Nursing experience of patients with Ebola virus disease in Chinese Ebola Treatment Unit in Liberia

Abstract Background Rates of bacteremia in Ebola virus disease (EVD) are not currently known. Given the potential for secondary bacterial infection during acute EVD, current treatment guidelines recommend empiric use of broad-spectrum antibiotics. We sought to determine rates of bacteremia among patients evaluated for EVD at the ELWA-3 Ebola Treatment Unit in Monrovia, Liberia during the 2013–16 West Africa epidemic. Methods Deidentified blood samples and matched clinical data from 235 Ebola virus (EBOV)-positive patients and 102 EBOV-negative patients were evaluated under a University of Liberia Pacific Institute for Research and Evaluation IRB-approved protocol. 0.2 mL aliquots of frozen whole blood samples collected at triage, prior to the administration of antibiotics, were inoculated into BD BACTEC Peds Plus bottles and incubated under aerobic conditions in a BD BACTEC FX40 for 5 days in the National Institute of Allergy and Infectious Disease Biosafety Level 4 laboratory in Hamilton, MT. Positive samples were sub-cultured on nonselective sheep blood agar and chocolate agar and pure colonies were selected for identification by 16S sequencing and by matrix assisted laser desorption ionization time-of-flight mass spectrometry. Results No difference in rates of bacteremia was detected among EBOV-positive vs. EBOV-negative patients – 3.8% and 3.9%, respectively. Predominant isolates included Staphylococcus epidermidis and other coagulase-negative staphylococci, thought consistent with contaminants. Pathogenic species included Staphylococcus aureus and possibly Paenibacillus spp. Conclusion These data suggest that bacteremia does not commonly complicate EVD. However, as both prolonged sample storage and low culture volume may negatively affect sensitivity, additional molecular analyses are needed to support this conclusion. The Intramural Research Program of the National Institutes of Health supported this work. Disclosures All authors: No reported disclosures.

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Comments on Rees et al.: safety and feasibility of a strategy of early central venous catheter insertion in a deployed UK military Ebola virus disease treatment unit

Intensive Care Medicine ◽

10.1007/s00134-015-3803-4 ◽

2015 ◽

Vol 41 (6) ◽

pp. 1168-1168 ◽

Cited By ~ 1

Author(s):

Julien Bordes ◽

Nicolas Gagnon ◽

Ludovic Karkowsky ◽

Jean Marie Cournac ◽

Claire Rousseau ◽

...

Keyword(s):

Central Venous Catheter ◽

Ebola Virus ◽

Virus Disease ◽

Venous Catheter ◽

Catheter Insertion ◽

Ebola Virus Disease ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

Disease Treatment ◽

Treatment Unit

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Post-Ebola Syndrome among Ebola Virus Disease Survivors in Montserrado County, Liberia 2016

BioMed Research International ◽

10.1155/2018/1909410 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8 ◽

Cited By ~ 21

Author(s):

Himiede W. Wilson ◽

Maame Amo-Addae ◽

Ernest Kenu ◽

Olayinka Stephen Ilesanmi ◽

Donne K. Ameme ◽

...

Keyword(s):

Ebola Virus ◽

Psychological Symptoms ◽

Virus Disease ◽

Clinical Care ◽

Adult Population ◽

Cross Sectional Study ◽

Ebola Virus Disease ◽

Cross Sectional ◽

Treatment Unit ◽

Health History

Introduction. An increased number of survivors have emerged from the 2014 West African Ebola Virus Disease (EVD) epidemic. Post-Ebola Syndrome (PES) is a group of physical and psychological symptoms affecting EVD survivors. This study aimed to estimate the prevalence of PES among EVD survivors in Montserrado County, Liberia. Method. A cross-sectional study design was conducted to determine the prevalence of PES, types, onset, and duration among survivors. Survivors in Montserrado County were recruited using multistage sampling methods. Quantitative data was collected using semistructured questionnaire. Variables were collected on EVD survivors demographics, pre- and post-Ebola health history. Result. Prevalence of Post-Ebola Syndrome was estimated to be 90% (242/268). PES was experienced by 67% (162/242) females. PES occurred mainly in the adult population between ages 25-34, 35% (84/242). The commonest symptoms were reported from the following systems of the human body: neurological system (eyes problem, headache, sleep disorder, and unusual tiredness) and musculoskeletal system (abdominal pain, chest pain, and joints pains). The onset of PES occurred between the first 1-12 weeks after being discharged from a treatment unit. Conclusion. Prevalence of PES is high. Clinical care for survivors should be strengthened.

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Essential Medications for Patients With Suspected or Confirmed Ebola Virus Disease in Resource-Limited Environments

Military Medicine ◽

10.7205/milmed-d-17-00010 ◽

2017 ◽

Vol 182 (9-10) ◽

pp. e2006-e2016 ◽

Cited By ~ 1

Author(s):

William F. Pierce ◽

Selena D. Ready ◽

John Tyson Chapman ◽

Corrinne Kulick ◽

Anastasia Shields ◽

...

Keyword(s):

Ebola Virus ◽

Virus Disease ◽

Ebola Virus Disease ◽

World Health ◽

Clinical Environment ◽

Treatment Unit ◽

Resource Limited ◽

Pharmacy Dispensing Data ◽

Dispensing Data ◽

The U.S

ABSTRACT Background: In 2014, the U.S. Public Health Service (USPHS) Commissioned Corps deployed to Monrovia, Liberia, to operate a 25-bed Ebola treatment unit (ETU) constructed by the U.S. Military. The ETU was named the Monrovia Medical Unit (MMU) and was constructed from an U.S. Air Force Expeditionary Medical Support (EMEDS) unit with modifications on the basis of consultation from Médecins Sans Frontières, the World Health Organization, and expert panels from the U.S. Department of Defense and Department of Health and Human Services. From November 12, 2014, to April 30, 2015, 42 patients (18 confirmed Ebola virus disease [EVD] and 24 suspected EVD) from nine countries were treated by USPHS providers at the MMU. The medications used in the MMU were primarily procured from the EMEDS 25-bed pharmacy cache. However, specific formulary additions were made for treatment of EVD. Methods: Using the MMU pharmacy dispensing data, we compared and contrasted the medications used in the MMU with recommendations in published EVD treatment guidelines for austere settings. Findings: After comparing and contrasting the MMU pharmacy dispensing data with publications with EVD medication recommendations applicable to resource-limited settings, 101 medications were included in the USPHS Essential Medications for the Management of EVD List (EML) for an austere, isolated clinical environment. Discussion/impact/recommendations: Because Ebola outbreaks often occur in remote areas, proactive planning, improved preparedness, and optimal patient care for EVD are needed, especially in the context of austere environments with a scarcity of resources. We developed the EML to assist in the planning for future Ebola outbreaks in a remote clinical environment and to provide a list of medications that have been used in an ETU. The EML is a comprehensive medication list that builds on the existing publications with EVD treatment recommendations applicable to supply-constrained clinical environments. As well, it is a resource for the provision of medications when evaluating donations, procurement, and may help inform estimates for product inventory requirements for an ETU. We hope the EML will improve readiness and enhance the capabilities of local and regional international responders.

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Safety and feasibility of a strategy of early central venous catheter insertion in a deployed UK military Ebola virus disease treatment unit

Intensive Care Medicine ◽

10.1007/s00134-015-3736-y ◽

2015 ◽

Vol 41 (5) ◽

pp. 735-743 ◽

Cited By ~ 18

Author(s):

P. S. C. Rees ◽

L. E. M. Lamb ◽

T. C. Nicholson-Roberts ◽

C. N. Ardley ◽

M. S. Bailey ◽

...

Keyword(s):

Central Venous Catheter ◽

Ebola Virus ◽

Virus Disease ◽

Venous Catheter ◽

Catheter Insertion ◽

Ebola Virus Disease ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

Disease Treatment ◽

Treatment Unit

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Rapid establishment of a frontline field laboratory in response to an imported outbreak of Ebola virus disease in western Uganda, June 2019

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009967 ◽

2021 ◽

Vol 15 (12) ◽

pp. e0009967

Author(s):

Amy J. Schuh ◽

Jackson Kyondo ◽

James Graziano ◽

Stephen Balinandi ◽

Markus H. Kainulainen ◽

...

Keyword(s):

United States ◽

General Hospital ◽

Ebola Virus ◽

Virus Disease ◽

Hemorrhagic Fever ◽

The United States ◽

Ebola Virus Disease ◽

World Health ◽

Treatment Unit ◽

Field Laboratory

The Democratic Republic of the Congo (DRC) declared an Ebola virus disease (EVD) outbreak in North Kivu in August 2018. By June 2019, the outbreak had spread to 26 health zones in northeastern DRC, causing >2,000 reported cases and >1,000 deaths. On June 10, 2019, three members of a Congolese family with EVD-like symptoms traveled to western Uganda’s Kasese District to seek medical care. Shortly thereafter, the Viral Hemorrhagic Fever Surveillance and Laboratory Program (VHF program) at the Uganda Virus Research Institute (UVRI) confirmed that all three patients had EVD. The Ugandan Ministry of Health declared an outbreak of EVD in Uganda’s Kasese District, notified the World Health Organization, and initiated a rapid response to contain the outbreak. As part of this response, UVRI and the United States Centers for Disease Control and Prevention, with the support of Uganda’s Public Health Emergency Operations Center, the Kasese District Health Team, the Superintendent of Bwera General Hospital, the United States Department of Defense’s Makerere University Walter Reed Project, and the United States Mission to Kampala’s Global Health Security Technical Working Group, jointly established an Ebola Field Laboratory in Kasese District at Bwera General Hospital, proximal to an Ebola Treatment Unit (ETU). The laboratory consisted of a rapid containment kit for viral inactivation of patient specimens and a GeneXpert Instrument for performing Xpert Ebola assays. Laboratory staff tested 76 specimens from alert and suspect cases of EVD; the majority were admitted to the ETU (89.3%) and reported recent travel to the DRC (58.9%). Although no EVD cases were detected by the field laboratory, it played an important role in patient management and epidemiological surveillance by providing diagnostic results in <3 hours. The integration of the field laboratory into Uganda’s National VHF Program also enabled patient specimens to be referred to Entebbe for confirmatory EBOV testing and testing for other hemorrhagic fever viruses that circulate in Uganda.

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Personal protective equipment solution for UK military medical personnel working in an Ebola virus disease treatment unit in Sierra Leone

Journal of Hospital Infection ◽

10.1016/j.jhin.2017.03.018 ◽

2017 ◽

Vol 96 (1) ◽

pp. 42-48 ◽

Cited By ~ 9

Author(s):

P. Reidy ◽

T. Fletcher ◽

C. Shieber ◽

J. Shallcross ◽

H. Towler ◽

...

Keyword(s):

Sierra Leone ◽

Personal Protective Equipment ◽

Ebola Virus ◽

Virus Disease ◽

Medical Personnel ◽

Ebola Virus Disease ◽

Protective Equipment ◽

Disease Treatment ◽

Treatment Unit

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843. The PALM Consortium: A Multicenter, Multioutbreak Randomized Controlled Trial of Ebola Virus Disease Therapeutics

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz359.028 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S12-S13

Author(s):

Sabue Mulangu

Keyword(s):

Randomized Controlled Trial ◽

Ebola Virus ◽

Virus Disease ◽

Controlled Trial ◽

Ebola Virus Disease ◽

Cold Chain ◽

Baseline Risk ◽

Treatment Unit ◽

Randomized Controlled ◽

Comparative Safety

Abstract Background Recent outbreaks of Ebola virus disease in the Democratic Republic of the Congo (DRC) reinforce the desperate need to establish definitively the comparative safety and efficacy of different medical countermeasures (MCM). Methods Through a multipartner governance framework under WHO coordination, the Institut National de Recherche Biomédicale and NIAID collaborated with clinical partners (the MOH, ALIMA, MSF) to launch a randomized controlled trial in 2018 in the North Kivu/Ituri provinces of DRC. PCR+ participants receiving enhanced supportive care are being randomized 1:1:1:1 to receive either ZMapp™ (control arm), remdesivir, mAb114, or REG-EB3 according to standard treatment regimens. Stratification is by site, country, and baseline nucleoprotein (NP) PCR cycle threshold (CT) ≤ 22 or > 22. The primary objective is a comparison of 28-day mortality relative to the control arm. The planned accrual is for 125 patients per arm. Secondary objectives include an evaluation of the comparative safety and tolerability of the 4 investigational MCMs, relative changes in viral load over time, comparisons of treatment efficacy according to baseline risk categories, 58-day mortality, RNA clearance from semen, and an assessment of the validity of drug-class comparisons, including efficacy. The study is monitored by an independent data and safety monitoring committee (DSMB). Results Enrollment commenced in the Ebola Treatment Unit in Beni in November, 2018, with sites in Butembo and Katwa added in early 2019. Time from study concept initiation to study start was only 3.5 months. Ongoing hurdles encountered to date include maintenance of cold chain requirements for the MCMs and marked volatility in the security situation surrounding sites affecting staff and patient safety. Despite these challenges, data quality and completed follow-up have been remarkably high and by mid-April, 2019, accrual to date (see table) had already surpassed the predefined threshold triggering an interim DSMB review. Conclusion Scientifically rigorous and ethically sound clinical research can take place during disease outbreaks even within a conflict zone. Results about the relative efficacy of the evaluated investigational MCMs are pending the completion of the trial. Disclosures All Authors: No reported Disclosures.

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