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N Engl J Med DOI:10.1056/NEJMoa1411680

Clinical illness and outcomes in patients with Ebola in Sierra Leone.

Publication TypeJournal Article
Year of Publication2014
AuthorsSchieffelin, JS, Shaffer, JG, Goba, A, Gbakie, M, Gire, SK, Colubri, A, Sealfon, RSG, Kanneh, L, Moigboi, A, Momoh, M, Fullah, M, Moses, LM, Brown, BL, Andersen, KG, Winnicki, S, Schaffner, SF, Park, DJ, Yozwiak, NL, Jiang, P-P, Kargbo, D, Jalloh, S, Fonnie, M, Sinnah, V, French, I, Kovoma, A, Kamara, FK, Tucker, V, Konuwa, E, Sellu, J, Mustapha, I, Foday, M, Yillah, M, Kanneh, F, Saffa, S, Massally, JLB, Boisen, ML, Branco, LM, Vandi, MA, Grant, DS, Happi, C, Gevao, SM, Fletcher, TE, Fowler, RA, Bausch, DG, Sabeti, PC, S Khan, H, Garry, RF
Corporate AuthorsKGH Lassa Fever Program, Viral Hemorrhagic Fever Consortium, WHO Clinical Response Team
JournalN Engl J Med
Volume371
Issue22
Pages2092-100
Date Published2014 Nov 27
ISSN1533-4406
KeywordsAbdominal Pain, Adult, Animals, Diarrhea, Ebolavirus, Epidemics, Female, Fever, Hemorrhagic Fever, Ebola, Humans, Male, Middle Aged, Mortality, Reverse Transcriptase Polymerase Chain Reaction, Sierra Leone, Viral Load, Vomiting
Abstract

BACKGROUND: Limited clinical and laboratory data are available on patients with Ebola virus disease (EVD). The Kenema Government Hospital in Sierra Leone, which had an existing infrastructure for research regarding viral hemorrhagic fever, has received and cared for patients with EVD since the beginning of the outbreak in Sierra Leone in May 2014.

METHODS: We reviewed available epidemiologic, clinical, and laboratory records of patients in whom EVD was diagnosed between May 25 and June 18, 2014. We used quantitative reverse-transcriptase-polymerase-chain-reaction assays to assess the load of Ebola virus (EBOV, Zaire species) in a subgroup of patients.

RESULTS: Of 106 patients in whom EVD was diagnosed, 87 had a known outcome, and 44 had detailed clinical information available. The incubation period was estimated to be 6 to 12 days, and the case fatality rate was 74%. Common findings at presentation included fever (in 89% of the patients), headache (in 80%), weakness (in 66%), dizziness (in 60%), diarrhea (in 51%), abdominal pain (in 40%), and vomiting (in 34%). Clinical and laboratory factors at presentation that were associated with a fatal outcome included fever, weakness, dizziness, diarrhea, and elevated levels of blood urea nitrogen, aspartate aminotransferase, and creatinine. Exploratory analyses indicated that patients under the age of 21 years had a lower case fatality rate than those over the age of 45 years (57% vs. 94%, P=0.03), and patients presenting with fewer than 100,000 EBOV copies per milliliter had a lower case fatality rate than those with 10 million EBOV copies per milliliter or more (33% vs. 94%, P=0.003). Bleeding occurred in only 1 patient.

CONCLUSIONS: The incubation period and case fatality rate among patients with EVD in Sierra Leone are similar to those observed elsewhere in the 2014 outbreak and in previous outbreaks. Although bleeding was an infrequent finding, diarrhea and other gastrointestinal manifestations were common. (Funded by the National Institutes of Health and others.).

URLhttp://www.nejm.org/doi/abs/10.1056/NEJMoa1411680?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov
DOI10.1056/NEJMoa1411680
Pubmed

http://www.ncbi.nlm.nih.gov/pubmed/25353969?dopt=Abstract

Alternate JournalN. Engl. J. Med.
PubMed ID25353969
PubMed Central IDPMC4318555
Grant List2R44AI088843 / AI / NIAID NIH HHS / United States
U19 AI115589 / AI / NIAID NIH HHS / United States
P20GM103501 / GM / NIGMS NIH HHS / United States
HHSN272201000022C / / PHS HHS / United States
1U01HG007480-01 / HG / NHGRI NIH HHS / United States
1DP2OD006514-01 / OD / NIH HHS / United States
1U19AI109762 / AI / NIAID NIH HHS / United States
U01 HG007480 / HG / NHGRI NIH HHS / United States
100890 / / Wellcome Trust / United Kingdom
1R01AI104621 / AI / NIAID NIH HHS / United States
T32 GM080177 / GM / NIGMS NIH HHS / United States
U19 AI109762 / AI / NIAID NIH HHS / United States
GM080177 / GM / NIGMS NIH HHS / United States
P20 RR021970 / RR / NCRR NIH HHS / United States
HHSN272201000022C / AI / NIAID NIH HHS / United States
HHSN272200900049C / AI / NIAID NIH HHS / United States
R44 AI088843 / AI / NIAID NIH HHS / United States
P20 GM103501 / GM / NIGMS NIH HHS / United States
R01 AI104621 / AI / NIAID NIH HHS / United States
DP2 OD006514 / OD / NIH HHS / United States
R01 AI099699 / AI / NIAID NIH HHS / United States
HHSN272200900049C / / PHS HHS / United States