Epidemiologic characteristics, clinical manifestations, and risk factors of 139 patients with Ebola virus disease in western Sierra Leone


      • The 2014 West Africa Ebola virus outbreak is the largest Ebola virus disease (EVD) epidemic on record, and Sierra Leone is one of the severe outbreak sites.
      • This study fully described epidemiological characteristics, clinical manifestations and clinical outcomes of 139 laboratory-confirmed EVD patients who admitted to the JUI Holding and Treatment Centre in western Sierra Leone between 15 November, 2014 and 18 January, 2015.
      • The median age of investigated patients was 29 years and 55.4% were female. Of them, 76 patients (54.7%) died, and 63 patients (45.3%) were cured.
      • Our data showed that mortality of EVD was associated with an older age, fever and probably hiccups.


      We aimed to fully describe epidemiologic characteristics, clinical manifestations, and clinical outcomes of Ebola virus disease (EVD), as well as detect independent factors significantly associated with mortality of the disease.


      One hundred thirty-nine confirmed EVD patients enrolled at the JUI Holding and Treatment Centre in western Sierra Leone between November 15, 2014, and January 18, 2015, and demographic and clinical data were retrospectively collected and analyzed.


      The median age of investigated patients was 29 years and 55.4% were women. Of them, 76 patients (54.7%) died and 63 patients (45.3%) were cured. Case fatality rate among male patients was higher than in female patients (69.4% vs 42.9%). Fatigue (82.0%), anorexia (70.5%), abdominal pain (59.7%), diarrhea (58.3%), vomiting (56.1%), fever (55.4%), and muscle pain (54.0%) were the most common symptoms. In addition, 55.4% of investigated patients reported fever. Bleeding was seen in 10.8% of patients.


      Our data show that mortality of EVD is associated with an older age, fever, and probably hiccups.

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        • Rewar S.
        • Mirdha D.
        Transmission of Ebola virus disease: an overview.
        Ann Glob Health. 2014; 80: 444-451
      1. Ebola virus disease fact sheet.
        (Available from:) (Accessed May 30, 2016)
        • Bociaga-Jasik M.
        • Piatek A.
        • Garlicki A.
        Ebola virus disease—pathogenesis, clinical presentation and management.
        Folia Med Cracov. 2014; 54: 49-55
        • Weyer J.
        • Grobbelaar A.
        • Blumberg L.
        Ebola virus disease: history, epidemiology and outbreaks.
        Curr Infect Dis Rep. 2015; 17: 480
        • WHO Ebola Response Team
        Ebola virus disease in West Africa–the first 9 months of the epidemic and forward projections.
        N Engl J Med. 2014; 371: 1481-1495
      2. Ebola virus disease—situation report (Sit-Rep).
        (Available from:) (Accessed May 30, 2016)
        • Cenciarelli O.
        • Pietropaoli S.
        • Malizia A.
        • Carestia M.
        • D'Amico F.
        • Sassolini A.
        • et al.
        Ebola virus disease 2013-2014 outbreak in west Africa: an analysis of the epidemic spread and response.
        Int J Microbiol. 2015; 2015: 769121
        • Kilmarx P.H.
        • Clarke K.R.
        • Dietz P.M.
        • Hamel M.J.
        • Husain F.
        • McFadden J.D.
        • et al.
        Ebola virus disease in health care workers–Sierra Leone, 2014.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 1168-1171
        • Kilgore P.E.
        • Grabenstein J.D.
        • Salim A.M.
        • Rybak M.
        Treatment of ebola virus disease.
        Pharmacotherapy. 2015; 35: 43-53
        • Schieffelin J.S.
        • Shaffer J.G.
        • Goba A.
        • Gbakie M.
        • Gire S.K.
        • Colubri A.
        • et al.
        Clinical illness and outcomes in patients with Ebola in Sierra Leone.
        N Engl J Med. 2014; 371: 2092-2100
        • Qin E.
        • Bi J.
        • Zhao M.
        • Wang Y.
        • Guo T.
        • Yan T.
        • et al.
        Clinical features of patients with ebola virus disease in Sierra Leone.
        Clin Infect Dis. 2015; 61: 491-495
        • Lado M.
        • Walker N.F.
        • Baker P.
        • Haroon S.
        • Brown C.S.
        • Youkee D.
        • et al.
        Clinical features of patients isolated for suspected Ebola virus disease at Connaught Hospital, Freetown, Sierra Leone: a retrospective cohort study.
        Lancet Infect Dis. 2015; 15: 1024-1033
        • Hunt L.
        • Gupta-Wright A.
        • Simms V.
        • Tamba F.
        • Knott V.
        • Tamba K.
        • et al.
        Clinical presentation, biochemical, and haematological parameters and their association with outcome in patients with Ebola virus disease: an observational cohort study.
        Lancet Infect Dis. 2015; 15: 1292-1299
        • Bah E.I.
        • Lamah M.C.
        • Fletcher T.
        • Jacob S.T.
        • Brett-Major D.M.
        • Sall A.A.
        • et al.
        Clinical presentation of patients with Ebola virus disease in Conakry, Guinea.
        N Engl J Med. 2015; 372: 40-47
      3. Case definition recommendations for Ebola or Marburg virus diseases.
        (Available from:) (Accessed May 30, 2016)
        • Yan T.
        • Mu J.
        • Qin E.
        • Wang Y.
        • Liu L.
        • Wu D.
        • et al.
        Clinical characteristics of 154 patients suspected of having Ebola virus disease in the Ebola holding center of Jui Government Hospital in Sierra Leone during the 2014 Ebola outbreak.
        Eur J Clin Microbiol Infect Dis. 2015; 34: 2089-2095
      4. Manual for the care and management of patients in Ebola Care Units/Community Care Centres.
        (Available from:) (Accessed May 30, 2016)
      5. Clinical management of patients with viral haemorrhagic fever.
        (Available from:) (Accessed May 30, 2016)
        • Ansumana R.
        • Jacobsen K.H.
        • Sahr F.
        • Idris M.
        • Bangura H.
        • Boie-Jalloh M.
        • et al.
        Ebola in Freetown area, Sierra Leone–a case study of 581 patients.
        N Engl J Med. 2015; 372: 587-588
        • Dallatomasina S.
        • Crestani R.
        • Sylvester Squire J.
        • Declerk H.
        • Caleo G.M.
        • Wolz A.
        • et al.
        Ebola outbreak in rural West Africa: epidemiology, clinical features and outcomes.
        Trop Med Int Health. 2015; 20: 448-454
        • Maganga G.D.
        • Kapetshi J.
        • Berthet N.
        • Kebela Ilunga B.
        • Kabange F.
        • Mbala Kingebeni P.
        • et al.
        Ebola virus disease in the Democratic Republic of Congo.
        N Engl J Med. 2014; 371: 2083-2091
        • Levine A.C.
        • Shetty P.P.
        • Burbach R.
        • Cheemalapati S.
        • Glavis-Bloom J.
        • Wiskel T.
        • et al.
        Derivation and internal validation of the Ebola prediction score for risk stratification of patients with suspected Ebola virus disease.
        Ann Emerg Med. 2015; 66 (e281): 285-293