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

2017 ◽  
Vol 182 (9-10) ◽  
pp. e2006-e2016 ◽  
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.

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

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.

Bacterial co-infection is rare in patients with Ebola virus disease in a military Ebola virus disease treatment unit in Sierra Leone

2015 ◽  
Vol 71 (3) ◽  
pp. 406-407 ◽  
Author(s):  
Lucy Lamb ◽  
Jack Robson ◽  
Christian Ardley ◽  
Mark Bailey ◽  
Stuart Dickson ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Ebola Virus ◽  
Virus Disease ◽  
Ebola Virus Disease ◽  
Disease Treatment ◽  
Treatment Unit

The Epidemiological Presentation Pattern of Ebola Virus Disease Outbreaks: Changes from 1976 to 2019

2020 ◽  
Vol 35 (3) ◽  
pp. 247-253
Author(s):  
Pedro Arcos González ◽  
Ángel Fernández Camporro ◽  
Anneli Eriksson ◽  
Carmen Alonso Llada
Keyword(s):  
At Risk ◽  
Ebola Virus ◽  
Virus Disease ◽  
Disease Outbreaks ◽  
Case Fatality ◽  
Ebola Virus Disease ◽  
World Health ◽  
Study Objective ◽  
Population At Risk ◽  
Case Fatality Ratio

AbstractIntroduction:Ebola Virus Disease (EVD) is the international health emergency paradigm due to its epidemiological presentation pattern, impact on public health, resources necessary for its control, and need for a national and international response.Study Objective:The objective of this work is to study the evolution and progression of the epidemiological presentation profile of Ebola disease outbreaks since its discovery in 1976 to the present, and to explore the possible reasons for this evolution from different perspectives.Methods:Retrospective observational study of 38 outbreaks of Ebola disease occurred from 1976 through 2019, excluding laboratory accidents. United Nations agencies and programs; Ministries of Health; the US Centers for Disease Control and Prevention (CDC); ReliefWeb; emergency nongovernmental organizations; and publications indexed in PubMed, EmBase, and Clinical Key have been used as sources of data. Information on the year of the outbreak, date of beginning and end, duration of the outbreak in days, number of cases, number of deaths, population at risk, geographic extension affected in Km2, and time of notification of the first cases to the World Health Organization (WHO) have been searched and analyzed.Results:Populations at risk have increased (P = .024) and the geographical extent of Ebola outbreaks has grown (P = .004). Reporting time of the first cases of Ebola to WHO has been reduced (P = .017) and case fatality (P = .028) has gone from 88% to 62% in the period studied. There have been differences (P = .04) between the outbreaks produced by the Sudan and Zaire strains of the virus, both in terms of duration and case fatality ratio (Sudan strain 74.5 days on average and 62.7% of case fatality ratio versus Zaire strain with 150 days on average and 55.4% case fatality ratio).Conclusion:There has been a change in the epidemiological profile of the Ebola outbreaks from 1976 through 2019 with an increase in the geographical extent of the outbreaks and the population at risk, as well as a significant decrease in the outbreaks case fatality rate. There have been advances in the detection and management capacity of outbreaks, and the notification time to the WHO has been reduced. However, there are social, economic, cultural, and political obstacles that continue to greatly hinder a more efficient epidemiological approach to Ebola disease, mainly in Central Africa.

scholarly journals 2311. Bacteremia Is Not Commonly Detected in Ebola Virus Disease

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S792-S792
Author(s):  
Matthew J Matson ◽  
Moses Massaquoi ◽  
Armand Sprecher ◽  
Ruggero Giuliani ◽  
Jeffrey K Edwards ◽  
...  
Keyword(s):  
Ebola Virus ◽  
Treatment Guidelines ◽  
Virus Disease ◽  
Current Treatment ◽  
Ebola Virus Disease ◽  
Coagulase Negative Staphylococci ◽  
Treatment Unit ◽  
Blood Samples ◽  
16S Sequencing ◽  
Low Culture

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.

Participatory Monitoring and Evaluation of Ebola Response Activities in Lofa County, Liberia: Some Lessons Learned

2019 ◽  
Vol 40 (1) ◽  
pp. 57-66
Author(s):  
Ithar Hassaballa ◽  
Stephen Fawcett ◽  
Charles Sepers ◽  
Florence DiGennaro Reed ◽  
Jerry Schultz ◽  
...  
Keyword(s):  
Evaluation System ◽  
Quantitative Methods ◽  
Ebola Virus ◽  
Virus Disease ◽  
Monitoring And Evaluation ◽  
Lessons Learned ◽  
Ebola Virus Disease ◽  
World Health ◽  
Response Effort ◽  
Participatory Monitoring

To address the Ebola outbreak in West Africa, the World Health Organization and the United Nations Children’s Fund led a multilevel and multisectoral intervention known as the Ebola response effort. Although surveillance systems were able to detect reduction in Ebola incidence, there was little understanding of the implemented activities within affected areas. To address this gap, this empirical case study examined (a) implementation of Ebola response activities and associated bending the curve of incidence of Ebola virus disease and (b) candidate factors associated with fuller implementation of the Ebola response effort. A mix of qualitative and quantitative methods were used to address these questions. A participatory monitoring and evaluation system was used to capture, code, characterize, and communicate nearly a hundred Ebola response activities implemented in Lofa County, a highly affected area in Liberia. The Ebola response effort was enabled by community engagement and collaboration across different sectors. Results showed fuller implementation corresponded with a marked reduction in Ebola virus disease. This report concludes with a discussion of how monitoring and evaluation can strengthen implementation of activities needed to address disease outbreaks.

Translating Professional Obligations to Care for Patients With Ebola Virus Disease Into Practice in Nonepidemic Settings

2015 ◽  
Vol 9 (5) ◽  
pp. 527-530 ◽  
Author(s):  
Jeremy Sugarman ◽  
Nancy Kass ◽  
Cynda H. Rushton ◽  
Mark T. Hughes ◽  
Thomas D. Kirsch
Keyword(s):  
Health Care Professionals ◽  
Policy Making ◽  
Ebola Virus ◽  
Virus Disease ◽  
Ebola Virus Disease ◽  
Clinical Environment ◽  
Professional Obligations ◽  
Factors Associated ◽  
Implementing Strategies ◽  
And Training

AbstractDetermining how clinicians should meet their professional obligations to treat patients with Ebola virus disease in nonepidemic settings necessitates considering measures to minimize risks to clinicians, the context of care, and fairness. Minimizing risks includes providing appropriate equipment and training, implementing strategies for reducing exposure to infectious material, identifying a small number of centers to provide care, and determining which risky procedures should be used when they pose minimal likelihood of appreciable clinical benefit. Factors associated with the clinical environment, such as the local prevalence of the disease, the nature of the setting, and the availability of effective treatment, are also relevant to obligations to treat. Fairness demands that the best possible medical care be provided for health care professionals who become infected and that the rights and interests of relevant stakeholders be addressed through policy-making processes. Going forward it will be essential to learn from current approaches and to modify them based on data. (Disaster Med Public Health Preparedness. 2015;9:527–530)

scholarly journals Descriptive analyses and risk of death due to Ebola Virus Disease, West Africa, 2014

2015 ◽  
Vol 9 (12) ◽  
pp. 1298-1307 ◽  
Author(s):  
Folorunso Oludayo Fasina ◽  
Olubukola T. Adenubi ◽  
Samuel T. Ogundare ◽  
Aminu Shittu ◽  
Dauda G. Bwala ◽  
...  
Keyword(s):  
West Africa ◽  
Sierra Leone ◽  
Healthcare Workers ◽  
Ebola Virus ◽  
Virus Disease ◽  
Healthcare Delivery ◽  
Ebola Virus Disease ◽  
World Health ◽  
Public Healthcare ◽  
Risk Of Death

Introduction: Since the first case of Ebola virus disease (EVD) in Guinea in 2013, major outbreaks have been reported in West Africa. Methodology: Cases and fatalities of EVD caused by Zaire Ebola virus (ZEBOV) were evaluated, and the risks of dying in the general population and in healthcare workers were assessed. Results: The case fatality rate estimated for EVD was 76.4% in 20 studies. Cumulative proportion of fatal cases in West Africa was 42.9%, 30.1%, and 64.2% in Liberia, Sierra Leone, and Guinea, respectively. The proportion of total deaths in Liberia, Sierra Leone, and Guinea was 42.5%, 35.8%, and 21.6%, respectively. Healthcare workers were at higher risk of dying compared with the general public, and the same applied to intense transmission countries and to countries with sufficient bed capacities. The declaration of a health emergency “out-of-control” situation by the World Health Organization on 8 August 2014 reduced the risk of death among patients. Factors including deplorable healthcare delivery infrastructure in war-ravaged regions of Africa, the impotence of governments to enforce public health regulations, and the loss of confidence in public healthcare delivery programs were key among others factors that enhanced the spread and magnitude of outbreaks. Conclusions: The findings underscore the need for an overall re-appraisal of the healthcare systems in African countries and the ability to cope with widespread epidemic challenges. Outbreaks like that of Ebola diseases should be handled not just as a medical emergency but also a socio-economic problem with significant negative economic impacts.

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