Clinical features and risk factors for adverse outcome in Ebola virus disease in Moyamba District Sierra Leone.

Journal Article · Sun May 01 00:00:00 EDT 2016 · Sandia journal manuscript; Not yet accepted for publication

OSTI ID:1427261

Haaskjold, Yngvar Lunde ^[1]; Bolkan, Hakon Angell ^[2]; Krogh, Kurt Østhuus ^[2]; Jongopi, James ^[3]; Berg, Ase ^[4]; Lundeby, Karen Marie ^[5]; Mellesmo, Sindre ^[2]; Garces, Pedro San José ^[6]; Josendal, Ola ^[1]; Opstad, Asmund ^[7]; Svensen, Erling ^[8]; Zabala, Matias ^[6]; Kamara, Alfred Sandy ^[3]; Riera, Melchor ^[6]; Arranz, Javier ^[6]; Stamper, Paul D. ^[9]; Austin, Paula ^[3]; Moosa, Alfredo J. ^[3]; Marke, Dennis ^[3]; Hassan, Shoaib ^[10] ; Blomberg, Bjorn ^[8]

---

1. Haukeland Univ. Hospital, Bergen (Norway)
2. St. Olav Hospital, Trondheim (Norway)
3. Moyamba District Hospital (Sierra Leone)
4. Stavanger Univ. Hospital, Stavanger (Norway)
5. Oslo Univ. Hospital, Oslo (Norway)
6. Medicos del Mundo, Madrid (Spain)
7. Haraldsplass Diaconal Hospital, Bergen (Norway)
8. Haukeland Univ. Hospital, Bergen (Norway); Univ. of Bergen (Norway)
9. MRIGlobal, Frederick, MD (United States)
10. World Health Organization (WHO), Geneva (Switzerland)

BACKGROUND The current outbreak of Ebola virus disease (EVD) in West Africa has attacked 24000 people, killed more than 10000 and disrupted social life. METHODS We studied retrospectively the clinical presentation and risk factors for fatal outcome in EVD among all patients admitted to the Ebola Treatment Center in Moyamba District, Sierra Leone. RESULTS Among a total of 88 admitted patients, eighty-two were tested by PCR and 31 (38%) were positive for Ebola virus. Ninety percent reported previous contact with EVD patients and 35% had participated in burials of EVD suspect deceased. No healthworkers were admitted. The most common symptoms on admission were weakness (97%), diarrhea (68%), fever (62%), loss of appetite (62%), vomiting (58%), pain in muscles (62%) and joints (55%), headache (55%), abdominal pain (45%) and conjunctivitis (42%). On admission, bleeding was present in one-third (11/31), while more than half (17/31) bled during the hospital stay. Fifty-eight percent (18/31) died, most within 4-11 days of onset. Significant predictors for fatal outcome were shorter time from onset to admission (P=0.02), high initial viral load (P<0.001), bleeding (P=0.004), and severe pain (P=0.001). The only two patients with hiccups died. CONCLUSIONS Bleeding was more common in our cohort than reported elsewhere during this epidemic, and predicted poor prognosis. Severe pain was common, particularly in fatal cases, and calls for improved and safe palliation, for instance with transdermal opiates. The lack of fever in one third of EBV cases may have implications for screening procedures and case definitions.

• Research Organization: Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)
• Sponsoring Organization: USDOE National Nuclear Security Administration (NNSA)
• DOE Contract Number: AC04-94AL85000
• OSTI ID: 1427261
• Report Number(s): SAND-2015-4067J; 584051
• Journal Information: Sandia journal manuscript; Not yet accepted for publication, Journal Name: Sandia journal manuscript; Not yet accepted for publication; ISSN 9999-0014
• Publisher: Sandia
• Country of Publication: United States
• Language: English