Ebola Treatment Center 2012 for MSF_UK Field Study Report MSFscience Description of clinical features, treatment and outcome of BDBV disease in the 2012 outbreak.

1. Thomas Kratz, Paul Roddy, Olimpia de la Rosa,
Diana Pou, Benjamin Jeffs,AntoineTshomba,
Matthias Borchert
Bundibugyo Ebola virus disease: symptoms, treatment and
outcomes in the Ebola Treatment Centre, Isiro, Democratic
Republic of Congo, 2012
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2. Background
 Ebolavirus: Filoviridae family, single stranded RNA viruses
 Humanopathogenic subtypes: Zaire, Sudan, Cote d’Ivoire, Bundibugyo (BDBV)
 MSF involved in all Filovirus outbreaks since 1995
 BDBV first discovered 2007 in Uganda
 Second outbreak declared 17th August 2012 in Isiro, Democratic Republic of
Congo (DRC)
 MSF activities during outbreak: EbolaTreatment Centre (ETC), active case
finding, prevention of transmission
 Anecdotal experience for BDBV : non-specific symptoms, lower case fatality
ratio (CFR) than Ebola-Zaire
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3. Objectives
 Overall objective: Description of clinical features, treatment and outcome of
BDBV disease in the 2012 outbreak
 Specific objectives:
 Describe patient characteristics
 Describe clinical symptoms and differential diagnoses of suspected BDBV
disease
 Estimate case fatality ratio (CFR)
 Explore the effect of case management and treatment on patient outcome
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5. Methods: demographic and clinical data collected by MSF
•Descriptive epidemiology of BDBV outbreak
•Techniques: Frequencies, proportions and 2-sided Fisher-exact tests with STATA ®
•Ethics Review Board (ERB): -Approved by Kisangani University (DRC)
-Met criteria for exemption from full review by MSF ERB
16
probable
18
lab-confirmed
(IgM Elisa or
PCR)
Community
cases
18
lab-confirmed
Free text data
entered inWord
forms
Data double-entered into EpiData:
•Notification charts
•Temperature/medication charts
•Symptom follow-up charts
Demographic
analysis
•Symptom prevalence
•Differential diagnoses
•Treatment & outcomes
EbolaTreatment
Centre (ETC) cases
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6. N (%)
Community
Probable
Cases
N (%)
Community
Confirmed
Cases
N (%) ETC
Confirmed
Cases
N (%)
Total
All cases
Sex Male 3 (18.8%) 2 (11.1%) 7 (38.1%) 12 (23.1%)
Female 13 (81.3%)* 16 (88.9%)* 11 (61.1%) 40 (76.9%)
Age (years) <15 1 (6.3%) 2 (11.1%) 1 (5.6%) 4 (7.7%)
15-54 12 (75.0%) 16 (88.9%) 14 (77.8%) 42 (80.8%)
>54 3 (18.8%) 0 3 (16.7%) 6 (11.5%)
TOTAL 16 18 18 52
Women over-represented in BDBV cases (50.2% general pop.)
* p<0.0001
Results: Sex/age distribution of probable and confirmed cases
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7. Results: Case fatality ratios (CFR) : by sex and age
CFR
Community
Probable
Cases
CFR
Community
Confirmed
Cases
CFR
ETC
Confirmed
Cases
CFR
TOTAL
All
Cases
Sex Male 3/3 (100.0%) 0/2 (0.0%) 2/7 (28.6%) 5/12 (41.7%)
Female 12/13 (92.3%) 4/16 (25.0%) 7/11 (63.6%) 23/40 (57.6%)
Age (years) < 15 1/1 (100.0%) 0/2 (0.0%) 1/1 (100.0%) 2/4 (50.0%)
15-54 12/12 (100.0%) 4/16 (25.0%) 8/14 (57.1%) 24/42 (57.1%)
>54 2/3 (66.7%) 0/0 (0.0%) 0/3 (0.0%) 2/6 (33.3%)
TOTAL 15/16 (93.8%) 4/18 (22.2%) 9/18 (50.0%) 28/52 (53.8%)
- CFR non-significantly higher in women than in men (p=0.51) and in the age group of
15-54 years (p=0.48)
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8. Results: Symptoms of the 18 confirmed ETC patients
Symptom Self-report
at admission
Developed in
hospital stay
Fever 15/17 (88.2%) 10/18 (55.6%)
Asthenia 16/17 (94.1%) 14/17 (82.4%)
Myalgia 12/17 (70.6%) 12/17 (70.6%)
Arthralgia - 13/17 (76.5%)
Anorexia 12/17 (70.6%) 14/17 (82.4%)
Sore throat 3/17 (17.7%) 12/17 (70.6%)
GI
(nausea/vomit/diarrho
ea)
11/17 (64.7%) 13/17 (76.4%)
Bleeding 5/17 (29.4%) 5/17 (29.4%)
Hiccups 11.8% 35.3%
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9. Results – treatment outcomes (ETC)
CFR not significantly lower but trend was for improved outcome in following patients:
- Received standard treatment of cefixime/multivitamins/paracetamol (40% vs. 63%, p=0.64)
- Received oral or intravenous rehydration (38% vs. 60%, p=0.64)
- Had body temperature and symptoms thoroughly documented (46% vs. 60%, p=1)
* Potential confounding if sicker patients were not able to take treatment
*Low sample size limited statistical power to detect associations between many of the variables
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10. Results: differential diagnoses
Initial diagnoses of the
18 ETC BDBV cases
N (%)
Malaria 13 (28.3%)
Intestinal Parasitosis 5 (10.9%)
Infectious Syndrome 5 (10.9%)
Gastritis 4 (8.7%)
Gastroenteritis 3 (6.5%)
Dehydration 3 (6.5%)
Amoebiasis 2 (4.4%)
Salmonellosis 2 (4.4%)
Typhoid Fever 2 (4.4%)
Immunodefiency Syndrome 2 (4.4%)
Dyspeptic Syndrome 1 (2.2%)
Abdominal Colics 1 (2.2%)
Initial diagnoses of the
18 ETC BDBV cases
N (%)
Cholera 1 (2.2%)
Arterial Hypotension 1 (2.2%)
Hypoglycemia 1 (2.2%)
TOTAL NUMBER OF DIAGNOSES 46 (100%)
BDBV often misdiagnosed as
another infectious disease,
e.g. malaria
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11. Conclusions
 Women more frequently affected by BDBV than men
 CFR higher in women and 15-54 year age group
 High prevalence of non-specific symptoms and gastrointestinal
signs, low prevalence of haemorrhage
 Hiccups and sore throat more prevalent during hospital stay than
pre-admission (late sign?)
 Thorough monitoring, standard treatment and rehydration may
improve outcome
 BDBV frequently misdiagnosed as other infectious diseases, e.g.
malaria
 Challenges : Quality of documentation, low case numbers
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12. Thank you for
your attention
We thank the healthcare
staff from Isiro and the
patients
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