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. 2016 Sep;22(9):1537-44.
doi: 10.3201/eid2209.151621. Epub 2016 Sep 15.

Clinical Features of and Risk Factors for Fatal Ebola Virus Disease, Moyamba District, Sierra Leone, December 2014-February 2015

Yngvar Lunde Haaskjold, Håkon Angell Bolkan, Kurt Østhuus Krogh, James Jongopi, Karen Marie Lundeby, Sindre Mellesmo, Pedro San José Garcés, Ola Jøsendal, Åsmund Øpstad, Erling Svensen, Luis Matias Zabala Fuentes, Alfred Sandy Kamara, Melchor Riera, Javier Arranz, David P Roberts, Paul D Stamper, Paula Austin, Alfredo J Moosa, Dennis Marke, Shoaib Hassan, Geir Egil Eide, Åse Berg, Bjørn Blomberg

Clinical Features of and Risk Factors for Fatal Ebola Virus Disease, Moyamba District, Sierra Leone, December 2014-February 2015

Yngvar Lunde Haaskjold et al. Emerg Infect Dis. 2016 Sep.

Abstract

The 2013-2016 outbreak of Ebola virus disease (EVD) in West Africa infected >28,000 people, including >11,000 who died, and disrupted social life in the region. We retrospectively studied clinical signs and symptoms and risk factors for fatal outcome among 31 Ebola virus-positive patients admitted to the Ebola Treatment Center in Moyamba District, Sierra Leone. We found a higher rate of bleeding manifestations than reported elsewhere during the outbreak. Significant predictors for death were shorter time from symptom onset to admission, male sex, high viral load on initial laboratory testing, severe pain, diarrhea, bloody feces, and development of other bleeding manifestations during hospitalization. These risk factors for death could be used to identify patients in need of more intensive medical support. The lack of fever in as many as one third of EVD cases may have implications for temperature-screening practices and case definitions.

Keywords: Ebola hemorrhagic fever; Ebola virus disease; Sierra Leone; clinical features; fatal disease; neglected diseases; risk factors; viruses.

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Figures

Figure 1
Figure 1
Survival analysis for patients with confirmed Ebola virus disease admitted to the treatment center in Moyamba District, Sierra Leone, December 19, 2014–February 17, 2015. Survival among A) all patients; B) male and female patients; C) patients with and without bleeding manifestations at admission; and D) patients with initial PCR results showing high- and low-level viremia, as defined by cycle thresholds <22 and >22, respectively.
Figure 2
Figure 2
Ebola viral load for patients with confirmed Ebola virus disease admitted to the treatment center in Moyamba District, Sierra Leone, December 19, 2014–February 17, 2015. Viral loads were determined by semiquantitative PCR and are expressed as cycle thresholds for patients with fatal (n = 18) and nonfatal (n = 13) disease.
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