We analyzed a detailed subset of data on confirmed and probable Ebola cases collected in Guinea, Liberia, Nigeria, and Sierra Leone as of September The majority of patients are 15 to 44 years of age The course of infection, including signs and symptoms, incubation period On the basis of the initial periods of exponential growth, the estimated basic reproduction numbers R 0 this web page 1.
The estimated current reproduction numbers R are 1. Assuming no change in the control measures for this epidemic, by November 2,the cumulative reported numbers of confirmed and probable cases are predicted to be in Guinea, in Liberia, and in Sierra Leone, exceeding 20, in total.
These data indicate that without drastic improvements in control measures, the numbers of cases of and deaths from EVD are expected to continue increasing from hundreds to thousands per week in the coming months.
Ebola Cases Time Series. As of September 14,a total of confirmed and probable cases of Ebola virus disease EVDas well as deaths from the virus, had been reported from five http://uht.me/essay-help/top-masters-essay-writers-for-hire-au.php in West Africa — Guinea, Liberia, Nigeria, Senegal, and Term Paper Edwin Edwards Leone.
In terms of reported morbidity and mortality, the current epidemic of EVD is far larger than all previous epidemics combined. The true numbers of cases and deaths are certainly higher. Here are numerous reports of symptomatic persons evading diagnosis and treatment, of laboratory diagnoses that have not been included in national databases, and of persons with suspected EVD who were buried without a diagnosis having been made.
Because Ebola virus is spread mainly through contact with the body fluids of symptomatic patients, transmission just click for source be stopped by a combination of early diagnosis, contact tracing, patient isolation and care, infection control, and safe burial. We now report on the clinical and epidemiologic characteristics of the epidemic in Guinea, Liberia, Nigeria, and Sierra Leone during the first 9 months of the epidemic as of September, 14, Senegal had reported only a single case.
We document trends in the epidemic thus far and project expected case numbers for the coming weeks if control measures are not enhanced. Full details of the methods, along with sensitivity and uncertainty analyses, are provided in Supplementary Appendix 1available with the full text of this article at NEJM.
A probable case is illness in any person suspected to have EVD who was evaluated by a clinician or any person who died from suspected Ebola and had an epidemiologic Term Paper Edwin Edwards to a person with a confirmed case but was not tested and did not have laboratory confirmation of the disease.
A probable or suspected case was classified as confirmed when a sample from the person was positive for Ebola virus in laboratory testing. Clinical and demographic data were collected with the use of a standard case investigation form see Supplementary Appendix 1 on confirmed, probable, and suspected EVD cases identified through clinical care, including hospitalization, and through contact tracing in Guinea, Liberia, Nigeria, and Sierra Leone.
To create the fullest possible picture of the unfolding epidemic, these data were supplemented by information collected in informal case reports, by data from diagnostic laboratories, and from burial records. The data recorded for each case included the district of residence, the district in which the disease was reported, the patient's age, sex, and signs and symptoms, the date of symptom onset and of case detection, the name of the hospital, the date of hospitalization, and the date of death or discharge.
A subgroup of case patients provided information on potentially infectious contacts with other persons who had Ebola virus disease, including possible exposure at funerals. We present here the results from analyses of detailed data on individual confirmed and probable cases recorded by each country in databases provided to the WHO as of September 14, ; analyses of confirmed and probable cases, together with suspected cases, are provided in Supplementary Appendix 1.
All information on individual patients has been anonymized for presentation.
We report on the frequency of symptoms in patients with confirmed and probable EVD cases overall and by country. We performed the analysis using logistic-regression models, with data on patients for whom there was a definitive outcome death or recovery by August 17, The case fatality rate was calculated as the percentage of fatal EVD cases among Term Paper Edwin Edwards cases with a known definitive clinical outcome see Supplementary Appendix 1.
For comparison, we also calculated a case fatality rate that was based only on the ratio of reported deaths to reported cases, including in the denominator cases for which the clinical outcome is unknown. We investigated five key time periods that characterize the progression of infection, the detection, care, just click for source recovery or death of a here with Ebola virus disease, and the transmission of infection: The incubation period was estimated retrospectively by having patients with confirmed cases recall the likely source of infectionwith a distinction made between persons with single exposures and those with multiple exposures.
In the case of multiple exposures, all the times of exposure were used to fit a parametric distribution see Supplementary Appendix 1 for a sensitivity analysis. The interval from symptom onset to hospitalization is summarized as the mean, rather than the median, number of days to reflect the average person-days of infectiousness in the community.
The mean duration of hospitalization was estimated as the average number of days from hospitalization to discharge and the average number of days from hospitalization to death, weighted by the proportion of patients who died.
We provide excellent essay writing service 24/7. Enjoy proficient essay writing and custom writing services provided by professional academic writers. We would like to show you a description here but the site won’t allow us. Original Article. Brief Report. Long-Term Control of HIV by CCR5 Delta32/Delta32 Stem-Cell Transplantation. Gero Hütter, M.D., Daniel Nowak, M.D., Maximilian Mossner. This paper explores the evidence that the First Contact meeting had occurred with extraterrestrials with a distinctive ‘Nordic’ appearance, the likelihood of an. BibMe Free Bibliography & Citation Maker - MLA, APA, Chicago, Harvard.
For each statistic we calculated the mean, median, and interquartile range and fitted a gamma probability distribution to model the variation among persons see the results in Supplementary Appendix 1. Separate estimates were obtained for health care workers and for all other adults.
For EVD, we expect the generation time distribution to be nearly identical to the serial interval distribution result derived in Supplementary Appendix 1.
The basic reproduction number R 0 is the average number of secondary cases that arise when one primary case is introduced into an uninfected population. These secondary cases arise after a period measured by the serial interval or by the generation time. When R 0 is greater Term Paper Edwin Edwards 1, infection may spread in the population, and the rate of spread is higher with increasingly high values of R 0. The doubling time the time required for the incidence to double was estimated on the basis of the reproduction number and the serial interval.
When R t falls below 1, infection cannot be sustained. Estimates of R 0 and R t help in evaluating the magnitude Term Paper Edwin Edwards the effort required to control the disease, the way in which transmission rates have fluctuated through time, and the effectiveness of control measures as they are implemented. We estimated R t over time from the time series of incidence of cases i. As described in Supplementary Appendix 1average estimates of R t for the period from July 28 to September 7,which were made on the basis of the date read article report to facilitate comparison with future cases, were used to project future cases, allowing for both uncertainty in the Term Paper Edwin Edwards of R t and stochastic variability in the transmission process.
A total of confirmed and probable cases and deaths were reported in the week of September 8 through September 14 alone. The numbers of confirmed and probable cases reported by each country over time are shown in Figure 1 and Figure 2. Detailed information was available on confirmed and probable cases; these cases were used in all our analyses, with the exception of projections results of analyses based on confirmed, probable, and suspected cases are provided in Supplementary Appendix 1.
The median age of persons with EVD was 32 years interquartile range, 21 to 44and there were no significant differences in the age distribution of persons with EVD among countries. The majority of persons with EVD There were also no significant differences among countries in the total numbers of male and female persons with EVD reported By Http://uht.me/essay-help/best-thesis-statement-ghostwriter-site-for-masters.php 14, a total of cases, including deaths, had been reported among health Term Paper Edwin Edwards workers.
Editor's note: A Chinese version (中文译本) of this article is available. BackgroundOn March 23, , the World Health Organization (WHO) was notified of an. The word coolie (also spelled koelie, kuli, cooli, cooly and quli), meaning a labourer, has a variety of other implications and is sometimes regarded as offensive or. Home of the University of Cambridge’s student newspaper, Varsity. Get the latest News, Comment, Sport, Features, Videos, Culture, Reviews and more from the. The Texarkana Gazette is the premier source for local news and sports in Texarkana and the surrounding Arklatex areas.
During Marcha rise in the numbers of cases in these two districts, in addition to the first reports from Lofa and other districts in Liberia, was followed by the discovery of cases in the capital, Conakry. During May, the focus of the epidemic in Guinea expanded to the neighboring districts of Kenema and Kailahun in Sierra Leone, and in June further cases were reported in Lofa district in Liberia.
These five districts have remained the focus of transmission in the border areas of the three countries. From July onward, there were sharp increases in case numbers at the epidemic foci in all three countries, at other sites away from the epicenter, and in the capital cities of Conakry, Freetown, and Monrovia Figure 1and animated map and timeline at NEJM.
However, although EVD has spread to many parts of Guinea, Liberia, and Sierra Leone, it has not been reported in all districts in the countries: Here 1 provides information on demographic characteristics and symptom frequency in patients with confirmed or probable EVD with a definitive outcome in Guinea, Liberia, Nigeria, and Sierra Leone.
The most common symptoms reported between symptom onset and case detection included fever Term Paper Edwin Edwards These patterns are Term Paper Edwin Edwards in each country see Supplementary Appendix 1. Assessing the case fatality rate during this epidemic is complicated by incomplete information on the clinical outcomes of many cases, both detected and undetected. Estimates of the case fatality rate Table 2 derived by calculating the ratio of all reported deaths to all reported cases to date are low in comparison with historical outbreaks and are highly variable among the affected countries.
This analysis shows that by September 14, a total of The case fatality rate in Nigeria was lower The case fatality rate among hospitalized case patients was The case fatality rate among health care workers ranged from Risk factors for a fatal outcome, after adjustment for country, are provided in Table Term Paper Edwin Edwards. Significant risk factors for death include an age of 45 years or older as compared with 44 years of age or younger odds ratio, 2.
The mean incubation period was The mean time from the onset of see more to hospitalization, a measure of the period of infectiousness in the community, was 5.
Edwin Hama - Today's paper
The mean time to death after admission to the hospital Term Paper Edwin Edwards 4. The mean length of stay in hospital continue reading 6. Estimates of the basic reproduction number, R 0were 1.
S7 in Supplementary Appendix 1. Although R 0 reflects the maximum potential for growth in case incidence, Fig. S7 in Supplementary Appendix 1 shows the variation in the estimated net reproduction number, R tduring the click at this page of the epidemic. Between March and Julythe R t for Guinea fluctuated around the threshold value of 1 but appeared to increase again in August, reflecting the rise in case incidence in Macenta district.
In Liberia, the R t remained above 1 for most of the period between March and August, reflecting the consistent increase in case incidence Fig.
S9 in that country. The growing numbers of cases reported from Guinea, Liberia, and Sierra Leone in August and early September suggest that the R t remains above 1 in a still-expanding epidemic reliable estimates of R t could be obtained only to early September owing to reporting delays.
As of September 14, the doubling time of the epidemic was We estimate that, at the Term Paper Edwin Edwards rate of increase, assuming no changes in control efforts, the cumulative number of confirmed and probable cases by November 2 the end of week 44 of the epidemic will be in Guinea, in Liberia, and in Sierra Leone, exceeding 20, cases in total Figure 4and Table S8 in Supplementary Appendix 2.
The true case load, including suspected cases and undetected cases, will be higher still. Although the current epidemic of EVD in West Africa is unprecedented in scale, the clinical course of infection and the transmissibility of the virus are similar to those in previous EVD outbreaks.
The incubation period, duration of illness, case fatality rate, and R 0 are all within the ranges reported for previous EVD epidemics. Certain characteristics of the affected populations may have led to the rapid geographic dissemination of infection. The populations of Guinea, Liberia, and Sierra Leone are highly interconnected, with much Term Paper Edwin Edwards traffic at the epicenter and relatively easy connections by road between rural towns and villages and between densely populated national capitals.
The large intermixing population has facilitated the spread of infection, but a large epidemic was not inevitable. The critical determinant of epidemic size appears to be the speed of implementation of rigorous control measures. Previous experience with EVD outbreaks, though they have been limited in size and geographic spread, suggests that transmission can be interrupted, and case incidence reduced, within 2 to 3 weeks after the introduction of control measures.
We estimate the R 0 to have varied between see more. This means that transmission has to be a little more than halved to achieve control of the epidemic and eventually to eliminate the virus from the human population.
Greater reductions in transmission would, of course, be desirable, but minimum requirements for the containment of EVD are far less severe than for the containment of more contagious diseases, such as measles. Between March and Julythe reproduction number in Guinea fluctuated around the threshold value of 1, suggesting that modest further intervention efforts at that point could have achieved control. The analyses in this paper can be used to inform recommendations regarding control measures.
The measured duration of the incubation period, and its variation, imply that the advice to follow case contacts for 21 days 1 is appropriate. Surprisingly, the mean was not shorter among health care workers, who are at risk both of acquiring and click the infection to others.
The average length of hospital stay of about 1 week 6. Even without allowing for underreporting, patients with confirmed, probable, or suspected infection were known to need clinical care in the week of September 8 through 14 alone, which far exceeds the present bed capacity in Guinea, Liberia, and Sierra Leone approximately beds here total.