The ability to accurately identify Ebola cases is crucial to curtailing the disease. A new study by an international team of investigators found that Ebola virus disease definitions from the World Health Organization were suboptimal, leading to an inability to distinguish Ebola from more common diseases such as malaria and typhoid fever and resulting in challenges to treatment and risk mitigation.
The definitions could be improved by including intense fatigue as a key symptom and contact history and excluding fever, a new study found.
The review, published in The Lancet Infectious Diseases , involved searching studies published between June 13, 1978, and Jan 14, 2020. Fourteen studies from 4 countries were included, representing 12,021 suspected cases of Ebola, of which 4,874 were confirmed. Investigators evaluated WHO virus disease case definitions, clinical and epidemiological characteristics and predictive risk scores.
Pooled sensitivity, which measures the true positive rate or the ability accurately identify those with the disease, was 81.5%, and specificity, which measures the true negative rate or ability to identify those without the disease, was 35.7%.
“The low specificity results in high numbers of false positives and thus potentially unnecessary admissions to Ebola treatment centres, with associated risk of nosocomial transmission and costs of managing suspected cases,” the study noted. “As a consequence, a large number of people who do not have Ebola virus disease will experience unnecessary invasive procedures, risk of being infected with Ebola virus, isolation from family, fear of being stigmatised, and delay to appropriate care, and community mistrust in response activities will increase.”
Excluding fever from the case definition at the community level could improve the sensitivity, according to the study, […]