Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned.
Successful Implementation of a Multicountry Clinical Surveillance and Data Collection System for Ebola Virus Disease in West Africa: Findings and Lessons Learned.
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DOI：
10.9745/ghsp-d-16-00186
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发表时间：
2016-09-28
期刊：
影响因子：
--
通讯作者：
Levine AC
中科院分区：
文献类型：
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作者：
Roshania R;Mallow M;Dunbar N;Mansary D;Shetty P;Lyon T;Pham K;Abad M;Shedd E;Tran AM;Cundy S;Levine AC
尽管资源和后勤限制，国际医疗团在2014年至2015年期间在利比里亚和塞拉利昂的5个埃博拉治疗单位照顾了数千人，同时收集了每位患者的数百个数据点。为便利今后人道主义应急行动中的数据收集和全球报告，国际社会应制定和采用标准化的数据表格和数据库，明确界定临床和流行病学变量。尽管资源和后勤限制，国际医疗团在2014年至2015年期间在利比里亚和塞拉利昂的5个埃博拉治疗单位照顾了数千人，同时收集了每位患者的数百个数据点。为便利今后人道主义应急行动中的数据收集和全球报告，国际社会应制定和采用标准化的数据表格和数据库，明确界定临床和流行病学变量。2014年在西非爆发的埃博拉病毒病（EVD）是有记录以来最大的一次。从2014年9月开始，国际医疗团在利比里亚和塞拉利昂管理5个埃博拉治疗单位，累计治疗约2,500名患者。我们对5个ETU在1年手术期间收集的患者数据进行了回顾性队列研究。为了从病人护理区收集临床和流行病学数据，每张图表要么在高风险区和低风险区之间的围栏上手动复制，要么在围栏上成像，要么在高风险区成像。每个ETU的数据被输入到一个单独的电子数据库中，这些数据后来被合并到一个单一的关系数据库中。批次质量保证抽样用于确保数据质量，重新输入图像记录中错误率较高的数据。IMC数据库包含2，768名患者的记录，其中包括2，351名患者的入院和完整的随访数据。在入院的患者中，470例（20.0%）EVD检测阳性，EVD阳性患者的总体病死率（CFR）为57.0%，EVD阴性患者为8.1%。虽然入院的男性比女性多（53.4%比46.6%），但诊断为EVD阳性的女性比例更高（25.6%比15.2%）。腹泻、红眼、与病人接触和参加葬礼在EVD患者中明显比其他诊断更常见。在EVD阳性患者中，年龄是死亡率的重要预测因素：5岁以下儿童（89.1%）和55岁以上成人（71.4%）的CFR最高。虽然之前的几份报告记录了单个ETU的经验，但本研究首次提供了来自同一组织在2个国家使用类似临床方案运行的多个ETU的数据。我们的经验表明，即使在严峻的环境和困难的条件下，人道主义组织也有可能在重大传染病爆发期间收集高质量的临床和流行病学数据。
Despite resource and logistical constraints, International Medical Corps cared for thousands at 5 Ebola treatment units in Liberia and Sierra Leone between 2014 and 2015 while collecting hundreds of data points on each patient. To facilitate data collection and global reporting in future humanitarian responses, standardized data forms and databases, with clear definitions of clinical and epidemiological variables, should be developed and adopted by the international community. Despite resource and logistical constraints, International Medical Corps cared for thousands at 5 Ebola treatment units in Liberia and Sierra Leone between 2014 and 2015 while collecting hundreds of data points on each patient. To facilitate data collection and global reporting in future humanitarian responses, standardized data forms and databases, with clear definitions of clinical and epidemiological variables, should be developed and adopted by the international community. The 2014 outbreak of Ebola virus disease (EVD) in West Africa was the largest ever recorded. Starting in September 2014, International Medical Corps (IMC) managed 5 Ebola treatment units (ETUs) in Liberia and Sierra Leone, which cumulatively cared for about 2,500 patients. We conducted a retrospective cohort study of patient data collected at the 5 ETUs over 1 year of operations. To collect clinical and epidemiological data from the patient care areas, each chart was either manually copied across the fence between the high-risk zone and low-risk zone, imaged across the fence, or imaged in the high-risk zone. Each ETU’s data were entered into a separate electronic database, and these were later combined into a single relational database. Lot quality assurance sampling was used to ensure data quality, with reentry of data with high error rates from imaged records. The IMC database contains records on 2,768 patient presentations, including 2,351 patient admissions with full follow-up data. Of the patients admitted, 470 (20.0%) tested positive for EVD, with an overall case fatality ratio (CFR) of 57.0% for EVD-positive patients and 8.1% for EVD-negative patients. Although more men were admitted than women (53.4% vs. 46.6%), a larger proportion of women were diagnosed EVD positive (25.6% vs. 15.2%). Diarrhea, red eyes, contact with an ill person, and funeral attendance were significantly more common in patients with EVD than in those with other diagnoses. Among EVD-positive patients, age was a significant predictor of mortality: the highest CFRs were among children under 5 (89.1%) and adults over 55 (71.4%). While several prior reports have documented the experiences of individual ETUs, this study is the first to present data from multiple ETUs across 2 countries run by the same organization with similar clinical protocols. Our experience demonstrates that even in austere settings under difficult conditions, it is possible for humanitarian organizations to collect high-quality clinical and epidemiologic data during a major infectious disease outbreak.