title: Ebola outbreak in rural West Africa: epidemiology, clinical features and outcomes.
abstract: OBJECTIVE
  To describe Ebola cases in the district Ebola management centre of in Kailahun, a remote rural district of Sierra Leone, in terms of geographic origin, patient and hospitalisation characteristics, treatment outcomes and time from symptom onset to admission.
  
  
  METHODS
  Data of all Ebola cases from June 23rd to October 5th 2014 were reviewed. Ebola was confirmed by reverse-transcriptase-polymerase-chain-reaction assay.
  
  
  RESULTS
  Of 489 confirmed cases (51% male, median age 28 years), 166 (34%) originated outside Kailahun district. Twenty-eight (6%) were health workers: 2 doctors, 11 nurses, 2 laboratory technicians, 7 community health workers and 6 other cadres. More than 50% of patients had fever, headache, abdominal pain, diarrhoea/vomiting. An unusual feature was cough in 40%. Unexplained bleeding was reported in 5%. Outcomes for the 489 confirmed cases were 227 (47%) discharges, 259 (53%) deaths and 3 transfers. Case fatality in health workers (68%) was higher than other occupations (52%, P = 0.05). The median community infectivity time was 6.5 days for both general population and health workers (P = 0.4).
  
  
  CONCLUSIONS
  One in three admitted cases originated outside Kailahun district due to limited national access to Ebola management centres - complicating contact tracing, safe burial and disinfection measures. The comparatively high case fatality among health workers requires attention. The community infectivity time needs to be reduced to prevent continued transmission.
authors.affiliation: Médecins Sans Frontières, Freetown, Sierra Leone.
authors.forename: Silvia
authors.initials: S
authors.lastname: Dallatomasina
authors.forename: Rosa
authors.initials: R
authors.lastname: Crestani
authors.forename: James
authors.initials: J
authors.lastname: Sylvester Squire
authors.forename: Hilde
authors.initials: H
authors.lastname: Declerk
authors.forename: Grazia Marta
authors.initials: GM
authors.lastname: Caleo
authors.forename: Anja
authors.initials: A
authors.lastname: Wolz
authors.forename: Kathryn
authors.initials: K
authors.lastname: Stinson
authors.forename: Gabriela
authors.initials: G
authors.lastname: Patten
authors.forename: Raphael
authors.initials: R
authors.lastname: Brechard
authors.forename: Osman Bamba-Moi
authors.initials: OB
authors.lastname: Gbabai
authors.forename: Armand
authors.initials: A
authors.lastname: Spreicher
authors.forename: Michel
authors.initials: M
authors.lastname: Van Herp
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D058872:Epidemics / Q000706:statistics & numerical data*; D005260:Female; D006282:Health Personnel; D019142:Hemorrhagic Fever, Ebola / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012424:Rural Population; D012807:Sierra Leone / Q000453:epidemiology; D055815:Young Adult
keywords: Ebola; Kailahun; MSF; agents de la santé; health workers; investigación de operaciones; operational research; recherche opérationnelle; trabajadores santiarios; Ébola