Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report

BackgroundAvailable data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited. MethodsWe reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015. ResultsA total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and sy...

/pdf/clinical-management-of-ebola-virus-disease-in-the-united-4onim3o70s.pdf

Clinical Management of Ebola Virus Disease in the United States and Europe.

Evidence-based guidelines for supportive care of patients with Ebola virus disease

BACKGROUND Ebola virus disease (EVD) in health workers (HWs) has been a major challenge during the 2014-2015 outbreak. We examined factors associated with Ebola virus exposure and mortality in HWs in Kenema District, Sierra Leone. METHODS We analyzed data from the Sierra Leone National Viral Hemorrhagic Fever Database, contact tracing records, Kenema Government Hospital (KGH) staff and Ebola Treatment Unit (ETU) rosters, and burial logs. RESULTS From May 2014 through January 2015, 600 cases of EVD originated in Kenema District, including 92 (15%) HWs, 66 (72%) of whom worked at KGH. Among KGH medical staff and international volunteers, 18 of 62 (29%) who worked in the ETU developed EVD, compared with 48 of 83 (58%) who worked elsewhere in the hospital. Thirteen percent of HWs with EVD reported contact with EVD patients, while 27% reported contact with other infected HWs. The number of HW EVD cases at KGH declined roughly 1 month after implementation of a new triage system at KGH and the opening of a second ETU within the district. The case fatality ratio for HWs and non-HWs with EVD was 69% and 74%, respectively. CONCLUSIONS The cluster of HW EVD cases in Kenema District is one of the largest ever reported. Most HWs with EVD had potential virus exposure both inside and outside of hospitals. Prevention measures for HWs must address a spectrum of infection risks in both formal and informal care settings as well as in the community.

/pdf/factors-underlying-ebola-virus-infection-among-health-m0zrkej2di.pdf

Factors Underlying Ebola Virus Infection Among Health Workers, Kenema, Sierra Leone, 2014–2015

David B. Banach, MD, MPH, MS; B. Lynn Johnston, MD, MS, FRCPC; Duha Al-Zubeidi, MD; Allison H. Bartlett, MD, MS; Susan Casey Bleasdale, MD; Valerie M. Deloney, MBA; Kyle B. Enfield, MD, MS; Judith A. Guzman-Cottrill, DO; Christopher Lowe, MD, MSc; Luis Ostrosky-Zeichner, MD; Kyle J. Popovich, MD, MS; Payal K. Patel, MD; Karen Ravin, MD, MS; Theresa Rowe, DO, MS; Erica S. Shenoy, MD, PhD; Roger Stienecker, MD; Pritish K. Tosh, MD; Kavita K. Trivedi, MD; and the Outbreak Response Training Program (ORTP) Advisory Panel

/pdf/outbreak-response-and-incident-management-shea-guidance-and-1rtqx7liwe.pdf

Outbreak Response and Incident Management: SHEA Guidance and Resources for Healthcare Epidemiologists in United States Acute-Care Hospitals.

As the outbreak of Ebola virus disease (EVD) in West Africa continues, clinical preparedness is needed in countries at risk for EVD (e.g., United States) and more fully equipped and supported clinical teams in those countries with epidemic spread of EVD in Africa. Clinical staff must approach the patient with a very deliberate focus on providing effective care while assuring personal safety. To do this, both individual health care providers and health systems must improve EVD care. Although formal guidance toward these goals exists from the World Health Organization, Medecin Sans Frontieres, the Centers for Disease Control and Prevention, and other groups, some of the most critical lessons come from personal experience. In this narrative, clinicians deployed by the World Health Organization into a wide range of clinical settings in West Africa distill key, practical considerations for working safely and effectively with patients with EVD.

/pdf/being-ready-to-treat-ebola-virus-disease-patients-3aav1jkoed.pdf

Being ready to treat Ebola virus disease patients.

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Being ready to treat Ebola virus disease patients.