Ebola Virus Disease, Democratic Republic of the Congo, 2014
Notice bibliographique
Résumé
During July-November 2014, the Democratic Republic of the Congo underwent its seventh Ebola virus disease (EVD) outbreak.The etiologic agent was Zaire Ebola virus; 66 cases were reported (overall case-fatality rate 74.2%).Through a retrospective observational study of confirmed EVD in 25 patients admitted to either of 2 Ebola treatment centers, we described clinical features and investigated correlates associated with death.Clinical features were mainly generic.At admission, 76% of patients had >1 gastrointestinal symptom and 28% >1 hemorrhagic symptom.The case-fatality rate in this group was 48% and was higher for female patients (67%).Cox regression analysis correlated death with initial low cycle threshold, indicating high viral load.Cycle threshold was a robust predictor of death, as were fever, hiccups, diarrhea, dyspnea, dehydration, disorientation, hematemesis, bloody feces during hospitalization, and anorexia in recent medical history.Differences from other outbreaks could suggest guidance for optimizing clinical management and disease control.E bola virus disease (EVD), a severe, often fatal illness in humans, has remained a major public health concern in many parts of sub-Saharan Africa since it appeared in 1976 in Zaire (now the Democratic Republic of the Congo [DRC]).The severity of disease caused by Ebola virus (family Filoviridae) varies considerably among the 5 known species.Three species (Zaire ebolavirus [ZEBOV], Bundibugyo ebolavirus, and Sudan ebolavirus) have caused outbreaks affecting dozens, and sometimes hundreds, of persons in Africa.Case-fatality rates (CFRs) vary by species and are highest for ZEBOV (up to 90%) (1).The largest EVD epidemic occurred during 2014-2016 in West Africa; it resulted in 28,646 cases and 11,323 deaths and affected 10 countries in Africa, Europe, and North America (2).Simultaneously, in 2014, another EVD outbreak occurred in Equateur Province in northwestern DRC.The first case, reported on July 26, 2014, in a pregnant woman married to a bush meat hunter, came from the village of Inkanamongo (3,4), close to the town of Boende; she was believed to be the index case-patient.This area is ≈700 km from the capital city, Kinshasa.No paved roads connect the 2 settlements, and communications depend mainly on travelers (3).The World Health Organization (WHO) declared the outbreak on August 24, 2014 (4).During the outbreak, July 26-October 4, 2014, a total of 66 EVD cases were reported (28 probable, 38 confirmed); 49 deaths were reported, for a CFR of 74%, including deaths in the community of persons with suspected EVD (5,6).One third of these case-patients were documented to have had direct contact with the index case-patient.A basic reproduction number of 0.84 (3) was estimated, which was lower than in any previous EVD epidemic (7).In comparison, West Africa had a reproduction number of 1.7-2.0 for the first 9 months of the outbreak (8).WHO declared the outbreak in DRC over on November 21, 2014, forty-two days after the last EVD case-patient tested negative and was discharged from the hospital (5).Genome sequencing identified ZEBOV as the outbreak's causative agent.However, genetic characterization of the virus pointed to a local variant because it has 99.2% of the genome in common with the strain isolated form the 1995 outbreak in Kikwit, DRC, and >96.8% identified in common with the ZEBOV simultaneously circulating in West Africa (3,9).To respond to this epidemic, in collaboration with the local authorities, Médecins Sans Frontières (MSF) opened an Ebola treatment center (ETC) to manage persons with suspected or confirmed EVD in Lokolia; this ETC was fully functional on September 10, 2014.A second ETC was set up inside the regional hospital in Boende on August 28.The activities in both ETCs were conducted until week 44.We describe the clinical features of EVD and predictors of death among patients treated in these ETCs during the 2014 outbreak in DRC. Methods We conducted a retrospective observational study on the basis of medical records of all patients with confirmed Ebola Virus Disease, Democratic Republic of the Congo, 2014Carolina Nanclares, Jimmy Kapetshi, Fanshen Lionetto, Olimpia de la Rosa,
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».