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. 2023 Jan 31;38(1):454.
doi: 10.4102/sajid.v38i1.454. eCollection 2023.

Ebola outbreak in Guinea, 2021: Clinical care of patients with Ebola virus disease

Boyo C Pare  1 , Alseny M Camara  1 , Aminata Camara  2   3 , Moussa Kourouma  2   3 , Koivogui Enogo  2 , Mohammed S Camara  1 , Laurent Akilimali  1 , Sayadi Sani  1 , Eric Barte de Sainte Fare  1 , Papys Lame  1 , Nicolas Mouly  1 , Marta Lado Castro-Rial  4 , Billy Sivahera  1   4 , Mahamoud S Cherif  5 , Abdoul H Beavogui  5 , Dally Muamba  1 , Joachim B Tamba  1 , Barry Moumié  2 , Richard Kojan  1 , Hans-Joerg Lang  1   6
Affiliations

Ebola outbreak in Guinea, 2021: Clinical care of patients with Ebola virus disease

Boyo C Pare et al. S Afr J Infect Dis. .

Abstract

Background: Experience from the Zaire Ebolavirus epidemic in the eastern Democratic Republic of the Congo (2018-2020) demonstrates that early initiation of essential critical care and administration of Zaire Ebolavirus specific monoclonal antibodies may be associated with improved outcomes among patients with Ebola virus disease (EVD).

Objectives: This series describes 13 EVD patients and 276 patients with suspected EVD treated during a Zaire Ebolavirus outbreak in Guinea in 2021.

Method: Patients with confirmed or suspected EVD were treated in two Ebola treatment centres (ETC) in the region of N'zérékoré. Data were reviewed from all patients with suspected or confirmed EVD hospitalised in these two ETCs during the outbreak (14 February 2021 - 19 June 2021). Ebola-specific monoclonal antibodies, were available 2 weeks after onset of the outbreak.

Results: Nine of the 13 EVD patients (age range: 22-70 years) survived. The four EVD patients who died, including one pregnant woman, presented with multi-organ dysfunction and died within 48 h of admission. All eight patients who received Ebola-specific monoclonal antibodies survived. Four of the 13 EVD patients were health workers. Improvement of ETC design facilitated implementation of WHO-recommended 'optimized supportive care for EVD'. In this context, pragmatic clinical training was integrated in routine ETC activities. Initial clinical manifestations of 13 confirmed EVD patients were similar to those of 276 patients with suspected, but subsequently non confirmed EVD. These patients suffered from other acute infections (e.g. malaria in 183 of 276 patients; 66%). Five of the 276 patients with suspected EVD died. One of these five patients had Lassa virus disease and a coronavirus disease 2019 (COVID-19) co-infection.

Conclusion: Multidisciplinary outbreak response teams can rapidly optimise ETC design. Trained clinical teams can provide WHO-recommended optimised supportive care, including safe administration of Ebola-specific monoclonal antibodies. Pragmatic training in essential critical care can be integrated in routine ETC activities.

Contribution: This article describes clinical realities associated with implementation of WHO-recommended standards of 'optimized supportive care' and administration of Ebola virus specific treatments. In this context, the importance of essential design principles of ETCs is underlined, which allow continuous visual contact and verbal interaction of health workers and families with their patients. Elements that may contribute to further quality of care improvements for patients with confirmed or suspected EVD are discussed.

Keywords: Ebola vaccination; Ebola-specific monoclonal antibodies; Lassa virus disease; Zaire Ebolavirus disease essential emergency and critical care; referral pathways.

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Conflict of interest statement

The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.

Figures

Figure 1
Figure 1
The setup of a modern-design Ebola treatment centre (ETC) and the chambre d’urgence biosécurisée pour épidémies or biosecure emergency rooms for epidemics (CUBE). Patients with confirmed or suspected Ebola virus disease are treated in single compartments (b, c). Each patient is visible from the low-risk zone. The CUBE (a) is of particular benefit for the treatment of critically ill patients and can be integrated rapidly in ETC setups as well as patient circuits of general health facilities.Pictures (b, c) from the DRC (2018–2020), with permission to print from Luca Fontana and Michele DiMarco (WHO).
Figure 2
Figure 2
Simplified description of level of care provided in Ebola treatment centres in N’zérékoré (NZK) and Gouécké (Guinea 2021).
See this image and copyright information in PMC

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