Heterogeneities in the case fatality ratio in the West African Ebola outbreak 2013 – 2016

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Title: Heterogeneities in the case fatality ratio in the West African Ebola outbreak 2013 – 2016
Author(s): Garske, T
Cori, A
Ariyarajah, A
Blake, I
Dorigatti, I
Eckmanns, T
Fraser, C
Hinsley, W
Jombart, T
Mills, H
Nedjati-Gilani, G
Newton, E
Nouvellet, P
Perkins, D
Riley, S
Schumacher, D
Shah, A
Van Kerkhove, M
Dye, C
Ferguson, N
Donnelly, C
Item Type: Journal Article
Abstract: The 2013 – 2016 Ebola outbreak in West Africa is the largest on record with 2 8 , 616 confirmed, probable and suspected case s and 11, 310 deaths officially recorded by 10 June 2016 , the true b urden likely considerably higher . The case fatality ratio (CFR, proporti on 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, Lib eria and Sierra Leone officially reported to the World Health Organization . The overall mean CFR was 6 2.9 % (95% CI: 6 1.9 % to 6 4.0 %) 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 hospitalised also played role s . We developed a statistical analysis to detect outliers in CFR between districts of residence and treatment centres , adjusting for known factors influencing surv ival and identified eight districts and three treatment centres 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 diff erences in survival , related to the quality of care or other factors, or was caused by differences in reporting practices or case ascertainment.
Publication Date: 26-May-2017
Date of Acceptance: 11-Nov-2016
URI: http://hdl.handle.net/10044/1/43614
ISSN: 1471-2970
Publisher: Royal Society, The
Journal / Book Title: Philosophical Transactions of the Royal Society B: Biological Sciences
Keywords: Evolutionary Biology
06 Biological Sciences
11 Medical And Health Sciences
Publication Status: Accepted
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

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