Clinical Features of and Risk Factors for Fatal Ebola Virus Disease, Moyamba District, Sierra Leone, December 2014–February 2015
Abstract
The current outbreak of Ebola virus disease (EVD) in West Africa has infected more than 28,000 people, killed more than 11,000 and disrupted social life. We studied retrospectively the clinical presentation and risk factors for fatal outcome among the 31 Ebola virus (EBV) positive patients admitted to the Ebola Treatment Center (ETC) in Moyamba District, Sierra Leone. We found a higher rate of bleeding manifestations than reported elsewhere during the current outbreak. Significant predictors for fatal outcome were shorter time from onset to admission, male sex, high viral load on initial lab test, severe pain, diarrhea, bloody stools, and development of other bleeding manifestations during hospital admission. Awareness of risk factors for fatal outcome could be used to identify patients in need of more intensive medical support. The lack of fever in as much as a third of EVD cases may have implications for temperature screening practices and case definitions.
- Authors:
-
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- Haukeland Univ. Hospital, Bergen (Norway)
- St. Olav Hospital, Trondheim (Norway)
- Moyamba District Hospital (Sierra Leone)
- Oslo Univ. Hospital (Norway)
- Medicos del Mundo, Madrid (Spain)
- Haraldsplass Diaconal Hospital, Bergen (Norway)
- Haukeland Univ. Hospital, Bergen (Norway); Univ. of Bergen (Norway)
- Hospital Son Espases, Palma de Mallorca (Spain)
- Medicos del Mundo, Madrid (Spain); Inst. de Investigacion de Palma (Spain)
- MRIGlobal, Rockville, MD (United States)
- Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)
- Public Health (Pakistan)
- Stavanger Univ. Hospital (Norway)
- Publication Date:
- Research Org.:
- Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)
- Sponsoring Org.:
- USDOE National Nuclear Security Administration (NNSA)
- OSTI Identifier:
- 1431289
- Report Number(s):
- SAND-2016-3865J
Journal ID: ISSN 1080-6040; 638710
- Grant/Contract Number:
- AC04-94AL85000
- Resource Type:
- Accepted Manuscript
- Journal Name:
- Emerging Infectious Diseases
- Additional Journal Information:
- Journal Volume: 22; Journal Issue: 9; Journal ID: ISSN 1080-6040
- Publisher:
- Centers for Disease Control and Prevention
- Country of Publication:
- United States
- Language:
- English
- Subject:
- 60 APPLIED LIFE SCIENCES
Citation Formats
Haaskjold, Yngvar Lunde, Bolkan, Hakon Angell, Krogh, Kurt Osthuus, Jongopi, James, Lundeby, Karen Marie, Mellesmo, Sindre, Garces, Pedro San Jose, Josendal, Ola, Opstad, Asmund, Svensen, Erling, Fuentes, Luis Matias Zabala, Kamara, Alfred Sandy, Riera, Melchor, Izquierdo, Javier Arranz, Roberts, David P., Stamper, Paul D., Austin, Paula, Moosa, Alfredo J., Marke, Dennis, Hassan, Shoaib, Berg, Ase, and Blomberg, Bjorn. Clinical Features of and Risk Factors for Fatal Ebola Virus Disease, Moyamba District, Sierra Leone, December 2014–February 2015. United States: N. p., 2016.
Web. doi:10.3201/eid2209.151621.
Haaskjold, Yngvar Lunde, Bolkan, Hakon Angell, Krogh, Kurt Osthuus, Jongopi, James, Lundeby, Karen Marie, Mellesmo, Sindre, Garces, Pedro San Jose, Josendal, Ola, Opstad, Asmund, Svensen, Erling, Fuentes, Luis Matias Zabala, Kamara, Alfred Sandy, Riera, Melchor, Izquierdo, Javier Arranz, Roberts, David P., Stamper, Paul D., Austin, Paula, Moosa, Alfredo J., Marke, Dennis, Hassan, Shoaib, Berg, Ase, & Blomberg, Bjorn. Clinical Features of and Risk Factors for Fatal Ebola Virus Disease, Moyamba District, Sierra Leone, December 2014–February 2015. United States. https://doi.org/10.3201/eid2209.151621
Haaskjold, Yngvar Lunde, Bolkan, Hakon Angell, Krogh, Kurt Osthuus, Jongopi, James, Lundeby, Karen Marie, Mellesmo, Sindre, Garces, Pedro San Jose, Josendal, Ola, Opstad, Asmund, Svensen, Erling, Fuentes, Luis Matias Zabala, Kamara, Alfred Sandy, Riera, Melchor, Izquierdo, Javier Arranz, Roberts, David P., Stamper, Paul D., Austin, Paula, Moosa, Alfredo J., Marke, Dennis, Hassan, Shoaib, Berg, Ase, and Blomberg, Bjorn. Thu .
"Clinical Features of and Risk Factors for Fatal Ebola Virus Disease, Moyamba District, Sierra Leone, December 2014–February 2015". United States. https://doi.org/10.3201/eid2209.151621. https://www.osti.gov/servlets/purl/1431289.
@article{osti_1431289,
title = {Clinical Features of and Risk Factors for Fatal Ebola Virus Disease, Moyamba District, Sierra Leone, December 2014–February 2015},
author = {Haaskjold, Yngvar Lunde and Bolkan, Hakon Angell and Krogh, Kurt Osthuus and Jongopi, James and Lundeby, Karen Marie and Mellesmo, Sindre and Garces, Pedro San Jose and Josendal, Ola and Opstad, Asmund and Svensen, Erling and Fuentes, Luis Matias Zabala and Kamara, Alfred Sandy and Riera, Melchor and Izquierdo, Javier Arranz and Roberts, David P. and Stamper, Paul D. and Austin, Paula and Moosa, Alfredo J. and Marke, Dennis and Hassan, Shoaib and Berg, Ase and Blomberg, Bjorn},
abstractNote = {The current outbreak of Ebola virus disease (EVD) in West Africa has infected more than 28,000 people, killed more than 11,000 and disrupted social life. We studied retrospectively the clinical presentation and risk factors for fatal outcome among the 31 Ebola virus (EBV) positive patients admitted to the Ebola Treatment Center (ETC) in Moyamba District, Sierra Leone. We found a higher rate of bleeding manifestations than reported elsewhere during the current outbreak. Significant predictors for fatal outcome were shorter time from onset to admission, male sex, high viral load on initial lab test, severe pain, diarrhea, bloody stools, and development of other bleeding manifestations during hospital admission. Awareness of risk factors for fatal outcome could be used to identify patients in need of more intensive medical support. The lack of fever in as much as a third of EVD cases may have implications for temperature screening practices and case definitions.},
doi = {10.3201/eid2209.151621},
journal = {Emerging Infectious Diseases},
number = 9,
volume = 22,
place = {United States},
year = {Thu Sep 01 00:00:00 EDT 2016},
month = {Thu Sep 01 00:00:00 EDT 2016}
}
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Works referenced in this record:
Ebola Haemorrhagic Fever – a Review
journal, January 2000
- Colebunders, R.; Borchert, M.
- Journal of Infection, Vol. 40, Issue 1
Emergence of Zaire Ebola Virus Disease in Guinea
journal, October 2014
- Baize, Sylvain; Pannetier, Delphine; Oestereich, Lisa
- New England Journal of Medicine, Vol. 371, Issue 15
Investigating the zoonotic origin of the West African Ebola epidemic
journal, November 2014
- Marí Saéz, Almudena; Weiss, Sabrina; Nowak, Kathrin
- EMBO Molecular Medicine, Vol. 7, Issue 1
Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak
journal, August 2014
- Gire, S. K.; Goba, A.; Andersen, K. G.
- Science, Vol. 345, Issue 6202
The Ebola Emergency — Immediate Action, Ongoing Strategy
journal, October 2014
- Farrar, Jeremy J.; Piot, Peter
- New England Journal of Medicine, Vol. 371, Issue 16
Ebola in west Africa: from disease outbreak to humanitarian crisis
journal, November 2014
- Piot, Peter; Muyembe, Jean-Jacques; Edmunds, W. John
- The Lancet Infectious Diseases, Vol. 14, Issue 11
WHO and partners launch Ebola response plan
journal, August 2014
- Green, Andrew
- The Lancet, Vol. 384, Issue 9942
Basic Clinical and Laboratory Features of Filoviral Hemorrhagic Fever
journal, November 2011
- Kortepeter, Mark G.; Bausch, Daniel G.; Bray, Mike
- The Journal of Infectious Diseases, Vol. 204, Issue suppl_3
Ebola in West Africa at One Year — From Ignorance to Fear to Roadblocks
journal, February 2015
- Drazen, Jeffrey M.; Campion, Edward W.; Rubin, Eric J.
- New England Journal of Medicine, Vol. 372, Issue 6
Molecular Evidence of Sexual Transmission of Ebola Virus
journal, December 2015
- Mate, Suzanne E.; Kugelman, Jeffrey R.; Nyenswah, Tolbert G.
- New England Journal of Medicine, Vol. 373, Issue 25
Pauline Cafferkey’s condition improves after Ebola relapse
journal, October 2015
- Smith, J.
- Nursing Standard, Vol. 30, Issue 8, p. 8-8
Containing a haemorrhagic fever epidemic: the Ebola experience in Uganda (October 2000–January 2001)
journal, January 2004
- Lamunu, M.; Lutwama, J. J.; Kamugisha, J.
- International Journal of Infectious Diseases, Vol. 8, Issue 1
Reemerging Sudan Ebola Virus Disease in Uganda, 2011
journal, September 2012
- Shoemaker, Trevor; MacNeil, Adam; Balinandi, Stephen
- Emerging Infectious Diseases, Vol. 18, Issue 9
Ebola Hemorrhagic Fever in Kikwit, Democratic Republic of the Congo: Clinical Observations in 103 Patients
journal, February 1999
- Bwaka, Mpia A.; Bonnet, Marie‐José; Calain, Philippe
- The Journal of Infectious Diseases, Vol. 179, Issue s1
Ebola outbreak in rural West Africa: epidemiology, clinical features and outcomes
journal, February 2015
- Dallatomasina, Silvia; Crestani, Rosa; Sylvester Squire, James
- Tropical Medicine & International Health, Vol. 20, Issue 4
Clinical Presentation of Patients with Ebola Virus Disease in Conakry, Guinea
journal, January 2015
- Bah, Elhadj Ibrahima; Lamah, Marie-Claire; Fletcher, Tom
- New England Journal of Medicine, Vol. 372, Issue 1
Clinical presentation, biochemical, and haematological parameters and their association with outcome in patients with Ebola virus disease: an observational cohort study
journal, November 2015
- Hunt, Luke; Gupta-Wright, Ankur; Simms, Victoria
- The Lancet Infectious Diseases, Vol. 15, Issue 11
Estrogen receptors regulate innate immune cells and signaling pathways
journal, April 2015
- Kovats, Susan
- Cellular Immunology, Vol. 294, Issue 2
Suppressive effects of androgens on the immune system
journal, April 2015
- Trigunaite, Abhishek; Dimo, Joana; Jørgensen, Trine N.
- Cellular Immunology, Vol. 294, Issue 2
Ebola Virus Outbreak Investigation, Sierra Leone, September 28–November 11, 2014
journal, November 2015
- Lu, Hui-Jun; Qian, Jun; Kargbo, David
- Emerging Infectious Diseases, Vol. 21, Issue 11
Clinical features of patients isolated for suspected Ebola virus disease at Connaught Hospital, Freetown, Sierra Leone: a retrospective cohort study
journal, September 2015
- Lado, Marta; Walker, Naomi F.; Baker, Peter
- The Lancet Infectious Diseases, Vol. 15, Issue 9
The WHO clinical case definition for suspected cases of Ebola virus disease arriving at Ebola holding units: reason to worry?
journal, September 2015
- Zachariah, Rony; Harries, Anthony D.
- The Lancet Infectious Diseases, Vol. 15, Issue 9
Derivation and Internal Validation of the Ebola Prediction Score for Risk Stratification of Patients With Suspected Ebola Virus Disease
journal, September 2015
- Levine, Adam C.; Shetty, Pranav Prathap; Burbach, Ryan
- Annals of Emergency Medicine, Vol. 66, Issue 3
Evaluation of a point-of-care blood test for identification of Ebola virus disease at Ebola holding units, Western Area, Sierra Leone, January to February 2015
journal, March 2015
- Walker, N.; Brown, C.; Youkee, D.
- Eurosurveillance, Vol. 20, Issue 12
Blood Chemistry Measurements and d ‐Dimer Levels Associated with Fatal and Nonfatal Outcomes in Humans Infected with Sudan Ebola Virus
journal, November 2007
- Rollin, Pierre E.; Bausch, Daniel G.; Sanchez, Anthony
- The Journal of Infectious Diseases, Vol. 196, Issue s2
The Contribution of Ebola Viral Load at Admission and Other Patient Characteristics to Mortality in a Médecins Sans Frontières Ebola Case Management Centre, Kailahun, Sierra Leone, June–October 2014
journal, May 2015
- Fitzpatrick, Gabriel; Vogt, Florian; Moi Gbabai, Osman B.
- Journal of Infectious Diseases, Vol. 212, Issue 11
Use of Viremia to Evaluate the Baseline Case Fatality Ratio of Ebola Virus Disease and Inform Treatment Studies: A Retrospective Cohort Study
journal, December 2015
- Faye, Oumar; Andronico, Alessio; Faye, Ousmane
- PLOS Medicine, Vol. 12, Issue 12
Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea
journal, March 2016
- Sissoko, Daouda; Laouenan, Cedric; Folkesson, Elin
- PLOS Medicine, Vol. 13, Issue 3
Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone
dataset, January 2015
- Schieffelin, John; Shaffer, Jeffrey; Goba, Augustine
- Harvard Dataverse
Derivation and Internal Validation of the Ebola Prediction Score for Risk Stratification of Patients With Suspected Ebola Virus Disease
journal, September 2015
- Levine, Adam C.; Shetty, Pranav Prathap; Burbach, Ryan
- Annals of Emergency Medicine, Vol. 66, Issue 3
Containing a haemorrhagic fever epidemic: the Ebola experience in Uganda (October 2000–January 2001)
journal, January 2004
- Lamunu, M.; Lutwama, J. J.; Kamugisha, J.
- International Journal of Infectious Diseases, Vol. 8, Issue 1
Raising the standard for clinical care of patients with Ebola virus disease
journal, November 2015
- Schieffelin, John S.; Jacob, Shevin T.
- The Lancet Infectious Diseases, Vol. 15, Issue 11
Symptoms closely associated with Ebola virus disease
journal, January 2016
- Gao, Xudong; Rong, Guanghua; Lu, Yinying
- The Lancet Infectious Diseases, Vol. 16, Issue 1
Ebola Haemorrhagic Fever – a Review
journal, January 2000
- Colebunders, R.; Borchert, M.
- Journal of Infection, Vol. 40, Issue 1
Ebola in Freetown Area, Sierra Leone — A Case Study of 581 Patients
journal, February 2015
- Ansumana, Rashid; Jacobsen, Kathryn H.; Idris, M’baimba
- New England Journal of Medicine, Vol. 372, Issue 6
License to Serve — U.S. Trainees and the Ebola Epidemic
journal, February 2015
- Rosenbaum, Lisa
- New England Journal of Medicine, Vol. 372, Issue 6
Ebola Hemorrhagic Fever in Kikwit, Democratic Republic of the Congo: Clinical Observations in 103 Patients
journal, February 1999
- Bwaka, Mpia A.; Bonnet, Marie‐José; Calain, Philippe
- The Journal of Infectious Diseases, Vol. 179, Issue s1
Blood Chemistry Measurements and d ‐Dimer Levels Associated with Fatal and Nonfatal Outcomes in Humans Infected with Sudan Ebola Virus
journal, November 2007
- Rollin, Pierre E.; Bausch, Daniel G.; Sanchez, Anthony
- The Journal of Infectious Diseases, Vol. 196, Issue s2
Ebola outbreak in rural West Africa: epidemiology, clinical features and outcomes
journal, February 2015
- Dallatomasina, Silvia; Crestani, Rosa; Sylvester Squire, James
- Tropical Medicine & International Health, Vol. 20, Issue 4
Genomic surveillance elucidates Ebola virus origin and transmission during the 2014 outbreak
journal, August 2014
- Gire, S. K.; Goba, A.; Andersen, K. G.
- Science, Vol. 345, Issue 6202
Use of Viremia to Evaluate the Baseline Case Fatality Ratio of Ebola Virus Disease and Inform Treatment Studies: A Retrospective Cohort Study
journal, December 2015
- Faye, Oumar; Andronico, Alessio; Faye, Ousmane
- PLOS Medicine, Vol. 12, Issue 12
Experimental Treatment with Favipiravir for Ebola Virus Disease (the JIKI Trial): A Historically Controlled, Single-Arm Proof-of-Concept Trial in Guinea
journal, March 2016
- Sissoko, Daouda; Laouenan, Cedric; Folkesson, Elin
- PLOS Medicine, Vol. 13, Issue 3
Investigating the zoonotic origin of the West African Ebola epidemic
journal, November 2014
- Marí Saéz, Almudena; Weiss, Sabrina; Nowak, Kathrin
- EMBO Molecular Medicine, Vol. 7, Issue 1
Clinical presentation of patients with ebola virus disease in Conakry, Guinea
text, January 2015
- N., Shindo,; A., Sprecher,; M. F. M., Baggi,
- Massachussetts Medical Society
Reemerging Sudan Ebola Virus Disease in Uganda, 2011
journal, September 2012
- Shoemaker, Trevor; MacNeil, Adam; Balinandi, Stephen
- Emerging Infectious Diseases, Vol. 18, Issue 9
Ebola Virus Outbreak Investigation, Sierra Leone, September 28–November 11, 2014
journal, November 2015
- Lu, Hui-Jun; Qian, Jun; Kargbo, David
- Emerging Infectious Diseases, Vol. 21, Issue 11
Works referencing / citing this record:
The Ebola virus disease outbreak in Tonkolili district, Sierra Leone: a retrospective analysis of the Viral Haemorrhagic Fever surveillance system, July 2014–June 2015
journal, January 2019
- Miglietta, Alessandro; Solimini, Angelo; Djeunang Dongho, Ghyslaine Bruna
- Epidemiology and Infection, Vol. 147
Case Fatality Ratio Estimates for the 2013–2016 West African Ebola Epidemic: Application of Boosted Regression Trees for Imputation
journal, July 2019
- Forna, Alpha; Nouvellet, Pierre; Dorigatti, Ilaria
- Clinical Infectious Diseases, Vol. 70, Issue 12
Heterogeneities in the case fatality ratio in the West African Ebola outbreak 2013–2016
journal, April 2017
- Garske, Tini; Cori, Anne; Ariyarajah, Archchun
- Philosophical Transactions of the Royal Society B: Biological Sciences, Vol. 372, Issue 1721
Key data for outbreak evaluation: building on the Ebola experience
journal, April 2017
- Cori, Anne; Donnelly, Christl A.; Dorigatti, Ilaria
- Philosophical Transactions of the Royal Society B: Biological Sciences, Vol. 372, Issue 1721
A meta-analysis of clinical studies conducted during the West Africa Ebola virus disease outbreak confirms the need for randomized control groups
journal, November 2019
- Dodd, Lori E.; Follmann, Dean; Proschan, Michael
- Science Translational Medicine, Vol. 11, Issue 520
Surviving Ebola: A historical cohort study of Ebola mortality and survival in Sierra Leone 2014-2015
journal, December 2018
- Wing, Kevin; Oza, Shefali; Houlihan, Catherine
- PLOS ONE, Vol. 13, Issue 12
Reporting quality of the 2014 Ebola outbreak in Africa: A systematic analysis
journal, June 2019
- Huynh, Nina; Baumann, Andrea; Loeb, Mark
- PLOS ONE, Vol. 14, Issue 6
Exploratory investigation of region level risk factors of Ebola Virus Disease in West Africa
journal, January 2018
- Levy, Benjamin; Odoi, Agricola
- PeerJ, Vol. 6
Case Fatality Ratio Estimates for the 2013-2016 West African Ebola Epidemic: Application of Boosted Regression Trees for Imputation
text, January 2018
- Forna, Alpha; Nouvellet, Pierre; Dorigatti, Ilaria
- Unpublished
Exploratory investigation of region level risk factors of Ebola virus disease in West Africa
posted_content, August 2018
- Levy, Benjamin; Odoi, Agricola
- PeerJ Preprints
Exploratory investigation of region level risk factors of Ebola virus disease in West Africa
posted_content, August 2018
- Levy, Benjamin; Odoi, Ogricola
- PeerJ Preprints
Case fatality ratio estimates for the 2013–2016 West African Ebola epidemic: application of Boosted Regression Trees for imputation
journal, February 2019
- Forna, A.; Nouvellet, P.; Dorigatti, I.
- International Journal of Infectious Diseases, Vol. 79
Case fatality ratio estimates for the 2013 – 2016 West African Ebola epidemic: application of Boosted Regression Trees for imputation.
text, January 2018
- Forna, Alpha; Nouvellet, Pierre; Dorigatti, Ilaria
- Unpublished
The Ebola virus disease outbreak in Tonkolili district, Sierra Leone: a retrospective analysis of the Viral Haemorrhagic Fever surveillance system, July 2014–June 2015
journal, January 2019
- Miglietta, Alessandro; Solimini, Angelo; Djeunang Dongho, Ghyslaine Bruna
- Epidemiology and Infection, Vol. 147
Ebola and Public Authority: Saving Loved Ones in Sierra Leone
journal, May 2019
- Parker, Melissa; Hanson, Tommy Matthew; Vandi, Ahmed
- Medical Anthropology, Vol. 38, Issue 5
Surviving Ebola: A historical cohort study of Ebola mortality and survival in Sierra Leone 2014-2015
journal, December 2018
- Wing, Kevin; Oza, Shefali; Houlihan, Catherine
- PLOS ONE, Vol. 13, Issue 12
Clinical Laboratory Values as Early Indicators of Ebola Virus Infection in Nonhuman Primates
journal, August 2017
- Reisler, Ronald B.; Yu, Chenggang; Donofrio, Michael J.
- Emerging Infectious Diseases, Vol. 23, Issue 8
Characterization of Ebola Virus Disease (EVD) in Rhesus Monkeys for Development of EVD Therapeutics
journal, January 2020
- Warren, Travis; Zumbrun, Elizabeth; Weidner, Jessica M.
- Viruses, Vol. 12, Issue 1
Exploratory investigation of region level risk factors of Ebola Virus Disease in West Africa
journal, January 2018
- Levy, Benjamin; Odoi, Agricola
- PeerJ, Vol. 6