Use of Viremia to Evaluate the Baseline Case Fatality Ratio of Ebola Virus Disease and Inform Treatment Studies: A Retrospective Cohort Study
In: ISSN: 1549-1277, 2015
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International audience ; BackgroundThe case fatality ratio (CFR) of Ebola virus disease (EVD) can vary over time and space for reasons that are not fully understood. This makes it difficult to define the baseline CFRs needed to evaluate treatments in the absence of randomized controls. Here, we investigate whether viremia in EVD patients may be used to evaluate baseline EVD CFRs.Methods and FindingsWe analyzed the laboratory and epidemiological records of patients with EVD confirmed by reverse transcription PCR hospitalized in the Conakry area, Guinea, between 1 March 2014 and 28 February 2015. We used viremia and other variables to model the CFR. Data for 699 EVD patients were analyzed. In the week following symptom onset, mean viremia remained stable, and the CFR increased with viremia, V, from 21% (95% CI 16%–27%) for low viremia (V < 104.4 copies/ml) to 53% (95% CI 44%–61%) for intermediate viremia (104.4 ≤ V < 105.2 copies/ml) and 81% (95% CI 75%–87%) for high viremia (V ≥ 105.2 copies/ml). Compared to adults (15–44 y old [y.o.]), the CFR was larger in young children (0–4 y.o.) (odds ratio [OR]: 2.44; 95% CI 1.02–5.86) and older adults (≥45 y.o.) (OR: 2.84; 95% CI 1.81–4.46) but lower in children (5–14 y.o.) (OR: 0.46; 95% CI 0.24–0.86). An order of magnitude increase in mean viremia in cases after July 2014 compared to those before coincided with a 14% increase in the CFR. Our findings come from a large hospital-based study in Conakry and may not be generalizable to settings with different case profiles, such as with individuals who never sought care.ConclusionsViremia in EVD patients was a strong predictor of death that partly explained variations in CFR in the study population. This study provides baseline CFRs by viremia group, which allow appropriate adjustment when estimating efficacy in treatment studies. In randomized controlled trials, stratifying analysis on viremia groups could reduce sample size requirements by 25%. We hypothesize that monitoring the viremia of hospitalized patients may ...
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Use of Viremia to Evaluate the Baseline Case Fatality Ratio of Ebola Virus Disease and Inform Treatment Studies: A Retrospective Cohort Study
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Autor/in / Beteiligte Person: | Faye, Oumar ; Andronico, Alessio ; Faye, Ousmane ; Salje, Henrik ; Boëlle, Pierre-Yves ; Magassouba, N’faly ; Bah, Elhadj Ibrahima ; Koivogui, Lamine ; Diallo, Boubacar ; Diallo, Alpha Amadou ; Keita, Sakoba ; Konde, Mandy Kader ; Fowler, Robert ; Fall, Gamou ; Cauchemez, Simon ; Sall, Amadou Alpha ; Institut Pasteur de Dakar ; Réseau International des Instituts Pasteur (RIIP) ; Modélisation mathématique des maladies infectieuses ; Institut Pasteur Paris (IP)-Centre National de la Recherche Scientifique (CNRS) ; Department of Epidemiology ; Johns Hopkins Bloomberg School of Public Health Baltimore ; Johns Hopkins University (JHU)-Johns Hopkins University (JHU) ; Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP) ; Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM) ; Laboratoire de Fièvres Hémorragiques de Guinée ; Donka, Hôpital ; Service des Maladies Infectieuses ; Institut National de Santé Publique Conakry, Guinée (INSP) ; Ministère de la Santé Conakry, Guinea ; World Health Organization Guinée ; Ministry of Health Guinée ; Centre d’Excellence de Formation et de Recherche sur le Paludisme et les Maladies Prioritaires en Guinée ; University of Toronto ; This study has received funding from the French Government's Investissement d'Avenir program, Laboratoire d'Excellence "Integrative Biology of Emerging Infectious Diseases" (grant n°ANR-10-LABX-62-IBEID), the NIGMS MIDAS initiative, the AXA Research Fund and the European Union Seventh Framework Programme (FP7/2007-2013) under Grant Agreement number 278433-PREDEMICS, Institut Pasteur Dakar. RF’s work was supported by a personnel award from the Heart and Stroke Foundation, Ontario Provincial Office. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ; ANR-10-LABX-0062,IBEID,Integrative Biology of Emerging Infectious Diseases(2010) ; European Project: 278433,EC:FP7:HEALTH,FP7-HEALTH-2011-two-stage,PREDEMICS(2011) |
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Zeitschrift: | ISSN: 1549-1277, 2015 |
Veröffentlichung: | HAL CCSD ; Public Library of Science, 2015 |
Medientyp: | academicJournal |
DOI: | 10.1371/journal.pmed.1001908 |
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