Clinical sequelae among individuals with pauci-symptomatic or asymptomatic Ebola virus infection and unrecognised Ebola virus disease in Liberia: a longitudinal cohort study.
Clinical sequelae among individuals with pauci-symptomatic or asymptomatic Ebola virus infection and unrecognised Ebola virus disease in Liberia: a longitudinal cohort study.
复制标题
DOI：
10.1016/s1473-3099(22)00127-x
复制
发表时间：
2022-08
影响因子：
56.3
通讯作者：
Moses, J. Soka
中科院分区：
文献类型：
--
作者：
Kelly, J. Daniel;Van Ryn, Collin;Badio, Moses;Fayiah, Tamba;Johnson, Kumblytee;Gayedyu-Dennis, Dehkontee;Weiser, Sheri D.;Porco, Travis C.;Martin, Jeffery N.;Sneller, Michael C.;Rutherford, George W.;Reilly, Cavan;Fallah, Mosoka P.;Moses, J. Soka
没有症状或无症状的埃博拉病毒感染和未被识别的埃博拉病毒疾病的个体是否会出现临床后遗症尚不清楚。我们评估了与埃博拉病毒病幸存者和未感染的接触者相比，患有无症状或无症状感染和未识别的埃博拉病毒病的个体的当前症状和体检结果。在2015年6月17日至2017年6月30日期间，我们研究了利比里亚的一组埃博拉病毒病幸存者及其接触者。使用调查、当前症状和体格检查结果以及血清学来确定报告的埃博拉病毒病、未识别的埃博拉病毒病、无症状或无症状的埃博拉病毒感染或无感染的疾病状态。我们预先指定了已知在埃博拉病毒病幸存者与其接触者之间存在差异的发现（尿频、头痛、疲劳、肌肉疼痛、记忆丧失、关节疼痛、神经系统发现、胸部发现、肌肉发现、关节发现、腹部发现和葡萄膜炎）。我们根据疾病状态估计了选定临床表现的患病率和发生率。我们的分析队列包括991名埃博拉病毒病幸存者和2688名密切接触者。从急性埃博拉病毒病发作至基线的中位时间为317天（IQR 271-366）。在222名血清反应阳性的接触者中，115人感染了症状不明显或无症状的埃博拉病毒，107人感染了未被识别的埃博拉病毒病。在基线时，关节疼痛，记忆丧失，肌肉疼痛和疲劳的流行结果在无症状或无症状感染或无感染的人群中最低，在与未识别的埃博拉病毒疾病接触的人群中较高，在埃博拉病毒疾病的报告幸存者中最高。关节疼痛是最常见的发现，在2466名无感染者中有434名（18%），115名无症状或无症状感染者中有14名（12%），107名未被识别的埃博拉病毒病患者中有31名（29%），991名报告埃博拉病毒病患者中有476名（48%）。在调整后的分析中，这种模式仍然适用于关节疼痛和记忆丧失。与未被识别的埃博拉病毒病接触者相比，幸存者关节疼痛的几率增加（调整后的比值比[OR] 2·13，95%CI 1·34-3·39）;与那些无症状或无症状感染者和未感染的接触者相比，未被识别的埃博拉病毒病接触者关节疼痛的几率增加（调整后的OR 1·89，95%CI 1·21-2·97）。幸存者记忆丧失的调整后几率比未被识别的埃博拉病毒病接触者高出4倍以上（调整后OR 4.47，95% CI 2.41 - 8.30），未被识别的埃博拉病毒病接触者比无症状或无症状感染者和未感染接触者高出2倍（调整后OR 2.05，95% CI 1.10 - 3.84）。到12个月时，三个感染组的流行率有所下降。我们的研究结果提供了与未被识别的埃博拉病毒病接触者中埃博拉病毒病后临床后遗症的证据，但在症状少或无症状的埃博拉病毒感染者中则没有。国家癌症研究所和国家过敏和传染病研究所的国立卫生研究院。
Whether or not individuals with pauci-symptomatic or asymptomatic Ebola virus infection and unrecognised Ebola virus disease develop clinical sequelae is unknown. We assessed current symptoms and physical examination findings among individuals with pauci-symptomatic or asymptomatic infection and unrecognised Ebola virus disease compared with Ebola virus disease survivors and uninfected contacts. Between June 17, 2015, and June 30, 2017, we studied a cohort of Ebola virus disease survivors and their contacts in Liberia. Surveys, current symptoms and physical examination findings, and serology were used to characterise disease status of reported Ebola virus disease, unrecognised Ebola virus disease, pauci-symptomatic or asymptomatic Ebola virus infection, or no infection. We pre-specified findings known to be differentially prevalent among Ebola virus disease survivors versus their contacts (urinary frequency, headache, fatigue, muscle pain, memory loss, joint pain, neurological findings, chest findings, muscle findings, joint findings, abdominal findings, and uveitis). We estimated the prevalence and incidence of selected clinical findings by disease status. Our analytical cohort included 991 reported Ebola virus disease survivors and 2688 close contacts. The median time from acute Ebola virus disease onset to baseline was 317 days (IQR 271–366). Of 222 seropositive contacts, 115 had pauci-symptomatic or asymptomatic Ebola virus infection and 107 had unrecognised Ebola virus disease. At baseline, prevalent findings of joint pain, memory loss, muscle pain, and fatigue were lowest among those with pauci-symptomatic or asymptomatic infection or no infection, higher among contacts with unrecognised Ebola virus disease, and highest in reported survivors of Ebola virus disease. Joint pain was the most prevalent finding, and was reported in 434 (18%) of 2466 individuals with no infection, 14 (12%) of 115 with pauci-symptomatic or asymptomatic infection, 31 (29%) of 107 with unrecognised Ebola virus disease, and 476 (48%) of 991 with reported Ebola virus disease. In adjusted analyses, this pattern remained for joint pain and memory loss. Survivors had an increased odds of joint pain compared with unrecognised Ebola virus disease contacts (adjusted odds ratio [OR] 2·13, 95% CI 1·34–3·39); unrecognised Ebola virus disease contacts had an increased odds of joint pain compared with those with pauci-symptomatic or asymptomatic infection and uninfected contacts (adjusted OR 1·89, 95% CI 1·21–2·97). The adjusted odds of memory loss was more than four-times higher among survivors than among unrecognised Ebola virus disease contacts (adjusted OR 4·47, 95% CI 2·41–8·30) and two-times higher among unrecognised Ebola virus disease contacts than in those with pauci-symptomatic or asymptomatic infection and uninfected contacts (adjusted OR 2·05, 95% CI 1·10–3·84). By 12 months, prevalent findings had decreased in the three infected groups. Our findings provide evidence of post-Ebola virus disease clinical sequelae among contacts with unrecognised Ebola virus disease but not in people with pauci-symptomatic or asymptomatic Ebola virus infection. National Cancer Institute and National Institute of Allergy and Infectious Diseases of the National Institutes of Health.