Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone

[Image courtesy of UNICEF, 2014]As of 25th October 2014, more than 10,100 cases of Ebola virus disease (EVD) were reported in Sierra Leone, Guinea, Liberia, Senegal, Nigeria, and Mali. Despite the scale of the outbreak, there is currently very little clinical and laboratory data available on patients with EVD. This study reviews the data on the first 106 patients that were diagnosed with EVD in Sierra Leone this year.Methods

• The study collected data from the Kenema Government Hospital in Sierra Leone
• Records of 106 patients that were diagnosed with EVD between 25th May and 18th June 2014 were analysed
• The load of the Ebola virus was assessed using quantitative reverse-transcriptase-polymerase-chain-reaction

Key findingsThe incubation period of EVD was estimated between 6 and 12 days. Around one in four (26%) of those who were diagnosed with the disease – and whose outcome is known – survived, giving a case fatality rate of 74%.More than half of the patients diagnosed with the disease were female (60%). Despite this, the case fatality rate was not found to be significantly different between males and females.The chance of survival did however vary with age; the proportion of deaths was lower among patients aged less than 21 years, in contrast those aged over 45 years. The article identifies a number of common symptoms among patients diagnosed with the disease. They are listed here together with the proportion of patients who presented each symptom:

• Fever (89%)
• Headache (80%)
• Weakness (66%)
• Dizziness (60%)
• Diarrhoea (51%)
• Abdominal pain (40%)
• Vomiting (34%)

Only one patient showed overt bleeding, suggesting that this is a less common symptom than in previous EVD outbreaks. On the other hand, as with previous outbreaks, clotting abnormalities such as vaginal bleeding in pregnant women were observed.Conclusions and key recommendationsThe authors emphasise the importance of ensuring that EVD facilities now focus on treating and improving the survival of patients, not just on providing a setting for quarantine.To read the article for free, click here.Schieffelin, J. S., Shaffer, J. G., Goba, A., Gbakie, M., Gire, S.K., Colubri, A., …, Garry, R. F. (2014). Clinical Illness and Outcomes in Patients with Ebola in Sierra Leone. The New England Journal of Medicine.