Evaluation of Management Strategies for Maximizing Supportive Care for Patients with Ebola Virus Disease

项目总结

PROJECT SUMMARY Since 1976, there have been nearly 20 confirmed outbreaks of Ebola Virus Disease (EVD), all originating in sub-Saharan Africa. The most recent outbreak in West Africa was by far the largest, leading to nearly 30,000 suspected and confirmed cases of EVD and 12,000 deaths. Although Guinea, Liberia, and Sierra Leone accounted for the vast majority of cases, infections imported from these countries were identified in seven additional countries, including the United States. The magnitude and geographic breadth of the recent epidemic, coupled with its high overall mortality, highlights the global health dangers posed by future EVD outbreaks and the associated need for better management strategies in order to improve disease survival. However, there remains a lack of high-quality data on the efficacy of various clinical interventions for EVD, and to date no multisite studies exist evaluating the impacts of commonly utilized supportive care and treatment modalities on patient-centered outcomes. Between September 2014 and December 2015, the humanitarian organization International Medical Corps (IMC) managed five Ebola Treatment Units (ETUs) in Liberia and Sierra Leone, which cared for over 2,500 patients, including 470 with confirmed EVD. From these sites, IMC collected over 25,000 pages of clinical, laboratory, and operational data. Prior to the closure of the ETUs, IMC underwent the painstaking work of extracting, digitizing, aggregating, and quality checking this data. This extensive process yielded a unique database that can now be used to evaluate the impacts of specific clinical interventions on patient-centered outcomes among EVD infected individuals. Using advanced statistical methodologies, the impacts of various supportive care interventions, including rehydration therapies, micronutrient supplementation, and antimicrobials, on mortality and duration of symptoms in EVD-infected patients will be evaluated. This research has the potential to improve the evidence-base for international EVD guidelines, identify potentially high-yield interventions for future study in controlled trials, and improve the quality of the overall response to future EVD epidemics.