Ebola virus disease and critical illness

Area of Science:

• Epidemiology
• Infectious Diseases
• Critical Care Medicine

Background:

• The 2016 West African Ebola virus disease (EVD) outbreak reported over 28,000 cases and 11,000 deaths to the WHO.
• EVD presents non-specifically with initial symptoms including fatigue, myalgias, headache, and fever, progressing to gastrointestinal issues, dehydration, and potential organ dysfunction.
• Severe EVD can lead to hypoxia, ventilation failure, hypovolemic shock, and multisystem organ dysfunction, which are frequent causes of death.

Purpose of the Study:

• To summarize the clinical presentation, demographics, and outcomes of the West African Ebola virus disease (EVD) outbreak.
• To highlight the impact of resource availability and supportive care on EVD mortality.
• To emphasize the importance of critical care capacity in managing EVD.

Main Methods:

• Review of reported cases and deaths from the World Health Organization.
• Analysis of EVD presentation, demographic data, and case fatality proportions.
• Comparison of mortality rates based on geographical location, resource availability, age, and viral load.

Main Results:

• The case fatality proportion in West Africa was approximately 40%, varying significantly by time, resources, age, and viral load.
• Mortality was substantially lower in Western Europe and the USA (<20%) compared to West Africa (40-90%).
• Neonates and older adults faced higher mortality risks.

Conclusions:

• No specific EVD therapy has proven effective in clinical trials.
• Supportive intensive care in well-resourced settings dramatically reduces EVD mortality.
• Enhancing global critical care capacity presents the most significant opportunity to improve EVD patient outcomes.