽  
M.Sc. Cécile Lefebvre ◽  
Alpha Kabinet Keita ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Immune Cell ◽  
Clinical Symptoms ◽  
Virus Disease ◽  
Expression Profiles ◽  
Gene Expression Profiles ◽  
Ebola Virus Disease ◽  
Treatment Center ◽  
Phenotypic Characterization

Abstract Clinical follow-up of Ebola virus disease (EVD) survivors revealed a persistence of clinical symptoms and higher risk of mortality. Long-term analyses of the immune and inflammatory profiles of EVD survivors are currently lacking. Here, we evaluate immune profile status and gene expression profiles in 35 Guinean EVD survivors (EBOV_S) from the last West African outbreak, a median of 23 months (IQR [18-25]) after discharge from the Ebola treatment center. We show a persistent increase of several biomarkers of inflammation, immune activation and gut tissue damage in EBOV_S compared to healthy donors living in the same area. These results are confirmed by phenotypic characterization of immune cell subsets revealing increases in activation marker expression and the frequencies of CD8+ T cells, exhausted B cells, non-classical NK cells and circulating dendritic cells. All survivors have EBOV-specific IgG antibodies and robust and polyfunctional EBOV-specific memory T-cell responses. Deep sequencing studies of the genes expressed in blood revealed a significant enrichment in genes associated with antiviral responses in EBOV_S. This study assess the long-term persistence of immunological dysfunction in survivors and identify a set of biological and genetic markers that could be used to define a signature of “chronic Ebola virus disease (CEVD)”.

JOINT ESTIMATION OF THE TRANSMISSIBILITY AND SEVERITY OF EBOLA VIRUS DISEASE IN REAL TIME

2017 ◽  
Vol 25 (04) ◽  
pp. 587-603 ◽  
Author(s):  
YUSUKE ASAI ◽  
HIROSHI NISHIURA
Keyword(s):  
Real Time ◽  
Ebola Virus ◽  
Virus Disease ◽  
Critical Role ◽  
Estimation Method ◽  
Case Fatality ◽  
Ascertainment Bias ◽  
Joint Estimation ◽  
Ebola Virus Disease ◽  
Strong Impact

The effective reproduction number [Formula: see text], the average number of secondary cases that are generated by a single primary case at calendar time [Formula: see text], plays a critical role in interpreting the temporal transmission dynamics of an infectious disease epidemic, while the case fatality risk (CFR) is an indispensable measure of the severity of disease. In many instances, [Formula: see text] is estimated using the reported number of cases (i.e., the incidence data), but such report often does not arrive on time, and moreover, the rate of diagnosis could change as a function of time, especially if we handle diseases that involve substantial number of asymptomatic and mild infections and large outbreaks that go beyond the local capacity of reporting. In addition, CFR is well known to be prone to ascertainment bias, often erroneously overestimated. In this paper, we propose a joint estimation method of [Formula: see text] and CFR of Ebola virus disease (EVD), analyzing the early epidemic data of EVD from March to October 2014 and addressing the ascertainment bias in real time. To assess the reliability of the proposed method, coverage probabilities were computed. When ascertainment effort plays a role in interpreting the epidemiological dynamics, it is useful to analyze not only reported (confirmed or suspected) cases, but also the temporal distribution of deceased individuals to avoid any strong impact of time dependent changes in diagnosis and reporting.

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