Evaluating Large-scale Blood Transfusion Therapy for the Current Ebola Epidemic in Liberia
Evaluating Large-scale Blood Transfusion Therapy for the Current Ebola Epidemic in Liberia
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DOI：
10.1093/infdis/jiv042
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发表时间：
2015-04-15
影响因子：
6.4
通讯作者：
Meyers, Lauren Ancel
中科院分区：
文献类型：
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作者：
Gutfraind, Alexander;Meyers, Lauren Ancel
背景。为了对抗2014-2015年西非埃博拉病毒病（EVD）的流行，世界卫生组织敦促快速评估恢复期全血（CWB）和血浆（CP）输血疗法。然而，广泛实施输血的可行性和可能的影响尚不清楚。我们扩展了疾病控制和预防中心发布的埃博拉病毒传播模型，将医院康复期的捐赠和输血纳入其中。利用利比里亚最近对埃博拉病毒病的流行病学估计，并假设恢复期输血将病死率降低至12.5%（范围为7.5%-17.5%），我们预测了全国范围内输血治疗增加的影响。根据2014年9月利比里亚估计的10%的病例住院率，到2015年10月，大规模CP治疗预计将挽救3586人的生命（死亡率降低3.1%；95%可信区间[CI]， 0.52% -4.5%）。在30%更高的住院率下，CP输注预计可挽救151人的生命（占总数的0.9%;95% CI, 0.21% -11%）。针对埃博拉病毒病的输血治疗是一种低成本措施，有可能挽救西非许多人的生命，但不会显著影响其流行。在所有考虑的情况下，预计CP输注比CWB更能降低死亡率。
Background. To combat the 2014-2015 Ebola virus disease (EVD) epidemic in West Africa, the World Health Organization urged the rapid evaluation of convalescent whole blood (CWB) and plasma (CP) transfusion therapy. However, the feasibility and likely impacts of broad implementation of transfusions are yet unknown.Methods. We extended an Ebola virus transmission model published by the Centers for Disease Control and Prevention to include hospital-based convalescent donations and transfusions. Using recent epidemiological estimates for EVD in Liberia and assuming that convalescent transfusions reduce the case-fatality rate to 12.5% (range, 7.5%-17.5%), we projected the impacts of a countrywide ramp-up of transfusion therapy.Results. Under the 10% case-hospitalization rate estimated for Liberia in September 2014, large-scale CP therapy is expected to save 3586 lives by October 2015 (3.1% mortality reduction; 95% confidence interval [CI], .52%-4.5%). Under a higher 30% hospitalization rate, CP transfusions are expected to save 151 lives (0.9% of the total; 95% CI, .21%-11%).Conclusions. Transfusion therapy for EVD is a low-cost measure that can potentially save many lives in West Africa but will not measurably influence the prevalence. Under all scenarios considered, CP transfusions are predicted to achieve greater reductions in mortality than CWB.