Ebola Virus Disease, Democratic Republic of the Congo, 2014
Bibliographic record
Abstract
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,
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".