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• W2227706143 abstract "A key response to control the recent Ebola virus disease outbreak in west Africa was the prompt isolation of suspected patients in specialised Ebola treatment units (ETUs).1Agua-Agum J Ariyarajah A Aylward B et al.West African Ebola epidemic after one year—slowing but not yet under control.N Engl J Med. 2015; 372: 584-587Crossref PubMed Scopus (140) Google Scholar, 2Zachariah R Harries AD The WHO clinical case definition for suspected cases of Ebola virus disease arriving at Ebola holding units: reason to worry?.Lancet Infect Dis. 2015; 15: 989-990Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar These patients were most often identified through contact tracing of patients with confirmed Ebola virus disease and then defined as having suspected Ebola virus disease on the basis of clinical symptoms. Fever was one of the frequently cited symptoms for referral.3WHO Ebola Response TeamEbola virus disease in west Africa—the first 9 months of the epidemic and forward projections.N Engl J Med. 2014; 371: 1481-1495Crossref PubMed Scopus (1149) Google Scholar, 4Lado M Walker NF Baker P 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: 1024-1033Summary Full Text Full Text PDF PubMed Scopus (88) Google Scholar However, the non-specificity of this symptom means that a large number of individuals with fever could have been erroneously admitted, placing additional pressure on an already overstretched health response.2Zachariah R Harries AD The WHO clinical case definition for suspected cases of Ebola virus disease arriving at Ebola holding units: reason to worry?.Lancet Infect Dis. 2015; 15: 989-990Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 5Pringle J Kuejne A Janssens M et al.Mass drug administration of antimalarials in the Ebola epidemic in Sierra Leone and Liberia. MSF Scientific Day; Royal Society of Medicine, London; May 7–8, 2015.http://www.msf.org.uk/sites/uk/files/2_56_pringle_ebola_ocba_sv_final.pdfGoogle Scholar Reducing the burden of fever caused by other infections—including malaria, which is highly endemic in this region—might have helped to alleviate this pressure.6Walker PG White MT Griffin JT Reynolds A Ferguson NM Ghani AC Malaria morbidity and mortality in Ebola-affected countries caused by decreased health-care capacity, and the potential effect of mitigation strategies: a modelling analysis.Lancet Infect Dis. 2015; 15: 825-832Summary Full Text Full Text PDF PubMed Scopus (117) Google Scholar In The Lancet Infectious Diseases, Cristina Carias and colleagues7Carias C Greening Jr, B Campbell C Meltzer MI Hamel MJ Preventive malaria treatment for contacts of patients with Ebola virus disease in the context of the west Africa 2014–15 Ebola response: an economic analysis.Lancet Infect Dis. 2015; (published online Dec 16.)http://dx.doi.org/10.1016/S1473-3099(15)00465-XGoogle Scholar report the results of an economic evaluation of the potential benefit of providing a course of malaria treatment to contacts of patients with Ebola virus disease as part of the wider epidemic response. The investigators compared the cost of providing the intervention with the benefits expressed in terms of reducing admissions of patients with suspected Ebola virus disease to ETUs. They found that administering a single course of artemisinin-based combination therapy (ACT) at the first point of contact would be cost saving across a wide range of settings, and would also reduce admission of contacts to ETUs by 10–36%. As with other malaria interventions, Carias and colleagues found that the cost savings of such a strategy depend on the timing of the intervention, with the greatest savings made during the malaria transmission season (between the months of May and November in the three affected countries). Their results also showed that these savings are greatest in children under the age of 5 years, who have the highest burden of clinical malaria disease. Furthermore, the investigators showed that these cost savings would hold for any setting in which the malaria parasite prevalence in 2–10 year olds is greater than 10%, representing a wide range of settings across Africa.8Bhatt S Weiss DJ Cameron E et al.The effect of malaria control on Plasmodium falciparum in Africa between 2000 and 2015.Nature. 2015; 526: 207-211Crossref PubMed Scopus (1548) Google Scholar One additional benefit not captured in this study is the reduction in malaria episodes and onward sequelae that would occur by providing effective antimalarial treatment to contacts whose fever was caused by malaria infection. Additionally, as the investigators note, treatment could be expected to provide up to a month of chemoprevention and hence protect against re-infection from malaria. Both effects could be particularly important given that access to health care was severely constrained during the outbreak.9Plucinski MM Guilavogui T Sidikiba S et al.Effect of the Ebola-virus-disease epidemic on malaria case management in Guinea, 2014: a cross-sectional survey of health facilities.Lancet Infectious Dis. 2015; 15: 1017-1023Summary Full Text Full Text PDF PubMed Scopus (100) Google Scholar Mass drug administration of antimalarials as both treatment and chemoprevention was successfully implemented during the Ebola virus disease outbreak in Sierra Leone and Liberia.5Pringle J Kuejne A Janssens M et al.Mass drug administration of antimalarials in the Ebola epidemic in Sierra Leone and Liberia. MSF Scientific Day; Royal Society of Medicine, London; May 7–8, 2015.http://www.msf.org.uk/sites/uk/files/2_56_pringle_ebola_ocba_sv_final.pdfGoogle Scholar This approach differs from that of Carias and colleagues', since it involves a much larger administration of antimalarial drugs across the community as a whole. Nevertheless, preliminary results suggest that it did reduce the presentation of people with fever at ETUs.5Pringle J Kuejne A Janssens M et al.Mass drug administration of antimalarials in the Ebola epidemic in Sierra Leone and Liberia. MSF Scientific Day; Royal Society of Medicine, London; May 7–8, 2015.http://www.msf.org.uk/sites/uk/files/2_56_pringle_ebola_ocba_sv_final.pdfGoogle Scholar A similar approach targeted at young children—seasonal malaria chemoprevention—has recently been adopted in the Sahel region to reduce the burden of malaria in areas of intense seasonal malaria transmission.10Cairns M Roca-Feltrer A Garske T et al.Estimating the potential public health impact of seasonal malaria chemoprevention in African children.Nat Commun. 2012; 3: 881Crossref PubMed Scopus (109) Google Scholar Extension of this intervention to areas with less peaked seasonal transmission could be cost effective both as a malaria intervention11Cairns M. Predictions of the potential impact of increasing the age range of SMC on malaria burden and on transmission from simulation models. ASTMH 64th Annual Meeting; Philadelphia, PA; Oct 25–29 2015. Symposium 17.Google Scholar and to reduce the strain on the health system, hence enabling a more rapid response to future Ebola virus disease outbreaks in the region. Any reduction in unnecessary admission to ETUs also has substantial benefits in terms of controlling the Ebola epidemic. Reducing the number of individuals in ETUs would not only be cost saving but also substantially relieve the pressure on an overburdened epidemic response. Additionally, it will reduce the potential for further transmission of Ebola virus disease within the ETUs. These results therefore highlight the critical role of point-of-care diagnostics that could rapidly distinguish contacts of patients with Ebola virus disease from individuals with symptoms such as fever due to other endemic infections.12Chua AC Cunningham J Moussy F Perkins MD Formenty P The case for improved diagnostic tools to control Ebola virus disease in west Africa and how to get there.PLoS Negl Trop Dis. 2015; 9: e0003734Crossref Scopus (33) Google Scholar A number of such tests are in development. Furthermore, results of a recent modelling study have shown that a point-of-care diagnostic to detect Ebola virus disease could have significantly reduced onward transmission of Ebola virus disease and hence shortened the overall epidemic by reducing unnecessary admission to the ETUs.13Nouvellet P Garske T Mills HL et al.The role of rapid diagnostics in managing Ebola epidemics.Nature. 2015; 528: S109-S116Crossref PubMed Scopus (80) Google Scholar Therefore, a response that combines rapid diagnostic tests with alternative strategies to reduce the presentation of other illnesses—such as the treatment and prevention of malaria in endemic countries—could help to rapidly contain future Ebola outbreaks. ACG has received grants from the Malaria Vaccine Initiative, Medicines for Malaria Venture, Integrated Vector Control Consortium, The Wellcome Trust, National Institutes of Health, WHO, Bill & Melinda Gates Foundation, and UK Medical Research Council, and non-financial support from GlaxoSmithKline, Oxford Policy Management/ Department for International Development, and The Global Fund. PGW declares no competing interests. Preventive malaria treatment for contacts of patients with Ebola virus disease in the context of the west Africa 2014–15 Ebola virus disease response: an economic analysisAdministration of preventive malaria treatment to contacts of patients with Ebola virus disease should be considered by public health officials when addressing Ebola virus disease outbreaks in countries and seasons where malaria reaches high levels of transmission. Full-Text PDF" @default.
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• W2227706143 title "Provision of malaria treatment for Ebola case contacts" @default.
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