Ebola management centre proximity associated with reduced delays of healthcare of Ebola Virus Disease (EVD) patients, Tonkolili, Sierra Leone, 2014–15
Identifieur interne : 000D68 ( Main/Exploration ); précédent : 000D67; suivant : 000D69Ebola management centre proximity associated with reduced delays of healthcare of Ebola Virus Disease (EVD) patients, Tonkolili, Sierra Leone, 2014–15
Auteurs : Georgios Theocharopoulos [Suède, France, Sierra Leone] ; Kostas Danis [Suède, France] ; Jane Greig [Royaume-Uni] ; Alexandra Hoffmann [Suède, Sierra Leone, Allemagne] ; Henriette De Valk [France] ; Augustine Jimissa [Sierra Leone] ; Sumaila Tejan [Sierra Leone] ; Mohammed Sankoh [Sierra Leone] ; Karline Kleijer [Pays-Bas] ; Will Turner [Sierra Leone] ; Jay Achar [Royaume-Uni] ; Jennifer Duncombe [Sierra Leone] ; Kamalini Lokuge [Royaume-Uni, Australie] ; Ivan Gayton [Royaume-Uni] ; Rob Broeder [Sierra Leone] ; Ronald Kremer [Pays-Bas] ; Grazia Caleo [Royaume-Uni]Source :
- PLoS ONE [ 1932-6203 ] ; 2017.
Descripteurs français
- KwdFr :
- Accessibilité des services de santé, Admission du patient, Adolescent, Adulte, Adulte d'âge moyen, Analyse de régression, Charge virale, Coopération, Délai jusqu'au traitement (), Ebolavirus, Enfant, Enfant d'âge préscolaire, Femelle, Fièvre hémorragique à virus Ebola (), Fièvre hémorragique à virus Ebola (mortalité), Fièvre hémorragique à virus Ebola (physiopathologie), Flambées de maladies, Humains, Jeune adulte, Mâle, Risque, Sierra Leone (épidémiologie), Sujet âgé, Vomissement (), Vomissement (physiopathologie), Études rétrospectives.
- MESH :
- mortalité : Fièvre hémorragique à virus Ebola.
- physiopathologie : Fièvre hémorragique à virus Ebola, Vomissement.
- épidémiologie : Sierra Leone.
- Accessibilité des services de santé, Admission du patient, Adolescent, Adulte, Adulte d'âge moyen, Analyse de régression, Charge virale, Coopération, Délai jusqu'au traitement, Ebolavirus, Enfant, Enfant d'âge préscolaire, Femelle, Fièvre hémorragique à virus Ebola, Flambées de maladies, Humains, Jeune adulte, Mâle, Risque, Sujet âgé, Vomissement, Études rétrospectives.
English descriptors
- KwdEn :
- Adolescent, Adult, Aged, Child, Child, Preschool, Disease Outbreaks, Ebolavirus, Female, Health Services Accessibility, Hemorrhagic Fever, Ebola (mortality), Hemorrhagic Fever, Ebola (physiopathology), Hemorrhagic Fever, Ebola (therapy), Humans, Male, Middle Aged, Patient Admission, Regression Analysis, Relief Work, Retrospective Studies, Risk, Sierra Leone (epidemiology), Time-to-Treatment (statistics & numerical data), Viral Load, Vomiting (physiopathology), Vomiting (therapy), Young Adult.
- MESH :
- epidemiology : Sierra Leone.
- mortality : Hemorrhagic Fever, Ebola.
- physiopathology : Hemorrhagic Fever, Ebola, Vomiting.
- statistics & numerical data : Time-to-Treatment.
- therapy : Hemorrhagic Fever, Ebola, Vomiting.
- Adolescent, Adult, Aged, Child, Child, Preschool, Disease Outbreaks, Ebolavirus, Female, Health Services Accessibility, Humans, Male, Middle Aged, Patient Admission, Regression Analysis, Relief Work, Retrospective Studies, Risk, Viral Load, Young Adult.
Abstract
Between August-December 2014, Ebola Virus Disease (EVD) patients from Tonkolili District were referred for care to two Médecins Sans Frontières (MSF) Ebola Management Centres (EMCs) outside the district (distant EMCs). In December 2014, MSF opened an EMC in Tonkolili District (district EMC). We examined the effect of opening a district-based EMC on time to admission and number of suspect cases dead on arrival (DOA), and identified factors associated with fatality in EVD patients, residents in Tonkolili District. Residents of Tonkolili district who presented between 12 September 2014 and 23 February 2015 to the district EMC and the two distant EMCs were identified from EMC line-lists. EVD cases were confirmed by a positive Ebola PCR test. We calculated time to admission since the onset of symptoms, case-fatality and adjusted Risk Ratios (aRR) using Binomial regression. Of 249 confirmed Ebola cases, 206 (83%) were admitted to the distant EMCs and 43 (17%) to the district EMC. Of them 110 (45%) have died. Confirmed cases dead on arrival (n = 10) were observed only in the distant EMCs. The median time from symptom onset to admission was 6 days (IQR 4,8) in distant EMCs and 3 days (IQR 2,7) in the district EMC (p<0.001). Cases were 2.0 (95%CI 1.4–2.9) times more likely to have delayed admission (>3 days after symptom onset) in the distant compared with the district EMC, but were less likely (aRR = 0.8; 95%CI 0.6–1.0) to have a high viral load (cycle threshold ≤22). A fatal outcome was associated with a high viral load (aRR 2.6; 95%CI 1.8–3.6) and vomiting at first presentation (aRR 1.4; 95%CI 1.0–2.0). The opening of a district EMC was associated with earlier admission of cases to appropriate care facilities, an essential component of reducing EVD transmission. High viral load and vomiting at admission predicted fatality. Healthcare providers should consider the location of EMCs to ensure equitable access during Ebola outbreaks.
Url:
DOI: 10.1371/journal.pone.0176692
PubMed: 28459838
PubMed Central: 5411047
Affiliations:
- Allemagne, Australie, France, Pays-Bas, Royaume-Uni, Sierra Leone, Suède
- Angleterre, Berlin, Grand Londres, Hollande-Septentrionale, Svealand
- Amsterdam, Berlin, Londres, Stockholm
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Le document en format XML
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Londres</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff009"><addr-line>National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canbera, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canbera</wicri:regionArea><wicri:noRegion>Canbera</wicri:noRegion></affiliation></author><author><name sortKey="Gayton, Ivan" sort="Gayton, Ivan" uniqKey="Gayton I" first="Ivan" last="Gayton">Ivan Gayton</name><affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>Manson Unit, Médecins Sans Frontières, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Manson Unit, Médecins Sans Frontières, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region 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Sweden</addr-line></nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Institut de Veille Sanitaire, Saint-Maurice, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Institut de Veille Sanitaire, Saint-Maurice</wicri:regionArea><wicri:noRegion>Saint-Maurice</wicri:noRegion><wicri:noRegion>Saint-Maurice</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Médecins Sans Frontières, Magburaka, Sierra Leone</addr-line></nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>Médecins Sans Frontières, Magburaka</wicri:regionArea><wicri:noRegion>Magburaka</wicri:noRegion></affiliation></author><author><name sortKey="Danis, Kostas" sort="Danis, Kostas" uniqKey="Danis K" first="Kostas" last="Danis">Kostas Danis</name><affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden</addr-line></nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Institut de Veille Sanitaire, Saint-Maurice, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Institut de Veille Sanitaire, Saint-Maurice</wicri:regionArea><wicri:noRegion>Saint-Maurice</wicri:noRegion><wicri:noRegion>Saint-Maurice</wicri:noRegion></affiliation></author><author><name sortKey="Greig, Jane" sort="Greig, Jane" uniqKey="Greig J" first="Jane" last="Greig">Jane Greig</name><affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>Manson Unit, Médecins Sans Frontières, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Manson Unit, Médecins Sans Frontières, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Hoffmann, Alexandra" sort="Hoffmann, Alexandra" uniqKey="Hoffmann A" first="Alexandra" last="Hoffmann">Alexandra Hoffmann</name><affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden</addr-line></nlm:aff><country xml:lang="fr">Suède</country><wicri:regionArea>European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm</wicri:regionArea><placeName><settlement type="city">Stockholm</settlement><region nuts="2">Svealand</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Médecins Sans Frontières, Magburaka, Sierra Leone</addr-line></nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>Médecins Sans Frontières, Magburaka</wicri:regionArea><wicri:noRegion>Magburaka</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="aff005"><addr-line>State Office for Health and Social Affairs, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>State Office for Health and Social Affairs, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff006"><addr-line>Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany</addr-line></nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="De Valk, Henriette" sort="De Valk, Henriette" uniqKey="De Valk H" first="Henriette" last="De Valk">Henriette De Valk</name><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>Institut de Veille Sanitaire, Saint-Maurice, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Institut de Veille Sanitaire, Saint-Maurice</wicri:regionArea><wicri:noRegion>Saint-Maurice</wicri:noRegion><wicri:noRegion>Saint-Maurice</wicri:noRegion></affiliation></author><author><name sortKey="Jimissa, Augustine" sort="Jimissa, Augustine" uniqKey="Jimissa A" first="Augustine" last="Jimissa">Augustine Jimissa</name><affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>District Health Management Team, Ministry of Health and Sanitation, Magburaka, Sierra Leone</addr-line></nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>District Health Management Team, Ministry of Health and Sanitation, Magburaka</wicri:regionArea><wicri:noRegion>Magburaka</wicri:noRegion></affiliation></author><author><name sortKey="Tejan, Sumaila" sort="Tejan, Sumaila" uniqKey="Tejan S" first="Sumaila" last="Tejan">Sumaila Tejan</name><affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>District Health Management Team, Ministry of Health and Sanitation, Magburaka, Sierra Leone</addr-line></nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>District Health Management Team, Ministry of Health and Sanitation, Magburaka</wicri:regionArea><wicri:noRegion>Magburaka</wicri:noRegion></affiliation></author><author><name sortKey="Sankoh, Mohammed" sort="Sankoh, Mohammed" uniqKey="Sankoh M" first="Mohammed" last="Sankoh">Mohammed Sankoh</name><affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>District Health Management Team, Ministry of Health and Sanitation, Magburaka, Sierra Leone</addr-line></nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>District Health Management Team, Ministry of Health and Sanitation, Magburaka</wicri:regionArea><wicri:noRegion>Magburaka</wicri:noRegion></affiliation></author><author><name sortKey="Kleijer, Karline" sort="Kleijer, Karline" uniqKey="Kleijer K" first="Karline" last="Kleijer">Karline Kleijer</name><affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>Operational Centre Amsterdam, Médecins Sans Frontières, Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Operational Centre Amsterdam, Médecins Sans Frontières, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Turner, Will" sort="Turner, Will" uniqKey="Turner W" first="Will" last="Turner">Will Turner</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Médecins Sans Frontières, Magburaka, Sierra Leone</addr-line></nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>Médecins Sans Frontières, Magburaka</wicri:regionArea><wicri:noRegion>Magburaka</wicri:noRegion></affiliation></author><author><name sortKey="Achar, Jay" sort="Achar, Jay" uniqKey="Achar J" first="Jay" last="Achar">Jay Achar</name><affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>Manson Unit, Médecins Sans Frontières, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Manson Unit, Médecins Sans Frontières, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Duncombe, Jennifer" sort="Duncombe, Jennifer" uniqKey="Duncombe J" first="Jennifer" last="Duncombe">Jennifer Duncombe</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Médecins Sans Frontières, Magburaka, Sierra Leone</addr-line></nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>Médecins Sans Frontières, Magburaka</wicri:regionArea><wicri:noRegion>Magburaka</wicri:noRegion></affiliation></author><author><name sortKey="Lokuge, Kamalini" sort="Lokuge, Kamalini" uniqKey="Lokuge K" first="Kamalini" last="Lokuge">Kamalini Lokuge</name><affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>Manson Unit, Médecins Sans Frontières, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Manson Unit, Médecins Sans Frontières, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff009"><addr-line>National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canbera, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canbera</wicri:regionArea><wicri:noRegion>Canbera</wicri:noRegion></affiliation></author><author><name sortKey="Gayton, Ivan" sort="Gayton, Ivan" uniqKey="Gayton I" first="Ivan" last="Gayton">Ivan Gayton</name><affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>Manson Unit, Médecins Sans Frontières, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Manson Unit, Médecins Sans Frontières, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Broeder, Rob" sort="Broeder, Rob" uniqKey="Broeder R" first="Rob" last="Broeder">Rob Broeder</name><affiliation wicri:level="1"><nlm:aff id="aff003"><addr-line>Médecins Sans Frontières, Magburaka, Sierra Leone</addr-line></nlm:aff><country xml:lang="fr">Sierra Leone</country><wicri:regionArea>Médecins Sans Frontières, Magburaka</wicri:regionArea><wicri:noRegion>Magburaka</wicri:noRegion></affiliation></author><author><name sortKey="Kremer, Ronald" sort="Kremer, Ronald" uniqKey="Kremer R" first="Ronald" last="Kremer">Ronald Kremer</name><affiliation wicri:level="3"><nlm:aff id="aff008"><addr-line>Operational Centre Amsterdam, Médecins Sans Frontières, Amsterdam, The Netherlands</addr-line></nlm:aff><country xml:lang="fr">Pays-Bas</country><wicri:regionArea>Operational Centre Amsterdam, Médecins Sans Frontières, Amsterdam</wicri:regionArea><placeName><settlement type="city">Amsterdam</settlement><region nuts="2" type="province">Hollande-Septentrionale</region></placeName></affiliation></author><author><name sortKey="Caleo, Grazia" sort="Caleo, Grazia" uniqKey="Caleo G" first="Grazia" last="Caleo">Grazia Caleo</name><affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>Manson Unit, Médecins Sans Frontières, London, United Kingdom</addr-line></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Manson Unit, Médecins Sans Frontières, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Child</term><term>Child, Preschool</term><term>Disease Outbreaks</term><term>Ebolavirus</term><term>Female</term><term>Health Services Accessibility</term><term>Hemorrhagic Fever, Ebola (mortality)</term><term>Hemorrhagic Fever, Ebola (physiopathology)</term><term>Hemorrhagic Fever, Ebola (therapy)</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Patient Admission</term><term>Regression Analysis</term><term>Relief Work</term><term>Retrospective Studies</term><term>Risk</term><term>Sierra Leone (epidemiology)</term><term>Time-to-Treatment (statistics & numerical data)</term><term>Viral Load</term><term>Vomiting (physiopathology)</term><term>Vomiting (therapy)</term><term>Young Adult</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Accessibilité des services de santé</term><term>Admission du patient</term><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de régression</term><term>Charge virale</term><term>Coopération</term><term>Délai jusqu'au traitement ()</term><term>Ebolavirus</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Femelle</term><term>Fièvre hémorragique à virus Ebola ()</term><term>Fièvre hémorragique à virus Ebola (mortalité)</term><term>Fièvre hémorragique à virus Ebola (physiopathologie)</term><term>Flambées de maladies</term><term>Humains</term><term>Jeune adulte</term><term>Mâle</term><term>Risque</term><term>Sierra Leone (épidémiologie)</term><term>Sujet âgé</term><term>Vomissement ()</term><term>Vomissement (physiopathologie)</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Sierra Leone</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>Hemorrhagic Fever, Ebola</term></keywords><keywords scheme="MESH" qualifier="mortalité" xml:lang="fr"><term>Fièvre hémorragique à virus Ebola</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Fièvre hémorragique à virus Ebola</term><term>Vomissement</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Hemorrhagic Fever, Ebola</term><term>Vomiting</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Time-to-Treatment</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Hemorrhagic Fever, Ebola</term><term>Vomiting</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Sierra Leone</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Adult</term><term>Aged</term><term>Child</term><term>Child, Preschool</term><term>Disease Outbreaks</term><term>Ebolavirus</term><term>Female</term><term>Health Services Accessibility</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Patient Admission</term><term>Regression Analysis</term><term>Relief Work</term><term>Retrospective Studies</term><term>Risk</term><term>Viral Load</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Accessibilité des services de santé</term><term>Admission du patient</term><term>Adolescent</term><term>Adulte</term><term>Adulte d'âge moyen</term><term>Analyse de régression</term><term>Charge virale</term><term>Coopération</term><term>Délai jusqu'au traitement</term><term>Ebolavirus</term><term>Enfant</term><term>Enfant d'âge préscolaire</term><term>Femelle</term><term>Fièvre hémorragique à virus Ebola</term><term>Flambées de maladies</term><term>Humains</term><term>Jeune adulte</term><term>Mâle</term><term>Risque</term><term>Sujet âgé</term><term>Vomissement</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Between August-December 2014, Ebola Virus Disease (EVD) patients from Tonkolili District were referred for care to two Médecins Sans Frontières (MSF) Ebola Management Centres (EMCs) outside the district (distant EMCs). In December 2014, MSF opened an EMC in Tonkolili District (district EMC). We examined the effect of opening a district-based EMC on time to admission and number of suspect cases dead on arrival (DOA), and identified factors associated with fatality in EVD patients, residents in Tonkolili District. Residents of Tonkolili district who presented between 12 September 2014 and 23 February 2015 to the district EMC and the two distant EMCs were identified from EMC line-lists. EVD cases were confirmed by a positive Ebola PCR test. We calculated time to admission since the onset of symptoms, case-fatality and adjusted Risk Ratios (aRR) using Binomial regression. Of 249 confirmed Ebola cases, 206 (83%) were admitted to the distant EMCs and 43 (17%) to the district EMC. Of them 110 (45%) have died. Confirmed cases dead on arrival (n = 10) were observed only in the distant EMCs. The median time from symptom onset to admission was 6 days (IQR 4,8) in distant EMCs and 3 days (IQR 2,7) in the district EMC (p<0.001). Cases were 2.0 (95%CI 1.4–2.9) times more likely to have delayed admission (>3 days after symptom onset) in the distant compared with the district EMC, but were less likely (aRR = 0.8; 95%CI 0.6–1.0) to have a high viral load (cycle threshold ≤22). A fatal outcome was associated with a high viral load (aRR 2.6; 95%CI 1.8–3.6) and vomiting at first presentation (aRR 1.4; 95%CI 1.0–2.0). The opening of a district EMC was associated with earlier admission of cases to appropriate care facilities, an essential component of reducing EVD transmission. High viral load and vomiting at admission predicted fatality. Healthcare providers should consider the location of EMCs to ensure equitable access during Ebola outbreaks.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Agua Agum, J" uniqKey="Agua Agum J">J Agua-Agum</name></author><author><name sortKey="Ariyarajah, A" uniqKey="Ariyarajah A">A Ariyarajah</name></author><author><name sortKey="Aylward, B" uniqKey="Aylward B">B Aylward</name></author><author><name sortKey="Blake, Im" uniqKey="Blake I">IM Blake</name></author><author><name sortKey="Brennan, R" uniqKey="Brennan R">R Brennan</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Dallatomasina, S" uniqKey="Dallatomasina S">S Dallatomasina</name></author><author><name sortKey="Crestani, R" uniqKey="Crestani R">R Crestani</name></author><author><name sortKey="Sylvester, Squire J" 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Squire</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>France</li><li>Pays-Bas</li><li>Royaume-Uni</li><li>Sierra Leone</li><li>Suède</li></country><region><li>Angleterre</li><li>Berlin</li><li>Grand Londres</li><li>Hollande-Septentrionale</li><li>Svealand</li></region><settlement><li>Amsterdam</li><li>Berlin</li><li>Londres</li><li>Stockholm</li></settlement></list><tree><country name="Suède"><region name="Svealand"><name sortKey="Theocharopoulos, Georgios" sort="Theocharopoulos, Georgios" uniqKey="Theocharopoulos G" first="Georgios" last="Theocharopoulos">Georgios Theocharopoulos</name></region><name sortKey="Danis, Kostas" sort="Danis, Kostas" uniqKey="Danis K" first="Kostas" last="Danis">Kostas Danis</name><name sortKey="Hoffmann, Alexandra" sort="Hoffmann, Alexandra" uniqKey="Hoffmann A" first="Alexandra" last="Hoffmann">Alexandra Hoffmann</name></country><country name="France"><noRegion><name sortKey="Theocharopoulos, Georgios" sort="Theocharopoulos, Georgios" uniqKey="Theocharopoulos G" first="Georgios" last="Theocharopoulos">Georgios Theocharopoulos</name></noRegion><name sortKey="Danis, Kostas" sort="Danis, Kostas" uniqKey="Danis K" first="Kostas" last="Danis">Kostas Danis</name><name sortKey="De Valk, Henriette" sort="De Valk, Henriette" uniqKey="De Valk H" first="Henriette" last="De Valk">Henriette De Valk</name></country><country name="Sierra Leone"><noRegion><name sortKey="Theocharopoulos, Georgios" sort="Theocharopoulos, Georgios" uniqKey="Theocharopoulos G" first="Georgios" last="Theocharopoulos">Georgios Theocharopoulos</name></noRegion><name sortKey="Broeder, Rob" sort="Broeder, Rob" uniqKey="Broeder R" first="Rob" last="Broeder">Rob Broeder</name><name sortKey="Duncombe, Jennifer" sort="Duncombe, Jennifer" uniqKey="Duncombe J" first="Jennifer" last="Duncombe">Jennifer Duncombe</name><name sortKey="Hoffmann, Alexandra" sort="Hoffmann, Alexandra" uniqKey="Hoffmann A" first="Alexandra" last="Hoffmann">Alexandra Hoffmann</name><name sortKey="Jimissa, Augustine" sort="Jimissa, Augustine" uniqKey="Jimissa A" first="Augustine" last="Jimissa">Augustine Jimissa</name><name sortKey="Sankoh, Mohammed" sort="Sankoh, Mohammed" uniqKey="Sankoh M" first="Mohammed" last="Sankoh">Mohammed Sankoh</name><name sortKey="Tejan, Sumaila" sort="Tejan, Sumaila" uniqKey="Tejan S" first="Sumaila" last="Tejan">Sumaila Tejan</name><name sortKey="Turner, Will" sort="Turner, Will" uniqKey="Turner W" first="Will" last="Turner">Will Turner</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Greig, Jane" sort="Greig, Jane" uniqKey="Greig J" first="Jane" last="Greig">Jane Greig</name></region><name sortKey="Achar, Jay" sort="Achar, Jay" uniqKey="Achar J" first="Jay" last="Achar">Jay Achar</name><name sortKey="Caleo, Grazia" sort="Caleo, Grazia" uniqKey="Caleo G" first="Grazia" last="Caleo">Grazia Caleo</name><name sortKey="Gayton, Ivan" sort="Gayton, Ivan" uniqKey="Gayton I" first="Ivan" last="Gayton">Ivan Gayton</name><name sortKey="Lokuge, Kamalini" sort="Lokuge, Kamalini" uniqKey="Lokuge K" first="Kamalini" last="Lokuge">Kamalini Lokuge</name></country><country name="Allemagne"><region name="Berlin"><name sortKey="Hoffmann, Alexandra" sort="Hoffmann, Alexandra" uniqKey="Hoffmann A" first="Alexandra" last="Hoffmann">Alexandra Hoffmann</name></region><name sortKey="Hoffmann, Alexandra" sort="Hoffmann, Alexandra" uniqKey="Hoffmann A" first="Alexandra" last="Hoffmann">Alexandra Hoffmann</name></country><country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Kleijer, Karline" sort="Kleijer, Karline" uniqKey="Kleijer K" first="Karline" last="Kleijer">Karline Kleijer</name></region><name sortKey="Kremer, Ronald" sort="Kremer, Ronald" uniqKey="Kremer R" first="Ronald" last="Kremer">Ronald Kremer</name></country><country name="Australie"><noRegion><name sortKey="Lokuge, Kamalini" sort="Lokuge, Kamalini" uniqKey="Lokuge K" first="Kamalini" last="Lokuge">Kamalini Lokuge</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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