RESUMEN
The 2016 CIOMS International ethical guidelines for health-related research involving humans states that 'health-related research should form an integral part of disaster response' and that, 'widespread emergency use [of unproven interventions] with inadequate data collection about patient outcomes must therefore be avoided' (Guideline 20). This position is defended against two lines of criticism that emerged during the 2014 Ebola outbreak. One holds that desperately ill patients have a moral right to try unvalidated medical interventions (UMIs) and that it is therefore unethical to restrict access to UMIs to the clinical trial context. The second holds that clinical trials in contexts of high-mortality diseases are morally suspect because equipoise does not exist between a standard of care that offers little prospect of clinical benefit and a UMI that might offer some clinical advantage.
Asunto(s)
Investigación Biomédica/ética , Desastres , Brotes de Enfermedades/ética , Guías como Asunto , Fiebre Hemorrágica Ebola/terapia , Experimentación Humana/ética , Cooperación Internacional , Enfermedad Crítica/mortalidad , Enfermedad Crítica/terapia , Disentimientos y Disputas , Urgencias Médicas , Ética Médica , Ética en Investigación , Medicina Basada en la Evidencia , Fiebre Hemorrágica Ebola/epidemiología , Derechos Humanos , Humanos , Condición Moral , Organizaciones , Práctica de Salud Pública/ética , Proyectos de Investigación , Valores Sociales , Nivel de AtenciónRESUMEN
Clinical and outcome data on pediatric Ebola virus disease are limited. We report a case-series of 33 pediatric patients with Ebola virus disease in a single Ebola Treatment Center in 2014-2015. The case-fatality rate was 42%, with the majority of deaths occurring within 10 days of admission.
Asunto(s)
Brotes de Enfermedades , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/terapia , Mortalidad Hospitalaria/tendencias , Antibacterianos/administración & dosificación , Antivirales/administración & dosificación , Niño , Preescolar , Estudios de Cohortes , Terapia Combinada , Cuidados Críticos/métodos , Enfermedad Crítica , Países en Desarrollo , Femenino , Fluidoterapia/métodos , Fiebre Hemorrágica Ebola/diagnóstico , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Estimación de Kaplan-Meier , Masculino , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Sierra Leona/epidemiología , Estadísticas no Paramétricas , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
SUMMARY Objective: This review aims to update knowledge about Ebola virus disease (EVD) and recent advances in its diagnosis, treatment and prevention. Method: A literature review was performed using the following databases: ISI Web of Knowledge, PubMed, IRIS, Scopus and the websites of the CDC and the WHO. Additionally, we have included articles and reports referenced in the basic literature search, and news that were considered relevant. Results: The Ebola virus, endemic in some parts of Africa, is responsible for a severe form of hemorrhagic fever in humans; bats are probably its natural reservoir. It is an extremely virulent virus and easily transmitted by bodily fluids. EVD's complex pathophysiology, characterized by immunosuppression as well as stimulation of an intense inflammatory response, results in a syndrome similar to septic shock. The diagnosis is difficult due to the initial symptoms that mimic other diseases. Despite the high mortality rates that can amount to 90%, a prophylaxis (chemical or vaccine) or effective treatment does not exist. Two vaccines and experimental therapies are being developed for the prevention and treatment of EVD. Conclusion: Although the virus is known for about 40 years, the lack of knowledge obtained and the disinterest of government authorities in the countries involved justify the state of emergency currently exists regarding this infectious agent. Only the coordination of multiple entities and the effective commitment of the international community will facilitate the control and effective prevention of EVD.
RESUMO Objetivo: esta revisão tem como objetivo atualizar os conhecimentos sobre a doença do vírus ébola (DVE) e sobre os recentes avanços nos métodos de diagnóstico, tratamento e prevenção. Método: foi realizada uma revisão de literatura, utilizando as seguintes bases de dados: ISI Web of Knowledge, PubMed, IRIS, Scopus e os sites do Centers for Disease Control and Prevention (CDC) e da Organização Mundial da Saúde (OMS). Adicionalmente, foram incluídos artigos e relatórios referenciados na pesquisa bibliográfica de base e notícias consideradas relevantes. Resultados: o vírus ébola, endêmico de algumas regiões da África, é responsável por uma forma grave de febre hemorrágica no homem, e os morcegos são provavelmente o seu reservatório natural. É um vírus extremamente virulento e de fácil transmissão pelos fluidos corporais. A complexa fisiopatologia da doença, caracterizada pela imunossupressão e pelo estímulo a uma intensa resposta inflamatória, resulta em uma síndrome semelhante ao choque séptico. O seu diagnóstico é difícil, por causa da sintomatologia inicial, que mimetiza outras doenças. Apesar das altas taxas de mortalidade, que podem alcançar os 90%, não existe profilaxia (química ou vacinal) ou tratamento eficaz. Encontram-se em desenvolvimento duas vacinas e terapias experimentais para a prevenção e o tratamento da DVE. Conclusão: apesar de ser um vírus conhecido há cerca de 40 anos, o escasso conhecimento obtido e o desinteresse das entidades governamentais de países envolvidos justificam o estado de emergência que se vive atualmente em relação a esse agente infeccioso. A coordenação por múltiplas entidades e o empenho efetivo da comunidade internacional facilitarão o seu controle e a prevenção eficaz.
Asunto(s)
Humanos , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/terapia , Enfermedades Desatendidas/diagnóstico , Enfermedades Desatendidas/terapia , Salud Global , Brotes de Enfermedades , Fiebre Hemorrágica Ebola/transmisión , Vacunas contra el Virus del Ébola/uso terapéutico , Ebolavirus/fisiologíaRESUMEN
OBJECTIVE: This review aims to update knowledge about Ebola virus disease (EVD) and recent advances in its diagnosis, treatment and prevention. METHOD: A literature review was performed using the following databases: ISI Web of Knowledge, PubMed, IRIS, Scopus and the websites of the CDC and the WHO. Additionally, we have included articles and reports referenced in the basic literature search, and news that were considered relevant. RESULTS: The Ebola virus, endemic in some parts of Africa, is responsible for a severe form of hemorrhagic fever in humans; bats are probably its natural reservoir. It is an extremely virulent virus and easily transmitted by bodily fluids. EVD's complex pathophysiology, characterized by immunosuppression as well as stimulation of an intense inflammatory response, results in a syndrome similar to septic shock. The diagnosis is difficult due to the initial symptoms that mimic other diseases. Despite the high mortality rates that can amount to 90%, a prophylaxis (chemical or vaccine) or effective treatment does not exist. Two vaccines and experimental therapies are being developed for the prevention and treatment of EVD. CONCLUSION: Although the virus is known for about 40 years, the lack of knowledge obtained and the disinterest of government authorities in the countries involved justify the state of emergency currently exists regarding this infectious agent. Only the coordination of multiple entities and the effective commitment of the international community will facilitate the control and effective prevention of EVD.
Asunto(s)
Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/terapia , Enfermedades Desatendidas/diagnóstico , Enfermedades Desatendidas/terapia , Brotes de Enfermedades , Vacunas contra el Virus del Ébola/uso terapéutico , Ebolavirus/fisiología , Salud Global , Fiebre Hemorrágica Ebola/transmisión , HumanosRESUMEN
STATEMENT: In this article, we describe an Ebola preparedness initiative with implementation across an academic health system. Key stakeholder centers of various disciplines and clinical experts collaborated in the development and design. Subject matter experts in the areas of Centers for Disease Control and Prevention and World Health Organization protocols for personal protective equipment donning and doffing conducted initial train-the-trainer sessions for program instructors. These trainers represented a cross-section of key clinical responders and environmental services. Through a parallel development process, a blended learning curriculum consisting of online modules followed by on-site training sessions was developed and implemented in both the simulation laboratory and the actual clinical care spaces in preparation for a Department of Health inspection. Lessons learned included identification of the need for iterative refinement based on instructor and trainee feedback, the lack of tolerance of practitioners in wearing full-body personal protective equipment for extended periods, and the ability of a large system to mount a rapid response to a potential public health threat through leveraging of expertise of its Simulation Program, Center for Quality, Safety and Innovation as well as a wide variety of clinical departments.
Asunto(s)
Planificación en Desastres/organización & administración , Personal de Salud/educación , Fiebre Hemorrágica Ebola/prevención & control , Entrenamiento Simulado/organización & administración , Curriculum , Retroalimentación Formativa , Fiebre Hemorrágica Ebola/terapia , Fiebre Hemorrágica Ebola/transmisión , Humanos , Control de Infecciones/organización & administración , Internet , Equipo de Protección Personal/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Estados UnidosAsunto(s)
Servicios de Salud del Niño/organización & administración , Atención Integral de Salud/organización & administración , Fiebre Hemorrágica Ebola/terapia , Adolescente , África Occidental , Niño , Preescolar , Manejo de la Enfermedad , Brotes de Enfermedades , Fiebre Hemorrágica Ebola/mortalidad , Humanos , PobrezaRESUMEN
Tramping through the Himalayan snows to treat patients after the 2005 Pakistan earthquake, internist Félix Báez could never have imagined he would be on the front lines of Ebola in Sierra Leone nine years later .much less that he would contract the deadly virus, live to tell the story and also to return to his team in Africa to continue the fight. At his side in the Geneva University Hospital, where he was airlifted, was Dr Jorge Pérez, today director of Cuba's Pedro Kourí Tropical Medicine Institute (IPK), but best known as "Cuba's AIDS doctor." Times have changed for both physicians, and Ebola is first on their minds as it rages on. At this writing, while there is cautious optimism in Liberia, the epidemic is not yet under control. Ebola has already infected nearly 22,000 people, taken over 8600 lives; Sierra Leone is one of the countries hardest hit. Among the sick and dying have been too many local health workers: 103 of the 138 infected, at last count. The first to sound the global alarm was Doctors Without Borders, which, like Cuba, already had health professionals on the ground in Africa; they were joined by many more, and Cuba was the country that offered the most assistance once WHO called for nations to step up with funds and, most importantly, human resources. Cuba sent 256 volunteers, all with significant international emergency experience: 38 to Guinea, 53 to Liberia and 165 to Sierra Leone. And more wait in the wings, specially-trained disaster medical workers who have already received their first round of Ebola courses at IPK. These Cuban and other international volunteers are bringing patients back from the brink of death, assisting national health workers and community educators. And people like Jorge Pérez are working to get to the bottom of Ebola to help prevent its spread throughout Africa and to other parts of the world. But to keep an epidemic like this from happening again, it will take more, much more. Not only could the global community have done a better job this time around. But as Jim Kim, President of the World Bank admonished, Ebola didn't start with disease, but rather with historic inequalities, the virus festering within health systems barely able to function. A lesson for us all. Hours before Dr Báez's return to Sierra Leone-where he is now-MEDICC Review interviewed him and Dr Pérez at IPK in Havana.
Asunto(s)
Fiebre Hemorrágica Ebola/terapia , África Occidental/epidemiología , Cuba/etnología , Brotes de Enfermedades , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Médicos , VoluntariosRESUMEN
Background Better treatments are urgently needed for the management of Ebola virus epidemics in Equatorial Africa. Methods We conducted a systematic review of the literature on the use of passive immunotherapy for the treatment or prevention of Ebola virus disease. We placed findings from this review into the context of passive immunotherapy currently used for venom-induced disease, and recent improvements in manufacturing of polyvalent antivenom products. Results Passive immunotherapy appears to be one of the most promising specific treatments for Ebola. However, its potential has been incompletely evaluated, considering the overall experience and recent improvement of immunotherapy. Development and use of heterologous serum derivatives could protect people exposed to Ebola viruses with reasonable cost and logistics. Conclusion Hyperimmune equine IgG fragments and purified polyclonal whole IgG deserve further consideration as treatment for exposure to the Ebola virus.(AU)
Asunto(s)
Fiebre Hemorrágica Ebola/prevención & control , Fiebre Hemorrágica Ebola/terapia , Inmunización Pasiva , ÁfricaRESUMEN
Ebola virus disease (EVD) was first identified in 1976 in Yambuku, Zaire (now the Democratic Republic of Congo), and is caused by an RNA virus in the filovirus family (Feldmann & Geisbert). The current strain circulation in West Africa is very similar to the original strain (>95% homology). The origin of the current outbreak remains unknown, but it is suspected to be from an animal reservoir with intermediary species (Fauci). Randomized clinical trials with adaptive design are ongoing to evaluate potential new therapies for EVD...
Asunto(s)
Humanos , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/tratamiento farmacológico , Fiebre Hemorrágica Ebola/terapiaRESUMEN
A major catastrophe hit Western Africa and we would like to put a definite end to that nightmare. Ever since in its initial identification in 1976, the Ebola virus is endemic in Zaire (currently, Democratic Republic of the Congo DRC), where it has exerted devastating effects. For many years now, the virus has mercilessly attacked our fellow men, killing entire families overnight and leaving thousands of children orphan.The current, being the seventh epidemic of Ebola hemorrhagic fever (EHF) in the RDC, also broke out in West Africa - Guinea, Liberia, Sierra Leone Nigeria and Senegal.The World Health Organization (WHO) called specialists from several countries and concentrated efforts that might result in a practical contribution to the control of cases. It is worth to observe that the epidemic has caused more than 1,400 deaths in 2014, being the fatality rate 60 to 90%.
Asunto(s)
Humanos , Crotalus horridus/uso terapéutico , Fiebre Hemorrágica Ebola/terapia , Ipecacuanha/uso terapéutico , /uso terapéutico , Terapéutica Homeopática , Dengue/epidemiología , Género Epidémico/prevención & controlRESUMEN
A major catastrophe hit Western Africa and we would like to put a definite end to that nightmare. Ever since in its initial identification in 1976, the Ebola virus is endemic in Zaire (currently, Democratic Republic of the Congo DRC), where it has exerted devastating effects. For many years now, the virus has mercilessly attacked our fellow men, killing entire families overnight and leaving thousands of children orphan.The current, being the seventh epidemic of Ebola hemorrhagic fever (EHF) in the RDC, also broke out in West Africa - Guinea, Liberia, Sierra Leone Nigeria and Senegal.The World Health Organization (WHO) called specialists from several countries and concentrated efforts that might result in a practical contribution to the control of cases. It is worth to observe that the epidemic has caused more than 1,400 deaths in 2014, being the fatality rate 60 to 90%.(AU)
Asunto(s)
Humanos , Fiebre Hemorrágica Ebola/terapia , /uso terapéutico , Crotalus horridus/uso terapéutico , Ipecacuanha/uso terapéutico , Terapéutica Homeopática , Dengue/epidemiología , Género Epidémico/prevención & controlRESUMEN
Se describe las características clínicas mas resaltantes de la fiebre hemorrágica por el virus del ebola. Se hace hincapié en el conocimiento del cuadro clínico y la evolución de la enfermedad que debe tener todo médico homeópata por la facilidad con que puede propagarse esta enfermedad a partir de los focos de origen, pero sobretodo por poseer un recurso terapéutico que debería ensayarse como se efectúo con enfermedades parecidas como son el cólera, en épocas pasadas, y que fueron muy exitosas. Se dividió en cuadro evolutivo en tres fases y se repertorizaron los síntomas más frecuentes de cada una de ellas para buscar los remedios que podrían prescribirse individualizando cada caso en particular. El genio epidémico probable es el arsenicum album
Asunto(s)
Humanos , Arsenicum Album , Ebolavirus , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/terapia , Homeopatía , VenezuelaRESUMEN
Ebola fever is a serious, life-threatening disease found in areas of Africa, South America and Asia. This update examines transmission, symptoms, diagnosis and nursing management.
Asunto(s)
Fiebre Hemorrágica Ebola , África/epidemiología , Asia/epidemiología , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/terapia , Humanos , Salud Pública , América del Sur/epidemiologíaRESUMEN
No other clinical entity has attached more attention now-a-day than those precipitated by the infection with a Hemorrhagic Fever Virus. Potentially caused by Arena, Bunya, Flavi, and Filoviradae, only the latter has had such a major impact throughout the world. Two major genuses have been recognized since they become evident for the first time in 1967, the single-species Marburg, and the 3-species-Ebola (E. zaire, sudan and reston). With the exception of the 2 outbreaks of E. reston (Washington, USA 1989-1993), all of them have taken place in Africa, where the virus is still hiding among the wild-life of the Tropical Rain Forest. Currently (in April 1995) the reemergence of Ebola virus has once more proven its fatality, leaving around 170 deaths in Zaire, 250 miles from its capital, Kinshasa. There is worldwide alert, sponsored by the CDC in Atlanta, the World Health Organization and the authorities in Zaire regarding its potential spreading to naive regions, in and out of Africa. The characteristic clinical picture of a viral hemorrhagic fever has no match. After a 2-21 days incubation period a viral-like illness develops. As days go by, symptoms worsen, and by the 7th day, a severe and diffuse bleeding tendency ensues. The individual's death is the most likely outcome in the great majority of cases. As a lethal virus, without an available treatment and a possible airborne-route of transmission, Ebola virus will always be considered a persistent threat to the global health
Asunto(s)
Humanos , Ebolavirus , Fiebre Hemorrágica Ebola , Brotes de Enfermedades , Ebolavirus , Fiebre Hemorrágica Ebola/complicaciones , Fiebre Hemorrágica Ebola/diagnóstico , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/terapia , Filoviridae/patogenicidad , VirulenciaRESUMEN
No other clinical entity has attached more attention now-a-day than those precipitated by the infection with a Hemorrhagic Fever Virus. Potentially caused by Arena, Bunya, Flavi, and Filoviradae, only the latter has had such a major impact throughout the world. Two major genuses have been recognized since they become evident for the first time in 1967, the single-species Marburg, and the 3-species-Ebola (E. zaire, sudan and reston). With the exception of the 2 outbreaks of E. reston (Washington, USA 1989-1993), all of them have taken place in Africa, where the virus is still hiding among the wild-life of the Tropical Rain Forest. Currently (in April 1995) the reemergence of Ebola virus has once more proven its fatality, leaving around 170 deaths in Zaire, 250 miles from its capital, Kinshasa. There is worldwide alert, sponsored by the CDC in Atlanta, the World Health Organization and the authorities in Zaire regarding its potential spreading to naive regions, in and out of Africa. The characteristic clinical picture of a viral hemorrhagic fever has no match. After a 2-21 days incubation period a viral-like illness develops. As days go by, symptoms worsen, and by the 7th day, a severe and diffuse bleeding tendency ensues. The individual's death is the most likely outcome in the great majority of cases. As a lethal virus, without an available treatment and a possible airborne-route of transmission, Ebola virus will always be considered a persistent threat to the global health.