Ebola outbreak in rural West Africa: epidemiology, clinical features and outcomes

Abstract

Objective: To describe Ebola cases in the district Ebola management centre of in Kailahun, a remote rural district of Sierra Leone, in terms of geographic origin, patient and hospitalisation characteristics, treatment outcomes and time from symptom onset to admission.

Methods: Data of all Ebola cases from June 23rd to October 5th 2014 were reviewed. Ebola was confirmed by reverse-transcriptase-polymerase-chain-reaction assay.

Results: Of 489 confirmed cases (51% male, median age 28 years), 166 (34%) originated outside Kailahun district. Twenty-eight (6%) were health workers: 2 doctors, 11 nurses, 2 laboratory technicians, 7 community health workers and 6 other cadres. More than 50% of patients had fever, headache, abdominal pain, diarrhoea/vomiting. An unusual feature was cough in 40%. Unexplained bleeding was reported in 5%. Outcomes for the 489 confirmed cases were 227 (47%) discharges, 259 (53%) deaths and 3 transfers. Case fatality in health workers (68%) was higher than other occupations (52%, P = 0.05). The median community infectivity time was 6.5 days for both general population and health workers (P = 0.4).

Conclusions: One in three admitted cases originated outside Kailahun district due to limited national access to Ebola management centres - complicating contact tracing, safe burial and disinfection measures. The comparatively high case fatality among health workers requires attention. The community infectivity time needs to be reduced to prevent continued transmission.

Keywords: Ebola; Kailahun; MSF; agents de la santé; health workers; investigación de operaciones; operational research; recherche opérationnelle; trabajadores santiarios; Ébola.

Figure 1

Trend in admissions to the Ebola management centre stratified by confirmed Ebola case and non-case, Kailahun, Sierra Leone during Epidemiology weeks 26–40 (June 23rd – October 5th 2014).

Figure 2

Trend in confirmed Ebola cases admitted to the Ebola management centre in Kailahun, Sierra Leone during Epidemiology weeks 26–40 (June 23rd – October 5th 2014).

Figure 3

Mapping of confirmed Ebola cases admitted to the Ebola management centre in Kailahun, Sierra Leone during Epidemiology weeks 26–40 (June 23rd – October 5th 2014). Area in white represents Kailahun district, Sierra Leone; Orange circles represent Ebola cases, the size of the circle being proportional to the number of cases.

Figure 4

Length of hospitalisation of confirmed Ebola cases among those who died or recovered at the Ebola management centre, Kailahun, Sierra Leone during Epidemiology weeks 26–40 (June 23rd – October 5th 2014).

Figure 5

Cumulative incidence of death among confirmed Ebola cases admitted to the Ebola management centre, Kailahun, Sierra Leone during Epidemiology weeks 26 to 40 (June 23rd – October 5th 2014).