EClinicalMedicine

BACKGROUND: As mortality remains high for patients with Ebola virus disease (EVD) despite new treatment options, the ability to level up the provided supportive care and to predict the risk of death is of major importance. This analysis of the EVISTA cohort aims to describe advanced supportive care provided to EVD patients in the Democratic Republic of the Congo (DRC) and to develop a simple risk score for predicting in-hospital death, called PREDS. METHODS: In this prospective cohort (NCT04815175), patients were recruited during the 10(th) EVD outbreak in the DRC across three Ebola Treatment Centers (ETCs). Demographic, clinical, biological, virological and treatment data were collected. We evaluated factors known to affect the risk of in-hospital death and applied univariate and multivariate Cox proportional-hazards analyses to derive the risk score in a training dataset. We validated the score in an internal-validation dataset, applying C-statistics as a measure of discrimination. FINDINGS: Between August 1(st) 2018 and December 31(th) 2019, 711 patients were enrolled in the study. Regarding supportive care, patients received vasopressive drug (n = 111), blood transfusion (n = 101), oxygen therapy (n = 250) and cardio-pulmonary ultrasound (n = 15). Overall, 323 (45%) patients died before day 28. Six independent prognostic factors were identified (ALT, creatinine, modified NEWS2 score, viral load, age and symptom duration). The final score range from 0 to 13 points, with a good concordance (C = 86.24%) and calibration with the Hosmer-Lemeshow test (p = 0.12). INTERPRETATION: The implementation of advanced supportive care is possible for EVD patients in emergency settings. PREDS is a simple, accurate tool that could help in orienting early advanced care for at-risk patients after external validation. FUNDING: This study was funded by ALIMA

A community-based contact isolation strategy to reduce the spread of Ebola virus disease: an analysis of the 2018-2020 outbreak in the Democratic Republic of the Congo

Introduction: Despite tremendous progress in the development of diagnostics, vaccines and therapeutics for Ebola virus disease (EVD), challenges remain in the implementation of holistic strategies to rapidly curtail outbreaks. We investigated the effectiveness of a community-based contact isolation strategy to limit the spread of the disease in the Democratic Republic of Congo (DRC). Methods: We did a quasi-experimental comparison study. Eligible participants were EVD contacts registered from 12 June 2019 to 18 May 2020 in Beni and Mabalako Health Zones. Intervention group participants were isolated to specific community sites for the duration of their follow-up. Comparison group participants underwent contact tracing without isolation. The primary outcome was measured as the reproduction number (R) in the two groups. Secondary outcomes were the delay from symptom onset to isolation and case management, case fatality rate (CFR) and vaccination uptake. Results: 27 324 EVD contacts were included in the study; 585 in the intervention group and 26 739 in the comparison group. The intervention group generated 32 confirmed cases (5.5%) in the first generation, while the comparison group generated 87 (0.3%). However, the 32 confirmed cases arising from the intervention contacts did not generate any additional transmission (R=0.00), whereas the 87 confirmed cases arising from the comparison group generated 99 secondary cases (R=1.14). The average delay between symptom onset and case isolation was shorter (1.3 vs 4.8 days; p&lt;0.0001), CFR lower (12.5% vs 48.4%; p=0.0001) and postexposure vaccination uptake higher (86.0% vs 56.8%; p&lt;0.0001) in the intervention group compared with the comparison group. A significant difference was also found between intervention and comparison groups in survival rate at the discharge of hospitalised confirmed patients (87.9% vs 47.7%, respectively; p=0.0004). Conclusion: The community-based contact isolation strategy used in DRC shows promise as a potentially effective approach for the rapid cessation of EVD transmission, highlighting the importance of rapidly implemented, community-oriented and trust-building control strategies.</p

Linguistique et poétique

Les textes présentés dans cet ouvrage développent une réflexion sur la nécessité de penser la langue d’écriture comme un espace de fiction et de friction. L’écrivain francophone, qu’il soit du Québec ou de la Belgique, du Maghreb ou de l’Afrique subsaharienne, d’Haïti ou du Pacifique, se trouve fréquemment dans une situation de décalage langagier tel qu’il doit s’exprimer dans une langue seconde qu’il maîtrise moins bien que sa langue maternelle, alors que celle-ci est exclue des usages littéraires reconnus. Le sentiment de la langue qui hante l’écrivain en situation de diglossie, donc d’insécurité linguistique, est supposé partagé par le lecteur qui est son pendant naturel et dont l’auteur se donne l’image dès qu’il se met à écrire. Ici l’énergie linguistique, basée sur une économie de l’abondance lexicale et sémantique est mise au service d’une stratégie d’écriture. On est en présence d’une forme plus ou moins violente de renouvellement de la langue seconde, une langue « volée » au colonisateur. Vol, viol et violence sont sereinement revendiqués et assumés comme un droit, celui d’écrire autrement, voire d’écrire mal, une langue non naturelle librement choisie. On s’aperçoit alors que l’écriture en langue seconde, par la création ou par la traduction, révèle inévitablement l’imaginaire qui habite la langue première de l’auteur. Cette pratique plus ou moins angoissée de l’écriture, loin d’être une cause de naufrage, se révèle être un extraordinaire moteur de créativité littéraire, donc de poéticité