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      Risk in the “Red Zone”: Outcomes for Children Admitted to Ebola Holding Units in Sierra Leone Without Ebola Virus Disease

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          Abstract

          We collected data on 1054 children admitted to Ebola Holding Units in Sierra Leone and describe outcomes of 697/1054 children testing negative for Ebola virus disease (EVD) and accompanying caregivers. Case-fatality was 9%; 3/630 (0.5%) children discharged testing negative were readmitted EVD-positive. Nosocomial EVD transmission risk may be lower than feared.

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          Most cited references8

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          Invasive bacterial co-infection in African children with Plasmodium falciparum malaria: a systematic review

          Background Severe malaria remains a major cause of pediatric hospital admission across Africa. Invasive bacterial infection (IBI) is a recognized complication of Plasmodium falciparum malaria, resulting in a substantially worse outcome. Whether a biological relationship exists between malaria infection and IBI susceptibility remains unclear. We, therefore, examined the extent, nature and evidence of this association. Methods We conducted a systematic search in August 2012 of three major scientific databases, PubMed, Embase and Africa Wide Information, for articles describing bacterial infection among children with P. falciparum malaria using the search string ‘(malaria OR plasmodium) AND (bacteria OR bacterial OR bacteremia OR bacteraemia OR sepsis OR septicaemia OR septicemia).’ Eligiblity criteria also included studies of children hospitalized with malaria or outpatient attendances in sub-Saharan Africa. Results A total of 25 studies across 11 African countries fulfilled our criteria. They comprised twenty cohort analyses, two randomized controlled trials and three prospective epidemiological studies. In the meta-analysis of 7,208 children with severe malaria the mean prevalence of IBI was 6.4% (95% confidence interval (CI) 5.81 to 6.98%). In a further meta-analysis of 20,889 children hospitalised with all-severity malaria and 27,641 children with non-malarial febrile illness the mean prevalence of IBI was 5.58 (95% CI 5.5 to 5.66%) in children with malaria and 7.77% (95% CI 7.72 to 7.83%) in non-malaria illness. Ten studies reported mortality stratified by IBI. Case fatality was higher at 81 of 336, 24.1% (95% CI 18.9 to 29.4) in children with malaria/IBI co-infection compared to 585 of 5,760, 10.2% (95% CI 9.3 to 10.98) with malaria alone. Enteric gram-negative organisms were over-represented in malaria cases, non-typhoidal Salmonellae being the most commonest isolate. There was weak evidence indicating IBI was more common in the severe anemia manifestation of severe malaria. Conclusions The accumulated evidence suggests that children with recent or acute malaria are at risk of bacterial infection, which results in an increased risk of mortality. Characterising the exact nature of this association is challenging due to the paucity of appropriate severity-matched controls and the heterogeneous data. Further research to define those at greatest risk is necessary to target antimicrobial treatment.
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            Impact of the Ebola outbreak on health systems and population health in Sierra Leone.

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              Nosocomial transmission of Ebola virus disease on pediatric and maternity wards: Bombali and Tonkolili, Sierra Leone, 2014.

              In the largest Ebola virus disease (EVD) outbreak in history, nosocomial transmission of EVD increased spread of the disease. We report on 2 instances in Sierra Leone where patients unknowingly infected with EVD were admitted to a general hospital ward (1 pediatric ward and 1 maternity ward), exposing health care workers, caregivers, and other patients to EVD. Both patients died on the general wards, and were later confirmed as being infected with EVD. We initiated contact tracing and assessed risk factors for secondary infections to guide containment recommendations.
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                Author and article information

                Journal
                Clin Infect Dis
                Clin. Infect. Dis
                cid
                Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
                Oxford University Press (US )
                1058-4838
                1537-6591
                01 July 2017
                20 March 2017
                20 March 2017
                : 65
                : 1
                : 162-165
                Affiliations
                [1 ] Infection, Immunity, Inflammation and Physiological Medicine, UCL Great Ormond Street Institute of Child Health , United Kingdom;
                [2 ] Save the Children , Sierra Leone and United Kingdom;
                [3 ] Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine , and
                [4 ] Kings Sierra Leone Partnership, Kings Centre for Global Health, Kings College London , United Kingdom;
                [5 ] 34 Military Hospital, Republic of Sierra Leone Armed Forces , Freetown,
                [6 ] Ola During Children’s Hospital, Sierra Leone Ministry of Health , Freetown,
                [7 ] Cap Anamur (German Emergency Doctors), Ola During Children’s Hospital , Freetown, and
                [8 ] Welbodi Partnership, Ola During Children’s Hospital , Freetown, Sierra Leone;
                [9 ] Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine , United Kingdom;
                [10 ] Western Area Emergency Response Centre , Freetown, Sierra Leone;
                [11 ] MRC Clinical Trials Unit at UCL ,
                [12 ] Department of Medical Statistics, London School of Hygiene and Tropical Medicine ,
                [13 ] Farr Institute of Health Informatics , London, and
                [14 ] Department of Clinical Research, London School of Hygiene and Tropical Medicine , United Kingdom
                Author notes
                [a]

                F.F. and K.W. contributed equally.

                Correspondence: F. Fitzgerald, Infection, Immunity, Inflammation, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK ( Felicity.fitzgerald@ 123456ucl.ac.uk ).
                Article
                cix223
                10.1093/cid/cix223
                5693324
                28369236
                819b90c3-a534-48bf-a585-bd3eac9873ff
                © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 December 2016
                : 10 March 2017
                Page count
                Pages: 4
                Funding
                Funded by: Wellcome Trust 10.13039/100004440
                Funded by: Medical Research Council 10.13039/501100000265
                Award ID: MR/K023535/1
                Categories
                Brief Reports

                Infectious disease & Microbiology
                ebola virus disease,viral hemorrhagic fever,children,pediatrics,nosocomial infection

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