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Artikel ; Online: Unrecognised Ebola virus infection in contact persons: what can we learn from it?

Fletcher, Tom E / Bower, Hilary

2019 Band 19, Heft 3, Seite(n) 225–226

Mesh-Begriff(e)	Cross-Sectional Studies ; Ebolavirus ; Guinea ; Hemorrhagic Fever, Ebola ; Humans ; Prevalence ; Retrospective Studies
Sprache	Englisch
Erscheinungsdatum	2019-02-11
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Comment
ZDB-ID	2061641-7
ISSN	1474-4457 ; 1473-3099
ISSN (online)	1474-4457
ISSN	1473-3099
DOI	10.1016/S1473-3099(18)30689-3
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online ; Forschungsdaten: (mit Forschungsdaten) A systematic review and meta-analysis of seroprevalence surveys of ebolavirus infection.

Bower, Hilary / Glynn, Judith R

Scientific data

2017 Band 4, Seite(n) 160133

Abstract: Asymptomatic ebolavirus infection could greatly influence transmission dynamics, but there is little consensus on how frequently it occurs or even if it exists. This paper summarises the available evidence on seroprevalence of Ebola, Sudan and Bundibugyo ...

Abstract	Asymptomatic ebolavirus infection could greatly influence transmission dynamics, but there is little consensus on how frequently it occurs or even if it exists. This paper summarises the available evidence on seroprevalence of Ebola, Sudan and Bundibugyo virus IgG in people without known ebolavirus disease. Through systematic review, we identified 51 studies with seroprevalence results in sera collected from 1961 to 2016. We tabulated findings by study population, contact, assay, antigen and positivity threshold used, and present seroprevalence point estimates and 95% confidence intervals. We classified sampled populations in three groups: those with household or known case-contact; those living in outbreak or epidemic areas but without reported case-contact; and those living in areas with no recorded cases of ebolavirus disease. We performed meta-analysis only in the known case-contact group since this is the only group with comparable exposures between studies. Eight contact studies fitted our inclusion criteria, giving an overall estimate of seroprevalence in contacts with no reported symptoms of 3.3% (95% CI 2.4-4.4, P<0.001), but with substantial heterogeneity.
Sprache	Englisch
Erscheinungsdatum	2017--31
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2775191-0
ISSN	2052-4463 ; 2052-4463
ISSN (online)	2052-4463
ISSN	2052-4463
DOI	10.1038/sdata.2016.133
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: On-the-spot report

Bower Hilary

Bulletin of the World Health Organization, Vol 79, Iss 10, Pp 1000-

Winter, an added health hazard in Afghan camps

2001 Band 1001

Schlagwörter	Public aspects of medicine ; RA1-1270 ; Medicine ; R ; DOAJ:Public Health ; DOAJ:Health Sciences
Sprache	Englisch
Erscheinungsdatum	2001-01-01T00:00:00Z
Verlag	World Health Organization
Dokumenttyp	Artikel ; Online
Datenquelle	BASE - Bielefeld Academic Search Engine (Lebenswissenschaftliche Auswahl)

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Artikel ; Online: A snapshot of the practicality and barriers to COVID-19 interventions: Public health and healthcare workers' perceptions in high and low- and middle-income countries.

Glazik, Rosanna / Moore, Hannah / Kennedy, David / Bower, Hilary / Rohan, Hana / Sharp, Ashley / Seale, Anna C

PloS one

2021 Band 16, Heft 11, Seite(n) e0260041

Abstract: Background: In response to the COVID-19 pandemic, governments have implemented a range of non-pharmaceutical interventions (NPIs) and pharmaceutical interventions (PIs) to reduce transmission and minimise morbidity and mortality, whilst maintaining ... ...

Abstract	Background: In response to the COVID-19 pandemic, governments have implemented a range of non-pharmaceutical interventions (NPIs) and pharmaceutical interventions (PIs) to reduce transmission and minimise morbidity and mortality, whilst maintaining social and economic activities. The perceptions of public health workers (PHWs) and healthcare workers (HCWs) are essential to inform future COVID-19 strategies as they are viewed as trusted sources and are at the forefront of COVID-19 response. The objectives of this study were to 1) describe the practicality of implementing NPIs and PIs and 2) identify potential barriers to implementation, as perceived by HCWs and PHWs. Methods: We conducted a cross-sectional study of PHWs and HCWs perceptions of the implementation, practicality of, and barriers to implementation of NPIs and PIs using an online survey (28/9/2020-1/11/2020) available in English, French and Portuguese. We used descriptive statistics and thematic analysis to analyse quantitative and qualitative responses. Results: In total, 226 respondents (67 HCWs and 159 PHWs) from 52 countries completed the survey and 222 were included in the final analysis. Participants from low and middle-income countries (LMICs) accounted for 63% of HCWs and 67% of PHWs, with the remaining from high-income (HICs). There was little difference between the perceptions of PHWs and HCWs in HICs and LMICs, with the majority regarding a number of common NPIs as difficult to implement. However, PHWs in HICs perceived restrictions on schools and educational institutions to be more difficult to implement, with a lack of childcare support identified as the main barrier. Additionally, most contact tracing methods were perceived to be more difficult to implement in HICs than LMICs, with a range of barriers reported. A lack of public support was the most commonly reported barrier to NPIs overall across both country income and professional groups. Similarly, public fear of vaccine safety and lack of vaccine supply were the main reported barriers to implementing a COVID-19 vaccine. However, PHWs and HCWs in LMICs perceived a lack of financial support and the vaccine being manufactured in another country as additional barriers. Conclusion: This snapshot provides insight into the difficulty of implementing interventions as perceived by PHWs and HCWs. There is no one-size-fits-all solution to implementing interventions, and barriers in different contexts do vary. Barriers to implementing a vaccine programme expressed here by HCWs and PHCWs have subsequently come to the fore internationally.
Mesh-Begriff(e)	Adolescent ; Adult ; Aged ; COVID-19/prevention & control ; COVID-19/transmission ; COVID-19/virology ; COVID-19 Vaccines/administration & dosage ; Contact Tracing/statistics & numerical data ; Cross-Sectional Studies ; Developing Countries ; Female ; Health Knowledge, Attitudes, Practice ; Health Personnel/psychology ; Humans ; Immunization Programs/statistics & numerical data ; Male ; Middle Aged ; Practice Guidelines as Topic/standards ; SARS-CoV-2/physiology ; Surveys and Questionnaires ; Young Adult
Chemische Substanzen	COVID-19 Vaccines
Sprache	Englisch
Erscheinungsdatum	2021-11-24
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0260041
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Influence of Landscape Patterns on Exposure to Lassa Fever Virus, Guinea.

Longet, Stephanie / Leggio, Cristina / Bore, Joseph Akoi / Key, Stephanie / Tipton, Tom / Hall, Yper / Koundouno, Fara Raymond / Bower, Hilary / Bhattacharyya, Tapan / Magassouba, N'Faly / Günther, Stephan / Henao-Restrapo, Ana-Maria / Rossman, Jeremy S / Konde, Mandy Kader / Fornace, Kimberly / Carroll, Miles W

Emerging infectious diseases

2023 Band 29, Heft 2, Seite(n) 304–313

Abstract: Lassa fever virus (LASV) is the causative agent of Lassa fever, a disease endemic in West Africa. Exploring the relationships between environmental factors and LASV transmission across ecologically diverse regions can provide crucial information for the ... ...

Abstract	Lassa fever virus (LASV) is the causative agent of Lassa fever, a disease endemic in West Africa. Exploring the relationships between environmental factors and LASV transmission across ecologically diverse regions can provide crucial information for the design of appropriate interventions and disease monitoring. We investigated LASV exposure in 2 ecologically diverse regions of Guinea. Our results showed that exposure to LASV was heterogenous between and within sites. LASV IgG seropositivity was 11.9% (95% CI 9.7%-14.5%) in a coastal study site in Basse-Guinée, but it was 59.6% (95% CI 55.5%-63.5%) in a forested study site located in Guinée Forestière. Seropositivity increased with age in the coastal site. We also found significant associations between exposure risk for LASV and landscape fragmentation in coastal and forested regions. Our study highlights the potential link between environmental change and LASV emergence and the urgent need for research on land management practices that reduce disease risks.
Mesh-Begriff(e)	Humans ; Lassa Fever/epidemiology ; Guinea/epidemiology ; Lassa virus ; Africa, Western
Sprache	Englisch
Erscheinungsdatum	2023-01-24
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	1380686-5
ISSN	1080-6059 ; 1080-6040
ISSN (online)	1080-6059
ISSN	1080-6040
DOI	10.3201/eid2902.212525
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel: 'Learn from the lessons and don't forget them': identifying transferable lessons for COVID-19 from meningitis A, yellow fever and Ebola virus disease vaccination campaigns.

Collins, Julie / Westerveld, Rosie / Nelson, Kate A / Rohan, Hana / Bower, Hilary / Lazenby, Siobhan / Ikilezi, Gloria / Bartlein, Rebecca / Bausch, Daniel G / Kennedy, David S

BMJ global health

2021 Band 6, Heft 9

Abstract: Introduction: COVID-19 vaccines are now being distributed to low- and middle-income countries (LMICs), with global urgency surrounding national vaccination plans. LMICs have significant experience implementing vaccination campaigns to respond to ... ...

Abstract	Introduction: COVID-19 vaccines are now being distributed to low- and middle-income countries (LMICs), with global urgency surrounding national vaccination plans. LMICs have significant experience implementing vaccination campaigns to respond to epidemic threats but are often hindered by chronic health system challenges. We sought to identify transferable lessons for COVID-19 vaccination from the rollout of three vaccines that targeted adult groups in Africa and South America: MenAfriVac (meningitis A); 17D (yellow fever) and rVSV-ZEBOV (Ebola virus disease). Methods: We conducted a rapid literature review and 24 semi-structured interviews with technical experts who had direct implementation experience with the selected vaccines in Africa and South America. We identified barriers, enablers, and key lessons from the literature and from participants' experiences. Interview data were analysed thematically according to seven implementation domains. Results: Participants highlighted multiple components of vaccination campaigns that are instrumental for achieving high coverage. Community engagement is an essential and effective tool, requiring dedicated time, funding and workforce. Involving local health workers is a key enabler, as is collaborating with community leaders to map social groups and tailor vaccination strategies to their needs. Vaccination team recruitment and training strategies need to be enhanced to support vaccination campaigns. Although recognised as challenging, integrating vaccination campaigns with other routine health services can be highly beneficial if well planned and coordinated across health programmes and with communities. Conclusion: As supplies of COVID-19 vaccines become available to LMICs, countries need to prepare to efficiently roll out the vaccine, encourage uptake among eligible groups and respond to potential community concerns. Lessons from the implementation of these three vaccines that targeted adults in LMICs can be used to inform best practice for COVID-19 and other epidemic vaccination campaigns.
Mesh-Begriff(e)	Adult ; COVID-19 ; COVID-19 Vaccines ; Ebola Vaccines ; Hemorrhagic Fever, Ebola/epidemiology ; Hemorrhagic Fever, Ebola/prevention & control ; Humans ; Immunization Programs ; Meningitis ; SARS-CoV-2 ; Yellow Fever/epidemiology ; Yellow Fever/prevention & control
Chemische Substanzen	COVID-19 Vaccines ; Ebola Vaccines
Sprache	Englisch
Erscheinungsdatum	2021-09-17
Erscheinungsland	England
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2021-006951
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Boosting understanding of Lassa Fever virus epidemiology: Field testing a novel assay to identify past Lassa Fever virus infection in blood and oral fluids of survivors and unexposed controls in Sierra Leone.

Akpogheneta, Onome / Dicks, Steve / Grant, Donald / Kanneh, Zainab / Jusu, Brima / Edem-Hotah, Joseph / Kanneh, Lansana / Alhasan, Foday / Gbakie, Michael / Schieffelin, John / Ijaz, Samreen / Tedder, Richard / Bower, Hilary

PLoS neglected tropical diseases

2021 Band 15, Heft 3, Seite(n) e0009255

Abstract: Background: Despite identification 50 years ago, the true burden of Lassa Fever (LF) across Africa remains undefined for reasons including research focus on hospitalised patients, lack of validated field-feasible tools which reliably identify past ... ...

Abstract	Background: Despite identification 50 years ago, the true burden of Lassa Fever (LF) across Africa remains undefined for reasons including research focus on hospitalised patients, lack of validated field-feasible tools which reliably identify past infection, and the fact that all assays require blood samples making large-scale surveys difficult. Designated a priority pathogen of epidemic potential requiring urgent research by the World Health Organisation, a better understanding of LF sero-epidemiology is essential to developing and evaluating new interventions including vaccines. We describe the first field testing of a novel species-neutral Double Antigen Binding Assay (DABA) designed to detect antibodies to LF in plasma and oral fluid. Methodology/principal findings: Paired plasma and oral fluid were collected in Sierra Leone from survivors discharged from Kenema Government Hospital Lassa Fever Unit between 1980 and 2018, and from controls recruited in Freetown in 2019. Epidemiological sensitivity and specificity of the DABA measured against historical diagnosis in survivors and self-declared non-exposed controls was 81.7% (95% CI 70.7%- 89.9%) and 83.3% (72.7%- 91.1%) respectively in plasma, and 71.8% (60.0%- 81.9%) and 83.3% (72.7%- 91.1%) respectively in oral fluid. Antibodies were identified in people infected up to 15 years and, in one case, 40 years previously. Participants found oral fluid collection easy and painless with 80% happy to give an oral fluid sample regularly. Conclusions/significance: Given the difficulties of assay validation in a resource-limited setting, including unexpected exposures and diagnostics of varying accuracy, the new assay performed well in both plasma and oral fluid. Sensitivity and specificity are expected to be higher when case/control ascertainment is more definitive and further work is planned to investigate this. Even at the performance levels achieved, the species-neutral DABA has the potential to facilitate the large-scale seroprevalence surveys needed to underpin essential developments in LF control, as well as support zoonotic investigations.
Mesh-Begriff(e)	Adult ; Antibodies, Viral/analysis ; Female ; Humans ; Lassa Fever/diagnosis ; Lassa Fever/epidemiology ; Lassa virus/immunology ; Male ; Middle Aged ; Saliva/virology ; Sierra Leone/epidemiology ; Survivors ; Viremia/diagnosis ; Viremia/epidemiology
Chemische Substanzen	Antibodies, Viral
Sprache	Englisch
Erscheinungsdatum	2021-03-31
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2429704-5
ISSN	1935-2735 ; 1935-2735
ISSN (online)	1935-2735
ISSN	1935-2735
DOI	10.1371/journal.pntd.0009255
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: "Learn from the lessons and don't forget them": Identifying transferable lessons for COVID-19 from meningitis A, yellow fever, and Ebola virus disease vaccination campaigns

Collins, Julie / Westerveld, Rosie / Nelson, Kate A / Rohan, Hana / Bower, Hilary / Lazenby, Siobhan / Ikilezi, Gloria / Bartlein, Rebecca / Bausch, Daniel G / Kennedy, David S

medRxiv

Abstract: ... Introduction: ... COVID-19 vaccines are now being distributed to low- and middle-income countries (LMICs), with global urgency surrounding national vaccination plans. LMICs have significant experience implementing vaccination campaigns to respond to ... ...

Abstract	Introduction: COVID-19 vaccines are now being distributed to low- and middle-income countries (LMICs), with global urgency surrounding national vaccination plans. LMICs have significant experience implementing vaccination campaigns to respond to epidemic threats but are often hindered by chronic health system challenges. We sought to identify transferable lessons for COVID-19 vaccination from the rollout of three vaccines that targeted adult groups in Africa and South America: MenAfriVac (meningitis A); 17D (yellow fever); and rVSV-ZEBOV (Ebola virus disease). Methods: We conducted a rapid literature review and 24 semi-structured interviews with technical experts who had direct implementation experience with the selected vaccines in Africa and South America. We identified barriers, enablers, and key lessons from the literature and from participants' experiences. Interview data were analysed thematically according to seven implementation domains. Results: Participants highlighted multiple components of vaccination campaigns that are instrumental for achieving high coverage. Community engagement is an essential and effective tool, requiring dedicated time, funding and workforce. Involving local health workers is a key enabler, as is collaborating with community leaders to map social groups and tailor vaccination strategies to their needs. Vaccination team recruitment and training strategies need to be enhanced to support vaccination campaigns. Although recognised as challenging, integrating vaccination campaigns with other routine health services can be highly beneficial if well planned and coordinated across health programmes and with communities. Conclusion: As supplies of COVID-19 vaccines become available to LMICs, countries need to prepare to efficiently roll out the vaccine, encourage uptake among eligible groups, and respond to potential community concerns. Lessons from the implementation of these three vaccines that targeted adults in LMICs can be used to inform best practice for COVID-19 and other epidemic vaccination campaigns.
Schlagwörter	covid19
Sprache	Englisch
Erscheinungsdatum	2021-07-19
Verlag	Cold Spring Harbor Laboratory Press
Dokumenttyp	Artikel ; Online
DOI	10.1101/2021.07.15.21260439
Datenquelle	COVID19

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Artikel ; Online: Early transmission and case fatality of Ebola virus at the index site of the 2013-16 west African Ebola outbreak: a cross-sectional seroprevalence survey.

Timothy, Joseph W S / Hall, Yper / Akoi-Boré, Joseph / Diallo, Boubacar / Tipton, Thomas R W / Bower, Hilary / Strecker, Thomas / Glynn, Judith R / Carroll, Miles W

The Lancet. Infectious diseases

2019 Band 19, Heft 4, Seite(n) 429–438

Abstract: Background: To date, epidemiological studies at the index site of the 2013-16 west African Ebola outbreak in Meliandou, Guinea, have been restricted in their scope. We aimed to determine the occurrence of previously undocumented Ebola virus disease (EVD) ...

Abstract	Background: To date, epidemiological studies at the index site of the 2013-16 west African Ebola outbreak in Meliandou, Guinea, have been restricted in their scope. We aimed to determine the occurrence of previously undocumented Ebola virus disease (EVD) cases and infections, and to reconstruct transmission events. Methods: This cross-sectional seroprevalence survey of the adult population of Meliandou used a highly specific oral fluid test and detailed interviews of all households in the village and key informants. Each household was interviewed, with all members prompted to describe the events of the outbreak, any illness within the household, and possible contact with suspected cases. Information for deceased individuals was provided by relatives living in the same household. Symptoms were based on Ebola virus Makona variant EVD case definitions (focusing on fever, vomiting, and diarrhoea). For antibody testing, we used an Ebola virus glycoprotein IgG capture enzyme immunoassay developed from a previously validated assay. A maximum exposure level was assigned to every participant using a predetermined scale. We used a generalised linear model (logit function) to estimate odds ratios for the association of sociodemographic variables and exposure level with Ebola virus infection. We adjusted estimates for age and maximum exposure, as appropriate. Findings: Between June 22, and July 9, 2017, we enrolled 237 participants from 27 households in Meliandou. Two households refused to participate and one was absent. All adults in participating households who were present for the interview provided an oral fluid swab for testing, of which 224 were suitable for analysis. In addition to the 11 EVD deaths described previously, on the basis of clinical description and oral fluid testing, we found two probable EVD deaths and eight previously unrecognised anti-Ebola virus IgG-positive survivors, including one who had mild symptoms and one who was asymptomatic, resulting in a case fatality of 55·6% (95% CI 30·8-78·5) for adults. Health-care work (adjusted odds ratio 6·64, 1·54-28·56; p=0·001) and level of exposure (odds ratio adjusted for linear trend across five levels 2·79, 1·59-4·883; p<0·0001) were independent risk factors for infection. Interpretation: Ebola virus infection was more widespread in this spillover population than previously recognised (21 vs 11 cases). We show the first serological evidence of survivors in this population (eight anti-Ebola virus IgG seropositive) and report a case fatality lower than previously reported (55·6% vs 100% in adults). These data show the high community coverage achievable by using a non-invasive test and, by accurately documenting the beginnings of the west African Ebola virus outbreak, reveal important insight into transmission dynamics and risk factors that underpin Ebola virus spillover events. Funding: US Food and Drug Administration, Wellcome Trust, and German Research Council.
Mesh-Begriff(e)	Adolescent ; Adult ; Antibodies, Viral/immunology ; Child, Preschool ; Cross-Sectional Studies ; Disease Outbreaks ; Ebolavirus/immunology ; Enzyme-Linked Immunosorbent Assay ; Family Characteristics ; Female ; Guinea/epidemiology ; Hemorrhagic Fever, Ebola/epidemiology ; Hemorrhagic Fever, Ebola/mortality ; Hemorrhagic Fever, Ebola/transmission ; Humans ; Immunoglobulin G/immunology ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Saliva/virology ; Seroepidemiologic Studies ; Surveys and Questionnaires ; Survivors ; Young Adult
Chemische Substanzen	Antibodies, Viral ; Immunoglobulin G
Sprache	Englisch
Erscheinungsdatum	2019-02-21
Erscheinungsland	United States
Dokumenttyp	Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	2061641-7
ISSN	1474-4457 ; 1473-3099
ISSN (online)	1474-4457
ISSN	1473-3099
DOI	10.1016/S1473-3099(18)30791-6
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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Artikel ; Online: Deaths, late deaths, and role of infecting dose in Ebola virus disease in Sierra Leone: retrospective cohort study.

Bower, Hilary / Smout, Elizabeth / Bangura, Mohamed S / Kamara, Osman / Turay, Cecilia / Johnson, Sembia / Oza, Shefali / Checchi, Francesco / Glynn, Judith R

BMJ (Clinical research ed.)

2016 Band 353, Seite(n) i2403

Abstract: Objectives: To assess the frequency of fatal recrudescence from Ebola virus disease after discharge from treatment centres, and explore the influence of infecting dose on case fatality rates.: Design: Retrospective cohort study.: Setting: ... ...

Abstract	Objectives: To assess the frequency of fatal recrudescence from Ebola virus disease after discharge from treatment centres, and explore the influence of infecting dose on case fatality rates. Design: Retrospective cohort study. Setting: Western Area, Sierra Leone. Participants: 151 survivors treated for Ebola virus disease at the Kerry Town treatment centre and discharged. Survivors were followed up for a vital status check at four to nine months after discharge, and again at six to 13 months after discharge. Verbal autopsies were conducted for four survivors who had died since discharge (that is, late deaths). Survivors still living in Western Area were interviewed together with their household members. Exposure level to Ebola virus disease was ascertained as a proxy of infecting dose, including for those who died. Main outcome measures: Risks and causes of late death; case fatality rates; odds ratios of death from Ebola virus disease by age, sex, exposure level, date, occupation, and household risk factors. Results: Follow-up information was obtained on all 151 survivors of Ebola virus disease, a mean of 10 months after discharge. Four deaths occurred after discharge, all within six weeks: two probably due to late complications, one to prior tuberculosis, and only one after apparent full recovery, giving a maximum estimate of recrudescence leading to death of 0.7%. In these households, 395 people were reported to have had Ebola virus disease, of whom 227 died. A further 53 people fulfilled the case definition for probable disease, of whom 11 died. Therefore, the case fatality rate was 57.5% (227/395) for reported Ebola virus disease, or 53.1% (238/448) including probable disease. Case fatality rates were higher in children aged under 2 years and adults older than 30 years, in larger households, and in infections occurring earlier in the epidemic in Sierra Leone. There was no consistent trend of case fatality rate with exposure level, although increasing exposure increased the risk of Ebola virus disease. Conclusions: In this study of survivors in Western Area, Sierra Leone, late recrudescence of severe Ebola virus disease appears to be rare. There was no evidence for an effect of infecting dose (as measured by exposure level) on the severity of disease.
Mesh-Begriff(e)	Adolescent ; Adult ; Aged ; Cause of Death ; Child ; Child, Preschool ; Ebolavirus/pathogenicity ; Female ; Follow-Up Studies ; Hemorrhagic Fever, Ebola/mortality ; Hemorrhagic Fever, Ebola/virology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Sierra Leone ; Survivors/statistics & numerical data ; Time Factors ; Virulence ; Young Adult
Sprache	Englisch
Erscheinungsdatum	2016-05-17
Erscheinungsland	England
Dokumenttyp	Journal Article
ZDB-ID	1362901-3
ISSN	1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
ISSN (online)	1756-1833
ISSN	0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
DOI	10.1136/bmj.i2403
Datenquelle	MEDical Literature Analysis and Retrieval System OnLINE

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