1. Francesco Grandesso, MSF
Patient characteristics and risk of mortality in the Médecins Sans Frontières Ebola Management Centres (EMCs) during the West African Ebola outbreak - Preliminary Analysis
Francesco Grandesso, MSF

2. Objectives
Provide an overall description of Ebola virus confirmed patients admitted in MSF main EMCs: age, sex, time to admission, case fatality rate (CFR)
Provide a preliminary analysis of the risk factors for death among confirmed and admitted patients

3. Freetown/Kissy 08-01-15 to 07-03-15
Conakry/Donka to
Magburaka to
Freetown/Pow to
Guéckédou to
Kailahun to
Freetown/Kissy to
Foya to
Monrovia/Elwa to Bo to

4. Patients admitted to MSF EMCs
Patients (up to 12th of April 2015)
Country
Centre
Admitted
Confirmed %
Guinea
Gueckedou
1635
1074
65.7
Donka
1940
779
40.2
Sierra Leone
Kailahun
1219
857
70.3 Bo
483
443
91.7
Freetown
401
170
42.4
Magburaka
136 46
33.8
Kissy
102 24
23.5
Liberia
Foya
695
384
55.3
Monrovia-ELWA3
1909
1241
65.0
All centres
8520
5018
58.9

5. Methodology
Pooling of 9 MSF EMC line-lists: 5 in Sierra Leone, 2 in Liberia and 2 in Guinea
Descriptive analysis of main patient characteristics at admission
Incidence rate ratios (IRR) from univariate and multivariate poisson regression analyses
adjusted for intra and inter-variation among EMC
to explore factors associated with risk of dying: age groups, sex, month of admission, time to admission, and cycle threshold at admission as proxy of viral load

6. Overall patient characteristics
Age
(years) n %
<5
279
5.6
5-14
693
14.0
15-54
3549
71.6
55+
437
8.8
Sex
Female
2543
50.7
Male
2472
49.3
Time to admission (days) n %
0-3
1645
35.3
4-7
2130
45.7
8-13
675
14.5
14+
212
4.5

7. Case fatality by centre
EMC
Cases
Deaths
CFR %
Risk ratio
[95% CI]
Gueckedou
1069
618
57.8
1.00 –
Donka
723
342
47.3
0.81
[ ]
Kailahun
853
390
45.7
0.79
[ ] Bo
441
171
38.8
0.67
[ ]
Freetown
166 83
50.0
0.85
[ ]
Magburaka 44 21
47.7
[ ]
Kissy 22 14
63.6
1.01
[ ]
Foya
381
228
59.8
1.04
[ ]
Monrovia-ELWA3
1204
690
57.3
0.97
[ ]
All centres
4903
2557
52.2

8. Changes in case fatality over time

9. Case fatality according to patients’ age

10. Factors associated with death (all centres)
Univariate analysis
Multivariate analysis
Admitted
Died %
IRR
[95% CI]
Month of admission –
0.96
[0.94–0.99]
Age (years)
<5
264
180
68.2
2.00
[1.65–2.41]
2.11
[1.73–2.58]
5-14
677
281
41.5
1.00
15-54
3348
1705
50.9
1.38
[1.22–1.57]
1.35
[1.19–1.55]
55+
399
273
68.4
2.22
[1.87–2.62]
2.21
[1.85–2.63]
Time to admission (days)
0-3
1529
835
54.6
4-7
2053
1051
51.2
1.01
[0.92–1.11]
1.02
[0.93–1.12]
8-13
655
313
47.8
1.03
[0.90–1.17]
[0.88–1.15]
14+
212 98
46.2
1.10
[0.89–1.35]
1.08
[0.87–1.34]
Sex
Female
2396
1210
50.5
Male
2344
1265
54.0
1.11
[1.02–1.20]
[1.02–1.21]

11. Cycle threshold associated with death

12. Factors associated with death
Univariate analysis
Multivariate analysis
Admitted
Died %
IRR
[95% CI]
Month of admission –
0.93
[0.90–0.96]
Age (years)
<5
176
120
68.2
1.96
[1.57–2.45]
1.82
[1.43–2.30]
5-14
520
215
41.3
1.00
15-54
2471
1259
51.0
1.37
[1.19–1.59]
[1.18–1.59]
55+
287
204
71.1
2.30
[1.89–2.78]
2.06
[1.69–2.51]
Time to admission (days)
0-3
1131
634
56.1
4-7
1557
803
51.6
0.98
[0.89–1.09]
1.04
[0.94–1.16]
8-13
473
225
47.6
0.96
[0.83–1.13]
1.14
[0.97–1.33]
14+
152 66
43.4
[0.74–1.24]
1.20
[0.93–1.55]
Cycle threshold
<18
517
474
91.7
7.29
[6.28–8.46]
7.28
[6.24–8.50]
18-22
1009
642
63.6
2.40
[2.14–2.69]
2.47
[2.19–2.79]
22+
1969
711
36.1
Sex
Female
1789
918
51.3
Male
1703
906
53.2
1.05
[0.96–1.15]
1.06
[0.96–1.17]

13. Limitations
Limited factors explored (i.e. clinical symptoms at admission and exposure/epidemiological link analysis not incorporated)
Limited to patients admitted (community deaths and deaths on arrival not included)
Time to admission questioned
Pooling of data from various contexts
Different laboratories and assays for Ebola PCR (and possibly used/reported antigens)

14. Discussion-Conclusion
Cycle threshold at admission the main predictor of death
Higher risk of death in relation to younger and older age
Death incidence rate decreases with time passing independently from the factors analysed
Symptoms at admission, treatment provided during the course of hospitalisation, workload in the EMC, distance to EMC, as well as factors associated with higher viral load should be further investigated

15. Acknowledgments
All MSF volunteers and local staff who work and have been working in the field
All epidemiologists and medical referents in the field and in MSF headquarters