S'abonner

Differential symptomology of possible and confirmed Ebola virus disease infection in the Democratic Republic of the Congo: a retrospective cohort study - 20/12/22

Doi : 10.1016/S1473-3099(22)00584-9 
Justus Nsio, MD b, , Denis-Luc Ardiet, MSc a, , , Rebecca M Coulborn, MPH a, Emmanuel Grellety, PhD a, Manuel Albela, MSc g, Francesco Grandesso, MSc a, Richard Kitenge, MD d, Dolla L Ngwanga, MD c, Bibiche Matady, MD d, Guyguy Manangama, PhD h, Mathias Mossoko, MSc b, John Kombe Ngwama, MD b, Placide Mbala, ProfMD e, Francisco Luquero, PhD a, Klaudia Porten, MD a, Steve Ahuka-Mundeke, ProfMD f, i
a Department of Epidemiology, Intervention, and Training, Epicentre, Paris, France 
b General Direction of Disease Control, Ministry of Health, Kinshasa, Democratic Republic of the Congo 
c Extended Program of Immunization, Ministry of Health, Kinshasa, Democratic Republic of the Congo 
d National Program of Emergencies and Humanitarian Actions, Ministry of Health, Kinshasa, Democratic Republic of the Congo 
e Department of Epidemiology, Institut National de la Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo 
f Department of Virology, Institut National de la Recherche Biomédicale (INRB), Kinshasa, Democratic Republic of the Congo 
g Medical Department, Médecins sans Frontières, Geneva, Switzerland 
h Department of Emergencies, Médecins sans Frontières, Paris, France 
i Département de Biologie Médicale, Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo 

* Correspondence to: Mr Denis-Luc Ardiet, Department of Epidemiology, Intervention, and Training, Epicentre, Paris 75019, France Department of Epidemiology, Intervention, and Training Epicentre Paris 75019 France

Summary

Background

In its earliest phases, Ebola virus disease’s rapid-onset, high fever, and gastrointestinal symptoms are largely indistinguishable from other infectious illnesses. We aimed to characterise the clinical indicators associated with Ebola virus disease to improve outbreak response.

Methods

In this retrospective analysis, we assessed routinely collected data from individuals with possible Ebola virus disease attending 30 Ebola health facilities in two provinces of the Democratic Republic of the Congo between Aug 1, 2018, and Aug 28, 2019. We used logistic regression analysis to model the probability of Ebola infection across 34 clinical variables and four types of possible Ebola virus disease exposures: contact with an individual known to have Ebola virus disease, attendance at any funeral, health facility consultation, or consultation with an informal health practitioner.

Findings

Data for 24 666 individuals were included. If a patient presented to care in the early symptomatic phase (ie, days 0–2), Ebola virus disease positivity was most associated with previous exposure to an individual with Ebola virus disease (odds ratio [OR] 11·9, 95% CI 9·1–15·8), funeral attendance (2·1, 1·6–2·7), or health facility consultations (2·1, 1·6–2·8), rather than clinical parameters. If presentation occurred on day 3 or later (after symptom onset), bleeding at an injection site (OR 33·9, 95% CI 12·7–101·3), bleeding gums (7·5, 3·7–15·4), conjunctivitis (2·4, 1·7–3·4), asthenia (1·9, 1·5–2·3), sore throat (1·8, 1·3–2·4), dysphagia (1·8, 1·4–2·3), and diarrhoea (1·6, 1·3–1·9) were additional strong predictors of Ebola virus disease. Some Ebola virus disease-specific signs were less prevalent among vaccinated individuals who were positive for Ebola virus disease when compared with the unvaccinated, such as dysphagia (–47%, p=0·0024), haematemesis (–90%, p=0·0131), and bleeding gums (–100%, p=0·0035).

Interpretation

Establishing the exact time an individual first had symptoms is essential to assessing their infection risk. An individual’s exposure history remains of paramount importance, especially in the early phase. Ebola virus disease vaccination reduces symptom severity and should also be considered when assessing the likelihood of infection. These findings about symptomatology should be translated into practice during triage and should inform testing and quarantine procedures.

Funding

Médecins Sans Frontières and its research affiliate Epicentre.

Le texte complet de cet article est disponible en PDF.

Plan


© 2023  Elsevier Ltd. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

  • Contenu

Vol 23 - N° 1

P. 91-102 - janvier 2023 Retour au numéro
Article précédent Article précédent
  • Antimalarial chemoprophylaxis for forest goers in southeast Asia: an open-label, individually randomised controlled trial
  • Rupam Tripura, Lorenz von Seidlein, Siv Sovannaroth, Thomas J Peto, James J Callery, Meas Sokha, Mom Ean, Chhouen Heng, Franca Conradis-Jansen, Wanassanan Madmanee, Pimnara Peerawaranun, Naomi Waithira, Panarasri Khonputsa, Monnaphat Jongdeepaisal, Kulchada Pongsoipetch, Paphapisa Chotthanawathit, Ung Soviet, Christopher Pell, Jureeporn Duanguppama, Huy Rekol, Joel Tarning, Mallika Imwong, Mavuto Mukaka, Nicholas J White, Arjen M Dondorp, Richard J Maude
| Article suivant Article suivant
  • Safety and immunogenicity of a primary series and booster dose of the meningococcal serogroup B-factor H binding protein vaccine (MenB-FHbp) in healthy children aged 1–9 years: two phase 2 randomised, controlled, observer-blinded studies
  • Helen S Marshall, Timo Vesikari, Peter C Richmond, Jacek Wysocki, Leszek Szenborn, Johannes Beeslaar, Jason D Maguire, Paul Balmer, Robert O’Neill, Annaliesa S Anderson, Jean-Louis Prégaldien, Roger Maansson, Han-Qing Jiang, John L Perez

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Mon compte


Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.


Tout le contenu de ce site: Copyright © 2025 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.