Original Research

Ebola outbreak in Guinea, 2021: Clinical care of patients with Ebola virus disease

Boyo C. Pare, Alseny M. Camara, Aminata Camara, Moussa Kourouma, Koivogui Enogo, Mohammed S. Camara, Laurent Akilimali, Sayadi Sani, Eric Barte de Sainte Fare, Papys Lame, Nicolas Mouly, Marta Lado Castro-Rial, Billy Sivahera, Mahamoud S. Cherif, Abdoul H. Beavogui, Dally Muamba, Joachim B. Tamba, Barry Moumié, Richard Kojan, Hans-Joerg Lang
Southern African Journal of Infectious Diseases | Vol 38, No 1 | a454 | DOI: https://doi.org/10.4102/sajid.v38i1.454 | © 2023 Boyo C. Pare, Alseny M. Camara, Aminata Camara, Moussa Kourouma, Koivogui Enogo, Mohammed S. Camara, Laurent Akilimali, Sayadi Sani, Eric Barte de Sainte Fare, Papys Lame, Nicolas Mouly, Marta Lado Castro-Rial, Billy Sivahera, Mahamoud S. Cherif, Abdoul H | This work is licensed under CC Attribution 4.0
Submitted: 08 June 2022 | Published: 31 January 2023

About the author(s)

Boyo C. Pare, Alliance for International Medical Action (ALIMA), Dakar, Senegal
Alseny M. Camara, Alliance for International Medical Action (ALIMA), Dakar, Senegal
Aminata Camara, Ministry of Health, Agence Nationale de Sécurité Sanitaire, N’zérékoré, Guinea; and, Ministry of Health, Hôpital Régionale de N’zérékoré, N’zérékoré, Guinea
Moussa Kourouma, Ministry of Health, Agence Nationale de Sécurité Sanitaire, N’zérékoré, Guinea; and, Ministry of Health, Hôpital Régionale de N’zérékoré, N’zérékoré, Guinea
Koivogui Enogo, Ministry of Health, Agence Nationale de Sécurité Sanitaire, N’zérékoré, Guinea
Mohammed S. Camara, Alliance for International Medical Action (ALIMA), Dakar, Senegal
Laurent Akilimali, Alliance for International Medical Action (ALIMA), Dakar, Senegal
Sayadi Sani, Alliance for International Medical Action (ALIMA), Dakar, Senegal
Eric Barte de Sainte Fare, Alliance for International Medical Action (ALIMA), Dakar, Senegal
Papys Lame, Alliance for International Medical Action (ALIMA), Dakar, Senegal
Nicolas Mouly, Alliance for International Medical Action (ALIMA), Dakar, Senegal
Marta Lado Castro-Rial, World Health Organization (WHO), Geneva, Switzerland
Billy Sivahera, Alliance for International Medical Action (ALIMA), Dakar, Senegal; and, World Health Organization (WHO), Geneva, Switzerland
Mahamoud S. Cherif, Centre National de Formation et de Recherche en Santé Rural de Maferinyah, Maferenya, Guinea
Abdoul H. Beavogui, Centre National de Formation et de Recherche en Santé Rural de Maferinyah, Maferenya, Guinea
Dally Muamba, Alliance for International Medical Action (ALIMA), Dakar, Senegal
Joachim B. Tamba, Alliance for International Medical Action (ALIMA), Dakar, Senegal
Barry Moumié, Ministry of Health, Agence Nationale de Sécurité Sanitaire, N’zérékoré, Guinea
Richard Kojan, Alliance for International Medical Action (ALIMA), Dakar,, Senegal
Hans-Joerg Lang, Alliance for International Medical Action (ALIMA), Dakar, Senegal; and, Witten/Herdecke- University, Global Child Health, Witten, Germany

Abstract

Background: Experience from the Zaire Ebolavirus epidemic in the eastern Democratic Republic of the Congo (2018–2020) demonstrates that early initiation of essential critical care and administration of Zaire Ebolavirus specific monoclonal antibodies may be associated with improved outcomes among patients with Ebola virus disease (EVD).

Objectives: This series describes 13 EVD patients and 276 patients with suspected EVD treated during a Zaire Ebolavirus outbreak in Guinea in 2021.

Method: Patients with confirmed or suspected EVD were treated in two Ebola treatment centres (ETC) in the region of N’zérékoré. Data were reviewed from all patients with suspected or confirmed EVD hospitalised in these two ETCs during the outbreak (14 February 2021 – 19 June 2021). Ebola-specific monoclonal antibodies, were available 2 weeks after onset of the outbreak.

Results: Nine of the 13 EVD patients (age range: 22–70 years) survived. The four EVD patients who died, including one pregnant woman, presented with multi-organ dysfunction and died within 48 h of admission. All eight patients who received Ebola-specific monoclonal antibodies survived. Four of the 13 EVD patients were health workers. Improvement of ETC design facilitated implementation of WHO-recommended ‘optimized supportive care for EVD’. In this context, pragmatic clinical training was integrated in routine ETC activities. Initial clinical manifestations of 13 confirmed EVD patients were similar to those of 276 patients with suspected, but subsequently non confirmed EVD. These patients suffered from other acute infections (e.g. malaria in 183 of 276 patients; 66%). Five of the 276 patients with suspected EVD died. One of these five patients had Lassa virus disease and a coronavirus disease 2019 (COVID-19) co-infection.

Conclusion: Multidisciplinary outbreak response teams can rapidly optimise ETC design. Trained clinical teams can provide WHO-recommended optimised supportive care, including safe administration of Ebola-specific monoclonal antibodies. Pragmatic training in essential critical care can be integrated in routine ETC activities.

Contribution: This article describes clinical realities associated with implementation of WHO-recommended standards of ‘optimized supportive care’ and administration of Ebola virus specific treatments. In this context, the importance of essential design principles of ETCs is underlined, which allow continuous visual contact and verbal interaction of health workers and families with their patients. Elements that may contribute to further quality of care improvements for patients with confirmed or suspected EVD are discussed.

 


Keywords

Zaire Ebolavirus disease essential emergency and critical care; referral pathways; Ebola-specific monoclonal antibodies; Ebola vaccination; Lassa virus disease

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