Subsequent mortality in survivors of Ebola virus disease in Guinea: a nationwide retrospective cohort study.

BACKGROUND: A record number of people survived Ebola virus infection in the 2013-16 outbreak in west Africa, and the number of survivors has increased after subsequent outbreaks. A range of post-Ebola sequelae have been reported in survivors, but little is known about subsequent mortality. We aimed to investigate subsequent mortality among people discharged from Ebola treatment units. METHODS: From Dec 8, 2015, Surveillance Active en ceinture, the Guinean national survivors' monitoring programme, attempted to contact and follow-up all survivors of Ebola virus disease who were discharged from Ebola treatment units. Survivors were followed up until Sept 30, 2016, and deaths up to this timepoint were recorded. Verbal autopsies were done to gain information about survivors of Ebola virus disease who subsequently died from their closest family members. We calculated the age-standardised mortality ratio compared with the general Guinean population, and assessed risk factors for mortality using survival analysis and a Cox proportional hazards regression model. FINDINGS: Of the 1270 survivors of Ebola virus disease who were discharged from Ebola treatment units in Guinea, information was retrieved for 1130 (89%). Compared with the general Guinean population, survivors of Ebola virus disease had a more than five-times increased risk of mortality up to Dec 31, 2015 (age-standardised mortality ratio 5·2 [95% CI 4·0-6·8]), a mean of 1 year of follow-up after discharge. Thereafter (ie, from Jan 1-Sept 30, 2016), mortality did not differ between survivors of Ebola virus disease and the general population. (0·6 [95% CI 0·2-1·4]). Overall, 59 deaths were reported, and the cause of death was tentatively attributed to renal failure in 37 cases, mostly on the basis of reported anuria. Longer stays (ie, equal to or longer than the median stay) in Ebola treatment units were associated with an increased risk of late death compared with shorter stays (adjusted hazard ratio 2·62 [95% CI 1·43-4·79]). INTERPRETATION: Mortality was high in people who recovered from Ebola virus disease and were discharged from Ebola treatment units in Guinea. The finding that survivors who were hospitalised for longer during primary infection had an increased risk of death, could help to guide current and future survivors' programmes and in the prioritisation of funds in resource-constrained settings. The role of renal failure in late deaths after recovery from Ebola virus disease should be investigated. FUNDING: WHO, International Medical Corps, and the Guinean Red Cross

Countrywide epidemiology of B, C and Delta hepatitis in Burkina Faso: the ANRS 12270 clustered cross-sectional study

International audienc

Countrywide epidemiology of B, C and Delta hepatitis in Burkina Faso: the ANRS 12270 clustered cross-sectional study

International audienc

Hepatitis B and C virus seroprevalence, Burkina Faso: a cross-sectional study

International audienceObjective To estimate population-wide hepatitis B and C seroprevalence using dried blood spot samples acquired for humanimmunodeficiency virus (HIV) surveillance as part of the 2010–2011 Demographic and Health Survey in Burkina Faso.Methods We used the database acquired during the multistage, clustered, population-based survey, in which 15 377 participants completedquestionnaires and provided dried blood spot samples for HIV testing. We extracted sociodemographic and geographic data includingage, sex, ethnicity, education, wealth, marital status and region for each participant. We performed hepatitis B and C assays on 14 886 HIVnegative samples between March to October 2015, and calculated weighted percentages of hepatitis seroprevalence for each variable.Findings We estimated seroprevalence as 9.1% (95% confidence interval, CI: 8.5–9.7) for the hepatitis B surface antigen and 3.6% (95% CI:3.3–3.8) for hepatitis C virus antibodies, classifying Burkina Faso as highly endemic for hepatitis B and low-intermediate for hepatitis C. Theseroprevalence of hepatitis was higher in men than in women, and varied significantly for both with age, education, ethnicity and region.Extremely high HCV-Ab seroprevalence (13.2%; 95% CI: 10.6–15.7) was identified in the Sud-Ouest region, in particular within the youngestage group (15–20 years), indicating an ongoing epidemic.Conclusion Our population-representative hepatitis seroprevalence estimates in Burkina Faso advocate for the inclusion of hepatitisserological tests and risk factor questionnaire items in future surveys, the results of which are crucial for the development of appropriatehealth policies and infection control programmes

Visual mismatch negativity to vanishing parts of objects in younger and older adults.

We investigated visual mismatch negativity (vMMN) to vanishing parts of continuously present objects by comparing the event-related potentials (ERPs) to infrequently (deviant) and frequently (standard) disappearing parts of the objects. This paradigm both excludes low-level stimulus-specific adaptation differences between the responses to deviants and standards, and increases the ecological validity of the stimuli. In comparison to frequently disappearing parts of the stimulus objects, infrequently vanishing parts elicited posterior negative event-related brain activity (vMMN). However, no vMMN emerged to the reappearance of the same parts of the objects. We compared the ERPs of an older and a younger sample of participants. In the 120-180 ms time period vMMN was similar in the two age groups, but in the 180-220 ms time period vMMN emerged only in the younger participants. We consider this difference as an index of more elaborate automatic processing of infrequent stimulus changes in younger adults