TY - JOUR
T1 - Heterogeneities in the case fatality ratio in the West African Ebola outbreak 2013–2016
AU - Garske, Tini
AU - Cori, Anne
AU - Ariyarajah, Archchun
AU - Blake, Isobel M
AU - Dorigatti, Ilaria
AU - Eckmanns, Tim
AU - Fraser, Christophe
AU - Hinsley, Wes
AU - Jombart, Thibaut
AU - Mills, Harriet
AU - Nedjati-Gilani, Gemma
AU - Newton, Emily
AU - Nouvellet, Pierre
AU - Perkins, Devin
AU - Riley, Steven
AU - Schumacher, Dirk
AU - Shah, Anita
AU - Van Kerkhove, Maria D
AU - Dye, Christopher
AU - Ferguson, Neil M
AU - Donnelly, Christl A
PY - 2017/5/26
Y1 - 2017/5/26
N2 - The 2013–2016 Ebola outbreak in West Africa is the largest on record with 28 616 confirmed, probable and suspected cases and 11 310 deaths officially recorded by 10 June 2016, the true burden probably considerably higher. The case fatality ratio (CFR: proportion of cases that are fatal) is a key indicator of disease severity useful for gauging the appropriate public health response and for evaluating treatment benefits, if estimated accurately. We analysed individual-level clinical outcome data from Guinea, Liberia and Sierra Leone officially reported to the World Health Organization. The overall mean CFR was 62.9% (95% CI: 61.9% to 64.0%) among confirmed cases with recorded clinical outcomes. Age was the most important modifier of survival probabilities, but country, stage of the epidemic and whether patients were hospitalized also played roles. We developed a statistical analysis to detect outliers in CFR between districts of residence and treatment centres (TCs), adjusting for known factors influencing survival and identified eight districts and three TCs with a CFR significantly different from the average. From the current dataset, we cannot determine whether the observed variation in CFR seen by district or treatment centre reflects real differences in survival, related to the quality of care or other factors or was caused by differences in reporting practices or case ascertainment.
AB - The 2013–2016 Ebola outbreak in West Africa is the largest on record with 28 616 confirmed, probable and suspected cases and 11 310 deaths officially recorded by 10 June 2016, the true burden probably considerably higher. The case fatality ratio (CFR: proportion of cases that are fatal) is a key indicator of disease severity useful for gauging the appropriate public health response and for evaluating treatment benefits, if estimated accurately. We analysed individual-level clinical outcome data from Guinea, Liberia and Sierra Leone officially reported to the World Health Organization. The overall mean CFR was 62.9% (95% CI: 61.9% to 64.0%) among confirmed cases with recorded clinical outcomes. Age was the most important modifier of survival probabilities, but country, stage of the epidemic and whether patients were hospitalized also played roles. We developed a statistical analysis to detect outliers in CFR between districts of residence and treatment centres (TCs), adjusting for known factors influencing survival and identified eight districts and three TCs with a CFR significantly different from the average. From the current dataset, we cannot determine whether the observed variation in CFR seen by district or treatment centre reflects real differences in survival, related to the quality of care or other factors or was caused by differences in reporting practices or case ascertainment.
U2 - 10.1098/rstb.2016.0308
DO - 10.1098/rstb.2016.0308
M3 - Article (Academic Journal)
C2 - 28396479
SN - 0962-8436
VL - 372
JO - Philosophical Transactions B: Biological Sciences
JF - Philosophical Transactions B: Biological Sciences
IS - 1721
M1 - 20160308
ER -