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Clinical Management of Ebola Virus Disease in the United States and Europe

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Clinical Management of Ebola Virus Disease in the United States and Europe. / Uyeki, Timothy M; Mehta, Aneesh K; Davey, Richard T; Liddell, Allison M; Wolf, Timo; Vetter, Pauline; Schmiedel, Stefan; Grünewald, Thomas; Jacobs, Michael; Arribas, Jose R; Evans, Laura; Hewlett, Angela L; Brantsaeter, Arne B; Ippolito, Giuseppe; Rapp, Christophe; Hoepelman, Andy I M; Gutman, Julie; Working Group of the U.S.–European Clinical Network on Clinical Management of Ebola Virus Disease Patients in the U.S. and Europe.

In: NEW ENGL J MED, Vol. 374, No. 7, 18.02.2016, p. 636-46.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Uyeki, TM, Mehta, AK, Davey, RT, Liddell, AM, Wolf, T, Vetter, P, Schmiedel, S, Grünewald, T, Jacobs, M, Arribas, JR, Evans, L, Hewlett, AL, Brantsaeter, AB, Ippolito, G, Rapp, C, Hoepelman, AIM, Gutman, J & Working Group of the U.S.–European Clinical Network on Clinical Management of Ebola Virus Disease Patients in the U.S. and Europe 2016, 'Clinical Management of Ebola Virus Disease in the United States and Europe', NEW ENGL J MED, vol. 374, no. 7, pp. 636-46. https://doi.org/10.1056/NEJMoa1504874

APA

Uyeki, T. M., Mehta, A. K., Davey, R. T., Liddell, A. M., Wolf, T., Vetter, P., Schmiedel, S., Grünewald, T., Jacobs, M., Arribas, J. R., Evans, L., Hewlett, A. L., Brantsaeter, A. B., Ippolito, G., Rapp, C., Hoepelman, A. I. M., Gutman, J., & Working Group of the U.S.–European Clinical Network on Clinical Management of Ebola Virus Disease Patients in the U.S. and Europe (2016). Clinical Management of Ebola Virus Disease in the United States and Europe. NEW ENGL J MED, 374(7), 636-46. https://doi.org/10.1056/NEJMoa1504874

Vancouver

Uyeki TM, Mehta AK, Davey RT, Liddell AM, Wolf T, Vetter P et al. Clinical Management of Ebola Virus Disease in the United States and Europe. NEW ENGL J MED. 2016 Feb 18;374(7):636-46. https://doi.org/10.1056/NEJMoa1504874

Bibtex

@article{50beb62d092345fb857a26f470e4e774,
title = "Clinical Management of Ebola Virus Disease in the United States and Europe",
abstract = "BACKGROUND: Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited.METHODS: We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015.RESULTS: A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%.CONCLUSIONS: Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.",
keywords = "Adult, Aged, Anti-Bacterial Agents, Combined Modality Therapy, Critical Care, Ebolavirus, Electrolytes, Europe, Female, Fluid Therapy, Hemorrhagic Fever, Ebola, Humans, Length of Stay, Male, Middle Aged, RNA, Viral, Respiration, Artificial, Severity of Illness Index, Transaminases, United States, Viral Load",
author = "Uyeki, {Timothy M} and Mehta, {Aneesh K} and Davey, {Richard T} and Liddell, {Allison M} and Timo Wolf and Pauline Vetter and Stefan Schmiedel and Thomas Gr{\"u}newald and Michael Jacobs and Arribas, {Jose R} and Laura Evans and Hewlett, {Angela L} and Brantsaeter, {Arne B} and Giuseppe Ippolito and Christophe Rapp and Hoepelman, {Andy I M} and Julie Gutman and {Working Group of the U.S.–European Clinical Network on Clinical Management of Ebola Virus Disease Patients in the U.S. and Europe} and Thierry Rolling",
year = "2016",
month = feb,
day = "18",
doi = "10.1056/NEJMoa1504874",
language = "English",
volume = "374",
pages = "636--46",
journal = "NEW ENGL J MED",
issn = "0028-4793",
publisher = "Massachussetts Medical Society",
number = "7",

}

RIS

TY - JOUR

T1 - Clinical Management of Ebola Virus Disease in the United States and Europe

AU - Uyeki, Timothy M

AU - Mehta, Aneesh K

AU - Davey, Richard T

AU - Liddell, Allison M

AU - Wolf, Timo

AU - Vetter, Pauline

AU - Schmiedel, Stefan

AU - Grünewald, Thomas

AU - Jacobs, Michael

AU - Arribas, Jose R

AU - Evans, Laura

AU - Hewlett, Angela L

AU - Brantsaeter, Arne B

AU - Ippolito, Giuseppe

AU - Rapp, Christophe

AU - Hoepelman, Andy I M

AU - Gutman, Julie

AU - Working Group of the U.S.–European Clinical Network on Clinical Management of Ebola Virus Disease Patients in the U.S. and Europe

AU - Rolling, Thierry

PY - 2016/2/18

Y1 - 2016/2/18

N2 - BACKGROUND: Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited.METHODS: We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015.RESULTS: A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%.CONCLUSIONS: Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.

AB - BACKGROUND: Available data on the characteristics of patients with Ebola virus disease (EVD) and clinical management of EVD in settings outside West Africa, as well as the complications observed in those patients, are limited.METHODS: We reviewed available clinical, laboratory, and virologic data from all patients with laboratory-confirmed Ebola virus infection who received care in U.S. and European hospitals from August 2014 through December 2015.RESULTS: A total of 27 patients (median age, 36 years [range, 25 to 75]) with EVD received care; 19 patients (70%) were male, 9 of 26 patients (35%) had coexisting conditions, and 22 (81%) were health care personnel. Of the 27 patients, 24 (89%) were medically evacuated from West Africa or were exposed to and infected with Ebola virus in West Africa and had onset of illness and laboratory confirmation of Ebola virus infection in Europe or the United States, and 3 (11%) acquired EVD in the United States or Europe. At the onset of illness, the most common signs and symptoms were fatigue (20 patients [80%]) and fever or feverishness (17 patients [68%]). During the clinical course, the predominant findings included diarrhea, hypoalbuminemia, hyponatremia, hypokalemia, hypocalcemia, and hypomagnesemia; 14 patients (52%) had hypoxemia, and 9 (33%) had oliguria, of whom 5 had anuria. Aminotransferase levels peaked at a median of 9 days after the onset of illness. Nearly all the patients received intravenous fluids and electrolyte supplementation; 9 (33%) received noninvasive or invasive mechanical ventilation; 5 (19%) received continuous renal-replacement therapy; 22 (81%) received empirical antibiotics; and 23 (85%) received investigational therapies (19 [70%] received at least two experimental interventions). Ebola viral RNA levels in blood peaked at a median of 7 days after the onset of illness, and the median time from the onset of symptoms to clearance of viremia was 17.5 days. A total of 5 patients died, including 3 who had respiratory and renal failure, for a mortality of 18.5%.CONCLUSIONS: Among the patients with EVD who were cared for in the United States or Europe, close monitoring and aggressive supportive care that included intravenous fluid hydration, correction of electrolyte abnormalities, nutritional support, and critical care management for respiratory and renal failure were needed; 81.5% of these patients who received this care survived.

KW - Adult

KW - Aged

KW - Anti-Bacterial Agents

KW - Combined Modality Therapy

KW - Critical Care

KW - Ebolavirus

KW - Electrolytes

KW - Europe

KW - Female

KW - Fluid Therapy

KW - Hemorrhagic Fever, Ebola

KW - Humans

KW - Length of Stay

KW - Male

KW - Middle Aged

KW - RNA, Viral

KW - Respiration, Artificial

KW - Severity of Illness Index

KW - Transaminases

KW - United States

KW - Viral Load

U2 - 10.1056/NEJMoa1504874

DO - 10.1056/NEJMoa1504874

M3 - SCORING: Journal article

C2 - 26886522

VL - 374

SP - 636

EP - 646

JO - NEW ENGL J MED

JF - NEW ENGL J MED

SN - 0028-4793

IS - 7

ER -