-
https://repository.netecweb.org/files/original/8c627eb47eeafb833f978b68c2c18f6c.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Online Course
Access portal to an online course.
Objectives
<h2>What you will learn</h2>
<p>By the end of this training, you will be able to:</p>
<ul>
<li>Describe at least two risk factors of Lassa fever.</li>
<li>Name at least two countries where Lassa fever is endemic.</li>
<li>Describe at least five signs or symptoms of Lassa fever.</li>
<li>Describe the implications of Lassa fever infection on pregnant women.</li>
<li>Describe the clinical syndrome associated with Lassa fever in children.</li>
<li>Describe my role, responsibilities, and scope of practice as a team member when diagnosing Lassa fever.</li>
</ul>
URL
https://www.cdc.gov/vhf/lassa/resources/training/training-medical-provider.html
Alternate URL
Other URLs if necessary.
https://www.cdc.gov/vhf/lassa/resources/index.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The Epidemiology and Clinical Presentation of Lassa Fever: Information for Medical Providers
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
<h2>Learn to Identify Lassa Fever</h2>
<p>While viral hemorrhagic fevers (VHFs), like Lassa fever, are very serious, they are not common in the U.S. However, it is important for healthcare providers to understand high consequence viruses, like Lassa fever, so they can appropriately diagnose and care for their patients. This video, the first in a two-part training series on Lassa fever, provides an overview, describing the epidemiology and clinical presentation of the virus.</p>
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-01-31
Contributor
An entity responsible for making contributions to the resource
2023-10-17 by Darrell Ruby, T&E group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-10-17
Clinical Care
Epidemiology
Lassa
R-Lead
R-T&E
Training
-
https://repository.netecweb.org/files/original/be3c1f11cef0bce53de0e22bdd323017.png
ffa8193d03702a0b82a1a1ca19b763a4
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Online Course
Access portal to an online course.
Objectives
<h2>What you will learn</h2>
<ul>
<li>Describe at least two methods for identifying a patient with Lassa fever infection in the clinical setting.</li>
<li>Describe at least two infection control recommendations when caring for a Lassa fever patient.</li>
<li>Identify the parameters for clinical management of patients with Lassa fever.</li>
<li>Describe post-exposure prophylaxis (PEP) for Lassa fever.</li>
<li>Describe my role, responsibility, and scope of practice as a team member in diagnosing and treating patients with Lassa fever.</li>
</ul>
<br />
<p>This activity provides 0.3 contact hours.</p>
URL
https://www.cdc.gov/vhf/lassa/resources/training/training-diagnosis-treat.html
Alternate URL
Other URLs if necessary.
https://www.cdc.gov/vhf/lassa/resources/index.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Diagnose and Treat Lassa Fever Video Training: Information for Medical Providers
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
<h2>Learn to diagnose and treat Lassa fever</h2>
<p>While viral hemorrhagic fevers (VHFs), like Lassa fever, are very serious, they are not common in the U.S. However, it is important for healthcare providers to understand high consequence viruses, like Lassa fever, so they can appropriately diagnose and care for their patients. This video is the second in a two-part training series on Lassa fever for healthcare providers. It focuses on methods for diagnosing Lassa fever and infection control measures to consider while caring for a patient with Lassa fever. Participants will learn about treatment options, as well as post-exposure prophylaxis (PEP).</p>
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2019-01-31
Contributor
An entity responsible for making contributions to the resource
2023-10-17 by Darrell Ruby, T&E group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-10-17
Clinical Care
Diagnosis
Lassa
Patient Care
R-Lead
R-T&E
Training
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Minhas, Anum S., Paul Scheel, Brian Garibaldi, Gigi Liu, Maureen Horton, Mark Jennings, Steven R. Jones, Erin D. Michos, and Allison G. Hays. 2020. "Takotsubo Syndrome in the Setting of COVID-19 Infection." JACC: Case Reports.
Abstract
<div class="abstract-content selected">
<p>A 58 year old woman was admitted with symptoms of COVID-19. She subsequently developed mixed shock and echocardiogram showed mid-distal left ventricular hypokinesis and apical ballooning, findings typical for stress, or Takotsubo, cardiomyopathy. Over the next few days her left ventricular function improved, further supporting reversibility of acute stress cardiomyopathy.</p>
</div>
<p><strong class="sub-title"> Keywords: </strong> ARDS, Acute respiratory distress syndrome; Acute cardiac dysfunction; COVD-19; COVID-19, Coronavirus Disease 2019; ECG, Electrocardiogram; EF, Ejection fraction; RV, Right ventricle; STEMI, ST-elevation myocardial infarction; Stress cardiomyopathy; Takotsubo; V-A, Veno-arterial; V-V ECMO, Veno-venous extracorporeal membrane oxygenation.</p>
<p class="copyright" id="copyright"></p>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
© 2020 Published by Elsevier on behalf of the American College of Cardiology Foundation.<br /><br />In press, Journal Pre-proof, open access
URL
https://pubmed.ncbi.nlm.nih.gov/32363351/
Read Online
Online location of the resource.
https://www.sciencedirect.com/science/article/pii/S2666084920304290
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Takotsubo Syndrome in the Setting of COVID-19 Infection
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
A 58 year old woman was admitted with symptoms of COVID-19. She subsequently developed mixed shock and echocardiogram showed mid-distal left ventricular hypokinesis and apical ballooning, findings typical for stress, or Takotsubo, cardiomyopathy.
Creator
An entity primarily responsible for making the resource
Minhas, Anum S., Paul Scheel, Brian Garibaldi, Gigi Liu, Maureen Horton, Mark Jennings, Steven R. Jones, Erin D. Michos, and Allison G. Hays.
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2024-03-28 by J. Mundy – Treatment & Care group review 2023 (Q2) skipped – bumping to 2024 (Q2)
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Critical Care
Example
Extracorporeal Membrane Oxygenation (ECMO)
R-T&C
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Wood, Simon N., Ernst C. Wit, Matteo Fasiolo, and Peter J. Green. 2020. "COVID-19 and the difficulty of inferring epidemiological parameters from clinical data." The Lancet Infectious Diseases.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30437-0/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30437-0/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 and the difficulty of inferring epidemiological parameters from clinical data
Subject
The topic of the resource
Research
Description
An account of the resource
Knowing the infection fatality ratio (IFR) is crucial for epidemic management: for immediate planning, for balancing the life-years saved against those lost to the consequences of management, and for considering the ethics of paying substantially more to save a life-year from the epidemic than from other diseases.<br /><br />Response to this article were published:<br /><ul><li><a href="https://repository.netecweb.org/items/show/895">Estimates of the severity of coronavirus disease 2019: a model-based analysis</a></li>
<li><a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30443-6/fulltext">COVID-19 and the difficulty of inferring epidemiological parameters from clinical data – Authors' reply</a></li>
</ul>
Creator
An entity primarily responsible for making the resource
Wood, Simon N., Ernst C. Wit, Matteo Fasiolo, and Peter J. Green.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-28
Type
The nature or genre of the resource
Publication
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Epidemiology
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Kuderer, Nicole M., Toni K. Choueiri, Dimpy P. Shah, Yu Shyr, Samuel M. Rubinstein, Donna R. Rivera, Sanjay Shete, Chih-Yuan Hsu, Aakash Desai, Gilberto de Lima Lopes, Jr., Petros Grivas, Corrie A. Painter, Solange Peters, Michael A. Thompson, Ziad Bakouny, Gerald Batist, Tanios Bekaii-Saab, Mehmet A. Bilen, Nathaniel Bouganim, Mateo Bover Larroya, Daniel Castellano, Salvatore A. Del Prete, Deborah B. Doroshow, Pamela C. Egan, Arielle Elkrief, Dimitrios Farmakiotis, Daniel Flora, Matthew D. Galsky, Michael J. Glover, Elizabeth A. Griffiths, Anthony P. Gulati, Shilpa Gupta, Navid Hafez, Thorvardur R. Halfdanarson, Jessica E. Hawley, Emily Hsu, Anup Kasi, Ali R. Khaki, Christopher A. Lemmon, Colleen Lewis, Barbara Logan, Tyler Masters, Rana R. McKay, Ruben A. Mesa, Alicia K. Morgans, Mary F. Mulcahy, Orestis A. Panagiotou, Prakash Peddi, Nathan A. Pennell, Kerry Reynolds, Lane R. Rosen, Rachel Rosovsky, Mary Salazar, Andrew Schmidt, Sumit A. Shah, Justin A. Shaya, John Steinharter, Keith E. Stockerl-Goldstein, Suki Subbiah, Donald C. Vinh, Firas H. Wehbe, Lisa B. Weissmann, Julie Tsu-Yu Wu, Elizabeth Wulff-Burchfield, Zhuoer Xie, Albert Yeh, Peter P. Yu, Alice Y. Zhou, Leyre Zubiri, Sanjay Mishra, Gary H. Lyman, Brian I. Rini, Jeremy L. Warner, Maheen Abidi, Jared D. Acoba, Neeraj Agarwal, Syed Ahmad, Archana Ajmera, Jessica Altman, Anne H. Angevine, Nilo Azad, Michael H. Bar, Aditya Bardia, Jill Barnholtz-Sloan, Briana Barrow, Babar Bashir, Rimma Belenkaya, Stephanie Berg, Eric H. Bernicker, Christine Bestvina, Rohit Bishnoi, Genevieve Boland, Mark Bonnen, Gabrielle Bouchard, Daniel W. Bowles, Fiona Busser, Angelo Cabal, Paolo Caimi, Theresa Carducci, Carla Casulo, James L. Chen, Jessica M. Clement, David Chism, Erin Cook, Catherine Curran, Ahmad Daher, Mark Dailey, Saurabh Dahiya, John Deeken, George D. Demetri, Sandy DiLullo, Narjust Duma, Rawad Elias, Bryan Faller, Leslie A. Fecher, Lawrence E. Feldman, Christopher R. Friese, Paul Fu, Julie Fu, Andy Futreal, Justin Gainor, Jorge Garcia, David M. Gill, Erin A. Gillaspie, Antonio Giordano, Grace Glace, Axel Grothey, Shuchi Gulati, Michael Gurley, Balazs Halmos, Roy Herbst, Dawn Hershman, Kent Hoskins, Rohit K. Jain, Salma Jabbour, Alokkumar Jha, Douglas B. Johnson, Monika Joshi, Kaitlin Kelleher, Jordan Kharofa, Hina Khan, Jeanna Knoble, Vadim S. Koshkin, Amit A. Kulkarni, Philip E. Lammers, John C. Leighton, Jr., Mark A. Lewis, Xuanyi Li, Ang Li, K. M. Steve Lo, Arturo Loaiza-Bonilla, Patricia LoRusso, Clarke A. Low, Maryam B. Lustberg, Daruka Mahadevan, Abdul-Hai Mansoor, Michelle Marcum, Merry Jennifer Markham, Catherine Handy Marshall, Sandeep H. Mashru, Sara Matar, Christopher McNair, Shannon McWeeney, Janice M. Mehnert, Alvaro Menendez, Harry Menon, Marcus Messmer, Ryan Monahan, Sarah Mushtaq, Gayathri Nagaraj, Sarah Nagle, Jarushka Naidoo, John M. Nakayama, Vikram Narayan, Heather H. Nelson, Eneida R. Nemecek, Ryan Nguyen, Pier Vitale Nuzzo, Paul E. Oberstein, Adam J. Olszewski, Susie Owenby, Mary M. Pasquinelli, John Philip, Sabitha Prabhakaran, Matthew Puc, Amelie Ramirez, Joerg Rathmann, Sanjay G. Revankar, Young Soo Rho, Terence D. Rhodes, Robert L. Rice, Gregory J. Riely, Jonathan Riess, Cameron Rink, Elizabeth V. Robilotti, Lori Rosenstein, Bertrand Routy, Marc A. Rovito, M. Wasif Saif, Amit Sanyal, Lidia Schapira, Candice Schwartz, Oscar Serrano, Mansi Shah, Chintan Shah, Grace Shaw, Ardaman Shergill, Geoffrey Shouse, Heloisa P. Soares, Carmen C. Solorzano, Pramod K. Srivastava, Karen Stauffer, Daniel G. Stover, Jamie Stratton, Catherine Stratton, Vivek Subbiah, Rulla Tamimi, Nizar M. Tannir, Umit Topaloglu, Eli Van Allen, Susan Van Loon, Karen Vega-Luna, Neeta Venepalli, Amit K. Verma, Praveen Vikas, Sarah Wall, Paul L. Weinstein, Matthias Weiss, Trisha Wise-Draper, William A. Wood, Wenxin Xu, Susan Yackzan, Rosemary Zacks, Tian Zhang, Andrea J. Zimmer, and Jack West. 2020. "Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study." The Lancet.
Abstract
<div class="section-paragraph">
<h3>Background</h3>
<div class="section-paragraph">Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness.</div>
<h3>Methods</h3>
<div class="section-paragraph">In this cohort study, we collected de-identified data on patients with active or previous malignancy, aged 18 years and older, with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from the USA, Canada, and Spain from the COVID-19 and Cancer Consortium (CCC19) database for whom baseline data were added between March 17 and April 16, 2020. We collected data on baseline clinical conditions, medications, cancer diagnosis and treatment, and COVID-19 disease course. The primary endpoint was all-cause mortality within 30 days of diagnosis of COVID-19. We assessed the association between the outcome and potential prognostic variables using logistic regression analyses, partially adjusted for age, sex, smoking status, and obesity. This study is registered with <a href="http://ClinicalTrials.gov" target="_blank" rel="noreferrer noopener">ClinicalTrials.gov</a>, <a href="http://clinicaltrials.gov/show/NCT04354701" target="_blank" rel="noreferrer noopener">NCT04354701</a>, and is ongoing.</div>
<h3>Findings</h3>
<div class="section-paragraph">Of 1035 records entered into the CCC19 database during the study period, 928 patients met inclusion criteria for our analysis. Median age was 66 years (IQR 57–76), 279 (30%) were aged 75 years or older, and 468 (50%) patients were male. The most prevalent malignancies were breast (191 [21%]) and prostate (152 [16%]). 366 (39%) patients were on active anticancer treatment, and 396 (43%) had active (measurable) cancer. At analysis (May 7, 2020), 121 (13%) patients had died. In logistic regression analysis, independent factors associated with increased 30-day mortality, after partial adjustment, were: increased age (per 10 years; partially adjusted odds ratio 1·84, 95% CI 1·53–2·21), male sex (1·63, 1·07–2·48), smoking status (former smoker <em>vs</em> never smoked: 1·60, 1·03–2·47), number of comorbidities (two <em>vs</em> none: 4·50, 1·33–15·28), Eastern Cooperative Oncology Group performance status of 2 or higher (status of 2 <em>vs</em> 0 or 1: 3·89, 2·11–7·18), active cancer (progressing <em>vs</em> remission: 5·20, 2·77–9·77), and receipt of azithromycin plus hydroxychloroquine (<em>vs</em> treatment with neither: 2·93, 1·79–4·79; confounding by indication cannot be excluded). Compared with residence in the US-Northeast, residence in Canada (0·24, 0·07–0·84) or the US-Midwest (0·50, 0·28–0·90) were associated with decreased 30-day all-cause mortality. Race and ethnicity, obesity status, cancer type, type of anticancer therapy, and recent surgery were not associated with mortality.</div>
<h3>Interpretation</h3>
<div class="section-paragraph">Among patients with cancer and COVID-19, 30-day all-cause mortality was high and associated with general risk factors and risk factors unique to patients with cancer. Longer follow-up is needed to better understand the effect of COVID-19 on outcomes in patients with cancer, including the ability to continue specific cancer treatments.</div>
<h3>Funding</h3>
<div class="section-paragraph">American Cancer Society, National Institutes of Health, and Hope Foundation for Cancer Research.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31187-9/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31187-9/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Data on patients with COVID-19 who have cancer are lacking. Here we characterise the outcomes of a cohort of patients with cancer and COVID-19 and identify potential prognostic factors for mortality and severe illness.<br /><br />A response to this article was published:<br />
<ul>
<li>Poortmans, Philip M., Valentina Guarneri, and Maria-João Cardoso. "<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31240-X/fulltext">Cancer and COVID-19: what do we really know?</a>" The Lancet.</li>
</ul>
Creator
An entity primarily responsible for making the resource
Kuderer, Nicole M., Toni K. Choueiri, Dimpy P. Shah, Yu Shyr, Samuel M. Rubinstein, Donna R. Rivera, Sanjay Shete, Chih-Yuan Hsu, Aakash Desai, Gilberto de Lima Lopes, Jr., Petros Grivas, Corrie A. Painter, Solange Peters, Michael A. Thompson, Ziad Bakouny, Gerald Batist, Tanios Bekaii-Saab, Mehmet A. Bilen, Nathaniel Bouganim, Mateo Bover Larroya, Daniel Castellano, Salvatore A. Del Prete, Deborah B. Doroshow, Pamela C. Egan, Arielle Elkrief, Dimitrios Farmakiotis, Daniel Flora, Matthew D. Galsky, Michael J. Glover, Elizabeth A. Griffiths, Anthony P. Gulati, Shilpa Gupta, Navid Hafez, Thorvardur R. Halfdanarson, Jessica E. Hawley, Emily Hsu, Anup Kasi, Ali R. Khaki, Christopher A. Lemmon, Colleen Lewis, Barbara Logan, Tyler Masters, Rana R. McKay, Ruben A. Mesa, Alicia K. Morgans, Mary F. Mulcahy, Orestis A. Panagiotou, Prakash Peddi, Nathan A. Pennell, Kerry Reynolds, Lane R. Rosen, Rachel Rosovsky, Mary Salazar, Andrew Schmidt, Sumit A. Shah, Justin A. Shaya, John Steinharter, Keith E. Stockerl-Goldstein, Suki Subbiah, Donald C. Vinh, Firas H. Wehbe, Lisa B. Weissmann, Julie Tsu-Yu Wu, Elizabeth Wulff-Burchfield, Zhuoer Xie, Albert Yeh, Peter P. Yu, Alice Y. Zhou, Leyre Zubiri, Sanjay Mishra, Gary H. Lyman, Brian I. Rini, Jeremy L. Warner, Maheen Abidi, Jared D. Acoba, Neeraj Agarwal, Syed Ahmad, Archana Ajmera, Jessica Altman, Anne H. Angevine, Nilo Azad, Michael H. Bar, Aditya Bardia, Jill Barnholtz-Sloan, Briana Barrow, Babar Bashir, Rimma Belenkaya, Stephanie Berg, Eric H. Bernicker, Christine Bestvina, Rohit Bishnoi, Genevieve Boland, Mark Bonnen, Gabrielle Bouchard, Daniel W. Bowles, Fiona Busser, Angelo Cabal, Paolo Caimi, Theresa Carducci, Carla Casulo, James L. Chen, Jessica M. Clement, David Chism, Erin Cook, Catherine Curran, Ahmad Daher, Mark Dailey, Saurabh Dahiya, John Deeken, George D. Demetri, Sandy DiLullo, Narjust Duma, Rawad Elias, Bryan Faller, Leslie A. Fecher, Lawrence E. Feldman, Christopher R. Friese, Paul Fu, Julie Fu, Andy Futreal, Justin Gainor, Jorge Garcia, David M. Gill, Erin A. Gillaspie, Antonio Giordano, Grace Glace, Axel Grothey, Shuchi Gulati, Michael Gurley, Balazs Halmos, Roy Herbst, Dawn Hershman, Kent Hoskins, Rohit K. Jain, Salma Jabbour, Alokkumar Jha, Douglas B. Johnson, Monika Joshi, Kaitlin Kelleher, Jordan Kharofa, Hina Khan, Jeanna Knoble, Vadim S. Koshkin, Amit A. Kulkarni, Philip E. Lammers, John C. Leighton, Jr., Mark A. Lewis, Xuanyi Li, Ang Li, K. M. Steve Lo, Arturo Loaiza-Bonilla, Patricia LoRusso, Clarke A. Low, Maryam B. Lustberg, Daruka Mahadevan, Abdul-Hai Mansoor, Michelle Marcum, Merry Jennifer Markham, Catherine Handy Marshall, Sandeep H. Mashru, Sara Matar, Christopher McNair, Shannon McWeeney, Janice M. Mehnert, Alvaro Menendez, Harry Menon, Marcus Messmer, Ryan Monahan, Sarah Mushtaq, Gayathri Nagaraj, Sarah Nagle, Jarushka Naidoo, John M. Nakayama, Vikram Narayan, Heather H. Nelson, Eneida R. Nemecek, Ryan Nguyen, Pier Vitale Nuzzo, Paul E. Oberstein, Adam J. Olszewski, Susie Owenby, Mary M. Pasquinelli, John Philip, Sabitha Prabhakaran, Matthew Puc, Amelie Ramirez, Joerg Rathmann, Sanjay G. Revankar, Young Soo Rho, Terence D. Rhodes, Robert L. Rice, Gregory J. Riely, Jonathan Riess, Cameron Rink, Elizabeth V. Robilotti, Lori Rosenstein, Bertrand Routy, Marc A. Rovito, M. Wasif Saif, Amit Sanyal, Lidia Schapira, Candice Schwartz, Oscar Serrano, Mansi Shah, Chintan Shah, Grace Shaw, Ardaman Shergill, Geoffrey Shouse, Heloisa P. Soares, Carmen C. Solorzano, Pramod K. Srivastava, Karen Stauffer, Daniel G. Stover, Jamie Stratton, Catherine Stratton, Vivek Subbiah, Rulla Tamimi, Nizar M. Tannir, Umit Topaloglu, Eli Van Allen, Susan Van Loon, Karen Vega-Luna, Neeta Venepalli, Amit K. Verma, Praveen Vikas, Sarah Wall, Paul L. Weinstein, Matthias Weiss, Trisha Wise-Draper, William A. Wood, Wenxin Xu, Susan Yackzan, Rosemary Zacks, Tian Zhang, Andrea J. Zimmer, and Jack West.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-28
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2024-03-28 by J. Mundy – Treatment & Care group review 2023 (Q2) skipped – bumping to 2024 (Q2)
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Clinical Care
Comorbidity
Coronavirus
COVID-19
R-Res&Pub
R-T&C
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Lee, Lennard Y. W., Jean Baptiste Cazier, T. Starkey, C. D. Turnbull, Rachel Kerr, and Gary Middleton. 2020. "COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study." The Lancet.
Abstract
<div class="section-paragraph">
<h3>Background</h3>
<div class="section-paragraph">Individuals with cancer, particularly those who are receiving systemic anticancer treatments, have been postulated to be at increased risk of mortality from COVID-19. This conjecture has considerable effect on the treatment of patients with cancer and data from large, multicentre studies to support this assumption are scarce because of the contingencies of the pandemic. We aimed to describe the clinical and demographic characteristics and COVID-19 outcomes in patients with cancer.</div>
<h3>Methods</h3>
<div class="section-paragraph">In this prospective observational study, all patients with active cancer and presenting to our network of cancer centres were eligible for enrolment into the UK Coronavirus Cancer Monitoring Project (UKCCMP). The UKCCMP is the first COVID-19 clinical registry that enables near real-time reports to frontline doctors about the effects of COVID-19 on patients with cancer. Eligible patients tested positive for severe acute respiratory syndrome coronavirus 2 on RT-PCR assay from a nose or throat swab. We excluded patients with a radiological or clinical diagnosis of COVID-19, without a positive RT-PCR test. The primary endpoint was all-cause mortality, or discharge from hospital, as assessed by the reporting sites during the patient hospital admission.</div>
<h3>Findings</h3>
<div class="section-paragraph">From March 18, to April 26, 2020, we analysed 800 patients with a diagnosis of cancer and symptomatic COVID-19. 412 (52%) patients had a mild COVID-19 disease course. 226 (28%) patients died and risk of death was significantly associated with advancing patient age (odds ratio 9·42 [95% CI 6·56–10·02]; p<0·0001), being male (1·67 [1·19–2·34]; p=0·003), and the presence of other comorbidities such as hypertension (1·95 [1·36–2·80]; p<0·001) and cardiovascular disease (2·32 [1·47–3·64]). 281 (35%) patients had received cytotoxic chemotherapy within 4 weeks before testing positive for COVID-19. After adjusting for age, gender, and comorbidities, chemotherapy in the past 4 weeks had no significant effect on mortality from COVID-19 disease, when compared with patients with cancer who had not received recent chemotherapy (1·18 [0·81–1·72]; p=0·380). We found no significant effect on mortality for patients with immunotherapy, hormonal therapy, targeted therapy, radiotherapy use within the past 4 weeks.</div>
<h3>Interpretation</h3>
<div class="section-paragraph">Mortality from COVID-19 in cancer patients appears to be principally driven by age, gender, and comorbidities. We are not able to identify evidence that cancer patients on cytotoxic chemotherapy or other anticancer treatment are at an increased risk of mortality from COVID-19 disease compared with those not on active treatment.</div>
<h3>Funding</h3>
<div class="section-paragraph">University of Birmingham, University of Oxford.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31173-9/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31173-9/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Individuals with cancer, particularly those who are receiving systemic anticancer treatments, have been postulated to be at increased risk of mortality from COVID-19. This conjecture has considerable effect on the treatment of patients with cancer and data from large, multicentre studies to support this assumption are scarce because of the contingencies of the pandemic. We aimed to describe the clinical and demographic characteristics and COVID-19 outcomes in patients with cancer.<br /><br />A response was published to this article:<br />
<ul>
<li>Poortmans, Philip M., Valentina Guarneri, and Maria-João Cardoso. " <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31240-X/fulltext">Cancer and COVID-19: what do we really know?</a>" The Lancet.</li>
</ul>
Creator
An entity primarily responsible for making the resource
Lee, Lennard Y. W., Jean Baptiste Cazier, T. Starkey, C. D. Turnbull, Rachel Kerr, and Gary Middleton.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-29
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2024-03-28 by J. Mundy – Treatment & Care group review 2023 (Q2) skipped – bumping to 2024 (Q2)
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Clinical Care
Comorbidity
Coronavirus
COVID-19
R-Res&Pub
R-T&C
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Nepogodiev, Dmitri, James C. Glasbey, Elizabeth Li, Omar M. Omar, Joana F. F. Simoes, Tom E. F. Abbott, Osaid Alser, Alexis P. Arnaud, Brittany K. Bankhead-Kendall, Kerry A. Breen, Miguel F. Cunha, Giana H. Davidson, Salomone Di Saverio, Gaetano Gallo, Ewen A. Griffiths, Rohan R. Gujjuri, Peter J. Hutchinson, Haytham M. A. Kaafarani, Hans Lederhuber, Markus W. Löffler, Hassan N. Mashbari, Ana Minaya-Bravo, Dion G. Morton, David Moszkowicz, Francesco Pata, George Tsoulfas, Mary L. Venn, Aneel Bhangu, Daniel Cox, April C. Roslani, Felix Alakaloko, Jean-Paul P. M. de Vries, Mahmoud A. Aaraj, Tom E. F. Abbott, Sarah J. Abbott, Mutwakil O. M. Abdalla, Ahmed S. Abdelaal, Adesoji O. Ademuyiwa, Thomas M. Aherne, Osman M. Ali, Ghadah Z. Alkadeeki, Ana C. Almeida, Mahmoud M. Alrahawy, Graeme K. Ambler, Ehab Alameer, Stefano M. Andreani, Beatriz De Andrés-Asenjo, Leyre Lopez Antonanzas, Salah G. Aoun, Fouad M. Ashoush, Knut Magne Augestad, Rocio B. Avellana, Funbi A. Ayeni, John O. O. Ayorinde, Bheemanakone H. Babu, Mirza M. A. S. Baig, Oreoluwa M. Bajomo, Olivia J. Baker, Markus P. Baker, Alexander J. Baldwin, Vin Shen Ban, Ryan D. Baron, Alberto G. Barranquero, Conor P. Barry, Alessandro Di Bartolomeo, Gary A. Bass, Michael F. Bath, H. Hunt Batjer, Andrew J. Beamish, Ajay P. Belgaumkar, Matthew N. Bence, Ruth A. Benson, Juan Carlos Bernal-Sprekelsen, Anuradha R. Bhama, Avi V. Bhavaraju, Walter L. Biffl, Chris M. Blundell, Alexander P. Boddy, Alexander B. J. Borgstein, David C. Bosanquet, Karen D. Bosch, Ahmad E. M. Bouhuwaish, Mehmet A. Bozkurt, Collin E. M. Brathwaite, Benjamin C. Brown, Oliver D. Brown, Allison K. Brown, Igor Lima Buarque, Alejandro D. Bueno-Cañones, Mustafa R. Bulugma, Joshua R. Burke, Matthew H. V. Byrne, Elima P. Cagigal-Ortega, Rachael A. Callcut, Francesca Di Candido, Michaela E. Canova, William J. Carlos, Edward J. Caruana, Liam D. Cato, Andrew B. Catton, Andrea Pisani Ceretti, Thomas J. G. Chase, Francesco Di Chiara, Abeed H. Chowdhury, Eric A. Chung, Pierfranco M. Cicerchia, Ethan C. S. Clough, Natasha L. Coleman, Chris G. Collins, Michelle L. Collins, Emily T. Colonna, Lara V. Comini, Tara M. Connolly, Patrick A. Coughlin, Laura Fernández-Gomez Cruzado, Brian R. Davidson, Richard J. Davies, Emma J. Davies, Niall F. Davis, Brett E. Dawson, Benjamin J. F. Dean, Maria Garcia-Conde Delgado, Jose J. Diaz, Kathryn E. Dickson, Manuel M. Diez-Alonso, Jan R. Dixon, Matthew J. Doe, Thomas D. Drake, Frederick T. Drake, John P. Duffy, Declan F. J. Dunne, Naomi J. M. Dunne, Virginia M. Durán-Muñoz-Cruzado, Alexander Z. E. Durst, Nicola J. Eardley, John G. Edwards, Ahmed H. Elfallal, Mahmoud M. A. Elfiky, Jessie A. Elliott, Sameh H. Emile, Katy M. Emslie, Frederick W. Endorf, Jamie L. Engel, Diego T. Enjuto, Eric W. Etchill, Jonathan P. Evans, Brian A. Fahey, Carlos S. Faria, Carlo V. Feo, Henry J. M. Ferguson, Beatriz Dieguez Fernandez, Andres Garcia Fernandez, Antonio J. Fernández, Borja Camacho Fernández-Pacheco, J. Edward Fitzgerald, Giovanni B. Fonsi, Roser Farré Font, Amy L. Fowler, Gregorio Di Franco, Kenneth R. Fretwell, Lorena Sanchon Fructuoso, Giuseppe K. Fusai, Miguel Hernandez Garcia, Miguel Angel Garcia-Ureña, Charn K. Gill, Suzanne S. Gisbertz, Roberto Del Giudice, Maria Carmela Giuffrida, Matteo Di Giuseppe, María Fanjul Gómez, Javier Serrano González, Ewen A. Griffiths, Claudio A. Guariglia, Alison J. Hainsworth, Bria J. Hall, James R. W. Hall, John S. Hammond, Maha H. Haqqani, Ewen M. Harrison, Joshua P. Hazelton, Maarten van Heinsbergen, Arnold D. K. Hill, Caroline B. Hing, Sameer A. Hirji, Michael W. S. Ho, Charlotte M. Holbrook, Thomas J. Holme, James C. Hopkins, David N. Hopkinson, Fahad S. Hossain, Victoria E. Hudson, Jane L. Hughes, E. Shelley Hwang, Mohamed A. H. Ibrahim, Simone M. Isolani, Pablo Galindo Jara, Michael D. Jenkinson, Hillary E. Jenny, Deva S. Jeyaretna, Robert P. Jones, Andrew P. Jones, Pascal K. C. Jonker, Maria L. Jönsson, Doireann P. Joyce, Kyle J. Kalkwarf, Sivesh K. Kamarajah, Mohamed El Kassas, Dara O. Kavanagh, James M. Keatley, Mohamed A. Khalefa, Jim S. Khan, Bilal H. Kirmani, Aaron P. Kisiel, Spyros Marinos Kouris, Mikolaj R. Kowal, Peter L. Labib, John O. Larkin, Johannes C. Lauscher, Wouter K. G. Leclercq, Frances S. J. Ledesma, André M. Leite-Moreira, Elaine Y. L. Leung, Sophia E. Lewis, Maria João Lima, Daniel J. Lin, Helen H. Liu, Aoife J. Lowery, Saida Martel Lozano, Catriona R. Luney, Mariana Magalhães Maia, Nicolò M. Mariani, Marco V. Marino, Angelo A. Marra, Christopher L. Marsh, Robert C. G. Martin, Simon J. McCluney, Robert C. McIntyre, Siobhan C. McKay, Kevin L. McKevitt, Ashley D. Meagher, Mohammad Q. Mehdi, Brian J. Mehigan, Melania Gonzalez-De Miguel, Maria-Carmen De Miguel-Ardevines, Carlos San Miguel-Mendez, Sarah J. Mills, Helen M. Mohan, John A. G. Moir, John R. T. Monson, Joana M. Monteiro, Maria T. Montella, Cristina Soto Montesinos, Marwa M. Morgom, Francisco S. Moura, Jose M. Muguerza, Suzanne H. Murphy, Paola De Nardi, David N. Naumann, Paul C. Neary, David T. A. Neely, Joshua S. Ng-Kamstra, Albert W. T. Ngu, Truong A. Nguyen, George E. Nita, Quentin M. Nunes, Rachel M. Nygaard, Lindsay B. O'Meara, John R. O'Neill, Barbara U. Okafor, Steven A. Olson, Aung Y. Oo, Pablo Collera Ormazabal, Alexander L. Osorio, Max J. Pachl, James T. Parry, Panna K. Patel, David Díaz Pérez, Carolina Martínez Pérez, Luis E. Pérez-Sánchez, Ana Nogues Pevidal, Anna P. Pezzuto, Matthew M. Philp, Thomas D. Pinkney, Joerg M. Pollok, Meical G. Povey, Alfredo Alonso Poza, Amarkumar D. Rajgor, Jagan N. Rao, Dimitri A. Raptis, Henry E. Rice, Paul F. Ridgway, Ana Munoz Rivas, Juan C. Rodriguez-Sanjuan, Luke J. Rogers, Anna Da Roit, Rebecca A. Rollett, Jose L. Romera, Siobhan M. Rooney, Vanessa I. Roxo, Bertrand Le Roy, Eduardo E. Rubio, Carolina Castro Ruiz, Manuel Losada Ruiz, Éanna J. Ryan, Abdel Rahman Saad, Samerah A. Saeed, Hiba A. Salama, Abdulrauf A. Salamah, María Gutiérrez Samaniego, Gianluca M. Sampietro, Diwakar R. Sarma, Kathryn B. Schaffer, Andreas A. Schnitzbauer, Rachel J. Scurrah, Olivia L. Serevina, Pedro A. Serralheiro, Joseph M. Sewards, Michael J. Shackcloth, Abigail V. Shaw, Andrea R. G. Sheel, Giuseppe S. Sica, Veronica De Simone, Aminder A. Singh, Rabindra P. Singh, Brendan L. Skelly, Henry G. Smith, Amir H. Sohail, Duncan R. Spalding, Laurie R. Springford, Anna E. Ssentongo, Pieter J. Steinkamp, Kent A. Stevens, Grant D. Stewart, Nicholas A. Stylianides, Tom B. B. Sullivan, Ahmed S. A. Taher, Muhammad S. Tamimy, Alethea M. Tang, Giovanni D. Tebala, Francisco J. Tejero-Pintor, Mohamed A. Thaha, Amy J. Thomas, Giorgio De Toma, Filippo La Torre, Antonio J. Torres, David N. Townshend, Isobel M. Trout, Sarah C. Tucker, Harmony K. Ubhi, Viviana A. Vega, George C. Velmahos, Catherine G. Velopulos, Yirupaiahgari K. S. Viswanath, Alfredo A. Vivas, Ryckie G. Wade, Martin S. Wadley, Joshua J. S. Wall, Andrew M. Walters, Oliver J. Warren, Chamindri K. Weerasinghe, Richard J. W. Wilkin, Katherine J. Williams, Stuart C. Winter, Justin C. R. Wormald, Franklin L. Wright, Souzana E. Xyda, Alastair L. Young, Mina M. G. Youssef, Farhat B. Yousuf, Hanan El Youzouri, Marco A. Zappa, Emmanuele Abate, Hossam Abdalaziz, Mostafa Abdelkarim, Hossam Abdou, Ahmad Aboelkassem-Ibrahim, Ala Abuown, Fernando Acebes-Garcia, Metesh Acharya, Michel Adamina, Emmanuel Addae-Boateng, Raiyyan Aftab, Arnav Agarwal, José Aguilar, Yousra Ahmed, Emma Aitken, Marwa Al-Azzawi, Somya Al-Embideen, Mahmoud Al-Masri, Hani Al-Najjar, Ahmad Al-Sukaini, Ruhina Alam, Derek Alderson, Zumrud Aliyeva, Firas Aljanadi, Murad Almasri, Paula Alonso-Ortuño, Fatih Altintoprak, Gamal Amira, Rabbia Amjad, Gabriele Anania, Tatjana Andabaka, Dimitrios Angelou, Seethalakshmi Annamalai, Valerio Annessi, James Anthoney, Sibtain Anwar, Mariyah Anwer, Juan Aragon-Chamizo, Antonella Ardito, Michele Arigoni, Teodora Armao, Armando Arminio, Lara Armstrong, Alexis Arnaud, Peter Asaad, James Ashcroft, Christopher Ashmore, Ahmad Asqalan, Emanuele Asti, Emmanuelle Aubry, Erman Aytac, Esther Ayuso-Herrera, Melody Baeza, Martin Bailon-Cuadrado, Bernarda Bakmaz, Caterina Baldi, Edoardo Baldini, Stefano Baldo, Michele Ballabio, Ioannis Baloyiannis, Gerard Baltazar, Fabrizio Bàmbina, Alessandro Bandiera, Emma Barlow, Roberto Barmasse, Christina Barmpagianni, Gianluca Baronio, Fabio Barra, Anne-Marie Bartsch, Amedra Basgaran, Amr Basha, Varvara Bashkirova, Marco Bastazza, Rachel Baumber, Elizabeth Belcher, Angela Belvedere, Inmaculada Benítez-Linero, Damien Bergeat, Matteo Bernasconi, Ashish Bhalla, Neal Bhutiani, Federica Bianco, Pietro Bisagni, Iain Blake, Ruth Blanco-Colino, Alma Blazquez-Martin, Matthew Boal, Luigi Bonavina, Giulia Bonavina, Giles Bond-Smith, Karen Booth, Filipe Borges, Felice Borghi, Konstantinos Bouchagier, Grainne Bourke, Emily Boyle, Gioia Brachini, Jessie Brain, Amanpreet Brar, Lisa Breckles, Frédéric Bretagnol, Genevieve Brixton, Placido Bruzzaniti, Teofila Bueser, Nathan Burnside, Albert Caballero, Enrique Calcerrada-Alises, Miriam Callahan, Enrique Camarero, Tommaso Campagnaro, Michela Campanelli, Massimo Candiani, Marina Cannoletta, Miguel Cantalejo-Diaz, Han Cao, Patrizio Capelli, Vita Capizzi, Giulio Carcano, Francesca Carissimi, Massimo Carlini, Michele Carlucci, Heather Carmichael, Milagros Carrasco, Mariana Carrillo, Michele Carvello, Massimiliano Casati, Carlo Castoro, Vanesa Catalan, Salomé Cavaleiro, Paola Cellerino, Giovanna Centinaio, Cristina Cernei, Cristina Cerro, Maurizio Cervellera, Sohini Chakrabortee, Stephanie Chamberlain, Jeffrey Chan, Grace Chang, Dauod Chaudhry, Alexandre Chebaro, David Chen, Govind Chetty, Zoe Chia, Ambra Chiappini, Massimo Chiarugi, Swathikan Chidambaram, Matteo Chiozza, Hanna Cholewa, Clara Chong, Ekta Choolani-Bhojwani, Dimitri Christoforidis, Karen Chui, Choyin Chung, Bruno Cirillo, Davide Citterio, Pauline Clermidi, Federico Coccolini, Gaia Colletti, Bruno Compagnoni, Vanesa Concepción-Martín, Marco Confalonieri, Hannah Connolly, Christel Conso, Luigi Conti, Zara Cooper, Carlo Corbellin, Fernando Cordera, Javier Corral, Marta Costa, Andrea Costanzi, Christian Cotsoglou, Valerio Cozza, Tamzin Cuming, Miles Curtis, Joseph Cuschieri, Michele D'Agruma, Giancarlo D'Andrea, Prita Daliya, Oliver Dare, Ebenezer Darko, Andrew Day, Ahmed Dehal, Dustin Dehart, Eduardo Delgado-Oliver, Max Denning, Anant Desai, Liesbeth Desender, Sara Dester, Alberto Díaz-García, Patricia Diaz-Peña, Bertrand Dousset, Alexandre Doussot, Nicolas Duchateau, Sarah Duff, Joel Dunning, Victoria Duque-Mallen, Jana Dziakova, Bridget Egan, Richard Egan, Abess El-Ali, Hossam Elfeki, Muhammed Elhadi, Mohammed Eljareh, Hannah Elkadi, Ramy Elkady, Fatimah Elkhafeefi, Ugo Elmore, Tarek Elmoslemany, Oliver Emmerson, Ibrahim Enemosah, Camilla English, William English, Simon Ereidge, Jorge Escartin, Mercedes Estaire-Gomez, Luke Evans, Jessica Evans, Rebecca Exley, Nicoló Fabbri, Giuseppe Falco, Pietro Familiari, Alessandro Fancellu, Shebani Farik, Tony Farrell, Matyas Fehervari, Adam Fell, Angel Fernandez-Camuñas, Reyes Fernández-Marín, María Fernández-Martínez, Francesco Ferrara, Guglielmo Ferrari, Simone Ferrero, Laura Findlay, Marco Fiore, Enrico Fiori, Michael Flatman, Ian Flindall, Blas Flor, Tommaso Fontana, Samuel Ford, David Ford, Stefano Forlani, Elisa Francone, Colomba Frattaruolo, Federico Frio, Annalisa Gagliano, Filippo Gagliardi, Sukhpreet Gahunia, Francesca Gaino, Tanzeela Gala, Elisa Galfrascoli, Luca Galimberti, Phoebe Gallagher, Raffaele Galleano, Armando Galván-Pérez, Emanuele Gammeri, Mario Ganau, Raúl Garcés-García, Gianluca Garulli, Isabel Gascon-Ferrer, Andrea Gattolin, Sebastien Gaujoux, Sergio Gentilli, Fanourios Georgiades, Amir Ghanbari, Dhruv Ghosh, Marco Giacometti, Anna-Victoria Giblin, Catherine Gilbert, Clara Giménez, Emmanouil Giorgakis, Manuel Gipponi, Paul Glen, Giles Goatly, Davide Gobatti, Chintamani Godbole, Kajal Gohil, Marcos Gómez, Juan-Carlos Gomez-Rosado, Emre Gonullu, Enrique Gonzalez-Gonzalez, Luca Gordini, Isabel Gracia, Carlos Gracia-Roche, Stefano Granieri, Susanna Green, Manuela Grivon, Thomas Grove, Marcello Guaglio, Eleonora Guaitoli, Alfredo Guglielmi, Soumya Guha, Claudio Gustavino, Amir Habeeb, Robert Hagger, Hazim Hakmi, Constantine Halkias, Claire Hall, Matthew Hampton, Siddhartha Handa, Laura Hansen, Iram Haq, Amer Harky, Rhiannon Harries, Joseph Harrison, Raashad Hasan, Mohammad Hawari, Paul Hawkin, Bethany Hebblethwaite, Susana Henriques, Emily Heritage, Pilar Hernandez-Juara, Maria Herrero-Lopez, Erik Hervieux, Bruno Heyd, Simon Higgs, Louise Hitchman, Beatrice Ho, Aisling Hogan, Frank Hölzle, Tanvir Hossain, Roy Houston, Libor Hurt, Peter Hutchinson, Giulio Iacob, Immacolata Iannone, Sherif Ibrahim, Domenico Iovino, Arda Isik, Sevda Jafarova, Tahir Jamil, Ullas Jayaraju, Edward Jenner, Elisa Jimenez-Higuera, Jaime Jimeno, Jack Johnstone, Mark Jones, Nicholas Judkins, Nicholas Kalavrezos, Venugopala Kalidindi, Maninder Kalkat, Mona Kamal, Carsten Kamphues, Chong Kang, Yasin Kara, Edward Karam, Ahmed Karim, Florence Kashora, David Kearney, Apoorva Khajuria, Umul Khan, Azam Khan, Chetan Khatri, Gabriel Kinnaman, James Kinross, Aaron Kler, Serafeim Klimopoulos, Ali Kocataş, Angelos Kolias, Alfred Königsrainer, Joop Konsten, Christos Kontovounisios, Amar Kourdouli, Emily Krishnan, Sverrir Kristinsson, Schelto Kruijff, Søren Kudsk-Iversen, Dorothy Kufeji, Nadav Kugler, Rugved Kulkarni, Hayato Kurihara, Letizia Laface, Zaher Lakkis, Mariam Lami, Aitor Landaluce-Olavarria, Pierfrancesco Lapolla, Ismail Lawani, Samuel Lawday, André Lázaro, Katia Lecolle, Sezai Leventoglu, Zoe Li, Ignatius Liew, Giorgio Lisi, Vincenzo Lizzi, Terence Lo, Daniele Lomiento, Marco Longhi, Emilie Lostis, Eftychios Lostoridis, Mahmoud Loubani, Alejandro Lowy-Benoliel, Alessandro Lucianetti, Louis Luke, Raimundas Lunevicius, Marco Luraghi, George Lye, Islam Mabrouk, Alberto Macchi, Luisa MacDonald, Nikolaos Machairas, Marco Madonini, Drew Magowan, Emeline Maisonneuve, Agata Majkowska, Lawrence Majkowski, Jason Mak, Stefano Malabarba, Michele Malerba, Syed Mannan, Joanna Manson, Ahmer Mansuri, Baris Mantoglu, Nichola Manu, Afnan Maqsood, Alessandra Marano, Adrian Marchbank, Pablo Marcos-Santos, Enrico Marrano, Janet Martin, Emmeline Martin, Guy Martin, Lorena Martin-Albo, Lorena Martín-Román, Fabio Martinelli, Fernando Martínez-dePaz, Antonio Martinez-German, Carlos Martinez-Pinedo, Ricardo Martins, Hisham Marwan, Federica Marzi, Olga Mateos-Sierra, Pierre Mathieu, Maria-Soledad Matute-Najarro, Andrew Maw, Dennis Mazingi, Vincenzo Mazzaferro, Andrew McCanny, Katherine McKenzie, Nicola McLarty, Iain McPherson, Esther Medina, Saniya Mediratta, Marzia Medone, Gautam Mehra, Simone Mele, Lidia Melero-Cortés, Fernando Mendoza-Moreno, Simona Meneghini, Giuseppe Mercante, Aude Merdrignac, Stephen Merola, Symeon Metallidis, Martin Michel, Marco Migliore, Jakov Mihanovic, Douglas Miller, Andrea Mingoli, Gary Minto, Antonello Mirabella, Nikhil Misra, Stefan Mitrasinovic, Victor Miu, Nader Moawad, Sylvie Mochet, Ali Modabber, Adam Mohammad, Midhun Mohan, Carmen Moliner-Sánchez, Francesco Mongelli, Michela Monteleone, Mauro Montuori, Rachel Moore, Ismael Mora-Guzmán, Xavier Morales, Dieter Morales, Luca Morelli, Lucia Morelli, Richard Morgan, Chris Morris, Pietro Mortini, Angelo Mosca, Dema Motter, Susan Moug, Samrat Mukherjee, Manhal Najdy, Apostolos Nakas, Ilgar Namazov, Pradyumna Naredla, Emmhamed Nasef, Heeam Nassa, Rahul Nath, Antonio Navarro-Sánchez, Scarlet Nazarian, Giampiero Negri, Deepika Nehra, Jason Neil-Dwyer, Jacopo Neri, Katy Newton, Herald Nikaj, Milagros Niquen, Sara Nobile, Jorge Nogueiro, Faustin Ntirenganya, Michael Nugent, Jordi Núñez, Juan Ocaña, Valentine Okechukwu, Fernando Oliva-Mompean, Ana Oliveira, Didier Ollat, Lavinia Onos, Liza Osagie-Clouard, Khabab Osman, Jessica Ottolina, Jared Ourieff, Oumaima Outani, Bankole Oyewole, Volkan Ozben, David Pacheco-Sanchez, David Padilla-Valverde, Madhava Pai, Salvatore Paiella, Samuel Paisley, Gianmarco Palini, Matteo Palmeri, Pedram Panahi, Alessandro Parente, Daniele Parlanti, Chetan Parmar, Angela Pascual, Mahul Patel, Abhijit Pathak, Sangram Patil, Piet Pattyn, Adam Peckham-Cooper, Corrado Pedrazzani, Gianluca Pellino, Chiara Peluso, André Pereira, António Pereira-Neves, M. D. Perez-Diaz, Marta Pérez-González, Baltasar Pérez-Saborido, Konstantinos Perivoliotis, Clare Perkins, Georgios Peros, Ornella Perotto, Teresa Perra, Patrizio Petrone, George Phenix, Sara Picazo, Rafael Picon-Rodriguez, Martina Piloni, Lorena Pingarrón-Martín, Enrico Pinotti, Adolfo Pisanu, Paolo Pizzini, Peter Pockney, Mauro Podda, Dina Podolsky, Gilberto Poggioli, Cecilia Pompili, Michael Pontari, Alberto Porcu, Ryan Potter, Claire Price, François-René Pruvot, Roger Pujol-Muncunill, Andrea Puppo, Markus Quante, Begoña Quintana-Villamandos, Ali Qureshi, Dejan Radenkovic, Ivan Rakvin, Irene Ramallo-Solís, Sean Ramcharan, Diego Ramos, Antonio Ramos-Bonilla, Joussi Ramzi, Sridhar Rathinam, Emanuele Rausa, Matteo Ravaioli, Sharanya Ravindran, Thomas Raymond, Aisha Razik, Jennifer Redfern, Julio Reguera-Rosal, Mariam Rela, Juan Rey-Biel, Cristina Rey-Valcarcel, Marta Ribolla, Tomos Richards, Michael Richmond, Erminio Righini, Javier Rio-Gomez, Harjoat Riyat, Sana Rizvi, Keith Roberts, Matthew Roberts, Stuart Robertson, Ronald Robertson, Alvaro Robin-Valle, Melissa Rochon, Mikel Rojo, Luigi Rolli, Silvio Romano, Elizabeth Ross, Howard Ross, Catherine Rossborough, Matteo Rottoli, Miguel Ruiz, Fernando Ruiz-Grande, Irene Ruiz-Martin, María Ruiz-Soriano, Andrea Ruzzenente, Ondrej Ryska, Carlos Saez, Andrea Sagnotta, Kapil Sahnan, Arun Sahni, Ali Salim, Ibrahim Sallam, Roberto Salvia, Elgun Samadov, Giuseppe Sammarco, Mafalda Sampaio-Alves, Alejandro Sánchez-Arteaga, Maria-Nieves Sanchez-Fuentes, Daniel Sanchez-Pelaez, Coral Sanchez-Perez, Maria Sanchez-Rubio, Jorge Sancho-Muriel, Julie Sanders, Maria-Pilar Santero-Ramirez, Thomas Santora, Antonio Santoro, Irene Santos, Hugo Santos-Sousa, Paolo Sapienza, Lodovico Sartarelli, Janahan Sarveswaran, Diego Sasia, Alain Saudemont, Sef Saudi-Moro, Shobhit Saxena, Dolly Saxena, Ahmad Sayasneh, Aurelien Scalabre, Andrew Schache, Riccardo Schiavina, Christian Schineis, Teresa Schreckenbach, Antonella Scorza, Lucy Scott, Sara Seegert, Agathe Seguin-Givelet, Ana Senent-Boza, Keith Seymour, Amanda Shabana, Karishma Shah, Jigar Shah, Preena Shah, Sujay Shah, Taner Shakir, Mostafa Shalaby, Sushma Shankar, Richard Shaw, Sameh Shehata, Amy Shenfine, Kelda Sheridan, Ahmed Sherief, Mohamed Sherief, Mohamed Sherif, Michael Shinkwin, Sebastian Shu, Kwabena Siaw-Acheampong, Pierpaolo Sileri, Abhinav Singh, Shailendra Singh, Sanjay Sinha, Deepti Sinha, Leandro Siragusa, Rajesh Sivaprakasam, Sriharan Sivayoganathan, Robert Smillie, Claire Smith, Andrew Smith, Christopher Smith, Dana Sochorova, Fiammetta Soggiu, Catrin Sohrabi, Catrin Sohrabi, Catrin Sohrabi, Francesca Solari, Piergiorgio Solli, Kjetil Soreide, Antonino Spinelli, Domenico Spoletini, Giuseppe Spriano, Sanskrithi Sravanam, Paddy Ssentongo, Sophie Stanger, Dionisios Stavroulias, Ben Steel, Marco Stella, Robbie Stewart, Sally Stringer, Nina Sulen, Sudha Sundar, Matthew Sundhu, Avni Suri, Arooj Syed, Peter Szatmary, Stephen Tabiri, Daniel Tadross, Lucio Taglietti, Rosamond Tansey, Dario Tartaglia, Ahmed Tawheed, Salim Tayeh, Tobias Teles, Valentina Testa, Nilanjana Tewari, Philipp Thoenissen, Kane Thomas, Anne Thomin, Jessica Thrush, Sean Tierney, Abhinav Tiwari, Simon Toh, Enrique Toledo, Valeria Tonini, Jared Torkington, Alfonso Torquati, Guido Torzilli, Joshua Totty, Paraskevi Tourountzi, Manuel Tousidonis, Philip Townend, Catherine Townsend, Alex Trompeter, Francesco Trotta, Stéphanie Truant, Jeancarlos Trujillo-Díaz, Georgios Tsoulfas, Celia Turco, Victor Turrado-Rodriguez, Giulia Turri, Harry Tustin, Jayne Tyler, Stylianos Tzedakis, George Tzovaras, Martine Uittenbogaart, Ramzan Ullah, Shane Urban, Alessia Urbani, Antonella Usai, Gianpaolo Vaccarella, Javier Valdes-Hernandez, Luca Valsecchi, Rajiv Vashisht, Andrea Vázquez-Fernández, Gowtham Venkatesan, Mary Venn, Cristina Vera-Mansilla, Roberto Vergari, Giuseppina Vescio, Raghavan Vidya, Paula Vieira, Vardhini Vijay, Dale Vimalachandran, Tommaso Violante, Anita Volpe, Fernanda Vovola, Paul Vulliamy, Rosemary Wall, Kate Wallwork, Alex Ward, David Warwick, Saima Waseem, Helen Weaver, Fiona Wells, Jiaxin Wen, Raha West, Emma Whitehall, Laura Wild, Alex Wilkins, Gethin Williams, Matthew Williams, Philipp Winnand, Ken Wong, Dawit Worku, Naomi Wright, Seema Yalamanchili, Danylo Yershov, Alp Yildiz, Richard Young, Can Yurttas, Frederic Zadegan, Noman Zafar, Rasheed Zakaria, Martina Zambon, Nicola Zanini, Alba Zarate, Philippe Zerbib, Maurizio Zizzo, Oded Zmora, Sandro Zonta, Mark I. van Berge Henegouwen, Willemijn Y. van der Plas, Inthekab Ali Mohamed Ali, Nur Amalina Che Bakri, Miguel Ángel Hernández Bartolomé, Juan Carlos Catalá Bauset, Mohamad K. Abou Chaar, Luigi M. P. Marino Cosentino, Carlos J. Gómez Díaz, Jose L. Garcia Galocha, Charles A. de Gheldere, Gustavo Mendonça Ataíde Gomes, Juan Beltrán de Heredia, Dan G. Blazer, III, William C. Nugent, III, Ali A. Ali karar, F. Borja De Lacy, Juan luis Blas Laina, Madan Jha Shane Lester, Aloka S. D. Liyanage, Faraj S. Al Maadany, Joshua A. De Marchi, Antonio Ramos-De la Medina, Reda H. M. Mithany, Cristina Sanchez del Pueblo, Gabrielle H. van Ramshorst, Maria Marqueta De Salas, Anthony C. De Souza, and M. Dolores Del Toro. 2020. "Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study." The Lancet.
Abstract
<div class="section-paragraph">
<h3>Background</h3>
<div class="section-paragraph">The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection.</div>
<h3>Methods</h3>
<div class="section-paragraph">This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation.</div>
<h3>Findings</h3>
<div class="section-paragraph">This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 82·6% (219 of 265) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p<0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p<0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p<0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047).</div>
<h3>Interpretation</h3>
<div class="section-paragraph">Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery.</div>
<h3>Funding</h3>
<div class="section-paragraph">National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31182-X/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31182-X/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study
Subject
The topic of the resource
Research
Description
An account of the resource
The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection.
Creator
An entity primarily responsible for making the resource
COVIDSurg Collaborative
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-05-29
Type
The nature or genre of the resource
Publication
Source
A related resource from which the described resource is derived
Nepogodiev, Dmitri, James C. Glasbey, Elizabeth Li, Omar M. Omar, Joana F. F. Simoes, Tom E. F. Abbott, Osaid Alser, Alexis P. Arnaud, Brittany K. Bankhead-Kendall, Kerry A. Breen, Miguel F. Cunha, Giana H. Davidson, Salomone Di Saverio, Gaetano Gallo, Ewen A. Griffiths, Rohan R. Gujjuri, Peter J. Hutchinson, Haytham M. A. Kaafarani, Hans Lederhuber, Markus W. Löffler, Hassan N. Mashbari, Ana Minaya-Bravo, Dion G. Morton, David Moszkowicz, Francesco Pata, George Tsoulfas, Mary L. Venn, Aneel Bhangu, Daniel Cox, April C. Roslani, Felix Alakaloko, Jean-Paul P. M. de Vries, Mahmoud A. Aaraj, Tom E. F. Abbott, Sarah J. Abbott, Mutwakil O. M. Abdalla, Ahmed S. Abdelaal, Adesoji O. Ademuyiwa, Thomas M. Aherne, Osman M. Ali, Ghadah Z. Alkadeeki, Ana C. Almeida, Mahmoud M. Alrahawy, Graeme K. Ambler, Ehab Alameer, Stefano M. Andreani, Beatriz De Andrés-Asenjo, Leyre Lopez Antonanzas, Salah G. Aoun, Fouad M. Ashoush, Knut Magne Augestad, Rocio B. Avellana, Funbi A. Ayeni, John O. O. Ayorinde, Bheemanakone H. Babu, Mirza M. A. S. Baig, Oreoluwa M. Bajomo, Olivia J. Baker, Markus P. Baker, Alexander J. Baldwin, Vin Shen Ban, Ryan D. Baron, Alberto G. Barranquero, Conor P. Barry, Alessandro Di Bartolomeo, Gary A. Bass, Michael F. Bath, H. Hunt Batjer, Andrew J. Beamish, Ajay P. Belgaumkar, Matthew N. Bence, Ruth A. Benson, Juan Carlos Bernal-Sprekelsen, Anuradha R. Bhama, Avi V. Bhavaraju, Walter L. Biffl, Chris M. Blundell, Alexander P. Boddy, Alexander B. J. Borgstein, David C. Bosanquet, Karen D. Bosch, Ahmad E. M. Bouhuwaish, Mehmet A. Bozkurt, Collin E. M. Brathwaite, Benjamin C. Brown, Oliver D. Brown, Allison K. Brown, Igor Lima Buarque, Alejandro D. Bueno-Cañones, Mustafa R. Bulugma, Joshua R. Burke, Matthew H. V. Byrne, Elima P. Cagigal-Ortega, Rachael A. Callcut, Francesca Di Candido, Michaela E. Canova, William J. Carlos, Edward J. Caruana, Liam D. Cato, Andrew B. Catton, Andrea Pisani Ceretti, Thomas J. G. Chase, Francesco Di Chiara, Abeed H. Chowdhury, Eric A. Chung, Pierfranco M. Cicerchia, Ethan C. S. Clough, Natasha L. Coleman, Chris G. Collins, Michelle L. Collins, Emily T. Colonna, Lara V. Comini, Tara M. Connolly, Patrick A. Coughlin, Laura Fernández-Gomez Cruzado, Brian R. Davidson, Richard J. Davies, Emma J. Davies, Niall F. Davis, Brett E. Dawson, Benjamin J. F. Dean, Maria Garcia-Conde Delgado, Jose J. Diaz, Kathryn E. Dickson, Manuel M. Diez-Alonso, Jan R. Dixon, Matthew J. Doe, Thomas D. Drake, Frederick T. Drake, John P. Duffy, Declan F. J. Dunne, Naomi J. M. Dunne, Virginia M. Durán-Muñoz-Cruzado, Alexander Z. E. Durst, Nicola J. Eardley, John G. Edwards, Ahmed H. Elfallal, Mahmoud M. A. Elfiky, Jessie A. Elliott, Sameh H. Emile, Katy M. Emslie, Frederick W. Endorf, Jamie L. Engel, Diego T. Enjuto, Eric W. Etchill, Jonathan P. Evans, Brian A. Fahey, Carlos S. Faria, Carlo V. Feo, Henry J. M. Ferguson, Beatriz Dieguez Fernandez, Andres Garcia Fernandez, Antonio J. Fernández, Borja Camacho Fernández-Pacheco, J. Edward Fitzgerald, Giovanni B. Fonsi, Roser Farré Font, Amy L. Fowler, Gregorio Di Franco, Kenneth R. Fretwell, Lorena Sanchon Fructuoso, Giuseppe K. Fusai, Miguel Hernandez Garcia, Miguel Angel Garcia-Ureña, Charn K. Gill, Suzanne S. Gisbertz, Roberto Del Giudice, Maria Carmela Giuffrida, Matteo Di Giuseppe, María Fanjul Gómez, Javier Serrano González, Ewen A. Griffiths, Claudio A. Guariglia, Alison J. Hainsworth, Bria J. Hall, James R. W. Hall, John S. Hammond, Maha H. Haqqani, Ewen M. Harrison, Joshua P. Hazelton, Maarten van Heinsbergen, Arnold D. K. Hill, Caroline B. Hing, Sameer A. Hirji, Michael W. S. Ho, Charlotte M. Holbrook, Thomas J. Holme, James C. Hopkins, David N. Hopkinson, Fahad S. Hossain, Victoria E. Hudson, Jane L. Hughes, E. Shelley Hwang, Mohamed A. H. Ibrahim, Simone M. Isolani, Pablo Galindo Jara, Michael D. Jenkinson, Hillary E. Jenny, Deva S. Jeyaretna, Robert P. Jones, Andrew P. Jones, Pascal K. C. Jonker, Maria L. Jönsson, Doireann P. Joyce, Kyle J. Kalkwarf, Sivesh K. Kamarajah, Mohamed El Kassas, Dara O. Kavanagh, James M. Keatley, Mohamed A. Khalefa, Jim S. Khan, Bilal H. Kirmani, Aaron P. Kisiel, Spyros Marinos Kouris, Mikolaj R. Kowal, Peter L. Labib, John O. Larkin, Johannes C. Lauscher, Wouter K. G. Leclercq, Frances S. J. Ledesma, André M. Leite-Moreira, Elaine Y. L. Leung, Sophia E. Lewis, Maria João Lima, Daniel J. Lin, Helen H. Liu, Aoife J. Lowery, Saida Martel Lozano, Catriona R. Luney, Mariana Magalhães Maia, Nicolò M. Mariani, Marco V. Marino, Angelo A. Marra, Christopher L. Marsh, Robert C. G. Martin, Simon J. McCluney, Robert C. McIntyre, Siobhan C. McKay, Kevin L. McKevitt, Ashley D. Meagher, Mohammad Q. Mehdi, Brian J. Mehigan, Melania Gonzalez-De Miguel, Maria-Carmen De Miguel-Ardevines, Carlos San Miguel-Mendez, Sarah J. Mills, Helen M. Mohan, John A. G. Moir, John R. T. Monson, Joana M. Monteiro, Maria T. Montella, Cristina Soto Montesinos, Marwa M. Morgom, Francisco S. Moura, Jose M. Muguerza, Suzanne H. Murphy, Paola De Nardi, David N. Naumann, Paul C. Neary, David T. A. Neely, Joshua S. Ng-Kamstra, Albert W. T. Ngu, Truong A. Nguyen, George E. Nita, Quentin M. Nunes, Rachel M. Nygaard, Lindsay B. O'Meara, John R. O'Neill, Barbara U. Okafor, Steven A. Olson, Aung Y. Oo, Pablo Collera Ormazabal, Alexander L. Osorio, Max J. Pachl, James T. Parry, Panna K. Patel, David Díaz Pérez, Carolina Martínez Pérez, Luis E. Pérez-Sánchez, Ana Nogues Pevidal, Anna P. Pezzuto, Matthew M. Philp, Thomas D. Pinkney, Joerg M. Pollok, Meical G. Povey, Alfredo Alonso Poza, Amarkumar D. Rajgor, Jagan N. Rao, Dimitri A. Raptis, Henry E. Rice, Paul F. Ridgway, Ana Munoz Rivas, Juan C. Rodriguez-Sanjuan, Luke J. Rogers, Anna Da Roit, Rebecca A. Rollett, Jose L. Romera, Siobhan M. Rooney, Vanessa I. Roxo, Bertrand Le Roy, Eduardo E. Rubio, Carolina Castro Ruiz, Manuel Losada Ruiz, Éanna J. Ryan, Abdel Rahman Saad, Samerah A. Saeed, Hiba A. Salama, Abdulrauf A. Salamah, María Gutiérrez Samaniego, Gianluca M. Sampietro, Diwakar R. Sarma, Kathryn B. Schaffer, Andreas A. Schnitzbauer, Rachel J. Scurrah, Olivia L. Serevina, Pedro A. Serralheiro, Joseph M. Sewards, Michael J. Shackcloth, Abigail V. Shaw, Andrea R. G. Sheel, Giuseppe S. Sica, Veronica De Simone, Aminder A. Singh, Rabindra P. Singh, Brendan L. Skelly, Henry G. Smith, Amir H. Sohail, Duncan R. Spalding, Laurie R. Springford, Anna E. Ssentongo, Pieter J. Steinkamp, Kent A. Stevens, Grant D. Stewart, Nicholas A. Stylianides, Tom B. B. Sullivan, Ahmed S. A. Taher, Muhammad S. Tamimy, Alethea M. Tang, Giovanni D. Tebala, Francisco J. Tejero-Pintor, Mohamed A. Thaha, Amy J. Thomas, Giorgio De Toma, Filippo La Torre, Antonio J. Torres, David N. Townshend, Isobel M. Trout, Sarah C. Tucker, Harmony K. Ubhi, Viviana A. Vega, George C. Velmahos, Catherine G. Velopulos, Yirupaiahgari K. S. Viswanath, Alfredo A. Vivas, Ryckie G. Wade, Martin S. Wadley, Joshua J. S. Wall, Andrew M. Walters, Oliver J. Warren, Chamindri K. Weerasinghe, Richard J. W. Wilkin, Katherine J. Williams, Stuart C. Winter, Justin C. R. Wormald, Franklin L. Wright, Souzana E. Xyda, Alastair L. Young, Mina M. G. Youssef, Farhat B. Yousuf, Hanan El Youzouri, Marco A. Zappa, Emmanuele Abate, Hossam Abdalaziz, Mostafa Abdelkarim, Hossam Abdou, Ahmad Aboelkassem-Ibrahim, Ala Abuown, Fernando Acebes-Garcia, Metesh Acharya, Michel Adamina, Emmanuel Addae-Boateng, Raiyyan Aftab, Arnav Agarwal, José Aguilar, Yousra Ahmed, Emma Aitken, Marwa Al-Azzawi, Somya Al-Embideen, Mahmoud Al-Masri, Hani Al-Najjar, Ahmad Al-Sukaini, Ruhina Alam, Derek Alderson, Zumrud Aliyeva, Firas Aljanadi, Murad Almasri, Paula Alonso-Ortuño, Fatih Altintoprak, Gamal Amira, Rabbia Amjad, Gabriele Anania, Tatjana Andabaka, Dimitrios Angelou, Seethalakshmi Annamalai, Valerio Annessi, James Anthoney, Sibtain Anwar, Mariyah Anwer, Juan Aragon-Chamizo, Antonella Ardito, Michele Arigoni, Teodora Armao, Armando Arminio, Lara Armstrong, Alexis Arnaud, Peter Asaad, James Ashcroft, Christopher Ashmore, Ahmad Asqalan, Emanuele Asti, Emmanuelle Aubry, Erman Aytac, Esther Ayuso-Herrera, Melody Baeza, Martin Bailon-Cuadrado, Bernarda Bakmaz, Caterina Baldi, Edoardo Baldini, Stefano Baldo, Michele Ballabio, Ioannis Baloyiannis, Gerard Baltazar, Fabrizio Bàmbina, Alessandro Bandiera, Emma Barlow, Roberto Barmasse, Christina Barmpagianni, Gianluca Baronio, Fabio Barra, Anne-Marie Bartsch, Amedra Basgaran, Amr Basha, Varvara Bashkirova, Marco Bastazza, Rachel Baumber, Elizabeth Belcher, Angela Belvedere, Inmaculada Benítez-Linero, Damien Bergeat, Matteo Bernasconi, Ashish Bhalla, Neal Bhutiani, Federica Bianco, Pietro Bisagni, Iain Blake, Ruth Blanco-Colino, Alma Blazquez-Martin, Matthew Boal, Luigi Bonavina, Giulia Bonavina, Giles Bond-Smith, Karen Booth, Filipe Borges, Felice Borghi, Konstantinos Bouchagier, Grainne Bourke, Emily Boyle, Gioia Brachini, Jessie Brain, Amanpreet Brar, Lisa Breckles, Frédéric Bretagnol, Genevieve Brixton, Placido Bruzzaniti, Teofila Bueser, Nathan Burnside, Albert Caballero, Enrique Calcerrada-Alises, Miriam Callahan, Enrique Camarero, Tommaso Campagnaro, Michela Campanelli, Massimo Candiani, Marina Cannoletta, Miguel Cantalejo-Diaz, Han Cao, Patrizio Capelli, Vita Capizzi, Giulio Carcano, Francesca Carissimi, Massimo Carlini, Michele Carlucci, Heather Carmichael, Milagros Carrasco, Mariana Carrillo, Michele Carvello, Massimiliano Casati, Carlo Castoro, Vanesa Catalan, Salomé Cavaleiro, Paola Cellerino, Giovanna Centinaio, Cristina Cernei, Cristina Cerro, Maurizio Cervellera, Sohini Chakrabortee, Stephanie Chamberlain, Jeffrey Chan, Grace Chang, Dauod Chaudhry, Alexandre Chebaro, David Chen, Govind Chetty, Zoe Chia, Ambra Chiappini, Massimo Chiarugi, Swathikan Chidambaram, Matteo Chiozza, Hanna Cholewa, Clara Chong, Ekta Choolani-Bhojwani, Dimitri Christoforidis, Karen Chui, Choyin Chung, Bruno Cirillo, Davide Citterio, Pauline Clermidi, Federico Coccolini, Gaia Colletti, Bruno Compagnoni, Vanesa Concepción-Martín, Marco Confalonieri, Hannah Connolly, Christel Conso, Luigi Conti, Zara Cooper, Carlo Corbellin, Fernando Cordera, Javier Corral, Marta Costa, Andrea Costanzi, Christian Cotsoglou, Valerio Cozza, Tamzin Cuming, Miles Curtis, Joseph Cuschieri, Michele D'Agruma, Giancarlo D'Andrea, Prita Daliya, Oliver Dare, Ebenezer Darko, Andrew Day, Ahmed Dehal, Dustin Dehart, Eduardo Delgado-Oliver, Max Denning, Anant Desai, Liesbeth Desender, Sara Dester, Alberto Díaz-García, Patricia Diaz-Peña, Bertrand Dousset, Alexandre Doussot, Nicolas Duchateau, Sarah Duff, Joel Dunning, Victoria Duque-Mallen, Jana Dziakova, Bridget Egan, Richard Egan, Abess El-Ali, Hossam Elfeki, Muhammed Elhadi, Mohammed Eljareh, Hannah Elkadi, Ramy Elkady, Fatimah Elkhafeefi, Ugo Elmore, Tarek Elmoslemany, Oliver Emmerson, Ibrahim Enemosah, Camilla English, William English, Simon Ereidge, Jorge Escartin, Mercedes Estaire-Gomez, Luke Evans, Jessica Evans, Rebecca Exley, Nicoló Fabbri, Giuseppe Falco, Pietro Familiari, Alessandro Fancellu, Shebani Farik, Tony Farrell, Matyas Fehervari, Adam Fell, Angel Fernandez-Camuñas, Reyes Fernández-Marín, María Fernández-Martínez, Francesco Ferrara, Guglielmo Ferrari, Simone Ferrero, Laura Findlay, Marco Fiore, Enrico Fiori, Michael Flatman, Ian Flindall, Blas Flor, Tommaso Fontana, Samuel Ford, David Ford, Stefano Forlani, Elisa Francone, Colomba Frattaruolo, Federico Frio, Annalisa Gagliano, Filippo Gagliardi, Sukhpreet Gahunia, Francesca Gaino, Tanzeela Gala, Elisa Galfrascoli, Luca Galimberti, Phoebe Gallagher, Raffaele Galleano, Armando Galván-Pérez, Emanuele Gammeri, Mario Ganau, Raúl Garcés-García, Gianluca Garulli, Isabel Gascon-Ferrer, Andrea Gattolin, Sebastien Gaujoux, Sergio Gentilli, Fanourios Georgiades, Amir Ghanbari, Dhruv Ghosh, Marco Giacometti, Anna-Victoria Giblin, Catherine Gilbert, Clara Giménez, Emmanouil Giorgakis, Manuel Gipponi, Paul Glen, Giles Goatly, Davide Gobatti, Chintamani Godbole, Kajal Gohil, Marcos Gómez, Juan-Carlos Gomez-Rosado, Emre Gonullu, Enrique Gonzalez-Gonzalez, Luca Gordini, Isabel Gracia, Carlos Gracia-Roche, Stefano Granieri, Susanna Green, Manuela Grivon, Thomas Grove, Marcello Guaglio, Eleonora Guaitoli, Alfredo Guglielmi, Soumya Guha, Claudio Gustavino, Amir Habeeb, Robert Hagger, Hazim Hakmi, Constantine Halkias, Claire Hall, Matthew Hampton, Siddhartha Handa, Laura Hansen, Iram Haq, Amer Harky, Rhiannon Harries, Joseph Harrison, Raashad Hasan, Mohammad Hawari, Paul Hawkin, Bethany Hebblethwaite, Susana Henriques, Emily Heritage, Pilar Hernandez-Juara, Maria Herrero-Lopez, Erik Hervieux, Bruno Heyd, Simon Higgs, Louise Hitchman, Beatrice Ho, Aisling Hogan, Frank Hölzle, Tanvir Hossain, Roy Houston, Libor Hurt, Peter Hutchinson, Giulio Iacob, Immacolata Iannone, Sherif Ibrahim, Domenico Iovino, Arda Isik, Sevda Jafarova, Tahir Jamil, Ullas Jayaraju, Edward Jenner, Elisa Jimenez-Higuera, Jaime Jimeno, Jack Johnstone, Mark Jones, Nicholas Judkins, Nicholas Kalavrezos, Venugopala Kalidindi, Maninder Kalkat, Mona Kamal, Carsten Kamphues, Chong Kang, Yasin Kara, Edward Karam, Ahmed Karim, Florence Kashora, David Kearney, Apoorva Khajuria, Umul Khan, Azam Khan, Chetan Khatri, Gabriel Kinnaman, James Kinross, Aaron Kler, Serafeim Klimopoulos, Ali Kocataş, Angelos Kolias, Alfred Königsrainer, Joop Konsten, Christos Kontovounisios, Amar Kourdouli, Emily Krishnan, Sverrir Kristinsson, Schelto Kruijff, Søren Kudsk-Iversen, Dorothy Kufeji, Nadav Kugler, Rugved Kulkarni, Hayato Kurihara, Letizia Laface, Zaher Lakkis, Mariam Lami, Aitor Landaluce-Olavarria, Pierfrancesco Lapolla, Ismail Lawani, Samuel Lawday, André Lázaro, Katia Lecolle, Sezai Leventoglu, Zoe Li, Ignatius Liew, Giorgio Lisi, Vincenzo Lizzi, Terence Lo, Daniele Lomiento, Marco Longhi, Emilie Lostis, Eftychios Lostoridis, Mahmoud Loubani, Alejandro Lowy-Benoliel, Alessandro Lucianetti, Louis Luke, Raimundas Lunevicius, Marco Luraghi, George Lye, Islam Mabrouk, Alberto Macchi, Luisa MacDonald, Nikolaos Machairas, Marco Madonini, Drew Magowan, Emeline Maisonneuve, Agata Majkowska, Lawrence Majkowski, Jason Mak, Stefano Malabarba, Michele Malerba, Syed Mannan, Joanna Manson, Ahmer Mansuri, Baris Mantoglu, Nichola Manu, Afnan Maqsood, Alessandra Marano, Adrian Marchbank, Pablo Marcos-Santos, Enrico Marrano, Janet Martin, Emmeline Martin, Guy Martin, Lorena Martin-Albo, Lorena Martín-Román, Fabio Martinelli, Fernando Martínez-dePaz, Antonio Martinez-German, Carlos Martinez-Pinedo, Ricardo Martins, Hisham Marwan, Federica Marzi, Olga Mateos-Sierra, Pierre Mathieu, Maria-Soledad Matute-Najarro, Andrew Maw, Dennis Mazingi, Vincenzo Mazzaferro, Andrew McCanny, Katherine McKenzie, Nicola McLarty, Iain McPherson, Esther Medina, Saniya Mediratta, Marzia Medone, Gautam Mehra, Simone Mele, Lidia Melero-Cortés, Fernando Mendoza-Moreno, Simona Meneghini, Giuseppe Mercante, Aude Merdrignac, Stephen Merola, Symeon Metallidis, Martin Michel, Marco Migliore, Jakov Mihanovic, Douglas Miller, Andrea Mingoli, Gary Minto, Antonello Mirabella, Nikhil Misra, Stefan Mitrasinovic, Victor Miu, Nader Moawad, Sylvie Mochet, Ali Modabber, Adam Mohammad, Midhun Mohan, Carmen Moliner-Sánchez, Francesco Mongelli, Michela Monteleone, Mauro Montuori, Rachel Moore, Ismael Mora-Guzmán, Xavier Morales, Dieter Morales, Luca Morelli, Lucia Morelli, Richard Morgan, Chris Morris, Pietro Mortini, Angelo Mosca, Dema Motter, Susan Moug, Samrat Mukherjee, Manhal Najdy, Apostolos Nakas, Ilgar Namazov, Pradyumna Naredla, Emmhamed Nasef, Heeam Nassa, Rahul Nath, Antonio Navarro-Sánchez, Scarlet Nazarian, Giampiero Negri, Deepika Nehra, Jason Neil-Dwyer, Jacopo Neri, Katy Newton, Herald Nikaj, Milagros Niquen, Sara Nobile, Jorge Nogueiro, Faustin Ntirenganya, Michael Nugent, Jordi Núñez, Juan Ocaña, Valentine Okechukwu, Fernando Oliva-Mompean, Ana Oliveira, Didier Ollat, Lavinia Onos, Liza Osagie-Clouard, Khabab Osman, Jessica Ottolina, Jared Ourieff, Oumaima Outani, Bankole Oyewole, Volkan Ozben, David Pacheco-Sanchez, David Padilla-Valverde, Madhava Pai, Salvatore Paiella, Samuel Paisley, Gianmarco Palini, Matteo Palmeri, Pedram Panahi, Alessandro Parente, Daniele Parlanti, Chetan Parmar, Angela Pascual, Mahul Patel, Abhijit Pathak, Sangram Patil, Piet Pattyn, Adam Peckham-Cooper, Corrado Pedrazzani, Gianluca Pellino, Chiara Peluso, André Pereira, António Pereira-Neves, M. D. Perez-Diaz, Marta Pérez-González, Baltasar Pérez-Saborido, Konstantinos Perivoliotis, Clare Perkins, Georgios Peros, Ornella Perotto, Teresa Perra, Patrizio Petrone, George Phenix, Sara Picazo, Rafael Picon-Rodriguez, Martina Piloni, Lorena Pingarrón-Martín, Enrico Pinotti, Adolfo Pisanu, Paolo Pizzini, Peter Pockney, Mauro Podda, Dina Podolsky, Gilberto Poggioli, Cecilia Pompili, Michael Pontari, Alberto Porcu, Ryan Potter, Claire Price, François-René Pruvot, Roger Pujol-Muncunill, Andrea Puppo, Markus Quante, Begoña Quintana-Villamandos, Ali Qureshi, Dejan Radenkovic, Ivan Rakvin, Irene Ramallo-Solís, Sean Ramcharan, Diego Ramos, Antonio Ramos-Bonilla, Joussi Ramzi, Sridhar Rathinam, Emanuele Rausa, Matteo Ravaioli, Sharanya Ravindran, Thomas Raymond, Aisha Razik, Jennifer Redfern, Julio Reguera-Rosal, Mariam Rela, Juan Rey-Biel, Cristina Rey-Valcarcel, Marta Ribolla, Tomos Richards, Michael Richmond, Erminio Righini, Javier Rio-Gomez, Harjoat Riyat, Sana Rizvi, Keith Roberts, Matthew Roberts, Stuart Robertson, Ronald Robertson, Alvaro Robin-Valle, Melissa Rochon, Mikel Rojo, Luigi Rolli, Silvio Romano, Elizabeth Ross, Howard Ross, Catherine Rossborough, Matteo Rottoli, Miguel Ruiz, Fernando Ruiz-Grande, Irene Ruiz-Martin, María Ruiz-Soriano, Andrea Ruzzenente, Ondrej Ryska, Carlos Saez, Andrea Sagnotta, Kapil Sahnan, Arun Sahni, Ali Salim, Ibrahim Sallam, Roberto Salvia, Elgun Samadov, Giuseppe Sammarco, Mafalda Sampaio-Alves, Alejandro Sánchez-Arteaga, Maria-Nieves Sanchez-Fuentes, Daniel Sanchez-Pelaez, Coral Sanchez-Perez, Maria Sanchez-Rubio, Jorge Sancho-Muriel, Julie Sanders, Maria-Pilar Santero-Ramirez, Thomas Santora, Antonio Santoro, Irene Santos, Hugo Santos-Sousa, Paolo Sapienza, Lodovico Sartarelli, Janahan Sarveswaran, Diego Sasia, Alain Saudemont, Sef Saudi-Moro, Shobhit Saxena, Dolly Saxena, Ahmad Sayasneh, Aurelien Scalabre, Andrew Schache, Riccardo Schiavina, Christian Schineis, Teresa Schreckenbach, Antonella Scorza, Lucy Scott, Sara Seegert, Agathe Seguin-Givelet, Ana Senent-Boza, Keith Seymour, Amanda Shabana, Karishma Shah, Jigar Shah, Preena Shah, Sujay Shah, Taner Shakir, Mostafa Shalaby, Sushma Shankar, Richard Shaw, Sameh Shehata, Amy Shenfine, Kelda Sheridan, Ahmed Sherief, Mohamed Sherief, Mohamed Sherif, Michael Shinkwin, Sebastian Shu, Kwabena Siaw-Acheampong, Pierpaolo Sileri, Abhinav Singh, Shailendra Singh, Sanjay Sinha, Deepti Sinha, Leandro Siragusa, Rajesh Sivaprakasam, Sriharan Sivayoganathan, Robert Smillie, Claire Smith, Andrew Smith, Christopher Smith, Dana Sochorova, Fiammetta Soggiu, Catrin Sohrabi, Catrin Sohrabi, Catrin Sohrabi, Francesca Solari, Piergiorgio Solli, Kjetil Soreide, Antonino Spinelli, Domenico Spoletini, Giuseppe Spriano, Sanskrithi Sravanam, Paddy Ssentongo, Sophie Stanger, Dionisios Stavroulias, Ben Steel, Marco Stella, Robbie Stewart, Sally Stringer, Nina Sulen, Sudha Sundar, Matthew Sundhu, Avni Suri, Arooj Syed, Peter Szatmary, Stephen Tabiri, Daniel Tadross, Lucio Taglietti, Rosamond Tansey, Dario Tartaglia, Ahmed Tawheed, Salim Tayeh, Tobias Teles, Valentina Testa, Nilanjana Tewari, Philipp Thoenissen, Kane Thomas, Anne Thomin, Jessica Thrush, Sean Tierney, Abhinav Tiwari, Simon Toh, Enrique Toledo, Valeria Tonini, Jared Torkington, Alfonso Torquati, Guido Torzilli, Joshua Totty, Paraskevi Tourountzi, Manuel Tousidonis, Philip Townend, Catherine Townsend, Alex Trompeter, Francesco Trotta, Stéphanie Truant, Jeancarlos Trujillo-Díaz, Georgios Tsoulfas, Celia Turco, Victor Turrado-Rodriguez, Giulia Turri, Harry Tustin, Jayne Tyler, Stylianos Tzedakis, George Tzovaras, Martine Uittenbogaart, Ramzan Ullah, Shane Urban, Alessia Urbani, Antonella Usai, Gianpaolo Vaccarella, Javier Valdes-Hernandez, Luca Valsecchi, Rajiv Vashisht, Andrea Vázquez-Fernández, Gowtham Venkatesan, Mary Venn, Cristina Vera-Mansilla, Roberto Vergari, Giuseppina Vescio, Raghavan Vidya, Paula Vieira, Vardhini Vijay, Dale Vimalachandran, Tommaso Violante, Anita Volpe, Fernanda Vovola, Paul Vulliamy, Rosemary Wall, Kate Wallwork, Alex Ward, David Warwick, Saima Waseem, Helen Weaver, Fiona Wells, Jiaxin Wen, Raha West, Emma Whitehall, Laura Wild, Alex Wilkins, Gethin Williams, Matthew Williams, Philipp Winnand, Ken Wong, Dawit Worku, Naomi Wright, Seema Yalamanchili, Danylo Yershov, Alp Yildiz, Richard Young, Can Yurttas, Frederic Zadegan, Noman Zafar, Rasheed Zakaria, Martina Zambon, Nicola Zanini, Alba Zarate, Philippe Zerbib, Maurizio Zizzo, Oded Zmora, Sandro Zonta, Mark I. van Berge Henegouwen, Willemijn Y. van der Plas, Inthekab Ali Mohamed Ali, Nur Amalina Che Bakri, Miguel Ángel Hernández Bartolomé, Juan Carlos Catalá Bauset, Mohamad K. Abou Chaar, Luigi M. P. Marino Cosentino, Carlos J. Gómez Díaz, Jose L. Garcia Galocha, Charles A. de Gheldere, Gustavo Mendonça Ataíde Gomes, Juan Beltrán de Heredia, Dan G. Blazer, III, William C. Nugent, III, Ali A. Ali karar, F. Borja De Lacy, Juan luis Blas Laina, Madan Jha Shane Lester, Aloka S. D. Liyanage, Faraj S. Al Maadany, Joshua A. De Marchi, Antonio Ramos-De la Medina, Reda H. M. Mithany, Cristina Sanchez del Pueblo, Gabrielle H. van Ramshorst, Maria Marqueta De Salas, Anthony C. De Souza, and M. Dolores Del Toro.
2019-nCoV
Clinical Care
Coronavirus
COVID-19
R-Res&Pub
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
von Weyhern, Claus Hann, Ines Kaufmann, Frauke Neff, and Marcus Kremer. 2020. "Early evidence of pronounced brain involvement in fatal COVID-19 outcomes." The Lancet.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31282-4/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31282-4/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Early evidence of pronounced brain involvement in fatal COVID-19 outcomes
Subject
The topic of the resource
Research
Description
An account of the resource
The first cases of COVID-19 in Germany were confirmed in the greater Munich area and isolated in our hospital. Subsequently, more than 690 patients were admitted for inpatient care, 103 of whom were transferred to the intensive care unit (ICU). 63 patients died in hospital. 587 patients recovered and were discharged.
Creator
An entity primarily responsible for making the resource
von Weyhern, Claus Hann, Ines Kaufmann, Frauke Neff, and Marcus Kremer.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-04
Type
The nature or genre of the resource
Publication
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Outcomes
R-Res&Pub
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Tabata, Sakiko, Kazuo Imai, Shuichi Kawano, Mayu Ikeda, Tatsuya Kodama, Kazuyasu Miyoshi, Hirofumi Obinata, Satoshi Mimura, Tsutomu Kodera, Manabu Kitagaki, Michiya Sato, Satoshi Suzuki, Toshimitsu Ito, Yasuhide Uwabe, and Kaku Tamura. 2020. "Clinical characteristics of COVID-19 in 104 people with SARS-CoV-2 infection on the Diamond Princess cruise ship: a retrospective analysis." The Lancet Infectious Diseases.
Abstract
<div class="section-paragraph">
<h3>Background</h3>
<div class="section-paragraph">The ongoing COVID-19 pandemic is a global threat. Identification of markers for symptom onset and disease progression is a pressing issue. We described the clinical features of people infected on board the <em>Diamond Princess</em> cruise ship who were diagnosed with asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or mild or severe COVID-19, on admission to the Self-Defense Forces Central Hospital (Tokyo, Japan) and at the end of observation.</div>
<h3>Methods</h3>
<div class="section-paragraph">This retrospective, single-centre study included participants with laboratory-detected SARS-CoV-2 infection who were admitted to the Self-Defense Forces Central Hospital from Feb 11 to Feb 25, 2020. Clinical records, laboratory data, and radiological findings were analysed. Clinical outcomes were followed up until discharge or Feb 26, 2020, whichever came first. We defined asymptomatic infection as SARS-CoV-2 infection with no history of clinical signs and symptoms, severe COVID-19 as clinical symptoms of pneumonia (dyspnoea, tachypnoea, peripheral capillary oxygen saturation <93%, and need for oxygen therapy), and mild COVID-19 as all other symptoms. Clinical features on admission were compared among patients with different disease severity, including asymptomatic infection, at the end of observation. We used univariable analysis to identify factors associated with symptomatic illness among asymptomatic people infected with SARS-CoV-2 and disease progression in patients with COVID-19.</div>
<h3>Findings</h3>
<div class="section-paragraph">Among the 104 participants included in the final analysis, the median age was 68 years (IQR 47–75) and 54 (52%) were male. On admission, 43 (41%) participants were classified as asymptomatic, 41 (39%) as having mild COVID-10, and 20 (19%) as having severe COVID-19. At the end of observation, 33 (32%) participants were confirmed as being asymptomatic, 43 (41%) as having mild COVID-19, and 28 (27%) as having severe COVID-19. Serum lactate hydrogenase concentrations were significantly higher in the ten participants who were asymptomatic on admission but developed symptomatic COVID-19 compared with the 33 participants who remained asymptomatic throughout the observation period (five [50%] <em>vs</em> four [12%] participants; odds ratio 7·25, 95% CI 1·43–36·70; p=0·020). Compared with patients with mild disease at the end of observation, patients with severe COVID-19 were older (median age 73 years [IQR 55–77] <em>vs</em> 60 years [40–71]; p=0·028) and had more frequent consolidation on chest CT (13 [46%] of 28 <em>vs</em> nine [21%] of 43; p=0·035) and lymphopenia (16 [57%] <em>vs</em> ten [23%]; p=0·0055) on admission.</div>
<h3>Interpretation</h3>
<div class="section-paragraph">Older age, consolidation on chest CT images, and lymphopenia might be risk factors for disease progression of COVID-19 and contribute to improved clinical management.</div>
<h3>Funding</h3>
<div class="section-paragraph">None.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30482-5/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30482-5/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Clinical characteristics of COVID-19 in 104 people with SARS-CoV-2 infection on the Diamond Princess cruise ship: a retrospective analysis
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
The ongoing COVID-19 pandemic is a global threat. Identification of markers for symptom onset and disease progression is a pressing issue. We described the clinical features of people infected on board the Diamond Princess cruise ship who were diagnosed with asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection or mild or severe COVID-19, on admission to the Self-Defense Forces Central Hospital (Tokyo, Japan) and at the end of observation.
Creator
An entity primarily responsible for making the resource
Tabata, Sakiko, Kazuo Imai, Shuichi Kawano, Mayu Ikeda, Tatsuya Kodama, Kazuyasu Miyoshi, Hirofumi Obinata, Satoshi Mimura, Tsutomu Kodera, Manabu Kitagaki, Michiya Sato, Satoshi Suzuki, Toshimitsu Ito, Yasuhide Uwabe, and Kaku Tamura.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-12
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2024-03-28 by J. Mundy – Treatment & Care group review 2023 (Q2) skipped – bumping to 2024 (Q2)
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Clinical Care
Coronavirus
COVID-19
R-Res&Pub
R-T&C
-
https://repository.netecweb.org/files/original/cdbe98a98cd13ba8f3f86d1bf901b394.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Feldstein, Leora R., Erica B. Rose, Steven M. Horwitz, Jennifer P. Collins, Margaret M. Newhams, Mary Beth F. Son, Jane W. Newburger, Lawrence C. Kleinman, Sabrina M. Heidemann, Amarilis A. Martin, Aalok R. Singh, Simon Li, Keiko M. Tarquinio, Preeti Jaggi, Matthew E. Oster, Sheemon P. Zackai, Jennifer Gillen, Adam J. Ratner, Rowan F. Walsh, Julie C. Fitzgerald, Michael A. Keenaghan, Hussam Alharash, Sule Doymaz, Katharine N. Clouser, John S. Giuliano, Anjali Gupta, Robert M. Parker, Aline B. Maddux, Vinod Havalad, Stacy Ramsingh, Hulya Bukulmez, Tamara T. Bradford, Lincoln S. Smith, Mark W. Tenforde, Christopher L. Carroll, Becky J. Riggs, Shira J. Gertz, Ariel Daube, Amanda Lansell, Alvaro Coronado Munoz, Charlotte V. Hobbs, Kimberly L. Marohn, Natasha B. Halasa, Manish M. Patel, and Adrienne G. Randolph. 2020. "Multisystem Inflammatory Syndrome in U.S. Children and Adolescents." New England Journal of Medicine.
Abstract
<h2 class="a-article-h2 f-h12">Background</h2>
<p class="f-body">Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome.</p>
<h2 class="a-article-h2 f-h12">Methods</h2>
<p class="f-body">We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms.</p>
<h2 class="a-article-h2 f-h12">Results</h2>
<p class="f-body">We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki’s disease–like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%).</p>
<h2 class="a-article-h2 f-h12">Conclusions</h2>
<p class="f-body">Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents. (Funded by the Centers for Disease Control and Prevention.)</p>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on NEJM
URL
https://www.nejm.org/doi/full/10.1056/NEJMoa2021680
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMoa2021680
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Multisystem Inflammatory Syndrome in U.S. Children and Adolescents
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome.
Creator
An entity primarily responsible for making the resource
Feldstein, Leora R., Erica B. Rose, Steven M. Horwitz, Jennifer P. Collins, Margaret M. Newhams, Mary Beth F. Son, Jane W. Newburger, Lawrence C. Kleinman, Sabrina M. Heidemann, Amarilis A. Martin, Aalok R. Singh, Simon Li, Keiko M. Tarquinio, Preeti Jaggi, Matthew E. Oster, Sheemon P. Zackai, Jennifer Gillen, Adam J. Ratner, Rowan F. Walsh, Julie C. Fitzgerald, Michael A. Keenaghan, Hussam Alharash, Sule Doymaz, Katharine N. Clouser, John S. Giuliano, Anjali Gupta, Robert M. Parker, Aline B. Maddux, Vinod Havalad, Stacy Ramsingh, Hulya Bukulmez, Tamara T. Bradford, Lincoln S. Smith, Mark W. Tenforde, Christopher L. Carroll, Becky J. Riggs, Shira J. Gertz, Ariel Daube, Amanda Lansell, Alvaro Coronado Munoz, Charlotte V. Hobbs, Kimberly L. Marohn, Natasha B. Halasa, Manish M. Patel, and Adrienne G. Randolph.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-29
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-04-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2022-07 by Andi, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - note "New asset to replace"
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Not updated
Pediatrics
R-SP
R-T&C
-
https://repository.netecweb.org/files/original/b0ac0ade688107db764f45823b5be06e.png
30d15b8d8679ca020a427e17f7871c8f
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Exercise
Exercise templates for training and education.
URL
https://www.cdc.gov/coronavirus/2019-ncov/hcp/training.html
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Training for Healthcare Professionals: Coronavirus Disease 2019 (COVID-19)
Subject
The topic of the resource
Training and Exercises
Description
An account of the resource
Training materials on: Clinical Care & Infection Control, Personal Protective Equipment (PPE), Nonpharmaceutical Interventions (NPIs), Emergency Preparedness and Response, and Additional Topics.
Creator
An entity primarily responsible for making the resource
CDC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-06-26
Contributor
An entity responsible for making contributions to the resource
2022-01-19 by Beth Beam
2023-03-30 by Jill Morgan - General Asset Review
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-03-30
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Emergency Management
Exercises and Drills
Infection Prevention and Control
Personal Protective Equipment (PPE)
R-PPE
Therapeutics
Training
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Reisinger, Alexander C., Gernot Schilcher, Juergen Prattes, Ines Zollner-Schwetz, and Philipp Eller. 2020. "Acute respiratory distress syndrome during a pandemic—an obvious diagnosis?" The Lancet Infectious Diseases 20 (7):873.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30468-0/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30468-0/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Acute respiratory distress syndrome during a pandemic—an obvious diagnosis?
Subject
The topic of the resource
Intake and Internal Transport
Description
An account of the resource
A man aged 28 years was admitted to hospital with fever and headache in April, 2020. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR testing from an oropharyngeal swab was negative, and he was discharged from hospital and sent home the next day. 8 days later, he presented again with dry cough and severe respiratory distress.
Creator
An entity primarily responsible for making the resource
Reisinger, Alexander C., Gernot Schilcher, Juergen Prattes, Ines Zollner-Schwetz, and Philipp Eller.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2024-03-27 IIT - haven't gotten back first review - bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-06-27
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Laboratory Testing
R-IIT
R-Res&Pub
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Kirschenbaum, Daniel, Lukas L. Imbach, Silvia Ulrich, Elisabeth J. Rushing, Emanuela Keller, Regina R. Reimann, Katrin B. M. Frauenknecht, Mona Lichtblau, Martin Witt, Thomas Hummel, Peter Steiger, Adriano Aguzzi, and Karl Frontzek. 2020. "Inflammatory olfactory neuropathy in two patients with COVID-19." The Lancet.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31525-7/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31525-7/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Inflammatory olfactory neuropathy in two patients with COVID-19
Subject
The topic of the resource
Research
Description
An account of the resource
We report two cases of olfactory neuropathy diagnosed at autopsy in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. One patient experienced anosmia. Information about anosmia was not available in the other patient.
Creator
An entity primarily responsible for making the resource
Kirschenbaum, Daniel, Lukas L. Imbach, Silvia Ulrich, Elisabeth J. Rushing, Emanuela Keller, Regina R. Reimann, Katrin B. M. Frauenknecht, Mona Lichtblau, Martin Witt, Thomas Hummel, Peter Steiger, Adriano Aguzzi, and Karl Frontzek.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-10
Type
The nature or genre of the resource
Publication
2019-nCoV
Clinical Care
Coronavirus
COVID-19
R-Res&Pub
-
https://repository.netecweb.org/files/original/ab9cbf9f8a30cbab7c468b9d24a4530d.png
71e4faf666f87142cbf181d942268d24
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Shaigany, Sheila, Marlis Gnirke, Allison Guttmann, Hong Chong, Shane Meehan, Vanessa Raabe, Eddie Louie, Bruce Solitar, and Alisa Femia. 2020. "An adult with Kawasaki-like multisystem inflammatory syndrome associated with COVID-19." The Lancet.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31526-9/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31526-9/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
An adult with Kawasaki-like multisystem inflammatory syndrome associated with COVID-19
Subject
The topic of the resource
Research
Description
An account of the resource
Multisystem inflammatory syndrome in children (MIS-C) is a newly described condition associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure that is reminiscent of both Kawasaki disease and toxic shock syndrome.
Creator
An entity primarily responsible for making the resource
Shaigany, Sheila, Marlis Gnirke, Allison Guttmann, Hong Chong, Shane Meehan, Vanessa Raabe, Eddie Louie, Bruce Solitar, and Alisa Femia.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-10
Type
The nature or genre of the resource
Publication
2019-nCoV
Clinical Care
Coronavirus
COVID-19
R-Res&Pub
-
https://repository.netecweb.org/files/original/9045bffdeda798e7cba0011c61e28913.png
71e4faf666f87142cbf181d942268d24
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Bradley, Benjamin T., Heather Maioli, Robert Johnston, Irfan Chaudhry, Susan L. Fink, Haodong Xu, Behzad Najafian, Gail Deutsch, J. Matthew Lacy, Timothy Williams, Nicole Yarid, and Desiree A. Marshall. 2020. "Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series." The Lancet.
Abstract
<div class="section-paragraph">
<h3>Background</h3>
<div class="section-paragraph">Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of an ongoing pandemic, with increasing deaths worldwide. To date, documentation of the histopathological features in fatal cases of the disease caused by SARS-CoV-2 (COVID-19) has been scarce due to sparse autopsy performance and incomplete organ sampling. We aimed to provide a clinicopathological report of severe COVID-19 cases by documenting histopathological changes and evidence of SARS-CoV-2 tissue tropism.</div>
<h3>Methods</h3>
<div class="section-paragraph">In this case series, patients with a positive antemortem or post-mortem SARS-CoV-2 result were considered eligible for enrolment. Post-mortem examinations were done on 14 people who died with COVID-19 at the King County Medical Examiner's Office (Seattle, WA, USA) and Snohomish County Medical Examiner's Office (Everett, WA, USA) in negative-pressure isolation suites during February and March, 2020. Clinical and laboratory data were reviewed. Tissue examination was done by light microscopy, immunohistochemistry, electron microscopy, and quantitative RT-PCR.</div>
<h3>Findings</h3>
<div class="section-paragraph">The median age of our cohort was 73·5 years (range 42–84; IQR 67·5–77·25). All patients had clinically significant comorbidities, the most common being hypertension, chronic kidney disease, obstructive sleep apnoea, and metabolic disease including diabetes and obesity. The major pulmonary finding was diffuse alveolar damage in the acute or organising phases, with five patients showing focal pulmonary microthrombi. Coronavirus-like particles were detected in the respiratory system, kidney, and gastrointestinal tract. Lymphocytic myocarditis was observed in one patient with viral RNA detected in the tissue.</div>
<h3>Interpretation</h3>
<div class="section-paragraph">The primary pathology observed in our cohort was diffuse alveolar damage, with virus located in the pneumocytes and tracheal epithelium. Microthrombi, where observed, were scarce and endotheliitis was not identified. Although other non-pulmonary organs showed susceptibility to infection, their contribution to the pathogenesis of SARS-CoV-2 infection requires further examination.</div>
<h3>Funding</h3>
<div class="section-paragraph">None.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31305-2/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31305-2/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Histopathology and ultrastructural findings of fatal COVID-19 infections in Washington State: a case series
Subject
The topic of the resource
Research
Description
An account of the resource
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of an ongoing pandemic, with increasing deaths worldwide. To date, documentation of the histopathological features in fatal cases of the disease caused by SARS-CoV-2 (COVID-19) has been scarce due to sparse autopsy performance and incomplete organ sampling.
Creator
An entity primarily responsible for making the resource
Bradley, Benjamin T., Heather Maioli, Robert Johnston, Irfan Chaudhry, Susan L. Fink, Haodong Xu, Behzad Najafian, Gail Deutsch, J. Matthew Lacy, Timothy Williams, Nicole Yarid, and Desiree A. Marshall.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-16
Type
The nature or genre of the resource
Publication
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Outcomes
R-Res&Pub
-
https://repository.netecweb.org/files/original/1220661bf117f7c223ff49df98bbc921.pdf
75ade442f49334997035e9250c660063
PDF Text
Text
NETEC COVID-19 Webinar Series:
Approach to Anticoagulation in COVID-19:
Evidence and Practice Patterns
�Content Outline (TOC)
Welcome
Trish Tennill, RN, BSN
�Overview
Welcome: Trish Tennill, RN, BSN
COVID-19 Coagulopathy:
Manila Gaddh, MD
Anticoagulation Evidence in COVID-19: Deepak Pradhan, MD, FCCP
Institutional Protocols: Vikram Mukherjee, MD
NETEC Resources: Trish Tennill, RN, BSN
Questions and Answers with NETEC
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
COVID-19 Coagulopathy
Manila Gaddh, MD
�COVID-19 Coagulopathy
COVID-19 Coagulopathy
Mild Thrombocytopenia
Mild elevation of Prothrombin Time
Elevated fibrinogen
Elevated D-dimer
Increased risk of thrombosis
Overt disseminated intravascular coagulopathy
(DIC), with hyperfibrinolytic/bleeding phenotype
is rare and develops in late stages of the disease
N Tang et al. JTH 2020; 18(4): 844-847
H. Fogarty et al. Br J Haem. 2020; 189(6): 1044-1049
Panigada M et al. JTH 2020. https://doi.org/10.1111/jth
�COVID-19 and Thrombotic Disease
r
B. Bikdeli et al. J Am Coll Card. 2020; 75: 2950-73
�COVID-19 Coagulopathy
Burden of Thrombosis
STUDY,
COUNTRY
DESIGN
POPULATIO
N
N
TPX
SCREENIN VTE RATE
G
Cui, China
Retrospective
ICU
81
No
No
25%
Helms, France
Prospective
ICU
150
Yes
No
16.7%* vs 2.1%
Klok, The
Netherlands
Retrospective
ICU
184
Yes
No
31%
Llitjos, France
Retrospective
ICU
26
Yes
Yes
69%
Lodigiani, Italy
Retrospective
Inpatient
388
Yes
No
21%
Poissy, France
Retrospective
ICU
107
Yes
No
20.6%* vs 6.1%
Thomas, United
Kingdom
Retrospective
ICU
63
Yes
No
29%
*Pulmonary Embolism only
�Autopsy Evidence
D.Wichmann et.al, Germany
Prospective Study
Alveolar
damage
Compare clinical findings with data
from autopsy
Organizing
microthrombus
B
r
Results
7/12 patients had unsuspected bilateral DVT
4/7 died from PE
6/9 men had fresh thrombi in
prostatic venous plexus
250 µm
D. Wichmann et al. Ann Int Med doi.10.7326/ M20-2003, L. Carsana et al. The Lancet infect dis. 2020
�Laboratory Predictors of Thrombosis
Marker
(Median)
D-dimer
•
•
•
Initial
Minimum
Peak
Fibrinogen
•
•
•
Initial
Minimum
Peak
C-Reactive Protein
•
•
•
Initial
Minimum
Peak
ESR
• Initial
• Mimum
• Peak
Ferritin
•
•
•
Initial
Minimum
Peak
No thrombotic/
bleeding complication
(n=347)
Thrombotic
complication
(n=38)
891
760
1377
1538
1336
4001
.0002
.0006
<.0001
579
549
662
696
669
828
.0045
.0028
.0001
63.3
35.4
130.3
124.7
94.2
277.7
.0011
<.0001
<.0001
38
36
56
47
43
91
.020
.079
.0077
504
453
707
825
750
1182
.015
.0056
.0020
r
P value
H. Al-Samkari et al. Blood 2020; 136(4): 489-500
�COVID-19 Coagulopathy
Thromboinflammation
Jackson SP et al. Blood 2019; 133:906-18
�COVID-19 Coagulopathy
Muscular Thrombotic & Inflammatory Response
Jackson SP et al. Blood 2019; 133:906-18
�COVID-19 Coagulopathy
Endotheliitis
Postulated to be a central feature of pathophysiology
SARS CoV-2 binds to host cells via the ACE-2 receptor
High density of ACE 2 receptors on endothelial cells
Endotheliitis and viral inclusions in endothelial cells have
been reported in COVID-19 autopsy series
M Ackermann et al. NEJM 2020
Z Varga et al. Lancet 2020; 395:1417-18
�Endotheliopathy in COVID-19-associated Coagulopathy
G Goshua et al:
• Single center study studied
markers of endothelial cell
and platelet activation
r
• Higher levels associated with
more severe disease ( ICU
admission) and mortality
G Goshua et al. Lancet haematology 2020;7:e575-82
�COVID-19 Coagulopathy
Immune Response and Thrombosis: NETs
Neutrophils (to a lesser extent, monocytes and eosinophils), release
extracellular traps in response to strong stimulation
NETs cause endothelial cell, platelet and factor XII activation resulting
in thrombosis
NETs Inhibit anticoagulant activity of TFPI >> thicker fibrin strands
resistant to fibrinolysis
Neutrophil aggregates and NETs occlude pulmonary microvasculatute
M, Leppkes et al. EBioMed. https://doi.org/10.1016/j.ebiom.2020.102925
�Virchow’s Triad IN COVID-19
Vascular
Endotheliitis
Platelet Activation
Viral RNA
DNA-NETS
VWF
Factor Xla
Thrombin-Fibrin
Endothelial
Dysfunction
Altered Blood Flow
RC Becker. J Thomb Thrombolysis. 2020.
https://doi.org/10.1007/s11239-020-02134-3
�Content Outline (TOC)
Anticoagulation Evidence in COVID-19
Deepak Pradhan, MD, FCCP
�Anticoagulation Evidence in COVID-19
Single center retrospective cohort study at Tongji Hospital in Wuhan, China
449 hospitalized severe COVID adult patients (RR≥30, Sao2 ≤93% at rest, P/F ≤300)
Tang et al. J Thromb Haemost, 2020.
�Anticoagulation Evidence in COVID-19
Methods:
• 99 patients received prophy heparin/LMWH for 7 days or more
• authors do not specify why DVT prophylaxis is not their standard of care for
hospitalized patients, just that DVTs occur less in Asians.
Results:
• 28-day mortality was the same for heparin-users and non-users (30% for both
groups)
• If patients were re-stratified by D-dimer level >3000 ng/mL, then heparin users
had a lower 28-day mortality rate (33 vs. 52%, p=0.017).
Tang et al. J Thromb Haemost, 2020.
�Anticoagulation Evidence in COVID-19
Limitations:
• Single center, retrospective design
• No mortality difference in less sick patients
• Minority (only 22%) received thromboprophylaxis; don’t know how/why these
patients received it [potential selection bias]
• Prophy was ≥ 7 days [introduces immortal time bias]
• Not controlled for confounders
Tang et al. J Thromb Haemost, 2020.
�Anticoagulation Evidence in COVID-19
Design:
• Single-center retrospective cohort study at Mount Sinai Health System, NYC,
03-4/11/2020
Association of Treatment Dose Anticoagulation With In-Hospital Survival Among Hospitalized Patients with COVID-19 PDF
�Anticoagulation Evidence in COVID-19
Results:
2773 patients, median 5 days hospitalization
28% received therapeutic AC, median duration 3 days of AC
In-hospital mortality 23% for both groups
Median survival 21 days (AC group), 14 days (non-AC group)
Mechanical ventilation 30% (AC group), 8% (non-AC group), p<0.001 [n= 395]
• In-hospital mortality 29% and median survival 21 days (AC group), 63% and 9
days (non-AC group)
• Multivariate Cox proportional hazards model: longer duration of AC associated
with reduced mortality risk (adjusted HR 0.86/day, p<0.001)
• Major bleeding in 3% (AC group), 1.9% (non-AC group)
•
•
•
•
•
Association of Treatment Dose Anticoagulation With In-Hospital Survival Among Hospitalized Patients with COVID-19 PDF
�Anticoagulation Evidence in COVID-19
Limitations:
•
•
•
•
•
•
Single center, retrospective design
Unknown indication for AC (indication bias)
AC agents and dosing not defined
Duration of therapeutic AC only 3 days?!
Prophylactic AC not articulated
Patients not classified regarding illness severity
• Immortal time bias
• Confounders
Association of Treatment Dose Anticoagulation With In-Hospital Survival Among Hospitalized Patients with COVID-19 PDF
�Anticoagulation Evidence in COVID-19
Design:
• Two-center (Western Connecticut) retrospective cohort study 4/1/2020 4/25/2020
Motta JK et al. medRxiv, 2020.
�Anticoagulation Evidence in COVID-19
Methods:
• Patients received either prophy or therapeutic AC (heparin/LMWH) started at the
time of hospital admission
• Of note, excluded therapeutic AC for thrombotic indication
• Prophy group received only prophy dosing for whole inpatient duration
Results:
• 374 patients (299 prophy group, 75 therapeutic group)
• Article does not mention why these 75 received therapeutic AC
Motta JK et al. medRxiv, 2020.
�Anticoagulation Evidence in COVID-19
Results (continued):
• Logistic model included: AC dosage, age, ethnicity, diabetes, history of cancer or
heart disease, hyperlipidemia, peak CRP, intensive care, mechanical ventilation,
and antibiotic use
• Risk of mortality was higher (aRR = 2.3, 95% CI = 1.0, 4.9, p = 0.04) for patients on
therapeutic AC as compared to prophylactic AC
Motta JK et al. medRxiv, 2020.
�Anticoagulation Evidence in COVID-19
Limitations:
• Retrospective design
• Western Connecticut (older population, majority white) [questions
generalizability]
• Unknown indication for therapeutic AC (indication bias)
• Duration of therapeutic AC not defined
• Patients not classified regarding illness severity; Prophy group 12% ICU and 7%
mechanical ventilation; Therapeutic group 36% ICU and 31% mechanical
ventilation
• No report of bleeding complications
• Confounders
Motta JK et al. medRxiv, 2020.
�Anticoagulation Evidence in COVID-19
Thromboprophylaxis
Acutely ill hospitalized COVID-19 patients (in the absence of contraindications) should
receive anticoagulant thromboprophylaxis
• LMWH, UFH, Fondaparinux
American Society of Hematology
International Society on Thrombosis and Haemostasis
American College of Cardiology
National Institute of Health
CHEST
Akima et al. J Thromb Haemost, 2020.
Barnes et al. J Thromb Thrombolysis, 2020.
Bikdeli et al. J Am Coll Cardiol, 2020.
COVID-19 Treatment Guidelines Panel. 2020.
Moores et al. CHEST, 2020.
�Anticoagulation Evidence in COVID-19
Areas for Future Research
Outpatients (no trials yet addressing thromboprophylaxis in COVID-19 outpatients)
Better defining the subpopulation at-risk for both macro and micro thrombi, and thus
identifying subgroup most to benefit from therapeutic AC
Validating bleeding risk scores in COVID-19 patients, and thus identifying subgroups at
greatest risk of harm from therapeutic AC
Dose of therapeutic AC/target goals
Role for antiplatelet therapy
Post-discharge therapeutic or prophylactic AC
�Referenced Studies
Akima S, McLintock C, Hunt BJ. RE: ISTH interim guidance to recognition and management of coagulopathy in COVID19. J Thromb Haemost. 2020;18(8):2057-2058.
Barnes, G.D., Burnett, A., Allen, A. et al. Thromboembolism and anticoagulant therapy during the COVID-19
pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis 50, 72–81 (2020).
Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and Thrombotic or Thromboembolic Disease: Implications for
Prevention, Antithrombotic Therapy, and Follow-Up: JACC State-of-the-Art Review. J Am Coll Cardiol.
2020;75(23):2950-2973.
r 2019 (COVID-19) Treatment Guidelines. National
COVID-19 Treatment Guidelines Panel. Coronavirus Disease
Institutes of Health. Available at https://www.covid19treatmentguidelines.nih.gov/. Accessed 08/09/2020.
Motta JK, et al "Clinical outcomes with the use of prophylactic versus therapeutic anticoagulation in COVID-19"
medRxiv 2020; DOI: 10.1101/2020.07.20.20147769.
Moores LK, Tritschler T, Brosnahan S, Carrier M, Collen JF, Doerschug K, Holley AB, Jimenez D, Le Gal G, Rali P, Wells
P. Prevention, Diagnosis, and Treatment of VTE in Patients With Coronavirus Disease 2019: CHEST Guideline and
Expert Panel Report. Chest. 2020 Jun 2:S0012-3692(20)31625-1.
Paranjpe I, Fuster V, Lala A, et al. Association of Treatment Dose Anticoagulation With In-Hospital Survival Among
Hospitalized Patients With COVID-19. J Am Coll Cardiol. 2020;76(1):122-124.
Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe
coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18(5):1094-1099.
�Content Outline (TOC)
Institutional Protocols
Vikram Mukherjee, MD
�Institution #1’s Approach
•
•
D-dimer <500
D-dimer 500-2000
D-dimer >2,000 & <10,000
D-dimer >10,000
Prophylactic Anticoagulation
Equipoise
Consider Therapeutic AC
Therapeutic AC Preferred
Enoxaparin subp preferred
Dose w/CrCl ≥ 30 mL/min
• <150 kg: 40 mg daily or
30 mg q12h
• BMI 40-50: 40 mg q12h
• BMI > 50: 60 mg q12h
Dose wCrCl <30 mL/min
• <150 kg: 30 mg daily
• BMI 40-50: 40 mg daily
• BMI > 50: 60 mg daily
Heparin subq If anuric/ESRD/AKI
• 50-150kg: 5000 units q8h
• <50kg: 5000 units 12h
• BMI >40: 7500 units q8h
•
•
•
Consider RCT: PROTECT-COVID-19
Prophylaxis vs. therapeutic AC
Refer to Study Protocol
Prophylactic AC as reflected in
D-dimer <500 box
VS.
Therapeutic AC:
• Enoxaparin 1 mg/kg q12h or
• IV Heparin at 10 u/kg/hr
titrate to antiXa 0.3-0.5 U/mL
If not in trial, use Prophylactic
Anticoagulation as reflected in
D-dimer <500 box
•
consider antiXa peak monitoring
r
Dose w/CrCl <30 mL/min
• <150 kg: 1mg/kg Qday
• BMI > 40: 0.75 mg/kg Qday
If enoxaparin contraindicated
• IV Heparin at 10 units/kg/hr titrate
to antiXa 0.3-0.5 U/mL – avoid
bolus dose
•
Therapeutic AC may be considered if
HIGH suspicion for DVT/PE
Enoxaparin subp preferred
Dose w/CrCl ≥ 30 mL/min
• <150 kg: 1mg/kg q12h
• BMI >40: 0.75 mg/kg q12h -
Alternatively
Consider RCT: PROTECT-COVID-19
Prophylaxis vs. therapeutic AC
•
Enoxaparin subp preferred
Dose w/CrCl ≥ 30 mL/min
• <150 kg: 1mg/kg BID
• BMI >40: 0.75 mg/kg BID consider antiXa peak monitoring
Dose w/CrCl <30 mL/min
• <150 kg: 1mg/kg q24h
• BMI > 40: 0.75 mg/kg q24h
If enoxaparin contraindicated
• IV Heparin at 10 units/kg/hr titrate
to antiXa 0.3-0.5 U/mL – avoid
bolus dose if PE not confirmed by
CT
�Institution #2’s Approach
Prophylactic anticoagulation in all patients unless absolute
contraindication
Threshold for initiation of therapeutic anticoagulation:
• Objective evidence of clot
• D-Dimer >5000
• D-Dimer >3000
r
• That is also increasing by >1,000 in the prior 24 hours
• D-Dimer>1000
• Beside DVT study
Daily risk/benefit assessment
�Institution #3’s Approach
LEVEL 1
For patients without known thrombus AND a D-dimer < 3,000:
• Standard prophylaxis
LEVEL 2
r
For patients without known thrombus
AND a D-dimer ≥ 3,000*:
• Intermediate dosing
LEVEL 3
For patients with known or suspected VTE, or otherwise unexplained
increase in oxygen requirement, dead space, or organ failure
(e.g., AKI, MSOF) with concern for microvascular thrombi
• Therapeutic dosing
�Venous or arterial thrombosis
Disseminated intravascular coagulation
Advanced age
Recent surgery or trauma
Cancer
Pregnancy or puerperium
r
Infection
Chronic inflammation
Liver disease
Renal disease
Thrombolytic therapy
Weitz JI, Fredenburgh JC, Eikelboom JW. A Test in Context: D-Dimer. J Am Coll Cardiol. 2017;70(19):2411-2420. doi:10.1016/j.jacc.2017.09.024
�Venous or arterial thrombosis
Disseminated intravascular coagulation
Advanced age
Recent surgery or trauma
Cancer
Pregnancy or puerperium
r
Infection
Chronic inflammation
Liver disease
Renal disease
Thrombolytic therapy
Weitz JI, Fredenburgh JC, Eikelboom JW. A Test in Context: D-Dimer. J Am Coll Cardiol. 2017;70(19):2411-2420. doi:10.1016/j.jacc.2017.09.024
Schutte T, Thijs A, Smulders YM. Never ignore extremely elevated D-dimer levels: they are specific for serious illness. Neth J Med. 2016;74(10):443-448.
�Content Outline (TOC)
NETEC Resources
Trish Tennill, RN, BSN
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Questions
and
Answers
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Friday, August 14, 2020 | 1:00 PM EST
Event Type
Webinar, watch at link below.
URL
https://youtu.be/ZmZvsLmq_AM
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Approach to Anticoagulation in COVID-19 webinar" src="https://www.youtube.com/embed/ZmZvsLmq_AM?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-anticoag" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-anticoag</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (8/14/20)/Online Course: Approach to Anticoagulation in COVID-19: Evidence and Practice Patterns
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
This webinar will articulate the pathophysiology of the hypercoagulable state seen in COVID-19 and discuss current evidence surrounding anticoagulation in COVID-19. Institutional practice patterns for anticoagulation will also be discussed.<br /><br />Webinar slides attached.<br />
<h2>Get educational credit for this webinar through <a href="https://courses.netec.org/courses/20-web-anticoag" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-14
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2024-03-28 by J. Mundy – Treatment & Care group review 2023 (Q2) skipped – bumping to 2024 (Q2)
Type
The nature or genre of the resource
Webinar and Online Course
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
CEU
CEUs
Clinical Care
Coronavirus
COVID-19
Hematology
Online Course
R-T&C
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Aiyegbusi, Olalekan Lee, and Melanie J. Calvert. 2020. "Patient-reported outcomes: central to the management of COVID-19." The Lancet.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31724-4/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31724-4/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Patient-reported outcomes: central to the management of COVID-19
Subject
The topic of the resource
Research
Description
An account of the resource
Patient-reported outcomes—self-assessments of patient health status—are central to COVID-19 response, recovery, and resilience.
Creator
An entity primarily responsible for making the resource
Aiyegbusi, Olalekan Lee, and Melanie J. Calvert.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-10
Type
The nature or genre of the resource
Publication
2019-nCoV
Clinical Care
Communications
Coronavirus
COVID-19
Outcomes
R-Res&Pub
-
https://repository.netecweb.org/files/original/0439d82e6cd60fa9534432ccfb492944.pdf
f42498d56b93f132719c56ee812c95a8
PDF Text
Text
International Journal of Infectious Diseases 99 (2020) 233–242
Contents lists available at ScienceDirect
International Journal of Infectious Diseases
journal homepage: www.elsevier.com/locate/ijid
Marburg virus disease: A summary for clinicians
Mark G. Kortepetera,*, Kerry Dierbergb, Erica S. Shenoyc, Theodore J. Cieslaka, on behalf
of the members of theMedical Countermeasures Working Group of the National Ebola
Training and Education Center's (NETEC) Special Pathogens Research Network (SPRN)1
a
b
c
University of Nebraska Medical Center, Omaha, NE, USA
Bellevue Hospital Center, New York, NY, USA
Massachusetts General Hospital, Boston, MA, USA
A R T I C L E I N F O
A B S T R A C T
Article history:
Received 12 February 2020
Received in revised form 9 July 2020
Accepted 23 July 2020
Objectives: This article summarizes the countermeasures for Marburg virus disease, focusing on
pathogenesis, clinical features and diagnostics. There is an emphasis on therapies and vaccines that have
demonstrated, through their evaluation in nonhuman primates (NHPs) and/or in humans, potential for
use in an emergency situation.
Methods: A standardized literature review was conducted on vaccines and treatments for Marburg virus
disease, with a focus on human and nonhuman primate data published in the last five years. More detail
on the methods that were used is summarized in a companion methods paper.
Results: The study identified six treatments and four vaccine platforms that have demonstrated, through
their efficacy in NHPs, potential benefit for treating or preventing infection in humans.
Conclusion: Succinct summaries of Marburg countermeasures are provided to give the busy clinician a
head start in reviewing the literature if faced with a patient with Marburg virus disease. Links to other
authoritative sources of information are also provided.
© 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open
access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Keywords:
Marburg virus
Filovirus
Ebola virus
Antiviral therapy
Antiviral countermeasure
Vaccine
Treatment
Introduction
This is the first in a planned series on the management of highly
hazardous communicable pathogens that may warrant specialized
infection control measures and lack licensed countermeasures.
Marburg virus, a member of the filovirus family, has caused
outbreaks in sub-Saharan Africa and can cause severe illness with
high case fatality rates (Brauburger et al., 2012). Person-to-person
spread may occur in household or nosocomial settings, where
infection control modalities are sub-optimal. Although Marburg
was discovered over 50 years ago, licensed prophylactic or
therapeutic countermeasures have yet to be developed. Since
the West African Ebola outbreak, increased effort has focused on
Marburg in addition to Ebola (Olejnik et al., 2019).
As was the case with Ebola, it is anticipated that future
outbreaks of Marburg virus disease (MVD) will trigger interest in
the use of investigational products. The clinical features and risks
of spread of MVD closely resemble Ebola virus disease (EVD);
* Corresponding author at: 98435 Nebraska Medical Center Omaha, NE 681984395.
E-mail address: Mark.kortepeter@gmail.com (M.G. Kortepeter).
1
See Appendix A.
supportive care, infection control and other response measures
(e.g. need for safe burials) are identical. However, much less is
known about MVD than EVD because there has not been a recent
large-scale outbreak of MVD or equivalent in scale to the EVD
2014–2016 West Africa outbreak. In addition, because the most
promising specific therapies for EVD are monoclonal antibodies
(Mabs), those that appear beneficial for EVD are likely inapplicable
for MVD treatment. Similarly, vaccination platforms, such as the
vesiculo stomatitis virus vaccine using antigens for EVD, have not
demonstrated cross-protection for MVD (Jones et al., 2005).
Methods
This study summarized the recently published literature
specific to MVD, in order to provide a practical list of potential
countermeasures. These are summarized in the accompanying
tables. The review involved a MeSH (National Center for
Biotechnology Information, 2019) search string (customized for
MVD) and divided the therapeutic evidence into categories: preexposure prophylaxis, post-exposure prophylaxis, treatment,
infection prevention and control, and diagnostics. The literature
review focused on the past five years; older data describing clinical
features and incubation periods were included. Title, abstract and
full text reviews of appropriate manuscripts, reviews and book
https://doi.org/10.1016/j.ijid.2020.07.042
1201-9712/© 2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http://
creativecommons.org/licenses/by-nc-nd/4.0/).
�234
M.G. Kortepeter et al. / International Journal of Infectious Diseases 99 (2020) 233–242
Box 1. The pathogen
Marburg virus is an enveloped, non-segmented, single-stranded, negative-sense RNA virus in the filovirus family. There is a single
species of Marburg – Marburg Marburgvirus – which includes two viruses with �20% divergence: Marburg and Ravn virus.
Marburg variants, with less genomic differences, include Marburg Musoke, Angola, an unnamed variant from the original 1967
outbreak (Ci67), and isolates within a variant (<7% divergence: Pop, Ci67). Marburg Angola, isolated from the largest outbreak,
appears to be the most pathogenic and yields a more rapid disease course in NHPs. The Marburg glycoprotein (GP) is the only viral
protein on the cell surface and has been the primary target for investigational viral vaccines.
Box 2. Epidemiology
Animal hosts: Presumed to be the Egyptian fruit bat (Rousettus aegyptiacus), based on epidemiologic linkage to outbreaks in caves
or among miners in sub-Saharan Africa. RNA, antibodies and viral isolation by culture have been demonstrated in a small minority
of bats. In addition, perpetuation of the virus in R. aegyptiacus has been demonstrated.
Transmission: Initial transmission to humans likely occurs from bats or another intermediate host (e.g. NHP, bush meat), but route
and specific body fluid involved (saliva from bat, guano, urine) is unknown. Transmission to humans by direct contact with blood or
body fluids of infected individuals occurs, with the majority of spread occurring through unprotected contact in the household or
healthcare setting. There is a single reported case of live virus isolated from the aqueous humor of a human survivor >2 months after
infection, so some degree of protected space persistence occurs, but there is less data on Marburg survivors than for Ebola. Although
frank airborne transmission has not been demonstrated in human outbreaks, droplet spread to mucous membranes presumably
occurs. Infection by direct application of aerosol to the airways has been demonstrated in animal models. Post-infection sexual
transmission and recovery of virus in the semen have been demonstrated.
Human infections: The first outbreak occurred in 1967 in Germany and Yugoslavia related to importation of African Green monkeys
(Cercopithecus aethiops) from Uganda. That outbreak resulted in 31 cases and seven deaths, some of which spread by household
or nosocomial contact. Since then, there have been nearly 600 cases in outbreaks originating in the following countries: Uganda,
Democratic Republic of Congo (DRC) and Angola. There have been fewer outbreaks of Marburg than Ebola. Marburg was
presumed to be less deadly than Ebola, until two large outbreaks occurred with high fatality rates. The first, in 1998–2000 in the DRC
(Durba), was associated with gold mining and resulted in 128 deaths and a case fatality rate of 83%, and was followed by the largest
outbreak thus far, in Angola, in 2005, with 329 deaths and a case fatality rate of 88%. The most recent outbreak of three cases
occurred in Uganda in 2018. Household members and healthcare workers are at particular risk. Overall, case fatality rates from the
outbreaks have ranged from 23–88%, likely related to the extent of supportive care available.
chapters were then conducted. Bibliography scans were also
completed on review articles and meta-analyses.
Clinical features
Incubation period
The incubation period is estimated to be 3–21 days (typically 5–
10 days), likely related to infectious dose and route (Brauburger
et al., 2012). The original Marburg outbreak described a range of 5–
9 days among patients with well-defined exposure dates (Martini,
1971; Stille and Boehle, 1971). A 2011 review noted a range of 3–13
days for filoviral (Zaire Ebolavirus and Marburgvirus) infection
based on definitive exposure dates (such as a known laboratory
accident) (Kortepeter et al., 2011). A study focused on Marburg
calculated an incubation period of 2–26 days (Pavlin, 2014).
Pathogenesis
Following exposure of mucosa or abraded skin, or through a
needle-stick or other penetrating injury, the virus gains entry to
the blood or lymphatic system and infects monocytes, macrophages and dendritic cells. Early replication occurs in these cells,
which are likely responsible for further dissemination to hepatocytes, endothelial cells, fibroblasts, and epithelial cells
(Rougeron et al., 2015). Filovirus binding to host cells has been
associated with several attachment factors, including a glycoprotein (GP) on the viral surface that mediates binding and entry. The
GP surface unit (GP1) binds to cellular receptors, and an internal
fusion loop (GP2) inserts into the cell membrane (Hoffmann et al.,
2017). Ebola and Marburg entry and the deposition of their
replication machinery appear related to intra-vesicular cleavage of
glycoprotein by host proteases, such as cathepsins, as well as to
fusion of viral GP with the host protein Niemann-Pick (Cross et al.,
2018). This process facilitates release of the viral core into the cell
cytoplasm, where replication occurs. Due to its location on the cell
surface and importance in binding and entry, the GP has been a key
target for the development of both Ebola and Marburg vaccines
and monoclonal antibody therapeutics.
Significant viral replication occurs in target organs such as the
spleen, liver and secondary lymphoid organs. The virulence and
high morbidity/mortality of the disease appears related to
unchecked viral replication (related in part to inhibition of IFN-1
synthesis), as people with ultimately fatal infections generally
exhibit high viral loads (Rougeron et al., 2015).
This replication is facilitated by the virus's ability to undercut
the host immune response by exploiting intracellular and
extracellular immune-mediated antiviral pathways (Cross et al.,
2018). A focus of therapeutics discovery is thus related to finding
small molecule antivirals that inhibit viral replication. Specific
Marburg viral proteins can impair or neutralize the innate immune
response.
Although lymphocytes are not directly infected by the virus,
apoptosis of T-lymphocytes and natural killer cells causes massive
depletion of lymphoid cells in the spleen, liver, lymph nodes, and
thymus, and influences the inability to mount an adaptive immune
response (Brauburger et al., 2012; Rougeron et al., 2015). Cell death
is likely linked to interactions with infected antigen-presenting
cells and soluble mediators.
Different aspects of the response feed upon each other. The
uncontrolled viral replication, a consequence of dysregulation of
the innate and adaptive immune responses, also leads to cytokine
�M.G. Kortepeter et al. / International Journal of Infectious Diseases 99 (2020) 233–242
235
storm and impaired humoral response, ultimately resulting in
multiorgan failure and death. Through different pathways,
immune dysfunction results in: (1) increased vascular permeability, influenced by TNF-alpha, NO and other vasoactive compounds;
(2) tissue damage, mediated through MCP-1 and IL-8; and (3)
disseminated intravascular coagulation influenced by abundant
tissue factor expressed by macrophages. In contrast to fatal
infections, the inflammatory response is early and moderate in
non-fatal infections (Rougeron et al., 2015).
mean of 9 days after onset. Those who survive this period are likely
to recover. Risk factors for severe disease or death have been
reported for Ebola, but not Marburg. These include old or very
young age, as well as higher viremia levels and elevated levels of
AST, BUN, creatinine, certain cytokines (IL6, IL8, IL10, macrophage
inflammatory protein 1β), ferritin, and D-dimer, decreased
albumin and calcium, and lack of antibody response (Hutchinson
and Rollin, 2007; Rollin et al., 2007; Schieffelin et al., 2014; WHO
Ebola Response Team et al., 2015).
Clinical spectrum of infection
Pathology
Asymptomatic cases of Marburg infection have not yet been
documented. One study conducted serological assessment of 121
household contacts for unrecognized and asymptomatic infection.
Two unrecognized cases were found, but both were symptomatic
upon further questioning (Borchert et al., 2006). Most Marburg
infections result in severe illness with prostration, bleeding
manifestations and multiorgan failure.
Autopsies have demonstrated focal necrosis without inflammation in the liver, spleen, testes, ovaries, and the pancreas, and
signs of hemorrhagic diatheses in all organs. Glial nodule
encephalitis has been noted throughout the brain. Significant
renal damage and signs of tubular insufficiency also occur.
Lymphatic tissue demonstrates plasmacellular and monocytoidal
transformation. Basophilic bodies have been noticed near necrotic
cells or as inclusion bodies in parenchymal cells (Martini, 1973).
Clinical course
Sequelae
Although there have been fewer outbreaks of Marburg than
Ebola, and hence fewer descriptions of disease, some of the most
detailed early clinical observations of filoviral hemorrhagic fever
come from Marburg outbreaks, including the 1967 outbreak in
Marburg and Frankfurt, Germany, and Belgrade, Yugoslavia, as well
as a subsequent outbreak among three travelers cared for in South
Africa (Martini, 1971; Gear et al., 1975).
Following the incubation period, patients usually become
abruptly ill with non-specific symptoms such as fever, chills,
headache, odynophagia, myalgia, vomiting, and diarrhea. Early cases
may be missed, owing to similarities with more common infections
such as malaria, typhoid, or rickettsial illness. Rash is a common
feature early in MVD, and is described as non-pruritic, erythematous
and maculopapular. It may begin focally, then become diffuse and
confluent. As noted during the original outbreak, “It began between
the fifth and seventh day at the buttocks, trunk, and outside of both
upper arms as a distinctly marked, pin-sized red papula around the
hair roots,” which lasted up to 24 h, then developed into a maculopapular rash, which later coalesced (Martini, 1971). Conjunctival
injection may also occur early.
During MVD, large swings in body temperature have been noted,
encompassing hyper- and hypo-pyrexia. In the original outbreak,
tachycardia corresponding to temperature elevationwas only seen in
fatal cases. Laboratory abnormalities include leukopenia and
lymphopenia, hypokalemia, normal to elevated levels of amylase,
thrombocytopenia, andelevated liverenzymes. Asillnessprogresses,
elevations in prothrombin time and partial thromboplastin time, as
well as clinical bleeding, may occur. Patients may develop multiple
foci of mucosal hemorrhage, typically in the conjunctivae, along with
easy bruising or persistent bleeding from venipuncture sites. Renal
function may be initially normal, although renal function is often
impaired and dialysis may be required by the end of the first week of
illness. Severe cases progress from prostration and obtundation to
hypotension, shock and multiorgan failure. In the West African
outbreak of EVD, significant gastrointestinal disease was described,
with vomiting and diarrhea leading to volume loss, acid base
disturbances and electrolyte imbalances (Duraffour et al., 2017).
Similar features can occur with Marburg and a recent review
summarized the clinical features of MVD (Bauer et al., 2019).
Mortality risk factors
The case fatality ratio has ranged from 23–90% (CDC, 2019).
Most fatal cases succumb during the second week of illness, a
Survivors have experienced prolonged convalescence and
numerous sequelae, including myalgia, exhaustion, hyperhidrosis,
skin desquamation, amnesia, testicular atrophy, decreased libido,
and hair loss (Brauburger et al., 2012; Martini, 1973). Live virus has
been recovered from samples of semen and aqueous humor for up
to 3 months after illness, and Marburg virus has also been found to
persist in the testes of nonhuman primates that have survived
(Gear et al., 1975; Kuming and Kokoris, 1977; Coffin et al., 2018).
One survivor transmitted infection to his wife through sexual
intercourse >2 months after illness (Martini, 1973).
Diagnostic testing
Diagnosis of MVD can be made using multiple modalities,
including culture, RT-PCR, serology, and immunohistochemistry,
depending on the time course of the infection. Typical diagnostic
samples include blood, other body fluids and tissue obtained at
autopsy. Reagents for Marburg testing may not be as widely
available as for Ebola. Clinicians in the United States (U.S.) should
first contact their state health department regarding a patient/
patient under investigation with suspected Marburg prior to
submitting any specimens. If the state health department prefers
that specimens go directly to the Centers for Disease Control and
Prevention (CDC) for testing, the specimens will be shipped to the
Division of High Consequence Pathogens and Pathology (DHCPP),
CDC (https://www.cdc.gov/ncezid/dhcpp/index.html [cdc.gov])
within the Viral Special Pathogens Branch (https://www.cdc.gov/
ncezid/dhcpp/vspb/index.html [cdc.gov]). Other potential sites for
such shipment include biosafety level 4 laboratories or the
Diagnostics Systems Division at the U.S. Army Medical Research
Institute of Infectious Diseases (USAMRIID) – 1-800-USA-RIID).
Potential treatment or prophylaxis countermeasures
Pre-exposure prophylaxis
No Marburg vaccines are approved in the U.S. or worldwide.
There is no cross protection between Ebola and Marburg virus
vaccines, although several constructs tested in cynomolgus
macaques have demonstrated protection against both Marburg
and Ravn viruses (Table 1). Three candidate Marburg vaccines
(cAd3, MVA-BN-Filo and MARV DNA) are in Phase I clinical trials
and one (MVA-BN-Filo) is scheduled for a Phase 2/3 clinical trial.
�236
M.G. Kortepeter et al. / International Journal of Infectious Diseases 99 (2020) 233–242
Table 1
Vaccines.
Vaccine
Manufacturer or
source/contact
cAd3
MVA-BN- Janssen
Filo
Pharmaceuticals,
Titusville, NJ (of
Johnson and
Johnson)
Description
NHP studies
Chimpanzee adenovirus
serotype 3 vector,
encoding wild type (WT)
glycoprotein (GP) from
Marburg virus
Human use (INDs, case reports, Phase 3/RCTs
phase 1 or 2)
No data for this construct for
Marburg. Protection with other
constructs: Ad26 alone (75%)
better than Ad35 with Ebola.
Ad26 plus Ad35 boost 100%.
cAd3 prime followed by MVA
boost was protective against
Ebola
No data for this construct for
Modified vaccinia
Ankara vector, encoding Marburg. An Ebola vaccine
glycoproteins from
demonstrated protection out to
Ebola, Sudan, and
10 months in Ebola-infected
Marburg viruses, and Tai NHPs using a cAd3 prime
Forest virus
followed by MVA boost 8 weeks
nucleoprotein
later
MARV
DNA
plasmid vaccine
Marburg DNA plasmid
expressing GP from
Marburg Angola
rVSVMARVGP
Recombinant vesiculo
stomatitis virus vector
for Marburg GP
VLP
Virus-like particles with
GP
Adenovirus vectored vaccines
Several adenovirus-based vaccines have been studied for EBOV,
but studies are limited for MARV. Recombinant adenovirus
serotype 5 (rAd5) is the most commonly used vector for
glycoprotein (GP) vaccines. In one study, macaques were given a
single dose of rAd5 vaccine expressing MARV-Angola GP. They
were challenged with homologous MARV 4 weeks later and none
developed clinical illness. A similar response was seen in four
macaques receiving three doses of MARV-Angola GP DNA prior to
vaccine in a prime-boost strategy (Geisbert et al., 2010a).
The complex adenovirus (CAdVax) platform uses five antigens:
EBOV, SUDV and MARV (Ravn, Musoke, and Ci67) glycoproteins,
and EBOV and MARV-Musoke nucleoproteins. Cynomolgus macaques were given this vaccine using a prime-boost strategy, and
challenged with EBOV, SUDV and MARV-Musoke/Ci67. Antibodies
were produced against all five filoviruses and no animals
developed clinical illness (Swenson et al., 2008a).
Use of adenovirus-based vectors has been limited by preexisting immunity in the population. To address this, less common
serotypes have been employed, and oral or nasal vaccine
administration has been used in animal models. Ad26 and
Ad35-vectored vaccines using Ebola GP demonstrated less
protection than Ad5, but Ad26 protected three of four NHPs after
Ebola challenge, and provided protection in a prime-boost strategy
employing an Ad35 vectored Ebola vaccine (Geisbert et al., 2011).
Similarly, chimpanzee Adenovirus 3 has been assessed as a
Notes/special
populations
Phase 1 clinical trial with
Marburg construct active, not
yet recruiting (NCT03475056)
Phase 1 trial for MVA-BN-filo in
prime-boost with Ad26.ZEBOV.
Better immune response after
Ad26.ZEBOV primary.
Sustained Ebola GP immunity
after either primary followed
by alternate boost. Response to
Marburg antigens not
measured
Study using a DNA prime/boost 90% antibody response in Phase
vaccine demonstrated
1 trial, 10 people; 1
protection, but all animals
discontinued for non-lifedeveloped signs/symptoms
threatening side effects; 4th
dose at 12 wks improved
waning antibody titers
No human trials, although a
Several tried with good
immune response. Sustained
similar Ebola vaccine has now
IgG response and protection
been used in three different
against clinical illness:
Ebola virus outbreaks in Africa
protected 20–30 min (5/5), 24 h is now licensed
(4/6) and 48 h (2/6) postchallenge
Vaccine against Musoke, Ci67,
Ravn with Ab response to all
three strains and crossprotection after challenge 4
weeks later
Multiple Marburg candidate platforms (rVSV, VLP, Adenovirus,
DNA) have demonstrated protection in NHPs (Reynolds and Marzi,
2017).
Regulatory
approvals
Phase 2/3
trials planned.
Use of
construct
against Ebola
planned in
response to
DRC Ebola
outbreak 2019
potential vector for GP. Four animals in two groups of different
doses survived post-vaccination challenge with Ebola virus
(Stanley et al., 2014) but durable protection was not achieved.
Use of a cAd3 prime followed by a Modified Vaccinia Ankara boost
at 8 weeks, with challenge 10 months later, demonstrated 100%
protection against Ebola. Similar studies in NHPs have not been
performed with Marburg, but clinical trials with similar vaccines
have been conducted. A Phase 1 clinical trial of a cAd3 Marburg
vaccine is currently ongoing (NIH 2020).
A Phase 1 clinical trial of Ad26.ZEBOV and MVA-BN-Filo
vaccines, published in 2016, included 87 participants who were
randomized to receive Ad26.ZEBOV or MVA-BN-Filo (modified
vaccinia Ankara vector vaccine, encoding glycoproteins from Ebola,
Sudan, Marburg, and Tai Forest viruses). After primary immunization, subjects were boosted with the alternate vaccine at 14, 28 or
56 days. There were no vaccine-related serious adverse events. 97%
of Ad26.ZEBOV recipients and 23% of MVA-BN-Filo recipients had
detectable IgG response 28 days after primary immunization, and
all recipients had detectable IgG levels at 21 days and 8 months
after receiving the alternate vaccine boost. Phase 2/3 trials of both
vaccines are planned (Milligan et al., 2016).
DNA vaccines
DNA vaccines against filoviruses have good safety profiles in NHP
trials, are easy to produce, and have the potential to induce humoral
and cellular immunity; however, these have demonstrated limited
immunogenicity in clinical trials (Lu et al., 2008; Falzarano et al.,
2011; Martin et al., 2006). DNA vaccines containing MARV-Musoke
GP and MARV-Angola GP tested in cynomolgus macaques produced
an IgG response and protection from homologous challenge;
�M.G. Kortepeter et al. / International Journal of Infectious Diseases 99 (2020) 233–242
237
however, all developed clinical illness, suggesting that the IgG
response alone did not control infection (Geisbert et al., 2010a;
Riemenschneider et al., 2003). DNA-based vaccines have been used
with greater success as part of a prime-boost strategy, such as with an
adenovirus vector. A Marburg DNA plasmid vaccine (VRCMARDNA025-00-VP) expressing MARV Angola DNA has completed
Phase 1 clinical testing. Ten people received vaccine (0, 4, 8 weeks):
90% had antibody responses; seven received a fourth dose at 12
weeks, which boosted waning antibody titers. No phase 2/3 trials are
currently underway.
Orthomyxoviruses, Picrornaviruses, and flaviviruses). Groups of
six cynomolgus macaques (Warren et al., 2014) were challenged
with Marburg virus and then given twice daily IM injections of
Galidesivir (15 mg/kg) 1, 24 and 48 h after challenge. All controls
died. Five of six animals survived in the 1-h group; all survived in
both the 24-h and 48-h groups. No overt signs of toxicity were
noted. Lower viremia levels, decreased clotting times and
improved liver enzyme levels were noted in treated animals.
Galidesivir has also demonstrated post-exposure protection
against Ebola virus in rhesus macaques.
Recombinant vesicular stomatitis virus (rVSV) vaccine
Vesicular stomatitis virus (VSV) is a negative-strand RNA virus of
the Rhabdoviridae family. MARV rVSV vaccines are replicationcompetent, and contain MARV GP in place of its innate surface
membrane glycoprotein; several have been studied in NHPs
(Geisbert et al., 2008). A vaccine using three VSV vectors containing
MARV, EBOV and SUDV GP given to NHPs produced antibody
responses to all three components, with 100% cross-protection
against MARV, EBOV, SUDV, and TAFV 28 days after vaccination. One
animal developed detectable viremia (Geisbert et al., 2009). Another
study demonstrated sustained IgG response and protection against
clinical illness in cynomolgus macaques challenged with MARV 14
months after rVSV-MARV-GP vaccination (Mire et al., 2014).
During the 2014–2016 West African EBOV epidemic, an rVSVEBOV vaccine was successfully used in a ring vaccination trial
(Henao-Restrepo et al., 2017). It has since been employed during
two recent EBOV outbreaks in the Democratic Republic of the
Congo (DRC). The vaccine is now approved in both the U.S. and
Europe. The rVSV platform appears promising for MARV; however,
there are no Phase I clinical trials yet in progress.
Testing in humans
A phase 1 safety study was concluded in 2016, but results have
not been published.
Virus-like particles (VLP)
Marburg VLP (mVLP) vaccines have been produced using matrix
protein VP40 and Marburg GP, producing VLPs similar in
morphology to Marburg virions (Warfield and Aman, 2011). A
VLP vaccine against MARV-Musoke, Ci67 and Ravn isolates was
tested in NHPs and produced antibody responses to all three
strains. Moreover, all demonstrated cross-protection when challenged with MARV 4 weeks later (Swenson et al., 2008b).
Post-exposure prophylaxis
Post-exposure prophylaxis (PEP) using a VSV-vectored vaccine
that incorporates Marburg glycoprotein reduced deaths when given
within 20–30 min (five of five protected), (Daddario-DiCaprio et al.,
2006) 24 h (five of six protected), or as late as 48 h (two of six
protected) after challenge with Marburg Musoke in rhesus macaques
(Geisbert et al., 2010b). Post-exposure protection was afforded,
depending on dose (high �1000 pfu, low �50 pfu), when rhesus
macaques were vaccinated against the more virulent Marburg
Angola variant within 20–30 min of challenge (Woolsey et al., 2018).
Treatment
Multiple pharmaceuticals active against Marburg are in
development, including immunotherapeutics, phosphorodiamidate morpholino oligomers (PMOs), lipid-encapsulated small
interfering RNAs, small molecule inhibitors, interferons, and
antiviral nucleoside analogs, shown in alphabetical order (Table 2).
Galidesivir – BCX4430 (Biocryst Pharmaceuticals)
Galidesivir is a synthetic nucleoside analogue that inhibits viral
RNA polymerase by acting as a non-obligate RNA chain terminator.
Galidesivir has activity against numerous viruses (Togaviruses,
Bunyaviruses, Arenaviruses, Paramyxoviruses, Coronaviruses,
Favipiravir – T-705 (Toyama Chemical Co., Ltd)
Favipiravir, a synthetic guanidine nucleoside analog with
broad-spectrum activity against multiple families of RNA viruses,
is licensed in Japan for the treatment of influenza. Early work
demonstrating efficacy in mouse models against Ebola virus led to
interest in its use during the West African outbreak. The results of a
large-scale trial (JIKI) in Guinea were inconclusive, although it
appeared to have efficacy in patients with lower viremia levels (Ct
value �20) (Sissoko et al., 2016). This trial used historical rather
than concurrent controls. Another recently published study from
Guinea demonstrated a trend to improved survival in the treated
cohort, albeit without a significant survival benefit (Kerber et al.,
2019). Bixler et al. demonstrated survival of five of six cynomolgus
macaques challenged with 1000 PFUs (Marburg Angola) when
favipiravir was given intravenously twice daily for 14 days,
beginning on the day of challenge; oral dosing did not produce
benefit (Bixler et al., 2018).
Remdesivir (Gilead Sciences)
Remdesivir is a prodrug of an adenosine analog with in vitro
activity against Marburg. It has been successfully used to treat EVD
in NHPs, and has recently demonstrated effectiveness in treating
Marburg-infected cynomolgus macaques 4–5 days post-exposure
at once daily doses of either 5 mg or 10 mg for 12 days (two doses,
50% and 83% survival, respectively) (Porter et al., 2020). Remdesivir
was given to a nurse who had recovered from EVD, but developed
meningoencephalitis 9 months later (Jacobs et al., 2016). Ebola was
detected in blood at a lower concentration than in CSF, and was
undetectable after 14 days of treatment, which included high-dose
steroids. Remdesivir was also given to a premature infant born to a
woman infected with Ebola during pregnancy. The infant also
received leukocytes and ZMapp, tolerated the treatment well and
was discharged from hospital (Dornemann et al., 2017).
Remdesivir was included in a four-drug randomized controlled
therapeutic trial in the DRC (the PALM study) (Mulangu et al.,
2019). The survival was lower in the remdesivir arm when
compared with two monoclonal antibody preparations (REGN-EB3
and Mab114) and it was deprioritized for further use for Ebola.
Widespread use of remdesivir has occurred as a countermeasure
during the 2019–2020 COVID-19 outbreak under emergency use
authorization, and there are numerous ongoing clinical trials with
it (Beigel et al., 2020).
Interferon-beta
EVD in humans is associated with robust interferon alpha
response, but little interferon beta (IFN-β) production. This finding
has led to studies wherein IFN-β was administered after Marburg
infection in macaques (Smith et al., 2013). Early treatment was
associated with increased mean survival time, but did not alter
mortality. The authors concluded that interferon beta might serve
as an adjunctive therapy.
�238
M.G. Kortepeter et al. / International Journal of Infectious Diseases 99 (2020) 233–242
Table 2
Marburg countermeasures – treatment with antivirals.
Therapy
Antivirals
NP-718-LNP
BCX4430
(Galidesivir)
AVI-7288
alone or in
combination
with
AVI-7287
as AVI-6003
Favipiravir
(T-705)
GS-5734
(remdesivir)
Manufacturer or
source/contact
Description
NHP studies
Tekmira/Arbutus
Biopharma,
Vancouver, BC,
Canada
Biocryst
Pharmaceuticals,
Durham, NC
Small-interfering RNA
targets nucleoprotein
Multiple microRNAs tested in
100% survival (16 NHPs)
with treatment 30 min–2 h humans, but not this product or
post infection
any others for filoviruses
Synthetic nucleoside
analogue that inhibits
viral RNA polymerase
17/18 survive with
treatment 1–48 h post
infection.
Also shown protection for
Ebola
83–100% protection with
treatment 24–96 h post
infection
Phosphorodiamidate
morpholino oligomers
with positive charges AVI 7288/7287 Target
NP/VP24 gene,
respectively
Toyama Chemical Synthetic guanidine
Company, Ltd,
nucleoside analog with
Japan
broad-spectrum
antiviral activity against
multiple families of RNA
viruses
Gilead Sciences,
Monophosphoramidate
Foster City, CA
prodrug of an adenosine
analog with broad
antiviral activity. Inhibits
Marburg in vitro
Sarepta
Therapeutics,
Cambridge, MA
Human use (INDs, case reports,
phase 1 or 2)
Polyclonal concentrated IgG
Concentrated (polyclonal) IgG was derived from vaccinated
NHPs that had survived challenge with Marburg (Table 3). An
initial study gave three doses (100 mg/kg) to rhesus macaques
following Marburg challenge, and resulted in 100% protection
without viremia or observed clinical illness, but the animals did
develop an IGM response. Re-challenge with Marburg 77 days later
demonstrated complete protection. In a second study the first dose
was given IV 48 h post-challenge, followed by doses on Day 4 and
Day 8. All three animals survived, although one developed mild
illness (Dye et al., 2012).
Monoclonal antibodies
After demonstrating protection against Marburg virus lethal
challenge in mice, a panel of MAbs was studied in guinea pigs and
NHPs. MR 191-N, a human monoclonal, was tested in rhesus
macaques with 50 mg/kg IV given at Day 4 and Day 7 post-infection
(Mire et al., 2017). All three treated animals survived. In a second
study, four of five and five of five animals survived challenge with
Marburg and Ravn viruses, respectively. The one treated nonsurvivor demonstrated the highest viremia level (>107 pfu/mL),
but had an initial drop in viremia followed by rebound unrelated to
generation of an escape mutant. The treated animals demonstrated
illness and laboratory abnormalities, but these resolved after
treatment, making this a potential candidate for therapy as well as
prophylaxis.
Testing in humans
MR 191-N was used following a recent lab exposure, but details
have not been published; human trials are being planned.
Numerous licensed monoclonal therapies have been used for
Regulatory
approvals
Notes/special
populations
Phase 1 study completed 2016.
Results not published
With AVI-6003, no significant
safety signals in two RCTs with 70
subjects
5/6 survived when begun Inconclusive results in West
IV on day of challenge, but Africa (JIKI) Ebola trial using
not with oral doses
historical controls. Lower viremia
(Ct �20) fared better
Protected 50 and 83% of
MARV-infected NHPs
against lethal disease
when initiated up to 4–5
days post-infection with
Marburg
Phase
3/
RCTs
Female nurse recovered after
treated for Ebola
meningoencephalitis relapse.
Multiple human trials ongoing for
COVID-19.
Used for MEURI compassionate
use in 2018–2019 DRC outbreak.
Lower survival than antibodyderived products in PALM RCT for
2018/19 Ebola outbreak in DRC
Licensed in
Japan for
influenza.
Has had
broad
human use
35–36-week-old
infant treated
whose mother
was infected with
Ebola during
pregnancy
other diseases. A three-antibody cocktail (ZMapp) was tested in a
randomized controlled trial (RCT) in humans with EVD during the
West Africa outbreak and led to improved outcomes among
recipients, compared with those receiving only supportive care.
Since the outbreak concluded before sufficient numbers of patients
were enrolled in the trial, statistical significance was not achieved.
ZMapp was also tested as part of a four-drug RCT (the PALM study)
during the 2018–2019 Ebola outbreak in the DRC (Mulangu et al.,
2019). Alternative Mab preparations (mAb114 and REGN-EB3) have
proven superior in reducing mortality. Given that the mAb1114
product consists of a single monoclonal antibody, whereas ZMapp
and REGN-EB3 are cocktails of three monoclonals, it provides some
credence that a single monoclonal preparation may be enough to
treat other VHF illnesses such as MVD. Given their demonstrated
efficacy against EVD, it is reasonable to consider Mabs as potential
therapeutics against MVD.
Phosphorodiamidate morpholino oligomers (PMOs) with positive
charges
PMOs inhibit mRNA translation through steric hindrance (Cross
et al., 2018). The morpholino group is similar to a ribose base in
RNA, and a methylene phosphorodiamidate linking moiety that
physically binds to mRNA prevents translational machinery from
accessing it. Addition of a piperazine residue provides a positive
charge (PMO plus), believed to enhance binding to negatively
charged mRNA and subvert development of resistant mutations.
Once antisense PMOs bind to target mRNA they are highly stable
and soluble, allowing high levels of inhibition and predictably low
levels of toxicity.
Initial testing of AVI-6003 (combination of AVI-7287 and AVI7288 that target MARV VP24 and NP, respectively) demonstrated
�M.G. Kortepeter et al. / International Journal of Infectious Diseases 99 (2020) 233–242
239
Table 3
Marburg countermeasures – treatment with antibodies.
Therapy
Manufacturer or
source/contact
Polyclonal
concentrated IgG
Monoclonal antibodies
Mapp
MR 191-N
Biopharmaceuticals,
San Diego, CA, and
Kentucky
Bioprocessing
Description
NHP studies
Human use (INDs,
case reports, phase 1
or 2)
Phase
3/
RCTs
Regulatory
approvals
Notes/special
populations
100% protection (6 NHPs)
Concentrated IgG derived from
previously vaccinated NHP survivors with three doses starting
from Marburg challenge
15–30 min or 48 h after
infection
Human monoclonal antibody made 12/13 and 3/3 NHPs
in Nicotiana tobacco plants binds the survived with treatment at
receptor binding site of Marburg GP D4/D7 or D5/D8 post
infection
a high level of protection against Marburg virus infection in mice,
guinea pigs and cynomolgus macaques. In NHPs, survival was
dose-dependent, with 100% protection demonstrated at doses of
20 mg/kg and 30 mg/kg when given 30–60 min post-exposure.
However, a subsequent study demonstrated failure of the AVI7287 component to protect NHPs. AVI-7288 appeared to be the
active compound and was selected for further testing in
cynomolgus macaques challenged with 1000 PFUs of Marburg
(Iversen et al., 2012). Animals were given doses of 15 mg/kg per
day for 14 days, starting at 24, 48 and 96 h post challenge,
yielding 83%, 100% and 83% protection, respectively. Human
dosing was extrapolated from this study (Heald et al., 2015;
Warren et al., 2016).
Testing in humans
In an RCT, AVI-6003 was tested in humans at ascending doses
(0.05–4.5 mg/kg) (Heald et al., 2014). It was well tolerated in 30
subjects, the most common adverse effects being gastrointestinal
symptoms, headaches and dizziness. Grade 1 elevations of ALT and
AST were noted in two subjects; mild elevations in amylase were
seen in eight. In a subsequent RCT involving 40 healthy volunteers,
subjects received daily infusions at doses ranging from 1–16 mg/kg
(Heald et al., 2015). No safety concerns or serious adverse events
were identified, although 10 participants developed headache or
other mild side effects. The protective dose for humans,
extrapolated from NHPs and AUC24, is 9.6 mg/kg. Monte Carlo
simulations supported a dose of 11 mg/kg to match mean
protective exposure in NHPs.
Small interfering RNAs (siRNAs). SiRNAs interfere with the
translation of mRNA by sterically blocking mRNA or by
triggering cleavage of the DNA/RNA duplex. An initial study
identified a siRNA – NP-718m – that targeted Marburg
nucleoprotein. When encapsulated in lipid nanoparticles
(ensuring cell entry by preferentially fusing with the endosomal
membrane), this compound inhibited replication of Marburg in
vitro and demonstrated broad protection against three Marburg
strains in guinea pigs (Ursic-Bedoya et al., 2014). Further study of
NP-718-LNP was undertaken in Marburg-infected rhesus
macaques (Thi et al., 2014). Twenty-one animals were
challenged with Marburg Angola (doses ranging 1000–1775
pfus) and received treatment (seven daily IV doses) with NP718-LNP at 30–45 min, 24, 48, and 72 h post infection. All 16 treated
animals survived. Clinical illness was much less severe and viremia
levels lower in treated animals.
Testing in humans. At least 14 siRNAs have entered into clinical
trials (www.clinicaltrials.gov) in which �1500 healthy volunteers
have been enrolled. However, none of those trials was designed for
testing potential filovirus countermeasures. One of the main
Used as an emergency
IND for a U.S. lab
exposure. Details not
public
challenges has been to develop efficient systems to deliver
accurate doses to targeted cells.
Infection prevention and control recommendations
Marburg patients might be optimally managed in specialized
biocontainment units. In the absence of such, infection prevention
and control guidelines for Marburg are similar to those for other
viral hemorrhagic fevers, primarily consisting of barrier nursing
techniques, including the use of personal protective equipment
(PPE) such as gowns, gloves, masks, and face shields or goggles to
prevent contact with blood or body fluids. Strict adherence to the
correct use of PPE, with attention to hand hygiene and prevention
of self-contamination, especially during doffing, is required.
Patients should be placed in a single room with dedicated
bathroom or commode. A U.S. Environmental Protection Agencyregistered hospital disinfectant with efficacy against enveloped
viruses should be used to disinfect environmental surfaces. Singleuse medical equipment should be used when possible. Reusable
equipment must be cleaned and disinfected according to the
Spaulding Classification scheme (CDC, 2008). The CDC and World
Health Organization have developed a manual of Infection Control
for Viral Haemorrhagic Fevers in the African Health Care Setting
(https://www.cdc.gov/vhf/abroad/vhf-manual.html). The CDC has
also developed guidelines for managing Ebola patients in
resourced settings (https://www.cdc.gov/vhf/ebola/clinicians/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvhf%
2Fabroad%2Fvhf-manual.html); these are also indicated for Marburg, and include focus on the use of PPE, waste management,
cleaning and disinfection, and other aspects of management.
Additional resources are available at www.netec.org.
To reduce the likelihood of occupational exposures, the use of
needles and sharps should be minimized. Facilities should develop
plans to manage employees who may have an exposure to blood or
body fluids. Aerosol-generating procedures should be undertaken
with extreme caution, preferably in an airborne infection isolation
room, with providers wearing appropriate PPE, including respiratory protection. In the U.S., waste generated in the care of patients
under investigation or patients with confirmed EVD is subject to
procedures set forth by local, state and federal regulations.
Extensive guidance is provided by the CDC on all aspects of care
of patients with VHF, including guidance on hemodialysis,
pregnant women, handling human remains, neonatal care,
selection and use of PPE, cleaning and disinfection, and management of waste.
Summary and recommendations
The model for use of investigational countermeasures during
outbreaks of EVD has been established, and a similar approach
�240
M.G. Kortepeter et al. / International Journal of Infectious Diseases 99 (2020) 233–242
would likely be taken during an MVD outbreak. Few of the
countermeasures listed here have been tested in humans with
MVD, and must be approached with caution through establishment of an FDA-approved investigational new drug (IND or
emergency IND) protocol with informed consent. Sources of
Marburg convalescent plasma are extremely limited, and the use
of convalescent plasma did not appear beneficial during the
2014–2016 EVD outbreak in West Africa. Monoclonal antibodies
against EVD appear more promising and, as noted above, an RCT
testing four potential therapeutics was stopped early by the data
safety monitoring board because of the apparent superiority of
two products (Mulangu et al., 2019). MR-191 appears promising
for Marburg, although it was used in a single human laboratory
exposure and details surrounding that use are unavailable.
Although NHP data for favipiravir and remdesivir appear
favorable, there are no data to indicate whether either would be
beneficial in humans. Remdesivir, used in the PALM trial in the
2018–2019 Ebola outbreak in DRC for expanded access and an
RCT, did not appear as beneficial as Mab preparations. It is
unknown whether the same would apply to Marburg, but given
that background it is reasonable to consider Mabs as potential
first choices for treatment, if available. The siRNA and PMO
products – NP-718-LNP and AVI-7288 – demonstrate good
protection of NHPs against Marburg, and both have been tested
in humans without any significant safety problems. However,
neither has been shown to provide superior protection in
humans, and given the lack of efficacy of those platforms for
Ebola in humans, those products would likely not be first choice
for use. Galidesivir demonstrates prophylactic efficacy against
Marburg out to 24 h; phase 1 results are pending. Given the less
robust response to EVD for the antiviral remdesivir, the antiviral
Galidesivir might be a potential second choice below a
monoclonal antibody preparation, such as MR-191-N.
Several vaccine platforms appear promising. Adenovirus
constructs show promise using strains having limited circulation
in humans, such as Ad26/35 or cAd3, but these have not been
tested against Marburg. DNA vaccines appear less protective in
NHPs and would likely need to be used in a prime-boost fashion
and the lack of existing licensed platforms lower their priority for
emergency use, from the authors’ opinion. The recombinant VSV
vaccine against Ebola is now licensed and has demonstrated safety
and a reported efficacy of 97.5%. A similar platform appears to
protect NHPs against Marburg. Although it has not yet been tested
in humans, such an approach might hold similar promise if used
for Marburg. VLPs also appear promising in NHPs but, again, have
not been tested in humans, and there are no licensed VLP vaccines.
Considering all these aspects, an adenovirus or VSV-vectored
vaccine appear the most promising at this time.
Many lessons learned from the Ebola experience in Africa
might be applied to future Marburg outbreaks. Notably, even if
promising investigational therapeutics are used, supportive care
– including close monitoring of vital signs, fluid resuscitation,
electrolyte and acid base monitoring – are critical components of
care that must be aggressively managed in order to optimize
patient outcomes in any field trials. Fischer et al. (2019) Because
medical countermeasures against Marburg are rapidly evolving,
updated information will be provided at www.netec.org as it
becomes available.
Conflict of interest
Dr. Kortepeter is a shareholder and Chair of the Scientific
Advisory Board of Integrum Scientifics. No other potential author
conflicts of interest noted.
Funding
Research reported in this publication was supported by the
United States Department of Health and Human Services Office of
the Assistant Secretary for Preparedness and Response under
award number 5 U3REP170552-003-02.
Disclaimers
The content and views expressed in this manuscript are the
responsibility of the authors and do not necessarily represent the
official views of the Department of Health and Human Services
Office of the Assistant Secretary for Preparedness and Response,
nor are they intended to represent the views of the authors’
individual institutions.
Ethical approval
The work described herein was solely a review of the literature
and as such did not have a requirement for Institutional Review
Board or Animal Use Committee approvals.
Appendix A.
The Medical Countermeasures Working Group Members:
Adam Beitscher, Denver Health Medical Center, Denver, CO
Nahid Bhadelia, Boston University Hospital, Boston, MA
Theodore J Cieslak, University of Nebraska Medical Center,
Omaha, NE
Richard T Davey, National Institute of Allergy and Infectious
Diseases, Bethesda, MD
Kerry Dierberg, Bellevue Hospital Center, New York, NY
Jared D Evans, Johns Hopkins Applied Physics Laboratory,
Laurel, MD
Maria G Frank, Denver Health Medical Center, Denver, CO
Jonathan Grein, Cedars Sinai Hospital, Los Angeles, CA
Mark G Kortepeter, University of Nebraska Medical Center,
Omaha, NE
Colleen S Kraft, Emory University Hospital, Atlanta, GA
Chris J Kratochvil, University of Nebraska Medical Center,
Omaha, NE
Karen Martins, Biological Advanced Research and Develop
Agency, Washington, DC
Susan McLellan, University of Texas Medical Branch, Galveston,
TX
Greg Measer, Food and Drug Administration (FDA), White Oak,
MD
Aneesh K Mehta, Emory University Hospital, Atlanta, GA
Vanessa Raabe, New York University Grossman School of
Medicine, New York, NY
George Risi, Biological Advanced Research and Develop Agency,
Washington, DC
Lauren Sauer, Johns Hopkins University Hospital, Baltimore, MD
Erica S Shenoy, Massachusetts General Hospital, Boston, MA
Timothy Uyeki, Centers for Disease Control and Prevention,
Atlanta, GA
References
Bauer MP, Timen A, Vossen ACTM, van Dissel JT. Marburg haemorrhagic fever in
returning travellers: an overview aimed at clinicians. Clin Microbiol Infect
2019;21:e28–31.
Beigel JH, Tomashek KM, Dodd LE, Mehta AK, Zingman BS, Kalil AC, et al. Remdesivir
for the treatment of Covid-19 – preliminary report. N Engl J Med 2020;, doi:
http://dx.doi.org/10.1056/NEJMoa2007764 Online ahead of print.
Bixler SL, Bocan TM, Wells K, Wetzel KS, Van Tongeren SA, Dong L, et al. Efficacy of
favipiravir (T-705) in nonhuman primates infected with Ebola virus or Marburg
virus. Antivir Res 2018;151:97–104.
�M.G. Kortepeter et al. / International Journal of Infectious Diseases 99 (2020) 233–242
Borchert M, Mulangu S, Swanepoel R, Libande ML, Tshomba A, Kulidri A, et al.
Serosurvey on household contacts of Marburg hemorrhagic fever patients.
Emerg Infect Dis 2006;12:433–9.
Brauburger K, Hume AJ, Muhlberger E, Olejnik J. Forty-five years of Marburg virus
research. Viruses 2012;4:1878–927.
CDC. A rational approach to disinfection and sterilization: guideline for disinfection
and sterilization in healthcare facilities. 2008 Available from: https://www.cdc.
gov/infectioncontrol/guidelines/disinfection/rational-approach.html.
[Accessed 21 January 2020].
CDC. Marburg hemorrhagic fever (Marburg HF). 2019 Available from: https://www.
cdc.gov/vhf/marburg/resources/outbreak-table.html. [Accessed 15 November
2019].
Coffin KM, Liu J, Warren TK, Blancett CD, Kuehl KA, Nichols DK, et al. Persistent
Marburg virus infection in the testes of nonhuman primate survivors. Cell Host
Microbe 2018;24:405–16.
Cross RW, Mire CE, Feldmann H, Geisbert TW. Post-exposure treatments for Ebola
and Marburg virus infections. Nat Rev Drug Discov 2018;17:418–34.
Daddario-DiCaprio KM, Geisbert TW, Stroher U, Geisbert JB, Grolla A, Fritz EA, et al.
Postexposure protection against Marburg haemorrhagic fever with recombinant vesicular stomatitis virus vectors in non-human primates: an efficacy
assessment. Lancet 2006;367:1399–404.
Dornemann J, Burzio C, Ronsse A, Sprecher A, De Clerck H, Van Herp M, et al. First
newborn baby to receive experimental therapies survives Ebola virus disease. J
Infect Dis 2017;215:171–4, doi:http://dx.doi.org/10.1093/infdis/jiw493.
Duraffour S, Malvy D, Sissoko D. How to treat Ebola virus infections? A lesson from
the field. Curr Opin Virol 2017;24:9–15.
Dye JM, Herbert AS, Kuehne AI, Barth JF, Muhammad MA, Zak SE, et al. Postexposure
antibody prophylaxis protects nonhuman primates from filovirus disease. Proc
Natl Acad Sci USA 2012;109:5034–9, doi:http://dx.doi.org/10.1073/pnas.1200
409109.
Falzarano D, Geisbert TW, Feldmann H. Progress in filovirus vaccine development:
evaluating the potential for clinical use. Expert Rev Vaccines 2011;10(1):63–77,
doi:http://dx.doi.org/10.1586/erv.10.152.
Fischer WA, Crozier I, Bausch DG, Muyembe J-J, Mulangu S, Diaz JV, et al. Shifting the
paradigm – applying universal standards of care to Ebola virus disease. N Engl J
Med 2019;380:1389–91, doi:http://dx.doi.org/10.1056/NEJMp1817070.
Gear JS, Cassel GA, Gear AJ, Trappler B, Clausen L, Meyers AM, et al. Outbreak of
Marburg virus disease in Johannesburg. Br Med J 1975;4:489–93.
Geisbert TW, Daddario-Dicaprio KM, Geisbert JB, Reed DS, Feldmann F, Grolla A,
et al. Vesicular stomatitis virus-based vaccines protect nonhuman primates
against aerosol challenge with Ebola and Marburg viruses. Vaccine 2008;26
(52):6894–900, doi:http://dx.doi.org/10.1016/j.vaccine.2008.09.082.
Geisbert TW, Geisbert JB, Leung A, Daddario-DiCaprio KM, Hensley LE, Grolla A, et al.
Single-injection vaccine protects nonhuman primates against infection with
Marburg virus and three species of Ebola virus. J. Virol 2009;83:7296–304.
Geisbert T, Bailey M, Geisbert JB, Asiedu C, Roederer M, Grazia-Pau M, et al. Vector
choice determines immunogenicity and potency of genetic vaccines against
Angola Marburg virus in nonhuman primates. J Virol 2010a;84(19):10386–94,
doi:http://dx.doi.org/10.1128/JVI.00594-10.
Geisbert TW, Hensley LE, Geisbert JB, Leung A, Johnson JC, Grolla A, et al.
Postexposure treatment of Marburg virus infections. Emerg Infect Dis
2010b;16:1119–22.
Geisbert TW, Bailey M, Hensley L, Asiedu C, Geisbert J, Stanley D, et al. Recombinant
adenovirus serotype 26 (Ad26) and Ad35 vaccine vectors bypass immunity to
Ad5 and protect nonhuman primates against ebolavirus challenge. J Virol
2011;85:4222–33, doi:http://dx.doi.org/10.1128/JVI.02407-10.
Heald AE, Iversen PL, Saoud JB, Sazani P, Charleston JS, Axtelle T, et al. Safety and
pharmacokinetic profiles of phosphorodiamidate morpholino oligomers with
activity against Ebola virus and Marburg virus: results of two single-ascendingdose studies. Antimicrob Agents Chemother 2014;58:6639–47, doi:http://dx.
doi.org/10.1128/AAC.03442-14.
Heald AE, Charleston JS, Iversen PL, Warren TK, Saoud JB, Al-Ibrahim M, et al. AVI7299 for Marburg virus in nonhuman primates and humans. N Engl J Med
2015;373:339–48, doi:http://dx.doi.org/10.1056/NEJMoa1410345.
Henao-Restrepo AM, Camacho A, Longini IM, Watson CH, Edmunds WJ, Egger M,
et al. Efficacy and effectiveness of an rVSV-vectored vaccine in preventing Ebola
virus disease: final results from the Guinea ring vaccination, open-label, clusterrandomised trial (Ebola Ça Suffit!). Lancet 2017;389:505–18.
Hoffmann M, Crone L, Dietzel E, Paijo J, Gonzalez-Hernandez M, Nehlmeier I, et al. A
polymorphism within the internal fusion loop of the Ebola virus glycoprotein
modulates host cell entry. J Virol 2017;91:1–14.
Hutchinson KL, Rollin PE. Cytokine and chemokine expression in humans infected
with Sudan Ebola virus. J Infect Dis 2007;196:S357–63.
Iversen PL, Warren TK, Wells JB, Garza NL, Mourich DV, Welch LS, et al. Discovery
and early development of AVI-7537 and AVI-7288 for the treatment of Ebola
virus and Marburg virus infections. Viruses 2012;4:2806–30, doi:http://dx.doi.
org/10.3390/v4112806.
Jacobs M, Rodger A, Bell DJ, Bhagani S, Cropley I, Filipe I, et al. Late Ebola virus
relapse causing meningoencephalitis: a case report. Lancet 2016;388:498–503,
doi:http://dx.doi.org/10.1016/S0140-6736(16)30386-5.
Jones SM, Feldmann H, Ströher U, Geisbert JB, Fernando L, Grolla A, et al. Live
attenuated recombinant vaccine protects nonhuman primates against Ebola
and Marburg viruses. Nat Med 2005;11:786–90.
Kerber R, Lorenz E, Duraffour S, Sissoko D, Rudolf M, Jaeger A, et al. Laboratory
findings, compassionate use of favipiravir, and outcome in patients with Ebola
241
virus disease, Guinea, 2015 –a retrospective observational study. J Infect Dis
2019;220(2):195–202, doi:http://dx.doi.org/10.1093/infdis/jiz078.
Kortepeter MG, Bausch DG, Bray M. Basic clinical and laboratory features of human
filoviral fever. J Infect Dis 2011;204:810–6.
Kuming BS, Kokoris N. Uveal involvement in Marburg virus disease. Br J Ophthalmol
1977;61:265–6.
Lu S, Wang S, Grimes-Serrano JM. Current progress of DNA vaccine studies in
humans. Expert Rev Vaccines 2008;7(2):175–91.
Martin JE, Sullivan NJ, Enama ME, Gordon IJ, Roederer M, Koup RA, et al. A DNA
vaccine for Ebola virus is safe and immunogenic in a phase I clinical trial. Clin
Vaccine Immunol 2006;13:1267–77.
Martini GA. Marburg virus disease. Clinical syndrome. In: Martini GA, Siegert R,
editors. Marburg virus disease. New York: Springer-Verlag; 1971. p. 1–9.
Martini GA. Marburg virus disease. Postgrad Med J 1973;49:542–6, doi:http://dx.
doi.org/10.1136/pgmj.49.574.542.
Milligan ID, Gibani MM, Sewell R, Clutterbuck EA, Campbell D, Plested E, et al. Safety
and immunogenicity of novel adenovirus type 26- and modified vaccinia
Ankara-vectored Ebola vaccines: a randomized clinical trial. JAMA 2016;315
(15):1610–23, doi:http://dx.doi.org/10.1001/jama.2016.4218.
Mire CE, Geisbert JB, Agans KN, Satterfield BA, Versteeg KM, Fritz EA, et al. Durability
of a vesicular stomatitis virus-based Marburg virus vaccine in nonhuman
primates. PLoS One 2014;9:e94355, doi:http://dx.doi.org/10.1371/journal.
pone.0094355.
Mire CE, Geisbert JB, Borisevich V, Fenton KA, Agans KA, Flyak AI, et al. Therapeutic
treatment of Marburg and Ravn virus infection in nonhuman primates with a
human monoclonal antibody. Sci Transl Med 2017;9(384), doi:http://dx.doi.org/
10.1126/scitranslmed.aai8711.
Mulangu S, Dodd LE, Davey RT, Mbaya OT, Proschan M, Mukadi D, et al. A
randomized, controlled trial of Ebola virus disease therapeutics. N Engl J Med
2019;381:2293–303, doi:http://dx.doi.org/10.1056/NEJMoa1910993.
MVA-BN1 -Filo, Ad26.ZEBOV. Vaccines in healthy volunteers. 2020 Available from:
https://clinicaltrials.gov/ct2/show/NCT02891980?term=vaccine&cond=marburg&rank=3. [Accessed 4 February 2020].
National Center for Biotechnology Information. Home – MeSH – NCBI. 2019
Available from: https://www.ncbi.nlm.nih.gov/mesh. [Accessed 16 October
2019].
Olejnik J, Muhlberger E, Hume AJ. Recent advances in marburgvirus research.
F1000Research 2019;8:1–13.
Pavlin BI. Calculation of incubation period and serial interval from multiple
outbreaks of Marburg virus disease. BMC Res Notes 2014;7:906, doi:http://dx.
doi.org/10.1186/1756-0500-7-906.
Porter DP, Weidner JM, Gomba L, Bannister R, Blair C, Jordon R, et al. Remdesivir (GS5734) is efficacious in cynomolgus macaques infected with Marburg virus. J
Infect Dis 2020;, doi:http://dx.doi.org/10.1093/infdis/jiaa290.
Reynolds P, Marzi A. Ebola and Marburg virus vaccines. Virus Genes
2017;53:501–15.
Riemenschneider J, Garrison A, Geisbert J, Jahrling P, Hevey M, Negley M, et al.
Comparison of individual and combination DNA vaccines for B. anthracis, Ebola
virus, Marburg virus and Venezuelan equine encephalitis virus. Vaccine
2003;21(25–26):4071–80.
Rollin PE, Bausch DG, Sanchez A. Blood chemistry measurements and D-Dimer
levels associated with fatal and nonfatal outcomes in humans infected with
Sudan Ebola virus. J Infect Dis 2007;196:S364–71.
Rougeron V, Feldmann H, Grard G, Becker S, Leroy EM. Ebola and Marburg
hemorrhagic fever. J Clin Virol 2015;64:111–9, doi:http://dx.doi.org/10.1016/j.
jcv.2015.01.014.
Schieffelin JS, Shaffer JG, Goba A, Gbakie M, Gire SK, Colubri A, et al. Clinical illness
and outcomes in patients with Ebola in Sierra Leone. N Engl J Med
2014;371:2092–110, doi:http://dx.doi.org/10.1056/NEJMoa1411680.
Sissoko D, Laouenan C, Folkesson E, M’Lebing AB, Beavogui AH, Baize S, et al.
Experimental treatment with favipiravir for Ebola virus disease (the JIKI trial): a
historically controlled, single-arm proof-of-concept trial in Guinea. PLoS Med
2016;13(3):e1001967, doi:http://dx.doi.org/10.1371/journal.pmed.1001967.
Smith LM, Hensley LE, Geisbert TW, Johnson J, Stossel A, Honko A, et al. Interferonbeta therapy prolongs survival in rhesus macaque models of Ebola and Marburg
hemorrhagic fever. J Infect Dis 2013;208:310–8, doi:http://dx.doi.org/10.1093/
infdis/jis921.
Stanley DA, Honko AN, Asiedu C, Trefry JC, Lau-Kilby AW, Johnson JC, et al.
Chimpanzee adenovirus vaccine generates acute and durable protective
immunity against ebolavirus challenge. Nat Med 2014;20:1126–9.
Stille W, Boehle E. Clinical course and prognosis of Marburg virus (“green monkey”)
disease. In: Martini GA, Siegert R, editors. Marburg virus disease. New York:
Springer-Verlag; 1971. p. 10–8.
Swenson DL, Wang D, Luo M, Warfield KL, Woraratanadharm J, Holman DH, et al.
Vaccine to confer to nonhuman primates complete protection against multistrain Ebola and Marburg virus infections. Clin Vaccine Immunol
2008a;15:460–7, doi:http://dx.doi.org/10.1128/CVI.00431-07.
Swenson DL, Warfield KL, Larsen T, Alves DA, Coberley SS, Bavari S. Monovalent
virus-like particle vaccine protects guinea pigs and nonhuman primates against
infection with multiple Marburg viruses. Expert Rev Vaccines 2008b;7:417–29,
doi:http://dx.doi.org/10.1586/14760584.7.4.417.
Thi EP, Mire CE, Ursic-Bedoya R, Geisbert JB, Lee ACH, Agans KN, et al. Marburg virus
infection in nonhuman primates: therapeutic treatment by lipid-encapsulated
siRNA. Sci Transl Med 2014;6:ra116, doi:http://dx.doi.org/10.1126/scitranslmed.
3009706.
�242
M.G. Kortepeter et al. / International Journal of Infectious Diseases 99 (2020) 233–242
Ursic-Bedoya R, Mire CE, Robbins M, Geisbert JB, Judge A, MacLachlan I, et al.
Protection against lethal Marburg virus infection mediated by lipid encapsulated small interfering RNA. J Infect Dis 2014;209:562–70.
Warfield KL, Aman J. Advances in virus-like particle vaccines for filoviruses. J Infect
Dis 2011;204(Suppl. 3):S1053, doi:http://dx.doi.org/10.1093/infdis/jir346.
Warren TK, Wells J, Panchal RG, Stuthman KS, Garza NL, Van Tongeren SA, et al.
Protection against filovirus diseases by a novel broad-spectrum nucleoside
analogue BCX4430. Nature 2014;508:402–5, doi:http://dx.doi.org/10.1038/
nature13027.
Warren TK, Whitehouse CA, Wells J, Welch L, Charleston JS, Heald A, et al. Delayed
time to treatment of an antisense morpholino oligomer is effective against
lethal Marburg virus infection in cynomolgus macaques. PLoS Neglect Trop Dis
2016;10:1–18, doi:http://dx.doi.org/10.1371/journal.pntd.0004456.
WHO Ebola Response Team, Agua-Agum J, Ariyarajah A, Blake IM, Cori A, Donnelly
CA, et al. Ebola virus disease among children in West Africa. N Engl J Med
2015;372(13):1274–7, doi:http://dx.doi.org/10.1056/NEJMc1415318.
Woolsey C, Geisbert JB, Matassov D, Agans KN, Borisevich V, Cross RW, et al.
Postexposure efficacy of recombinant vesicular stomatitis virus vectors against
high and low doses of Marburg virus variant Angola in nonhuman primates. J
Infect Dis 2018;218:S582–7, doi:http://dx.doi.org/10.1093/infdis/jiy293.
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Kortepeter, M. G., K. Dierberg, E. S. Shenoy, and T. J. Cieslak. 2020. "Marburg Virus Disease: a Summary for Clinicians." <em>International Journal of Infectious Disease</em>. 99:233-42.
Abstract
<div class="abstract-content selected">
<p><strong class="sub-title"> Objectives: </strong> This article is a summary of countermeasures for Marburg virus disease focusing on pathogenesis, clinical features, and diagnostics, with an emphasis on therapies and vaccines that have demonstrated potential for use in an emergency situation, through their evaluation in nonhuman primates (NHPs) and/or in humans.</p>
<p><strong class="sub-title"> Methods: </strong> A standardized literature review was conducted on vaccines and treatments for each pathogen, with a focus on human and nonhuman primate data published in the last five years. More detail on the methods used are summarized in a companion methods paper.</p>
<p><strong class="sub-title"> Results: </strong> We identified six treatments and four vaccine platforms that have demonstrated potential benefit for treating or preventing infection in humans, through their efficacy in NHPs.</p>
<p><strong class="sub-title"> Conclusion: </strong> We provide succinct summaries of Marburg countermeasures to give the busy clinician a head start in reviewing the literature if faced with a patient with Marburg virus disease. We also provide links to other authoritative sources of information.</p>
</div>
<p><strong class="sub-title"> Keywords: </strong> Ebola virus; Marburg virus; antiviral countermeasure; antiviral therapy; filovirus; treatment; vaccine.</p>
<p class="copyright" id="copyright">Copyright © 2020. Published by Elsevier Ltd.</p>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online, Elsevier Open Access and Pub Med Central. <br /><a href="https://doi.org/10.1016/j.ijid.2020.07.042">https://doi.org/10.1016/j.ijid.2020.07.042</a> 1201-9712/<br />2020 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. <br />This is an open access article under the CC BY-NC-ND license (<a href="https://creativecommons.org/licenses/by-nc-nd/4.0/">https://creativecommons.org/licenses/by-nc-nd/4.0/</a>)
URL
https://pubmed.ncbi.nlm.nih.gov/32758690/
Read Online
Online location of the resource.
https://www.ijidonline.com/article/S1201-9712(20)30586-5/pdf
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Marburg Virus Disease: a Summary for Clinicians
Subject
The topic of the resource
Research
Description
An account of the resource
This article is a summary of countermeasures for Marburg virus disease focusing on pathogenesis, clinical features, and diagnostics, with an emphasis on therapies and vaccines that have demonstrated potential for use in an emergency situation, through their evaluation in nonhuman primates (NHPs) and/or in humans.
Creator
An entity primarily responsible for making the resource
the Medical Countermeasures Working Group of the National Ebola Training and Education Center’s (NETEC’s) Special Pathogens Research Network (SPRN)
Source
A related resource from which the described resource is derived
Kortepeter, M. G., K. Dierberg, E. S. Shenoy, and T. J. Cieslak.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-03
Type
The nature or genre of the resource
Publication
Category A
Clinical Care
Diagnosis
Isolation/Biocontainment
Marburg
R-Res&Pub
Treatment and Care
Viral Hemorrhagic Fever
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Jiang, Li, Kun Tang, Mike Levin, Omar Irfan, Shaun K. Morris, Karen Wilson, Jonathan D. Klein, and Zulfiqar A. Bhutta. 2020. "COVID-19 and multisystem inflammatory syndrome in children and adolescents." The Lancet Infectious Diseases.
Abstract
<h2 class="top" id="seccestitle10"><span class="top__text">Summary</span></h2>
<div class="section-paragraph">
<div class="section-paragraph">As severe acute respiratory syndrome coronavirus 2 continues to spread worldwide, there have been increasing reports from Europe, North America, Asia, and Latin America describing children and adolescents with COVID-19-associated multisystem inflammatory conditions. However, the association between multisystem inflammatory syndrome in children and COVID-19 is still unknown. We review the epidemiology, causes, clinical features, and current treatment protocols for multisystem inflammatory syndrome in children and adolescents associated with COVID-19. We also discuss the possible underlying pathophysiological mechanisms for COVID-19-induced inflammatory processes, which can lead to organ damage in paediatric patients who are severely ill. These insights provide evidence for the need to develop a clear case definition and treatment protocol for this new condition and also shed light on future therapeutic interventions and the potential for vaccine development.</div>
<h3>Translations</h3>
<div class="section-paragraph">For the French, Chinese, Arabic, Spanish and Russian translations of the abstract see Supplementary Materials section.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30651-4/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30651-4/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
COVID-19 and multisystem inflammatory syndrome in children and adolescents
Subject
The topic of the resource
Research
Description
An account of the resource
As severe acute respiratory syndrome coronavirus 2 continues to spread worldwide, there have been increasing reports from Europe, North America, Asia, and Latin America describing children and adolescents with COVID-19-associated multisystem inflammatory conditions.<br /><br />A response to this article was published:<br /><ul><li>Schwartz, Michael. 2020. "<a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30786-6/fulltext" target="_blank" rel="noreferrer noopener">MIS-C: post-infectious syndrome or persistent infection?</a>" The Lancet Infectious Diseases.</li>
</ul>
Creator
An entity primarily responsible for making the resource
Jiang, Li, Kun Tang, Mike Levin, Omar Irfan, Shaun K. Morris, Karen Wilson, Jonathan D. Klein, and Zulfiqar A. Bhutta.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-17
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-07 by Amyna, Special Populations Treatment & Care group
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-31
Relation
A related resource
Y
2019-nCoV
Children
Clinical Care
Coronavirus
COVID-19
Neonates
Pediatrics
R-Res&Pub
R-SP
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Young, Barnaby E., Siew-Wai Fong, Yi-Hao Chan, Tze-Minn Mak, Li Wei Ang, Danielle E. Anderson, Cheryl Yi-Pin Lee, Siti Naqiah Amrun, Bernett Lee, Yun Shan Goh, Yvonne C. F. Su, Wycliffe E. Wei, Shirin Kalimuddin, Louis Yi Ann Chai, Surinder Pada, Seow Yen Tan, Louisa Sun, Purnima Parthasarathy, Yuan Yi Constance Chen, Timothy Barkham, Raymond Tzer Pin Lin, Sebastian Maurer-Stroh, Yee-Sin Leo, Lin-Fa Wang, Laurent Renia, Vernon J. Lee, Gavin J. D. Smith, David Chien Lye, and Lisa F. P. Ng. 2020. "Effects of a major deletion in the SARS-CoV-2 genome on the severity of infection and the inflammatory response: an observational cohort study." The Lancet.
Abstract
<h2 class="top" id="seccestitle10"><span class="top__text">Summary</span></h2>
<div class="section-paragraph">
<h3>Background</h3>
<div class="section-paragraph">Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with a 382-nucleotide deletion (∆382) in the open reading frame 8 (ORF8) region of the genome have been detected in Singapore and other countries. We investigated the effect of this deletion on the clinical features of infection.</div>
<h3>Methods</h3>
<div class="section-paragraph">We retrospectively identified patients who had been screened for the ∆382 variant and recruited to the PROTECT study—a prospective observational cohort study conducted at seven public hospitals in Singapore. We collected clinical, laboratory, and radiological data from patients' electronic medical records and serial blood and respiratory samples taken during hospitalisation and after discharge. Individuals infected with the ∆382 variant were compared with those infected with wild-type SARS-CoV-2. Exact logistic regression was used to examine the association between the infection groups and the development of hypoxia requiring supplemental oxygen (an indicator of severe COVID-19, the primary endpoint). Follow-up for the study's primary endpoint is completed.</div>
<h3>Findings</h3>
<div class="section-paragraph">Between Jan 22 and March 21, 2020, 278 patients with PCR-confirmed SARS-CoV-2 infection were screened for the ∆382 deletion and 131 were enrolled onto the study, of whom 92 (70%) were infected with the wild-type virus, ten (8%) had a mix of wild-type and ∆382-variant viruses, and 29 (22%) had only the ∆382 variant. Development of hypoxia requiring supplemental oxygen was less frequent in the ∆382 variant group (0 [0%] of 29 patients) than in the wild-type only group (26 [28%] of 92; absolute difference 28% [95% CI 14–28]). After adjusting for age and presence of comorbidities, infection with the ∆382 variant only was associated with lower odds of developing hypoxia requiring supplemental oxygen (adjusted odds ratio 0·07 [95% CI 0·00–0·48]) compared with infection with wild-type virus only.</div>
<h3>Interpretation</h3>
<div class="section-paragraph">The ∆382 variant of SARS-CoV-2 seems to be associated with a milder infection. The observed clinical effects of deletions in ORF8 could have implications for the development of treatments and vaccines.</div>
<h3>Funding</h3>
<div class="section-paragraph">National Medical Research Council Singapore.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31757-8/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31757-8/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Effects of a major deletion in the SARS-CoV-2 genome on the severity of infection and the inflammatory response: an observational cohort study
Subject
The topic of the resource
Research
Description
An account of the resource
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with a 382-nucleotide deletion (∆382) in the open reading frame 8 (ORF8) region of the genome have been detected in Singapore and other countries. We investigated the effect of this deletion on the clinical features of infection.
Creator
An entity primarily responsible for making the resource
Young, Barnaby E., Siew-Wai Fong, Yi-Hao Chan, Tze-Minn Mak, Li Wei Ang, Danielle E. Anderson, Cheryl Yi-Pin Lee, Siti Naqiah Amrun, Bernett Lee, Yun Shan Goh, Yvonne C. F. Su, Wycliffe E. Wei, Shirin Kalimuddin, Louis Yi Ann Chai, Surinder Pada, Seow Yen Tan, Louisa Sun, Purnima Parthasarathy, Yuan Yi Constance Chen, Timothy Barkham, Raymond Tzer Pin Lin, Sebastian Maurer-Stroh, Yee-Sin Leo, Lin-Fa Wang, Laurent Renia, Vernon J. Lee, Gavin J. D. Smith, David Chien Lye, and Lisa F. P. Ng.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-18
Type
The nature or genre of the resource
Publication
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Outcomes
R-Res&Pub
Research
-
https://repository.netecweb.org/files/original/c74274f8df89783d85c34ab100a47b92.png
71e4faf666f87142cbf181d942268d24
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Furtado, Remo H. M., Otavio Berwanger, Henrique A. Fonseca, Thiago D. Corrêa, Leonardo R. Ferraz, Maura G. Lapa, Fernando G. Zampieri, Viviane C. Veiga, Luciano C. P. Azevedo, Regis G. Rosa, Renato D. Lopes, Alvaro Avezum, Airton L. O. Manoel, Felipe M. T. Piza, Priscilla A. Martins, Thiago C. Lisboa, Adriano J. Pereira, Guilherme B. Olivato, Vicente C. S. Dantas, Eveline P. Milan, Otavio C. E. Gebara, Roberto B. Amazonas, Monalisa B. Oliveira, Ronaldo V. P. Soares, Diogo D. F. Moia, Luciana P. A. Piano, Kleber Castilho, Roberta G. R. A. P. Momesso, Guilherme P. P. Schettino, Luiz Vicente Rizzo, Ary Serpa Neto, Flávia R. Machado, and Alexandre B. Cavalcanti. 2020. "Azithromycin in addition to standard of care versus standard of care alone in the treatment of patients admitted to the hospital with severe COVID-19 in Brazil (COALITION II): a randomised clinical trial." The Lancet.
Abstract
<h2 class="top" id="seccestitle10"><span class="top__text">Summary</span></h2>
<div class="section-paragraph">
<h3>Background</h3>
<div class="section-paragraph">The efficacy and safety of azithromycin in the treatment of COVID-19 remain uncertain. We assessed whether adding azithromycin to standard of care, which included hydroxychloroquine, would improve clinical outcomes of patients admitted to the hospital with severe COVID-19.</div>
<h3>Methods</h3>
<div class="section-paragraph">We did an open-label, randomised clinical trial at 57 centres in Brazil. We enrolled patients admitted to hospital with suspected or confirmed COVID-19 and at least one additional severity criteria as follows: use of oxygen supplementation of more than 4 L/min flow; use of high-flow nasal cannula; use of non-invasive mechanical ventilation; or use of invasive mechanical ventilation. Patients were randomly assigned (1:1) to azithromycin (500 mg via oral, nasogastric, or intravenous administration once daily for 10 days) plus standard of care or to standard of care without macrolides. All patients received hydroxychloroquine (400 mg twice daily for 10 days) because that was part of standard of care treatment in Brazil for patients with severe COVID-19. The primary outcome, assessed by an independent adjudication committee masked to treatment allocation, was clinical status at day 15 after randomisation, assessed by a six-point ordinal scale, with levels ranging from 1 to 6 and higher scores indicating a worse condition (with odds ratio [OR] greater than 1·00 favouring the control group). The primary outcome was assessed in all patients in the intention-to-treat (ITT) population who had severe acute respiratory syndrome coronavirus 2 infection confirmed by molecular or serological testing before randomisation (ie, modified ITT [mITT] population). Safety was assessed in all patients according to which treatment they received, regardless of original group assignment. This trial was registered at <a href="http://ClinicalTrials.gov" target="_blank" rel="noreferrer">ClinicalTrials.gov</a>, <a href="http://clinicaltrials.gov/show/NCT04321278" target="_blank" rel="noreferrer">NCT04321278</a>.</div>
<h3>Findings</h3>
<div class="section-paragraph">447 patients were enrolled from March 28 to May 19, 2020. COVID-19 was confirmed in 397 patients who constituted the mITT population, of whom 214 were assigned to the azithromycin group and 183 to the control group. In the mITT population, the primary endpoint was not significantly different between the azithromycin and control groups (OR 1·36 [95% CI 0·94–1·97], p=0·11). Rates of adverse events, including clinically relevant ventricular arrhythmias, resuscitated cardiac arrest, acute kidney failure, and corrected QT interval prolongation, were not significantly different between groups.</div>
<h3>Interpretation</h3>
<div class="section-paragraph">In patients with severe COVID-19, adding azithromycin to standard of care treatment (which included hydroxychloroquine) did not improve clinical outcomes. Our findings do not support the routine use of azithromycin in combination with hydroxychloroquine in patients with severe COVID-19.</div>
<h3>Funding</h3>
<div class="section-paragraph">COALITION COVID-19 Brazil and EMS.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31862-6/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31862-6/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Azithromycin in addition to standard of care versus standard of care alone in the treatment of patients admitted to the hospital with severe COVID-19 in Brazil (COALITION II): a randomised clinical trial
Subject
The topic of the resource
Research
Description
An account of the resource
The efficacy and safety of azithromycin in the treatment of COVID-19 remain uncertain. We assessed whether adding azithromycin to standard of care, which included hydroxychloroquine, would improve clinical outcomes of patients admitted to the hospital with severe COVID-19.<br /><br />A response to this article was published:
<ul><li>Oldenburg, Catherine E., and Thuy Doan. 2020. "<a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31863-8/fulltext" target="_blank" rel="noreferrer">Azithromycin for severe COVID-19</a>." The Lancet.</li>
</ul>
Creator
An entity primarily responsible for making the resource
Furtado, Remo H. M., Otavio Berwanger, Henrique A. Fonseca, Thiago D. Corrêa, Leonardo R. Ferraz, Maura G. Lapa, Fernando G. Zampieri, Viviane C. Veiga, Luciano C. P. Azevedo, Regis G. Rosa, Renato D. Lopes, Alvaro Avezum, Airton L. O. Manoel, Felipe M. T. Piza, Priscilla A. Martins, Thiago C. Lisboa, Adriano J. Pereira, Guilherme B. Olivato, Vicente C. S. Dantas, Eveline P. Milan, Otavio C. E. Gebara, Roberto B. Amazonas, Monalisa B. Oliveira, Ronaldo V. P. Soares, Diogo D. F. Moia, Luciana P. A. Piano, Kleber Castilho, Roberta G. R. A. P. Momesso, Guilherme P. P. Schettino, Luiz Vicente Rizzo, Ary Serpa Neto, Flávia R. Machado, and Alexandre B. Cavalcanti.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-08
Type
The nature or genre of the resource
Publication
2019-nCoV
Clinical Care
Clinical Trial
Coronavirus
COVID-19
R-Res&Pub
Therapeutics
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Flinn, Jade B., Noreen A. Hynes, Lauren M. Sauer, Lisa L. Maragakis, and Brian T. Garibaldi. 2020. "The role of dedicated biocontainment patient care units in preparing for COVID-19 and other infectious disease outbreaks." Infection Control & Hospital Epidemiology:1-14.
Abstract
<div class="abstract">
<h2 class="title">Abstract</h2>
<div class="abstract-content selected">
<p>In response to the Ebola outbreak of 2014-2016, the US Office of the Assistant Secretary for Preparedness and Response (ASPR) established 10 regional treatment centers, called biocontainment units (BCUs) to prepare and provide care for patients infected with high consequence pathogens. Many of these BCUs were among the first units to activate for COVID-19 patient care. The activities of the Johns Hopkins BCU in the three domains of containment care ---(1) preparedness planning, education and training, (2) patient care and unit operations, and (3) research and innovation---helped prepare the Johns Hopkins Health System for COVID-19. Here we describe the role of the JH BCU in the Hopkins COVID-19 response to illustrate the value of BCUs in the current pandemic and their potential role in preparing healthcare facilities and health systems for future infectious disease threats.</p>
</div>
<p><strong class="sub-title"> Keywords: </strong> COVID-19; biocontainment; emergency preparedness; infection control and prevention; infectious disease preparedness.</p>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Online through Cambridge Core
URL
https://pubmed.ncbi.nlm.nih.gov/32883382/
Read Online
Online location of the resource.
https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/role-of-dedicated-biocontainment-patient-care-units-in-preparing-for-covid19-and-other-infectious-disease-outbreaks/639CCE780D75ECDC70DD67CFFAD1C46A
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The role of dedicated biocontainment patient care units in preparing for COVID-19 and other infectious disease outbreaks
Subject
The topic of the resource
Physical Infrastructure
Description
An account of the resource
In response to the Ebola outbreak of 2014-2016, the US Office of the Assistant Secretary for Preparedness and Response (ASPR) established 10 regional treatment centers, called biocontainment units (BCUs) to prepare and provide care for patients infected with high consequence pathogens. Many of these BCUs were among the first units to activate for COVID-19 patient care.
Creator
An entity primarily responsible for making the resource
Flinn, Jade B., Noreen A. Hynes, Lauren M. Sauer, Lisa L. Maragakis, and Brian T. Garibaldi.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-04
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2023-08-31 by Shawn Gibbs - PhysInfr General Review
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-08-31
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Example
Isolation/Biocontainment
Outbreaks
Preparedness
R-Lead
R-PhIn
R-Res&Pub
Special Pathogens
Treatment and Care
-
https://repository.netecweb.org/files/original/840a5b3eb0d83e90f0f487520d270e08.pdf
28ad95255890051ba0ae6c9f36764dbe
PDF Text
Text
NETEC COVID-19 Webinar Series:
Pediatric Perspectives During a Pandemic
�Content Outline (TOC)
Welcome
Amanda Grindle, MSN, RN
�Overview
Welcome: Amanda Grindle, RN, MSN
Pediatric Perspective During a Pandemic: Andi Shane, MD, MPH, MSc
Multi-System Inflammatory Disease in Children (MIS-C):
The CHOA Experience : Preeti Jaggi, MD
COVID-19 and the Heart: A Pediatric Perspective: Matt Oster, MD, MPH
NETEC Resources: Amanda Grindle, RN, MSN
Questions and Answers with NETEC:
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Pediatric Perspective During a Pandemic
Andi Shane, MD, MPH, MSc
�Comparative Epidemiology of Acute COVID-19 in Children and Adults
r
https://covid.cdc.gov/covid-data-tracker; updated 02 Oct 2020
�Pediatric Perspectives During a Pandemic
Infection and Transmission Among Children
What we don’t know:
• Are children as susceptible to infection by SARS-CoV-2 compared with adults?
• Can children transmit SARS-CoV-2 as effectively as adults?
• Does transmission result in infection, and does infection result in disease?
What we do know:
• Children likely have the same or higher viral loads in their nasopharynx
compared with adults
• Children can transmit SARS-CoV-2 effectively in households and camp settings
�Pediatric Perspectives During a Pandemic
Burden of COVID-19 in Children
Less likely to develop severe illness compared with adults
Children still at risk of developing severe illness and complications
Rate of hospitalization among children is low (8.0 /100,000) compared with
adults (165 /100,000 population); may be increasing
Children have lower rates of mechanical ventilation and death than adults
Of the children who have developed severe illness, most with underlying medical
conditions including obesity, diabetes, asthma and chronic lung disease
Most who are infected with SARS-CoV-2 do not usually develop severe illness
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html accessed 02Oct2020
�Pediatric Perspectives During a Pandemic
Hospitalization Associated with Acute COVID-19 in Children
Hospitalization rates in the United States are higher among Hispanic/Latino children and
black, non-Hispanic children and non-Hispanic black children compared with white
children
• May be related to higher rates of obesity and other underlying conditions among
these populations
Similar to adults, children with severe COVID-19 may develop respiratory failure,
myocarditis, shock, acute renal failure, coagulopathy, and multi-organ system failure
Some children have developed appendicitis, intussusception or diabetic ketoacidosis
Children infected with SARS-CoV-2 are also at risk for developing multisystem
inflammatory syndrome in children (MIS-C)
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html accessed 02Oct2020
�Clinical Management
Treatment of COVID-19 in children is mostly supportive; intervention may be needed in
some who are hospitalized
Remdesivir, with variable results in clinical trials in adults, is now available for purchase
r
The safety and effectiveness of Remdesivir for treatment of COVID-19 is being evaluated in children
(NCT04431453)
The National Institutes of Health (NIH) suggests that dexamethasone may be beneficial in pediatric
patients with acute COVID-19 respiratory disease who are receiving mechanical ventilation1
Children infected with SARS-CoV-2 can present with other serious conditions such as diabetic
ketoacidosis or intussusception, and a broad differential must be maintained
1
https://files.covid19treatmentguidelines.nih.gov/guidelines/section/section_45.pdf accessed 02Oct2020
�Pediatric Perspectives During a Pandemic
Challenges to Family Centered Care
Visitor restrictions
Essential personnel only in room
Common areas for siblings closed
PPE frightening to children
Decreased ability to communicate wearing masks
Children unable or unwilling to wear masks
�Pediatric Perspectives During a Pandemic
Advocate for Children in Treatment and Prevention Trials
Advocacy for children’s participation in treatment trials
• 107 current studies listed in COVID-19 Studies from the World Health
Organization Database
• 383 current studies in ClinicalTrials.gov
Advocacy for inclusion of children in vaccine studies
�Well Child Care
Shelter-in-place orders resulted in declines in outpatient pediatric visits and fewer vaccine doses
administered during the early COVID-19 pandemic
Clinicians should work with families to keep children up to date with all recommended vaccinations by
identifying children who have missed well-child visits and/or recommended vaccinations and contact
them to schedule in-person appointments, with prioritization of infants, children age < 24 months and
school-aged children
Developmental surveillance and early childhood screenings, including developmental and autism
r
screening, should continue along with referrals for early intervention services
All newborns should be seen by a pediatric healthcare provider shortly after hospital discharge (three to
five days of age in-person, to evaluate feeding and weight gain, check for dehydration and jaundice,
ensure all components of newborn screening were completed with appropriate confirmatory testing and
follow-up, and evaluate maternal well-being
Clinicians should educate patients and families about infection prevention
in clinics, emergency departments, hospitals, and clinics
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html accessed 02Oct2020
�K-12 School Closures
Status of COVID-19 Pandemic-Associated Public K-12 School Closures –
United States, February 18 – June 30, 2020 (Archived)
r
https://covid.cdc.gov/covid-data-tracker; updated 13 Aug 2020
�Pediatric Perspectives During a Pandemic
Return to School
Children with symptoms of any infectious disease should not attend school
The length of isolation depends on the most likely etiology of illness
Return to school policies for children with COVID-19 based on local epidemiology
A negative test or excuse note should not be required for return to school upon
completion of the 10 days of isolation with improvement of symptoms
If a child is assessed to likely not have COVID-19 by a clinician, he/she should be allowed
to return to school according to existing school policies for non-COVID illnesses
(resolution of fever without antipyretics for 24 hours for non-COVID viral illnesses or
after initiation of antibiotics for bacterial illnesses, if indicated)
https://www.cdc.gov/coronavirus/2019-ncov/hcp/pediatric-hcp.html accessed 02Oct2020
�Content Outline (TOC)
Multi-System Inflammatory Disease in
Children (MIS-C): The CHOA Experience
Preeti Jaggi, MD
�Background
SARS CoV-2 generally causes less severe acute illness in children
April 27, alert from the NHS: cases of severe myocardial dysfunction, some with
features of Kawasaki disease, and several with shock requiring vasopressive
medications as supportive care
Later this was described in NYC and throughout
areas in the US
r
Features similar to Kawasaki disease
Conjunctival injection, rash, coronary dilation
Similar
Different Older age, higher percentage with shock
Features similar to toxic shock syndrome
Similar
Different
Diffuse rash, shock, thrombocytopenia, multi-system involvement
Rash mostly not diffuse erythroderma
�Background: Toxic Shock Syndrome
Toxic Shock Syndrome
r
Date of download: 8/5/2015 Copyright © 2015 American Academy of Pediatrics
�Multi-System Inflammatory Disease in Children (MIS-C):
The CHOA Experience
Background
Features similar to rheumatologic illness
• HLH/macrophage activation syndrome: cytopenia, hyper-inflammatory state
• State seen in underlying rheumatologic illness such as JIA, SLE
MIS-C: Most greater than 5 years of age
Abdominal complaints (pain, diarrhea, vomiting) in about half
Most are otherwise healthy
Epidemiology seems to follow approximately one month after peaks of
community COVID-19 cases
�Health Department – Reported Cases of Multisystem Inflammatory Syndrome
in Children (MIS-C) in the United States (N=935)
r
42% Hispanic, 33% Black/non Hispanic, 14% White
non-Hispanic, 2% Asian
55% Males
Over 50% are 5-14 years of age
�MIS-C: Likely Many Scenarios
Serology +
MIS-C
Mild or no COVID-19
r
Severe COVID-19
predominantly respiratory
MIS-C
Kawasaki disease (PCR or serology positive)
Other illness (PCR or serology positive)
Meet MIS-C Case Definition
PCR +
Fever
Evidence of
inflammation
2 organ systems
“Severe” illness
No other plausible
diagnosis
Evidence of
serologic
conversion,
contact, or NP +
�12-Year-Old..
12 y/o: Day 2 of illness: Came to ED with fevers, vomiting
Day 3 of illness: Returned to ED with persistent fevers, new cough
Day 5 of illness: Returned to ED with fevers, SOB
• 39.6oC HR 129 BP 108/63 RR 26-40 89% O2 saturation
• Due to increased distress on HFNC 15L 100%, transferred to PICU for BiPAP
r
HD #1
HD #3
Patel; Pediatrics, 2020
�7-Year-Old..
1
• Fevers ranged from 102-104F
• Abd pain is constant, diarrhea, vomiting
• NBNB emesis 1-2 episodes per day
• Rash: “red dots like mosquito bites” on palms
D#1
2
• Progresses to have conjunctival injection and dry, cracked lips
• Rx Zofran for presumed AGE r
• Rash progressed à red and splotchy on shoulders, arms, back
D#2
3
D#5
• Neck pain
• Hypotension
• Decreased left ventricular function
• Admitted to ICU, treated with IVIG and eventually improves
�COVID-19 and Kawasaki Disease: Novel Virus and Novel Case
6 mo with fever, fussiness, decreased PO
Rash on day 2
Figure 1. Bulbar conjunctival injection.
Irritability, limbic-sparing conjunctivitis,
and dry lips on day 4
Swelling of hands on day 5
Left shift, anemia, elevated CRP and ESR,
low albumin
Treated with IVIG and high dose ASA
Echo normal
SARS-CoV-2 RT-PCR positive from
admission
Jones, VG, Hospital Pediatrics 2020
Image shared with parental permission.
r
�CHOA Cases
Symptomatic, NP SWAB +
MIS-C Cases
r
�Demographics in Acute COVID versus MIS-C
MIS-C
(n=57)
Acute COVID (n=952)
Age, median (IQR)
10.26 (2.5-15)
Gender, % male
P value
8.26 (5.9-11.9)
NS
52.5%
59.6%
NS
Ethnicity, Hispanic
364 (38.2%)
16 (28%)
NS
Race, Black
376 (39.4%)
38 (67%)
p<0.001
r
�Severity of Illness in Children with MIS-C
Total
Length of stay, days
7, median (IQR 4-9)
% requiring ICU care
74% (41/55)
r
Myocardial dysfunction
60%
Immunomodulators (anakinra, tocilizumab)
8.6%
Vasoactive medications
57%
�Multi-System Inflammatory Disease in Children (MIS-C):
The CHOA Experience
Preliminary Observations
MIS-C is probably a collection of syndromes
• Acute infection with severe disease
• Post infection after an undetectable initial illness
MIS-C may disproportionately affect Black children
• Don’t know infection rates in asymptomatic children
MIS-C is associated with severe illness
Using quantitative serology, MIS-C appears most similar to
convalescent COVID
�Content Outline (TOC)
COVID-19 and the Heart:
A Pediatric Perspective
Matt Oster, MD, MPH
�Proposed Mechanisms of Cardiac Injury
Immunopathology
Hyperinflammation
Biomarkers of injury
SARS-CoV-2
Direct Myocardial Injury
r
Arrhythmias
Acute Coronary Syndromes
HFpEF, HFrEF
Respiratory failure,
Hypoxemia
Akhmerov and Marbán. Circulation Research 2020
Children’s Healthcare of Atlanta | Emory University
�COVID-19 and Cardiac Involvement
Acute involvement
• Not seeing a lot in children
(but are we really checking?)
r
Long-term
• Myocarditis?
• Arrhythmias?
• Sinus bradycardia?
et al. Heart Rhythm 2020.
Children’s Healthcare of Atlanta |Siripanthong
Emory University
�Acute Effects in Children
r
Kim et al. MMWR 2020
Children’s Healthcare of Atlanta | Emory University
�Multisystem Inflammatory Syndrome: Cardiac Involvement
r
Godfred-Cato
Children’s Healthcare of Atlanta | Emory
University et al. MMWR 2020
�COVID-19 and the Heart: A Pediatric Perspective
What is Myocarditis?
Inflammatory disease of the heart muscle
Male predominance
Primarily young adults
Dasgupta et al. CHD 2019.
�COVID-19 and the Heart: A Pediatric Perspective
Why Do We Care About Myocarditis?
Cause of death in 9% of athletes in whom a cardiovascular event was
documented1
Of 243 analyzed cases of sudden death in ages 1-17yo in 2015-2016, 19
(8%) had myocarditis or endocarditis2
1
Maron et al. Circulation 2009.
2
Burns et al. Journal of Pediatrics 2020.
�COVID-19 and the Heart: A Pediatric Perspective
Myocarditis in Adults
German study of 100 adults
• Median age 49
• 1/3 hospitalized, 2/3 at home (with 18 asymptomatic)
• MRI 2-3 months after COVID infection
• Cardiac involvement by MRI in 78%, with 60% with ongoing inflammation
Puntmann et al. JAMA Cardiology 2020
�COVID-19 and the Heart: A Pediatric Perspective
Myocarditis in College Athletes
26 college athletes, 4 of whom met CMR criteria for myocarditis
• 0/10 females had myocarditis, 4/16 males)
12 subjects had mild symptoms during acute infection (2 of the 4 with eventual
myocarditis)
0 subjects had ST/T wave changes on ECG, elevated troponin, or abnormal ventricular
size or function by echo
Rajpal et al. JAMA Cardiology 2020
�Hospitalized?
NO
Asymptomatic or mild
COVID-19 symptoms?
(no fever and <3d of sx)
YES
NO
Cardiac involvement
during
hospitalization
Normal physical exam
and ECG
NO
(at PCP or cardiology)?
YE
S
Does not need
further cardiac
evaluation.
Cleared for sports.
YE
S
Cardiology follow-up
not needed.
Cleared for sports.
YE
S
Cardiology follow-up
not needed.
Cleared for sports.
NO
Manage accordingly
based on other
potential cardiac
conditions.
OR
Diagnosed with
MIS-C?
YES
NO
Cardiology workup as
indicated by
r Normal?
cardiologist.
NO
Follow up with
Cardiology 2 weeks
after Discharge
Myocarditis?
YE
S
Follow myocarditis
protocol. Restricted
from sports until
cleared by cardiology.
�MIS-C Follow-up Plan
ECG
Echo
2 weeks
6 weeks
3 months
6 months
All
All
All
All
All
Only if persistent
coronary involvement at
6 weeks
All
All
r
MRI
Stress Test
If EVER cardiac
dysfunction
TBD if abnormal
cardiac MRI findings
at 3 months
If at least 8yo and EVER
cardiac dysfunction
TBD if abnormal
stress test at 3
months
Children’s Healthcare of Atlanta | Emory University
�COVID-19 and the Heart: A Pediatric Perspective
Conclusions
Cardiac involvement during acute COVID-19
infection is not common in children
Heart involvement is VERY common in MIS-C
Follow-up varies by type of infection and degree
of heart involvement
�Questions
and
Answers
�Content Outline (TOC)
NETEC Resources
Amanda Grindle, MSN, RN
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Friday, October 16, 2020 | 1:00 PM EST
Event Type
Webinar, watch at link below
URL
https://youtu.be/mseYyxUrMk4
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Pediatric in Pandemic Webinar" src="https://www.youtube.com/embed/mseYyxUrMk4?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-peds2" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-peds2</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (10/16/20)/Online Course: Pediatric Perspectives During a Pandemic
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
In this webinar, we’ll describe the epidemiology of acute COVID-19, including post-infectious manifestations and the unique aspects of caring for children during a pandemic. We will also discuss the features of MIS-C and how to devise a diagnostic and acute management plan and integrate potential post-recovery complications into the development of follow-up plans for a child with MIS-C.<br /><br />Webinar slides attached.<br /><br />
<h2>Get educational credit for this webinar through <a href="https://courses.netec.org/courses/20-web-peds2" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-10-16
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-04-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2022-07 by Amyna, Special Populations Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - skipped - bump to next review
Relation
A related resource
Y
Y - D0.1Tx/D0.2Tx Qualtrics # 811, original # 3b
Type
The nature or genre of the resource
Webinar and Online Course
2019-nCoV
CEU
CEUs
Children
Clinical Care
Complications
Coronavirus
COVID-19
Online Course
Pandemic
Pediatrics
R-SP
R-T&C
Treatment and Care
Webinar
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Barbaro, Ryan P., Graeme MacLaren, Philip S. Boonstra, Theodore J. Iwashyna, Arthur S. Slutsky, Eddy Fan, Robert H. Bartlett, Joseph E. Tonna, Robert Hyslop, Jeffrey J. Fanning, Peter T. Rycus, Steve J. Hyer, Marc M. Anders, Cara L. Agerstrand, Katarzyna Hryniewicz, Rodrigo Diaz, Roberto Lorusso, Alain Combes, Daniel Brodie, Peta Alexander, Nicholas Barrett, Jan Bělohlávek, Dale Fisher, John Fraser, Ali Ait Hssain, Jae Sung Jung, Michael McMullan, Yatin Mehta, Mark T. Ogino, Matthew L. Paden, Kiran Shekar, Christine Stead, Yasir Abu-Omar, Vanni Agnoletti, Anzila Akbar, Huda Alfoudri, Carlos Alviar, Vladimir Aronsky, Erin August, Georg Auzinger, Hilda Aveja, Rhonda Bakken, Joan Balcells, Sripal Bangalore, Bernard W. Barnes, Alaiza Bautista, Lorraine L. Bellows, Felipe Beltran, Peyman Benharash, Marco Benni, Jennifer Berg, Pietro Bertini, Pablo Blanco-Schweizer, Melissa Brunsvold, Jenny Budd, Debra Camp, Mark Caridi-Scheible, Edmund Carton, Elena Casanova-Ghosh, Anthony Castleberry, Christopher T. Chipongian, Chang Woo Choi, Alessandro Circelli, Elliott Cohen, Michael Collins, Scott Copus, Jill Coy, Brandon Crist, Leonora Cruz, Mirosław Czuczwar, Mani Daneshmand, Daniel Davis Ii, Kim De la Cruz, Cyndie Devers, Toni Duculan, Lucian Durham, Subbarao Elapavaluru, Carlos V. Elzo Kraemer, EdmÍLson Cardoso Filho, Jillian Fitzgerald, Giuseppe Foti, Matthew Fox, David Fritschen, David Fullerton, Elton Gelandt, Stacy Gerle, Marco Giani, Si Guim Goh, Sara Govener, Julie Grone, Miles Guber, Vadim Gudzenko, Daniel Gutteridge, Jennifer Guy, Jonathan Haft, Cameron Hall, Ibrahim Fawzy Hassan, Rubén Herrán, Hitoshi Hirose, Abdulsalam Saif Ibrahim, Don Igielski, Felicia A. Ivascu, Jaume Izquierdo Blasco, Julie Jackson, Harsh Jain, Bhavini Jaiswal, Andrea C. Johnson, Jenniver A. Jurynec, Norma M. Kellter, Adam Kohl, Zachary Kon, Markus Kredel, Karen Kriska, Chandra Kunavarapu, Oude Lansink-Hartgring, Jeliene LaRocque, Sharon Beth Larson, Tracie Layne, Stephane Ledot, Napolitan Lena, Jonathan Lillie, Gösta Lotz, Mark Lucas, Lee Ludwigson, Jacinta J. Maas, Joanna Maertens, David Mast, Scott McCardle, Bernard McDonald, Allison McLarty, Chelsea McMahon, Patrick Meybohm, Bart Meyns, Casey Miller, Fernando Moraes Neto, Kelly Morris, Ralf Muellenbach, Meghan Nicholson, Serena O'Brien, Kathryn O'Keefe, Tawnya Ogston, Gary Oldenburg, Fabiana M. Oliveira, Emily Oppel, Diego Pardo, Diego Pardo, Sara J. Parker, Finn M. Pedersen, Crescens Pellecchia, Jose A. S. Pelligrini, Thao T. N. Pham, Ann R. Phillips, Tasneem Pirani, Paweł Piwowarczyk, Robert Plambeck, William Pruett, Brittany Quandt, Kollengode Ramanathan, Alejandro Rey, Christian Reyher, Jordi Riera del Brio, Rachel Roberts, David Roe, Peter P. Roeleveld, Janet Rudy, Luis F. Rueda, Emanuele Russo, Jesús Sánchez Ballesteros, Nancy Satou, Mauricio Guidi Saueressig, Paul C. Saunders, Margaret Schlotterbeck, Patricia Schwarz, Nicole Scriven, Alexis Serra, Mohammad Shamsah, Lucy Sim, Alexandra Smart, Adam Smith, Deane Smith, Maggie Smith, Neel Sodha, Michael Sonntagbauer, Marc Sorenson, Eric B. Stallkamp, Allison Stewart, Kathy Swartz, Koji Takeda, Shaun Thompson, Bridget Toy, Divina Tuazon, Makoto Uchiyama, Obiora I. Udeozo, Scott van Poppel, Corey Ventetuolo, Leen Vercaemst, Nguyen V. Vinh Chau, I. Wen Wang, Carrie Williamson, Brock Wilson, and Helen Winkels. 2020. "Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry." The Lancet.
Abstract
<h2 class="top" id="seccestitle10"><span class="top__text">Summary</span></h2>
<div class="section-paragraph">
<h3>Background</h3>
<div class="section-paragraph">Multiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. However, initial reports of ECMO use in patients with COVID-19 described very high mortality and there have been no large, international cohort studies of ECMO for COVID-19 reported to date.</div>
<h3>Methods</h3>
<div class="section-paragraph">We used data from the Extracorporeal Life Support Organization (ELSO) Registry to characterise the epidemiology, hospital course, and outcomes of patients aged 16 years or older with confirmed COVID-19 who had ECMO support initiated between Jan 16 and May 1, 2020, at 213 hospitals in 36 countries. The primary outcome was in-hospital death in a time-to-event analysis assessed at 90 days after ECMO initiation. We applied a multivariable Cox model to examine whether patient and hospital factors were associated with in-hospital mortality.</div>
<h3>Findings</h3>
<div class="section-paragraph">Data for 1035 patients with COVID-19 who received ECMO support were included in this study. Of these, 67 (6%) remained hospitalised, 311 (30%) were discharged home or to an acute rehabilitation centre, 101 (10%) were discharged to a long-term acute care centre or unspecified location, 176 (17%) were discharged to another hospital, and 380 (37%) died. The estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 37·4% (95% CI 34·4–40·4). Mortality was 39% (380 of 968) in patients with a final disposition of death or hospital discharge. The use of ECMO for circulatory support was independently associated with higher in-hospital mortality (hazard ratio 1·89, 95% CI 1·20–2·97). In the subset of patients with COVID-19 receiving respiratory (venovenous) ECMO and characterised as having acute respiratory distress syndrome, the estimated cumulative incidence of in-hospital mortality 90 days after the initiation of ECMO was 38·0% (95% CI 34·6–41·5).</div>
<h3>Interpretation</h3>
<div class="section-paragraph">In patients with COVID-19 who received ECMO, both estimated mortality 90 days after ECMO and mortality in those with a final disposition of death or discharge were less than 40%. These data from 213 hospitals worldwide provide a generalisable estimate of ECMO mortality in the setting of COVID-19.</div>
<h3>Funding</h3>
<div class="section-paragraph">None.</div>
</div>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32008-0/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32008-0/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Multiple major health organisations recommend the use of extracorporeal membrane oxygenation (ECMO) support for COVID-19-related acute hypoxaemic respiratory failure. However, initial reports of ECMO use in patients with COVID-19 described very high mortality and there have been no large, international cohort studies of ECMO for COVID-19 reported to date.
Creator
An entity primarily responsible for making the resource
Barbaro, Ryan P., Graeme MacLaren, Philip S. Boonstra, Theodore J. Iwashyna, Arthur S. Slutsky, Eddy Fan, Robert H. Bartlett, Joseph E. Tonna, Robert Hyslop, Jeffrey J. Fanning, Peter T. Rycus, Steve J. Hyer, Marc M. Anders, Cara L. Agerstrand, Katarzyna Hryniewicz, Rodrigo Diaz, Roberto Lorusso, Alain Combes, Daniel Brodie, Peta Alexander, Nicholas Barrett, Jan Bělohlávek, Dale Fisher, John Fraser, Ali Ait Hssain, Jae Sung Jung, Michael McMullan, Yatin Mehta, Mark T. Ogino, Matthew L. Paden, Kiran Shekar, Christine Stead, Yasir Abu-Omar, Vanni Agnoletti, Anzila Akbar, Huda Alfoudri, Carlos Alviar, Vladimir Aronsky, Erin August, Georg Auzinger, Hilda Aveja, Rhonda Bakken, Joan Balcells, Sripal Bangalore, Bernard W. Barnes, Alaiza Bautista, Lorraine L. Bellows, Felipe Beltran, Peyman Benharash, Marco Benni, Jennifer Berg, Pietro Bertini, Pablo Blanco-Schweizer, Melissa Brunsvold, Jenny Budd, Debra Camp, Mark Caridi-Scheible, Edmund Carton, Elena Casanova-Ghosh, Anthony Castleberry, Christopher T. Chipongian, Chang Woo Choi, Alessandro Circelli, Elliott Cohen, Michael Collins, Scott Copus, Jill Coy, Brandon Crist, Leonora Cruz, Mirosław Czuczwar, Mani Daneshmand, Daniel Davis Ii, Kim De la Cruz, Cyndie Devers, Toni Duculan, Lucian Durham, Subbarao Elapavaluru, Carlos V. Elzo Kraemer, EdmÍLson Cardoso Filho, Jillian Fitzgerald, Giuseppe Foti, Matthew Fox, David Fritschen, David Fullerton, Elton Gelandt, Stacy Gerle, Marco Giani, Si Guim Goh, Sara Govener, Julie Grone, Miles Guber, Vadim Gudzenko, Daniel Gutteridge, Jennifer Guy, Jonathan Haft, Cameron Hall, Ibrahim Fawzy Hassan, Rubén Herrán, Hitoshi Hirose, Abdulsalam Saif Ibrahim, Don Igielski, Felicia A. Ivascu, Jaume Izquierdo Blasco, Julie Jackson, Harsh Jain, Bhavini Jaiswal, Andrea C. Johnson, Jenniver A. Jurynec, Norma M. Kellter, Adam Kohl, Zachary Kon, Markus Kredel, Karen Kriska, Chandra Kunavarapu, Oude Lansink-Hartgring, Jeliene LaRocque, Sharon Beth Larson, Tracie Layne, Stephane Ledot, Napolitan Lena, Jonathan Lillie, Gösta Lotz, Mark Lucas, Lee Ludwigson, Jacinta J. Maas, Joanna Maertens, David Mast, Scott McCardle, Bernard McDonald, Allison McLarty, Chelsea McMahon, Patrick Meybohm, Bart Meyns, Casey Miller, Fernando Moraes Neto, Kelly Morris, Ralf Muellenbach, Meghan Nicholson, Serena O'Brien, Kathryn O'Keefe, Tawnya Ogston, Gary Oldenburg, Fabiana M. Oliveira, Emily Oppel, Diego Pardo, Diego Pardo, Sara J. Parker, Finn M. Pedersen, Crescens Pellecchia, Jose A. S. Pelligrini, Thao T. N. Pham, Ann R. Phillips, Tasneem Pirani, Paweł Piwowarczyk, Robert Plambeck, William Pruett, Brittany Quandt, Kollengode Ramanathan, Alejandro Rey, Christian Reyher, Jordi Riera del Brio, Rachel Roberts, David Roe, Peter P. Roeleveld, Janet Rudy, Luis F. Rueda, Emanuele Russo, Jesús Sánchez Ballesteros, Nancy Satou, Mauricio Guidi Saueressig, Paul C. Saunders, Margaret Schlotterbeck, Patricia Schwarz, Nicole Scriven, Alexis Serra, Mohammad Shamsah, Lucy Sim, Alexandra Smart, Adam Smith, Deane Smith, Maggie Smith, Neel Sodha, Michael Sonntagbauer, Marc Sorenson, Eric B. Stallkamp, Allison Stewart, Kathy Swartz, Koji Takeda, Shaun Thompson, Bridget Toy, Divina Tuazon, Makoto Uchiyama, Obiora I. Udeozo, Scott van Poppel, Corey Ventetuolo, Leen Vercaemst, Nguyen V. Vinh Chau, I. Wen Wang, Carrie Williamson, Brock Wilson, and Helen Winkels.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-09-25
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2024-03-28 by J. Mundy – Treatment & Care group review 2023 (Q2) skipped – bumping to 2024 (Q2)
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Extracorporeal Membrane Oxygenation (ECMO)
R-Res&Pub
R-T&C
Treatment and Care
-
https://repository.netecweb.org/files/original/b04a1a1f9d2a958617938d2efe1b8f14.pdf
0afc7003794937e28de7aa41e2599b8a
PDF Text
Text
08-03-20
�08-03-20
�08-03-20
�08-03-20
�08-03-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Tips for Assembling, Testing, and Running Proning Teams
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
This is an interactive pdf guide explaining tips for running a successful proning team. Running a successful proning team requires the careful coordination of medical teams, equipment, and PPE. This guide lists considerations and best practices during and after the peak of the COVID-19 crisis.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-08-03
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
2019-nCoV
Clinical Care
Clinical Care Guidelines
Coronavirus
COVID-19
Emergency Management
Proning
R-EM
Treatment and Care
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Khalil, A., P. von Dadelszen, T. Draycott, A. Ugwumadu, P. O'Brien, and L. Magee. 2020. "Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic." Jama 324 (7):705-6.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on JAMA and Lancet.
URL
https://pubmed.ncbi.nlm.nih.gov/32648892/
Read Online
Online location of the resource.
https://jamanetwork.com/journals/jama/fullarticle/2768389
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Change in the Incidence of Stillbirth and Preterm Delivery During the COVID-19 Pandemic
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
High rates of preterm birth and cesarean delivery have been reported in women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, studies have inadequate power to assess uncommon outcomes like stillbirth (fetal death ≥24 weeks’ gestation).<br /><br />The authors published a follow up to this article:<br />
<ul>
<li>Khalil, Asma, Peter von Dadelszen, Erkan Kalafat, Mercede Sebghati, Shamez Ladhani, Austin Ugwumadu, Tim Draycott, Pat O'Brien, and Laura Magee. 2020. "<a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30779-9/fulltext" target="_blank" rel="noreferrer noopener">Change in obstetric attendance and activities during the COVID-19 pandemic.</a>" The Lancet Infectious Diseases.<br /><br /><br /></li>
</ul>
Creator
An entity primarily responsible for making the resource
Khalil, A., P. von Dadelszen, T. Draycott, A. Ugwumadu, P. O'Brien, and L. Magee.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-07-10
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group - 3 years - note "New asset to replace"
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Labor and Delivery
Neonates
Not updated
Pregnancy
R-Res&Pub
R-SP
R-T&C
SARS-CoV-2
-
https://repository.netecweb.org/files/original/159e6b8af02fe7a17712df7f3238dacb.pdf
0d5fd79ebfb2fe08176fc410e308fd82
PDF Text
Text
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Pandemic Ethics: Triage and Beyond
Subject
The topic of the resource
Emergency Management
Description
An account of the resource
This printable flyer infographic covers shifting standards of care in a pandemic, ethics, and triage.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-10-07
Contributor
An entity responsible for making contributions to the resource
2024-03-27 Emergency Management skipped in review – bump to next quarter
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-27
2019-nCoV
Clinical Care
Coronavirus
COVID-19
Crisis Standards of Care
Emergency Management
Ethics
Pandemic
R-EM
Standard of Care
Treatment and Care
-
https://repository.netecweb.org/files/original/87163f99d52cc618a9d1f6c047ba6fa1.pdf
885a05aa0888dd47d9543a0f1795ab23
PDF Text
Text
10-15-20
�10-15-20
08-03-20
�10-15-20
08-03-20
�10-15-20
08-03-20
�10-15-20
08-03-20
�10-15-20
08-03-20
��
10-15-20
08-03-20
�10-15-20
08-03-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Respiratory Support Strategies
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
This is a printable flyer infographic and interactive pdf that covers different topics in respiratory support strategies.<br /><br />View <a href="https://repository.netecweb.org/items/show/1518">this flyer in Spanish</a>.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-10-15
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2024-03-28 by J. Mundy – Treatment & Care group review 2023 (Q2) skipped – bumping to 2024 (Q2)
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Airborne Transmission
Clinical Care
Coronavirus
COVID-19
R-T&C
Respirator
Respiratory Pathogen
Treatment and Care
-
https://repository.netecweb.org/files/original/d336760c55567987a21e7a1c05fc420a.pdf
b2e6ad64ef0315c2ccf294220ddc67ae
PDF Text
Text
NETEC COVID-19 Webinar Series:
COVID-19 and Acute Renal Failure
�Content Outline (TOC)
Welcome
Trish Tennill, RN, BSN
�Overview
Welcome: Trish Tennill, RN, BSN
Epidemiology of Acute Kidney Injury in COVID-19: William Bender, MD
Management of Acute Kidney Injury: Nina Caplin, MD, MS, FACP
Renal Replacement Therapy Managing Supply Problems:
NETEC Resources: Trish Tennill, RN, BSN
Questions and Answers with NETEC:
Manish Tandon, MD
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Epidemiology of Acute Kidney Injury (AKI)
in COVID-19
William Bender, MD
�Epidemiology
China
• Wide range in reported rates
of acute kidney injury
• Wang et al
• 138 hospitalized patients
• Zhongnan Hospital
• January 1 through
January 28
r
Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069
�Epidemiology
China
• Yang et al
• 52 critically ill patients
• Mechanical ventilation
• FiO2 greater than 60%
• Wuhan Jin Yin-tan Hospital
• December 24, 2019 through
January 26, 2020
r
Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8: 475–81
�Epidemiology
China • Guan et al
• 1099 patients
• 552 hospitals across 30 provinces
• December 11, 2019 through January 29, 2020
r
Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-1720.
�Epidemiology of Acute Kidney Injury (AKI)
in COVID-19
Epidemiology
United States
• Much higher proportion of acute kidney injury in hospitalized patients
• Hirsch et al
• 5449 hospitalized patients
• 13 academic and community hospitals in metropolitan New York
• March 1st through April 5th
• 1993 (36.6%) with acute kidney injury
• 285 (5.2%) required RRT
Hirsch JS, Ng JH, Ross DW, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209-218.
�Epidemiology
r
Hirsch JS, Ng JH, Ross DW, et al. Acute kidney injury in patients hospitalized with COVID-19. Kidney Int. 2020;98(1):209-218.
�Epidemiology
United States
• Mohamed et al
• 575 hospitalized patients
• Academic medical center
in New Orleans
r
• March 2020
• 161 (28%) with acute
kidney injury
• 89 (15%) required RRT
Mohamed MM, Lukitsch I, Torres-Ortiz AE, et al: Acute kidney injury associated with coronavirus disease 2019 in Urban New Orleans. Kidney360 1: 614–623, 2020.
�Epidemiology of Acute Kidney Injury (AKI)
in COVID-19
Epidemiology
United States
• STOP-COVID
• Multicenter cohort study
• 3099 critically ill patients with COVID-19
• 67 US hospitals
• March 4th through April 11th
• 637 (20.6%) developed AKI and required RRT
Gupta S, Coca SG, Chan L et al; STOP-COVID Investigators. AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19. J Am Soc Nephrol. 2020 Oct 16: Epub ahead of print.
�Epidemiology of Acute Kidney Injury (AKI)
in COVID-19
Risk Factors
United States
Chan L, Coca S: Acute kidney injury in the time of COVID-19. Kidney360 1: 588–590, 2020.
�Epidemiology of Acute Kidney Injury (AKI)
in COVID-19
Risk Factors
United States
• STOP-COVID
Patient-level risk factors for AKI-RRT
ü CKD
ü Male sex
ü Non-White race
ü Hypertension
ü Diabetes mellitus
ü Higher body mass index
ü Higher D-dimer
ü Greater severity of hypoxemia
on ICU admission
Gupta S, Coca SG, Chan L et al; STOP-COVID Investigators. AKI Treated with Renal Replacement Therapy in Critically Ill Patients with COVID-19. J Am Soc Nephrol. 2020 Oct 16: Epub ahead of print.
�Content Outline (TOC)
Management of Acute Kidney Injury (AKI)
Nina Caplin, MD, MS, FACP
�Management of Acute Kidney Injury (AKI)
Acute Kidney Disorder (AKI) During COVID-19
AKI (defined as proteinuria, hematuria, oliguria, rise in serum creatinine) was seen
in 60-70% patients admitted with COVID, 90% of intubated patients
AKI stage 2-3 was seen in ICU intubated patients with up to 40% requiring RRT, 14%
hospitalized patients. Typically the patients were also hemodynamically compromised
requiring multiple pressors
Mortality rate of patients with COVID requiring RRT in the spring varied typically
from 50-100% at different institutions
Since the springtime the mortality rate has improved, likely due to more experience
and treatment with anticoagulation and steroids in critical patients. 25.6% of
hospitalized patients in March and 7.6% in August - J of Hosp Med Oct 23,2020
�Causes of Acute Kidney Injury in COVID-19 Patients
Multifactorial-possible causes include
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Direct cellular injury from the virus through entry possibly through the ACE2 receptor
Pro-inflammatory cytokines
Thromboembolic events
Hemodynamic alterations
Hypovolemia/prerenal AKI
Nephrotoxic medications, contrast dye
r
Heart failure
Sepsis
Hypoxemia
High PEEP - thought to influence glomerular filtration and urine output
There is no specific treatment for COVID AKI. Currently treatment is supportive.
Rate of reported AKI range in ICU patients 3%-66%
Intensive Care Medicine 2020 July; 46(7) Gabarre et al
�Management of Acute Kidney Injury (AKI)
Dialysis Modalities Typically Used During the COVID-19 Surge
CVVH-continuous venovenous hemofiltration
PIRRT such as SLEDD
IHD-intermittent hemodialysis
Acute PD
The modality should be determined by the patient’s needs as well as
the expertise of the staff and availability of the staff, supplies and
equipment. The modality is affected by the availability of machines,
disposable supplies and trained staff.
�Outcomes Among Patients Hospitalized with COVID-19 and AKI
r
High mortality rate in patients who developed AKI, especially if in the ICU and
requiring RRT experienced at another NY hospital system
Outcomes among Patients Hospitalized with COVID-19 and Acute Kidney Injury Ng et al, AJKD Sept 19, 2020.
�Management of Acute Kidney Injury (AKI)
AKI has been found to be an independent RF for a high mortality
Significant association between kidney failure and death
3235 hospitalized patients with COVID, AKI found in 1406 (46%)
20% required RRT, of the ICU patients 34% required RRT
AKI in the ICU 52% mortality
Acute Kidney Injury in Hospitalized Patients with COVID-19. Chan et al MedRxiv May, 2020
Credit: NIAID - scanning electron microscope image shows SARS-CoV-2 (orange)
�Resource
HD
CVVH
Acute PD
Acceptance
Familiar, commonly used
Familiar, commonly used
Not used in Bellevue except rarely for chronic PD patient
Nursing staff
Limited trained dialysis nurses
and many sick from COVID-19
Non nursing Staff
Difficult to train acutely
MD staffing
Adequate number of
nephrologists to oversee
Non-disposable
Equipment
Fixed number of dialysis
machines
Disposable
equipment
Adequate supplies
Disease related
limitations
Hemodynamic instability
Benefits
Easy placement of dialysis
catheter
Easy placement of dialysis catheters
PD catheter placed at the bedside. Vascular access sepsis risk
avoided, less blood loss, biocompatible
PD skills easier to learn. Gradual volume removal
Potential risks
Sepsis, clotting, blood loss,
hypotension, bioincompatible
membrane
Sepsis, clotting, blood loss, hypocalcemia,
alkalosis, potentially bioincompatible
Infection (peritonitis, tunnel infection), leak, inflow/outflow
problems, hyperglycemia, bleeding at surgical site
Other issues
Requires plumbing in room
Not available in the ED overflow ICU
24 hours before peritoneum primed for effective dialysis
ICU nurses trained in CVVH
But ICU nurses overwhelmed with increased
patient number
Difficult to train. Trained non-ICU nurses but
needed significant oversight by the ICU nurses
Easier to train medical staff. Nephrologist-trained deployed
MD’s, PA’s, and non-dialysis nurses
Adequate number of nephrologists and
intensivists to oversee
Increased Nephrology staff needed to implement the
program. Surgeons available due to canceled elective cases
ICU nurses trained in PD, but rare use. Required retraining
effort when already overwhelmed
Not needed for manual PD, initially no cyclers, obtained 18
cyclers
Percutaneous insertion kits not available. Used OR kits with
Filters depleted by clotting and using machines
open approach for placement
for two people per day. Filters
r and fluid
Initial supplier rationed PD supplies Ordered from alternative
rationed by supplier
supplier.
Hypercoagulability with significant number of
Hypermetabolic, prone positioning was used, laparoscopic
clotted filters
placement avoided, ARDS on ventilator
Fixed number of CVVH machines
Limitations of different KRT modalities during the COVID-19 surge. ED: emergency department; HD:
Hemodialysis; CVVH: continuous venovenous hemofiltration; ARDS: acute
�Management of Acute Kidney Injury (AKI)
Acute Peritoneal Dialysis
VERSUS
Hemodialysis
Gabriel DP et al
RCT comparing CPD vs DHD
No significant difference between continuous PD and daily HD in
mortality, metabolic control, recovery of renal function
Survival rate CPD 58%, DHD 52%, duration of therapy was longer in the
DHD group 5.5 days vs 7.5 days
Conclusion
CPD can be considered an alternative to other forms of RRT in AKI
Continuous Peritoneal dialysis compared with daily hemodialysis in patients with acute kidney injury. Gabriel et al Perit Dial Int. 2009 Feb
�Management of Acute Kidney Injury (AKI)
Acute Peritoneal Dialysis
VERSUS
CCRT
Al-Hweish et al RCT continuous tidal PD vs CVVHDF
125 patients randomized to treatment CVVHDF vs continuous tidal PD
Survival PD 69.8%, CVVHDF 46.8%
Significantly less infections in the PD 9.5% vs CVVHDF 17.7%
Recovery of kidney function 60.3% vs 35.5% PD vs CVVHDF
Favorable outcomes in continuous high volume PD vs CVVHDF
• Improved mortality, lower infection rates, More recovery of AKI, shorter
length of ICU stay
Acute Kidney Injury in Critically Ill Patients: a Prospective Randomized Study of Tidal Peritoneal Dialysis Versus Continuous Renal Replacement Therapy. Al-Hwiesh et al Ther Apher Dial 2018 Aug
�Management of Acute Kidney Injury (AKI)
Barriers to Acute Peritoneal Dialysis in the U.S.
No certain clearance and fluid removal so ICU staff not comfortable since
lack of experience, used to programming fluid removal with CVVH
Surgeon and radiologist expertise in PD catheter placement is limited in
most US hospitals
Nursing training is minimal in most hospitals, however easier to train
medical staff to perform acute PD vs other more technological dependent
modalities. Also much less nursing/medical staff time required to perform
PD for 24 hours. Does not require blood tests every 6 hours
Likely better for hypercoagulable, septic, heart failure patients and
patients with vascular access difficulty
�Content Outline (TOC)
Renal Replacement Therapy (RRT)
Managing Supply Problems
Manish Tandon, MD
�Renal Replacement Therapy
Managing Supply Problems
Demand Outstrips Capabilities
Renal Replacement Therapy in austere environments
• Dialysis capabilities present but severely damaged
• Dialysis capabilities negligible, but needed
• Dialysis capabilities present, but insufficient for the surge
RRT remained a low expectancy of shortage
• Google scholar search on 10/31/20
• COVID + supply shortages – 14,800 results
• COVID + supply shortages + dialysis – 1,110 results
• COVID + supply shortages + dialysis + ICU – 47 results
Doi: 10.4061/2011/748053
�Early Versus Late Demand/Supply Mismatch
Covid-19: Increasing demand for dialysis sparks fears of supply shortage - BMJ
• Significant risk of mismatch between supply and demand
• Despite NHS England working with equipment manufacturers
Estimating Shortages in Capacity to Deliver Continuous Kidney Replacement
Therapy During the COVID-19 Pandemic in the United States - AJKD
r
• Best case scenario – shortages in 3 states,
614 CRRT machines
• Worst case scenario – shortages in 26 states, 4,540 machines
• Recommend national stockpile
Nephrology and COVID-19 – JAMA
• Significant mismatches between needs and critical supplies in NYC and Boston
• No shortages in later areas such as Houston
doi: 10.1136/bmj.m1588
doi:10.1053/j.ajkd.2020.07.005
JAMA 2020; 324(12):1137
�Potential Capacity Limitations
Who Gets What When Supply
Chains are Disrupted?
• Favor most important customers
• Maximize short-term revenues
r
• Treat everyone equally
• Shape demand
• Alter products
• Take care of the vulnerable
MIT Sloan Management Review, May 27, 2020
�Renal Replacement Therapy
Managing Supply Problems
Potential Capacity Limitations
Durable equipment
Infrastructure
Disposables
Expertise
The Solution
Understand the alternatives and their limitations
Be flexible and constantly adapt
�Renal Replacement Therapy
Managing Supply Problems
Understanding Options for Renal Replacement Therapy
qIntermittent hemodialysis
qContinuous renal replacement therapy
qPeritoneal dialysis
qWithholding dialysis
�Hemodialysis
Most difficult to rapidly ramp up
High cost and limited durable equipment
• Portable vs fixed machines
• Need for adequate plumbing if using portable machines
Most extensive training for nurses
r
Physician expertise - managed entirely by renal
Adapt by running shorter or less frequent dialysis runs
Shift to 24-hour coverage if adequate staffing
Used as supplement to other modalities
Preserve for outpatient needs
�Continuous Renal Replacement Therapy
Considered ideal choice for hemodynamically unstable patients
Requires access – easy
Requires nursing expertise and availability – moderate learning curve
• Modifications in protocols to allow fewer interactions with machine
Requires physician expertise – moderate learning curve
• Simplified with protocols and handbook
r
Fluids and filter limitations
• Limited availability of fluids and filters
• Modify use to maximize filter life
• Fluids can be “created” internally
Clotting concerns with COVID
• Lower ionized calcium in filter with citrate; CVVHDF for less hemoconcentration
Limited number of CRRT machines
�Peritoneal Dialysis
Easiest learning curve for nursing
Labor intensive for effective fluid removal
• Simplified with use of cyclers
Access – moderate difficulty – in ICU, in IR, in OR
• Need to obtain catheters and access kits
r
Many patients contraindicated – prior lower
abdominal surgery
Most worrisome complications related to long term use
Physician expertise
• Placement by surgeons, IR, invasive nephrologists
• Run by renal only
Potentially difficulty getting adequate clearance for hypermetabolic state
Use in ICU vs floor; potential combined with HD
doi: 10.1053/j.ajkd.2020.06.001
doi.org/10.1101/2020.08.16.20175992
�Opportunities
Strategies to reduce AKI and need for RRT
Modification of CRRT to make it easier to manage
Modification of order sets to allow a nurse to make necessary changes
Use of adsorptive filters with CRRT
r
Villa et al. Critical Care (2020) 24:605
�Renal Replacement Therapy
Managing Supply Problems
Summary
Need to prepare for potential supply/demand mismatch
Training
Durable equipment
Alternative supply chains
Modify protocols
Monitor critical supplies
BE ADAPTABLE
�Questions
and
Answers
�Content Outline (TOC)
NETEC Resources
Trish Tennill, RN, BSN
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Deploy
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Wednesday, November 4, 2020 | 1:00 PM EST
Event Type
Webinar, watch at link below.
URL
https://youtu.be/VfDvqTtRM_w
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="COVID-19 and Acute Renal Failure webinar" src="https://www.youtube.com/embed/VfDvqTtRM_w?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-renalfail" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-renalfail</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (11/04/20)/Online Course: COVID-19 and Acute Renal Failure
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
COVID-19 and Acute Renal Failure: In this webinar, participants will be able to identify risk factors associated with COVID-19-related acute kidney injury, discuss strategies to minimize resource scarcity related to those undergoing renal replacement therapy during a crisis situation and describe the management and long-term outcomes of renal failure during the COVID-19 pandemic.<br /><br />Webinar slides attached.<br /><br /><br />
<h2>Get educational credit for this webinar "COVID-19: Current State of the Pandemic" through <a href="https://courses.netec.org/courses/20-web-renalfail" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-11-04
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2024-03-28 by J. Mundy – Treatment & Care group review 2023 (Q2) skipped – bumping to 2024 (Q2)
Relation
A related resource
Y - D0.1Tx/D0.2Tx Qualtrics # 821, Additional Resource
Type
The nature or genre of the resource
Webinar and Online Course
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
CEU
CEUs
Clinical Care
Comorbidity
Complications
Coronavirus
COVID-19
Online Course
R-T&C
Treatment and Care
-
https://repository.netecweb.org/files/original/f88a81984f1986ce1328d4e2fc47ec8a.pdf
734dcf51dda1922ff042efb097442140
PDF Text
Text
NETEC COVID-19 Webinar Series:
Care Transitions to Home Health:
Key COVID-19 Considerations
�Content Outline (TOC)
Welcome
Kate Boulter, BAN, RN, MPH
�Overview
Welcome: Kate Boulter, BAN, RN, MPH
Care Transitions to Home Health: Amanda Holst, MS, CCC-SLP
Maternal Child Care Transitions to Home Health: Kelly Mackling, RN, BSN
NETEC Resources: Kate Boulter, BAN, RN, MPH
Questions and Answers with NETEC:
�Welcome
National Emerging Special Pathogens
Training and Education Center
Mission Statement
To increase the capability of the United States public health and
health care systems to safely and effectively manage individuals
with suspected and confirmed special pathogens
For more information
Please visit us at www.netec.org
or email us at info@netec.org
�NETEC Overview
Assessment
Education
Technical
Assistance
Research
Network
Empower hospitals to gauge
their readiness using
Provide self-paced
education through
Onsite & Remote
Guidance
Online Repository
Self-Assessment
Measure facility and
healthcare worker
readiness using
Metrics
Meet Fred
Online Trainings
Compile
Online Repository
Deliver didactic and handson simulation training via
In-Person Courses
of tools and resources
Develop customizable
Exercise Templates
based on the HSEEP model
Provide direct feedback
to hospitals via
On-Site
Assessment
COVID-19 focused
Webinars
Built for rapid implementation
of clinical research protocols
Provide
Emergency On-Call
Mobilization
Cross-Cutting, Supportive Activities
Develop Policies,
Procedures and
Data Capture Tools
to facilitate research
Create infrastructure for a
Specimen
Biorepository
�Content Outline (TOC)
Care Transitions for Home Health:
Key COVID-19 Considerations
Amanda Holst, MS, CCC-SLP
�Care Transitions to Home Health
Collaboration and Communication
Collaboration and Communication are
essential during the care transition process
Referral and intake process
• Timely, frequent, objective, collaborative and transparent communication
Promote the safety of:
Patients
Caregivers/ family members
Home Health clinicians
�Collaboration and Communication: Intake Process
Communication with patient and caregivers/family during the intake process
Brief subjective assessment of health literacy related to COVID-19 and
infection control practices
Challenge
Limited public knowledge on COVID-19, on infection control
practices and impact on loved ones
r
Brief subjective assessment on caregiving
status in home
Challenge
Uniqueness of each situation requires custom solutions
Brief subjective assessment on social determinants
Challenge
Impact of social determinants of health during the recovery of COVID-19
�Collaboration and Communication: Intake Process
Key Considerations & Information to Obtain from the Referral Source
When did the patient first begin experiencing s/s and/or date of positive test?
Are there new medical needs in the transition home, such as oxygen,
durable medical equipment, or increased caregiving?
How was the patient exposed (if known)?
r
Who else resides in the home or is in the home frequently?
Single dwelling or communal living space? Multigenerational?
Recent travel? Employment?
Others exhibiting s/s or test positive?
Persons in home able and willing to provide caregiving?
Is it a safe discharge plan?
Patient?
Caregivers/family?
Others in the home setting?
�Collaboration and Communication: Internal Processes
Screening call prior to every in-home visit
Patient
Caregivers/family in the home
Others in the home setting
COVID-19 confirmed or COVID-19 monitoring after home health admission
• Visits on hold until COVID-19 results obtained (if appropriate)
• Use of remote patient monitoring
• Assign to COVID team
r
Quick transition to COVID-19 positive HH Team
Use of remote patient monitoring (RPM)
• Daily screening for all patients with RMP
• COVID-19 confirmed or COVID monitored
• Daily biometrics
• Survey questions
• Daily oversight by a nurse
�Case Study One
Lesson: This case study demonstrates application of discussed key considerations
Situation
•
•
•
•
•
Early in pandemic - Elderly husband (COVID+ patient) and spouse
Both ESL communicators
Patient with a chronic autoimmune neuromuscular disease that causes muscle weakness
Short hospital stay
No visitors allowed in hospital
r
�Case Study One
Lesson: This case study demonstrates application of discussed key considerations
Situation
•
•
•
•
•
Early in pandemic - Elderly husband (COVID+ patient) and spouse
Both ESL communicators
Patient with a chronic autoimmune neuromuscular disease that causes muscle weakness
Short hospital stay
No visitors allowed in hospital
r
Impact
• Spouse had minimal role in the patient’s discharge planning from acute to home care
• Poor health literacy by spouse/caregiver
• Impacted medical regime, nutrition
• Patient’s weakened functional level at time of hospital discharge created challenges
• Limited COVID-19 infection prevention practices and exposure risks
• Including exposure to the spouse
• Spouse not physically, mentally or emotionally prepared for patient’s transition to home
• Patient declined rapidly when arriving home
�Case Study One
Lesson: This case study demonstrates application of discussed key considerations
Resolution
• In 24-hour period at home, he required rehospitalization and ICU intervention
•
•
After extended stay in the hospital patient was medically stable and physically stronger for
safe transition back to home
During patient’s stay, spouse also recovered at home
• Collaboration with hospital on discharge planning process
VNA and hospital have an established relationship
r
• Discussed challenges faced during this care transition
• Hospital developed a discharge planning team and incorporated feedback
• Use of video chat
• Involvement of other family members
• Frequent communication on patient status prior to care transition home
•
• Home Health team gained further insight
•
•
•
Discussed possibility of rapid and sudden deterioration
Frequent oxygen level monitoring throughout the day
Considerations specific to apartment living
• Shared living spaces • ALF/ILF living situations •
Friends/neighbors visiting
�Case Study Two
Lesson: This case study emphasizes the importance of transparent communication
Situation
•
•
•
•
Early in pandemic – Elderly woman
Referral from skilled nursing facility (SNF); lives alone
Son planning to assist in care transition and provide intermittent caregiving assistance
At time of discharge and time of referral, patient, son, and HHA unaware/not informed
patient was exposed to COVID-19 while inpatient
r
�Case Study Two
Lesson: This case study emphasizes the importance of transparent communication
Situation
•
•
•
•
Early in pandemic – Elderly woman
Referral from skilled nursing facility (SNF); lives alone
Son planning to assist in care transition and provide intermittent caregiving assistance
At time of discharge and time of referral, Patient, son, and HHA unaware/not informed
patient was exposed to COVID-19 while inpatient
r
Impact
“Near miss” exposure for HHA staff
• Patient's son requested a delay in the home health admission for a couple
of days so he could re-arrange his schedule and be at the admission
• On the date of admission, patient received a call that she tested positive
• Re-assigned to HHA COVID-19 team
• Exposure to son; contracted COVID-19
�Case Study Two
Lesson: This case study emphasizes the importance of transparent communication
Resolution
• Collaboration with SNF on discharge planning
• Transparency with exposures and testing
Enhanced referral screening process
r
• Initial inquiries into any known positives among residents or staff in facilities
• Many facilities have transformed their communication and transparency,
enhancing collaboration and reducing unnecessary exposures
• Re-assigned to HHA COVID-19 team
• Exposure to son and then contracted COVID-19
• Temporarily moved out of his home to mother’s house in order to reduce
exposure risk to spouse and to care for mother
�Case Study Three
Lesson: This case study illustrates the uniqueness of every situation
and the importance of creative and holistic care
Situation
• Elderly husband and wife both hospitalized, COVID-19 positive
• Wife passed away during inpatient ICU stay
• Husband transitioned to home with home health
r
�Case Study Three
Lesson: This case study illustrates the uniqueness of every situation
and the importance of creative and holistic care
Situation
• Elderly Husband and wife both hospitalized, COVID-19 positive
• Wife passed away during inpatient ICU stay
• Husband transitioned to home with home health
Impact
r
Critical to address the entire person
Physical
• Ability to care for self at home
Emotional
Mental well-being
• Standard rehabilitation for COVID-19 recovery
• Need to learn skills for daily living activities he is now responsible
�Case Study Three
Lesson: This case study illustrates the uniqueness of every situation
and the importance of creative and holistic care
Resolution
• Therapy goals included developing the instrumental activities of daily living
(IADLs), that were previously performed by his wife
• Shopping, meal preparation, laundry,
and house keeping
r
• Offered hospice bereavement services
Extended utilization of remote patient
monitoring for additional support to combat
Loneliness
Depression
�Content Outline (TOC)
Maternal Child Care Transitions to Home Health:
Key COVID-19 Considerations
Kelly Mackling, RN, BSN
�Maternal Child Care Transitions to Home Health
Considerations and Key Aspects
Early months of
COVID-19 pandemic
We had many women testing positive
just prior to delivery
Their spouses/significant others are essential workers
• Working in close, crowded conditions
• Riding/commuting in groups
Living in multi generational or multi family homes
• Sharing communal spaces such as bathrooms and kitchens
Limited COVID-19 knowledge and infection control practices
• Difficult to meet CDC recommendations
• Unreliable information being obtained from family, friends, and social media
�Maternal Child Care Transitions to Home Health
Considerations and Key Aspects
Early months of
COVID-19 pandemic
We had many women testing positive
just prior to delivery
Increased COVID-19 risk exposure
• Due to financial hardships of the pandemic
• Especially hit hard are low income and minorities
• Many have limited paid time off, if any. Must prioritize work in order to
have income
• Food insecurities and household bills
• Food insecurities exasperated by children out of school and limited
or no daycare
• Due to the type of work’s inability to allow for remote work or work from home
�Case Study One
Lesson: This case study emphasizes the financial and cultural impact
Situation
• Multi family home/small home
• Husband/father of baby positive COVID-19,
• Including two other household members
• Essential workers, all worked at same packing house
r
• Mom going home with new baby
�Case Study One
Lesson: This case study emphasizes the financial and cultural impact
Situation
• Multi family home/small home
• Husband/father of baby positive COVID-19,
• Including two other household members
• Essential workers, all worked at same packing house
r
• Mom going home with new baby
Impact
• Poor health literacy
• Unreliable sources of educational information (family, friends and social media)
• May be scared to seek access to healthcare
• Limited knowledge on COVID infection control practices and exposure risks
• Language and cultural barriers
• Crowded living conditions
• Loss of income(s)
• 3 male household members lost income
�Case Study One
Lesson: This case study emphasizes the financial and cultural impact
Resolution
• Educate on science-based information
• Homecare referring to CDC, VNA infection prevention protocols
• Discouraging using friends, family and social media as sole educational source
• Encourage accessing healthcare
r living conditions
• Educate on preventing spread in crowded
• Keeping distance in common areas
• Encourage wearing a mask at home
• Adapting cultural practices safely
• Meals, food prep and visitors
• Use of interpreter and teach back methods to make sure understanding
• Use of friends to run for groceries
• Provide information and referrals for resources due to loss of income for short period
• For example: food pantry, utility assistance, etc)
�Case Study Two
Lesson: This case study highlights the need of social and family support
Situation
•
•
•
•
•
New mother, COVID-19 positive with prolonged hospital stay due to severe infection
and need of respiratory support
Baby home from hospital with family member who had limited experience with babies
Baby born early and in need of frequent follow ups at MD and home nurse visits for feeding
and weight gain problems
r
Mother has 5 other young children, family member
was caring for them
Need for planning when mother comes home from hospital. Who was going to care for her? Need for
24-hour assistance as she was not able to tend to children
�Case Study Two
Lesson: This case study highlights the need of social and family support
Situation
•
•
•
•
•
New mother, COVID-19 positive with prolonged hospital stay due to severe infection
and need of respiratory support
Baby home from hospital with family member who had limited experience with babies
Baby born early and in need of frequent follow ups at MD and home nurse visits for feeding
and weight gain problems
r
Mother has 5 other young children, family member
was caring for them
Need for planning when mother comes home from hospital. Who was going to care for her? Need for
24-hour assistance as she was not able to tend to children
Impact
• Limited knowledge of infection prevention and identifying COVID-19 symptoms
• Lack of social support
• Need of help in the monitoring other children for COVID-19 symptoms
• Caregiver’s lack of knowledge regarding infant care (including feeding, bathing, infant sleep, etc.)
• Financial impacts of hospitalization
• Premature infant requiring frequent medical follow-ups
• Mother discharging from hospital unable to care for self or her children
�Case Study Two
Lesson: This case study highlights the need of social and family support
Resolution
• Encourage monitoring for new symptoms in other household members
and limiting visitors to home
• Assisting in scheduling for follow-up appts and reliable transportation
• Visiting nurse to schedule appointments, remind when date approaches
• Set up transportation through doctor’s office
r
• Provide information on resources for financial assistance
• Use hospital social worker
• Gave education on where to access groceries and logistics to pay
• Provide education and support for family caregiver
• Basic infant care
• Feeding
• Sleeping patterns
• Medications
• Provided bed for the baby
�Case Study Three
Lesson: This case study addresses COVID-19 and mental wellbeing
Situation
• New mother, COVID-19 positive, teenager and living with her parents
• Early in pandemic when safety of newborns was unknown and separation
from mother instructed
• Mother isolating in basement bedroom
• Mother planned to breastfeed
r
• Grandmother caring for infant
�Case Study Three
Lesson: This case study addresses COVID-19 and mental wellbeing
Situation
• New mother, COVID-19 positive, teenager and living with her parents
• Early in pandemic when safety of newborns was unknown and separation
from mother instructed
• Mother isolating in basement bedroom
• Mother planned to breastfeed
r
• Grandmother caring for infant
Impact
• Mother and new baby separated at birth for 10 days
• Physical and emotional well being of mother
• Mother at higher risk for postpartum depression
• Feeling of isolation for herself and from her child
• Prevention of infection and exposure risk for infant as well as other household members
• Newborn and mother separated
• Physical isolation
�Case Study Three
Lesson: This case study addresses COVID-19 and mental wellbeing
Resolution
• Encourage use of technology so mother can “interact” with infant
• Use of facetime and photo sharing via phone with grandmother and infant
• Encourage mother to be involved even when cannot physically be present
• Updates given to mother after all nursing visits
r
• Encourage other household members to monitor for symptoms
• Educate grandmother on infant care
• Provide mother with close follow-up to monitor for post partum depression
• Frequent follow ups from nurse to make sure mother was mentally well
• Nurse also there to answer any questions mother had
• Provide in person follow-up when able to be with infant again for education
• As soon as mother was out of isolation in-person visits could commence
�Summary
Communication, collaboration, and transparency between community healthcare
providers is critical for safe care transitions
• These serve as mitigation strategies in the prevention of the spread of COVID-19
There are several key considerations in the care transition process that promote
the safety of patients, caregivers/family members, and healthcare workers, starting
at the referral and intake process
r
In consideration of the home and community environment, it is important to
educate patients, caregivers and/or family members the infection prevention
strategies, including practical applications in the home
“Alone we can do so little; together we can do so much.”
-Helen Keller
�Questions
and
Answers
�Content Outline (TOC)
NETEC Resources
Kate Boulter, BAN, RN, MPH
�Resources: NETEC
NETEC is Here to Help
NETEC will continue to build resources, develop online education,
and deliver technical training to meet the needs of our partners
Ask for help!
Send questions to info@netec.org - they will be answered by NETEC SMEs
Submit a Technical Assistance request at NETEC.org
�Contact
NETEC eLearning Center
NETEC Skill videos
courses.netec.org
youtube.com/thenetec
Join the Conversation!
@theNETEC
@the_NETEC
Use hashtag: #NETEC
Website
Repository
Email
netec.org
repository.netecweb.org
info@netec.org
��
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Contingency and Crisis Capacities
Description
An account of the resource
<h3>This is a collection of Contingency and Crisis capacity resources. What are Contingency and Crisis capacities?</h3>
<p style="margin-left:1.25rem;">This collection of resources contains recommendations facilitating conservation of equipment and supplies during <strong>contingency</strong> (expected shortages) and <strong>crisis</strong> (known shortages) capacities and <em><strong>should not be applied</strong></em> as guidance when <strong>conventional capacities</strong> are available.</p>
<p style="margin-left:1.25rem;">Contingency and then crisis capacity measures augment conventional capacity measures and are meant to be considered and <strong>implemented sequentially</strong> (<a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-masks.html" target="_blank" rel="noreferrer noopener">CDC</a>). They are recommended in the following sequence:</p>
<p><img src="https://www.cdc.gov/coronavirus/2019-ncov/images/hcp/conventional-contingency-crisis-graphic.png" style="height:150px;" alt="conventional-contingency-crisis-graphic.png" /></p>
<ul style="margin-left:2rem;">
<li><strong>Conventional capacity</strong> include measures consisting of engineering, administrative, and personal protective equipment (PPE) controls that should already be implemented in general infection prevention and control plans in healthcare settings.</li>
<li><strong>Contingency capacity</strong> measures may be used temporarily during periods of expected shortages. Contingency capacity strategies should only be implemented after considering and implementing conventional capacity strategies.</li>
<li><strong>Crisis capacity</strong> strategies are not commensurate with U.S. standards of care but may need to be considered during periods of known shortages. Crisis capacity strategies should only be implemented after considering and implementing conventional and contingency capacity strategies.</li>
</ul>
<h3>Key Facts:</h3>
<ul>
<li>When using these strategies, healthcare facilities should (<a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">CDC</a>):
<ul>
<li>Consider these options and <strong>implement them sequentially</strong></li>
<li>Understand their current PPE inventory, supply chain, and <a href="https://www.cdc.gov/niosh/topics/pandemic/ppe.html#anchor_68992">utilization rate</a></li>
<li>Train healthcare personnel on PPE use and have them demonstrate competency with donning and doffing any PPE ensemble that is used to perform job responsibilities</li>
<li>Once PPE availability returns to normal, promptly resume conventional practices</li>
</ul>
</li>
</ul>
<h3>Where to Start:</h3>
<ul>
<li>Consult the CDC guidance on optimizing Personal Protective Equipment (PPE) supplies here: <a href="https://www.cdc.gov/niosh/topics/pandemic/conserving.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/conserving.html</a>
<ul>
<li>Strategies for Optimizing the Supply of Facemasks: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-n95.html</a></li>
<li>Strategies for Optimizing the Supply of Eye Protection: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-eye.html</a></li>
<li>Strategies for Optimizing the Supply of Isolation Gowns: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gowns.html</a></li>
<li>Strategies for Optimizing the Supply of Disposable Medical Gloves: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-gloves.html</a></li>
<li>Summary for Healthcare Facilities: Strategies for Optimizing the Supply of PPE during Shortages: <a href="https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html" target="_blank" rel="noreferrer noopener">https://www.cdc.gov/niosh/topics/pandemic/strategies-ppe.html</a></li>
</ul>
</li>
<li>See NETEC's selection of tools on <a href="/exhibits/show/ppecons">PPE (COVID-19) Use and Conservation</a>.</li>
</ul>
<h3>Contingency and Crisis Capacity Resources:</h3>
<p style="margin-left:1.25rem;">Browse through the resources at the bottom of this page, under <a href="#collection-items">Collection Resources</a>, to find strategies to help with reuse and extended use of supplies.</p>
<h3>N95 Flowchart - are Crisis Capacity Strategies necessary?</h3>
<p style="margin-left:1.25rem;">Start with the flowchart below to see how to determine when contingency and crisis capacity strategies are necessary.<br /><br /></p>
<div style="text-align:center;"><img src="https://repository.netecweb.org/files/original/9056d3ca25a1fd00b4e26bb772a96d9c.png" style="margin-left:auto;margin-right:auto;" width="60%" alt="9056d3ca25a1fd00b4e26bb772a96d9c.png" /></div>
Webinar
Portal access to a webinar
Duration
Length of time involved (seconds, minutes, hours, days, class periods, etc.)
Friday, November 6, 2020 | 1:00 PM EST
Event Type
Webinar, watch at link below.
URL
https://youtu.be/fwU6Ip1AerI
Player
Field for the html for a video player.
<br /><iframe width="560" height="315" title="Care Transitions to Home Health webinar" src="https://www.youtube.com/embed/fwU6Ip1AerI?autoplay=0" frameborder="0"></iframe>
Alternate URL
Other URLs if necessary.
CEU online course: <a href="https://courses.netec.org/courses/20-web-home2" target="_blank" rel="noreferrer noopener">https://courses.netec.org/courses/20-web-home2</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
NETEC COVID-19 Webinar Series (11/06/20)/Online Course: Care Transitions to Home Health: Key COVID-19 Considerations
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
In this webinar, we will discuss the importance of effective collaboration and communication during the intake/screening and referral processes concerning COVID-19 between home health clinicians, patients, and caregivers, articulate how to adapt to the CDC guidelines at home pertaining to challenges experienced when a mother of a newborn child tests positive for COVID-19 based on complex case studies, and summarize the various approaches necessary to effectively address encounters surrounding poor health literacy in minority populations affected by the pandemic as derived from clinical case scenarios.<br /><br />
<h2>Get educational credit for this webinar "COVID-19: Current State of the Pandemic" through <a href="https://courses.netec.org/courses/20-web-home2" target="_blank" rel="noreferrer noopener">Courses.netec.org</a>.</h2>
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-11-06
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2026-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 Treatment & Care group (1 year)
2022-07 by Amyna, Special Populations Treatment & Care group (3 years)
2023-12-15 by Clayton Mowrer, Special Populations Treatment & Care group (3 years) C&C
Relation
A related resource
Y
Type
The nature or genre of the resource
Webinar and Online Course
2019-nCoV
CEU
CEUs
Clinical Care
Contingency and crisis capacities
Coronavirus
COVID-19
Neonates
Online Course
R-SP
R-T&C
Treatment and Care
-
https://repository.netecweb.org/files/original/870740e497230274aff1db2f08c27b53.pdf
f06f784b3a8b447714185d44957e473c
PDF Text
Text
11-02-20
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Develop
Description
An account of the resource
<h2><span>These files will help you <strong><em>develop</em></strong> your program and plans based on what you have discovered.</span></h2>
<p style="font-size:120%;">Find model protocols and procedures and more in-depth training resources. You can go to the <a href="/exhibits/show/leadership"><button>Leadership Toolbox</button></a> or the <a href="https://repository.netecweb.org/exhibits/show/specialpopulations"><button>Special Populations</button></a> section. You can also go to the <a href="https://repository.netecweb.org/exhibits/show/netec-education/justintime"><button> Just in Time Training</button></a> page, the <a href="https://repository.netecweb.org/exhibits/show/ppe101/ppe"><button> PPE</button></a> page, or the <a href="https://repository.netecweb.org/exhibits/show/ems/prehospital"><button>EMS</button></a> page. <span>Subscribe to the NETEC <a href="https://www.youtube.com/channel/UCDpHc1LkcEpiWR0q7ll5eZQ" target="_blank" rel="noreferrer noopener"><button>Youtube Channel</button></a> to get all new Skills videos!</span></p>
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Renal Replacement Therapy in Patients with COVID-19: Increased Need for Renal Replacement Therapy (RRT)
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Printable flyer infographic about Renal Replacement Therapy in Patients with COVID-19: Increased Need for Renal Replacement Therapy (RRT).<br /><br />During the COVID-19 pandemic, the need for RRT - both inside and outside the ICU - has increased. In some cases facilities are unable to keep up with the demand for RRT.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-11-02
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2024-03-28 by J. Mundy – Treatment & Care group review 2023 (Q2) skipped – bumping to 2024 (Q2)
Relation
A related resource
Y - D0.1Tx/D0.2Tx Qualtrics # 821, Additional Resource
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Clinical Care
Comorbidity
Coronavirus
COVID-19
Not updated
R-T&C
Treatment and Care
-
https://repository.netecweb.org/files/original/f731fef379764bc0c6cac7f3fa1c103f.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on NEJM.
URL
https://www.nejm.org/doi/full/10.1056/NEJMc2031085
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMc2031085
Citation
Citation information for the publication itself.
Manzano, Giovanna S., Jared K. Woods, and Anthony A. Amato. 2020. "Covid-19–Associated Myopathy Caused by Type I Interferonopathy." New England Journal of Medicine.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Covid-19–Associated Myopathy Caused by Type I Interferonopathy
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
The syndrome of Covid-19 infection includes myalgias and elevated creatine kinase levels in at least a third of patients. Whether the elevation in creatine kinase level is caused by viral infection of muscle, toxic effects of cytokines, or another mechanism is unclear. There are few reports of muscle-biopsy findings in patients with Covid-19. We describe a patient with Covid-19 infection and myopathy who had a muscle-biopsy specimen showing evidence of virus-induced type I interferonopathy.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-11-20
Type
The nature or genre of the resource
Publication
Creator
An entity primarily responsible for making the resource
Manzano, Giovanna S., Jared K. Woods, and Anthony A. Amato.
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-11-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2024-03-28 by J. Mundy – Treatment & Care group review 2023 (Q2) skipped – bumping to 2024 (Q2)
Identifier
An unambiguous reference to the resource within a given context
Adult Care
2019-nCoV
Case Study
Clinical Care
Coronavirus
COVID-19
R-Res&Pub
R-T&C
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Aydillo, Teresa, Ana S. Gonzalez-Reiche, Sadaf Aslam, Adriana van de Guchte, Zenab Khan, Ajay Obla, Jayeeta Dutta, Harm van Bakel, Judith Aberg, Adolfo García-Sastre, Gunjan Shah, Tobias Hohl, Genovefa Papanicolaou, Miguel-Angel Perales, Kent Sepkowitz, N. Esther Babady, and Mini Kamboj. 2020. "Shedding of Viable SARS-CoV-2 after Immunosuppressive Therapy for Cancer." New England Journal of Medicine.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on NEJM.
URL
https://www.nejm.org/doi/full/10.1056/NEJMc2031670
Read Online
Online location of the resource.
https://www.nejm.org/doi/full/10.1056/NEJMc2031670
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Shedding of Viable SARS-CoV-2 after Immunosuppressive Therapy for Cancer
Subject
The topic of the resource
Infection Control
Description
An account of the resource
Detection of replication-competent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most reliable indicator of contagiousness.
Creator
An entity primarily responsible for making the resource
Aydillo, Teresa, Ana S. Gonzalez-Reiche, Sadaf Aslam, Adriana van de Guchte, Zenab Khan, Ajay Obla, Jayeeta Dutta, Harm van Bakel, Judith Aberg, Adolfo García-Sastre, Gunjan Shah, Tobias Hohl, Genovefa Papanicolaou, Miguel-Angel Perales, Kent Sepkowitz, N. Esther Babady, and Mini Kamboj.
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-12-01
Type
The nature or genre of the resource
Publication
Contributor
An entity responsible for making contributions to the resource
2022-12-07 general asset review - IPC (move to T&C)
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-12-10
2019-nCoV
Airborne Transmission
Case Study
Clinical Care
Coronavirus
COVID-19
Droplet Transmission
R-Res&Pub
R-T&C
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Abstract
<div class="abstract">
<div class="abstract-content selected">
<p><strong class="sub-title"> Background: </strong> Outpatient coronavirus disease 2019 (COVID-19) has been insufficiently characterized. To determine the progression of disease and determinants of hospitalization, we conducted a prospective cohort study.</p>
<p><strong class="sub-title"> Methods: </strong> Outpatient adults with positive reverse transcription polymerase chain reaction results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were recruited by phone between April 21 and July 23, 2020, after receiving outpatient or emergency department testing within a large health network in Maryland, United States. Symptoms were collected by participants on days 0, 3, 7, 14, 21, and 28, and portable pulse oximeter oxygen saturation (SaO<sub>2</sub>), heart rate, and temperature were collected for 15 consecutive days. Baseline demographics, comorbid conditions, and vital signs were evaluated for risk of subsequent hospitalization using negative binomial and logistic regression.</p>
<p><strong class="sub-title"> Results: </strong> Among 118 SARS-CoV-2-infected outpatients, the median age (interquartile range [IQR]) was 56.0 (50.0-63.0) years, and 50 (42.4%) were male. Among individuals in the first week of illness (n = 61), the most common symptoms included weakness/fatigue (65.7%), cough (58.8%), headache (45.6%), chills (38.2%), and anosmia (27.9%). Participants returned to their usual health a median (IQR) of 20 (13-38) days from symptom onset, and 66.0% of respondents were at their usual health during the fourth week of illness. Over 28 days, 10.9% presented to the emergency department and 7.6% required hospitalization. The area under the receiver operating characteristics curve for the initial home SaO<sub>2</sub> for predicting subsequent hospitalization was 0.86 (95% CI, 0.73-0.99).</p>
<p><strong class="sub-title"> Conclusions: </strong> Symptoms often persisted but uncommonly progressed to hospitalization among outpatients with COVID-19. Home SaO<sub>2</sub> may be a helpful tool to stratify risk of hospitalization.</p>
</div>
<p><strong class="sub-title"> Keywords: </strong> ambulatory care; coronavirus infections/epidemiology; middle aged; recovery of function; treatment outcome.</p>
</div>
<p class="copyright" id="copyright">© The Author(s) 2021. Published by Oxford University Press on behalf of Infectious Diseases Society of America.</p>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Open Access on Oxford Academic
URL
https://pubmed.ncbi.nlm.nih.gov/33614816/
Read Online
Online location of the resource.
https://academic.oup.com/ofid/article/8/2/ofab007/6064812
Citation
Citation information for the publication itself.
Blair, P. W., D. M. Brown, M. Jang, A. A. R. Antar, J. C. Keruly, V. S. Bachu, J. L. Townsend, J. A. Tornheim, S. C. Keller, L. Sauer, D. L. Thomas, and Y. C. Manabe. 2021. "The Clinical Course of COVID-19 in the Outpatient Setting: A Prospective Cohort Study." Open forum infectious diseases 8 (2):ofab007.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
The Clinical Course of COVID-19 in the Outpatient Setting: A Prospective Cohort Study
Subject
The topic of the resource
Research
Description
An account of the resource
Outpatient coronavirus disease 2019 (COVID-19) has been insufficiently characterized. To determine the progression of disease and determinants of hospitalization, we conducted a prospective cohort study.
Creator
An entity primarily responsible for making the resource
the Ambulatory COVID Study Team
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-01-05
Type
The nature or genre of the resource
Publication
Source
A related resource from which the described resource is derived
Blair, P. W., D. M. Brown, M. Jang, A. A. R. Antar, J. C. Keruly, V. S. Bachu, J. L. Townsend, J. A. Tornheim, S. C. Keller, L. Sauer, D. L. Thomas, and Y. C. Manabe.
2019-nCoV
Clinical Care
Coronavirus
COVID-19
R-Res&Pub
Treatment and Care
-
https://repository.netecweb.org/files/original/4d4c68089118a26f592ad144a5e90e17.pdf
c721b41cbf4982261990495da912df36
PDF Text
Text
Estrategias para la asistencia respiratoria
Cánula nasal
Ventilación mecánica
no invasiva
Ventilación invasiva
Modificaciones de
dispositivos de VMNI
para uso con VI
Referencias
Introduccion
Un numero alto de pacientes críticos con el COVID-19 que presentan el SDRA [síndrome de dificultad de respiración aguda] o
síntomas similares a ARDS requieren ventilación mecánica. Con respecto a este grupo, existen repuestas variables al PPCR
[presión positiva continua en las vías respiratorias] y también grados variables del funcionamiento pulmonar. La lista aquí incluida
muestra el rango de herramientas disponibles para asistir con la ventilación, incluyendo maneras para modificar equipo de
ventilación mecánica no invasiva (VMNI) y para suplementar equipo de ventilación mecánica invasiva (VMI).
El orden sugerido con respecto a la asistencia
respiratoria es el siguiente:
Cánula nasal
Cánula nasal de alto flujo
Posicionamiento prono [agregar link para el webinar y
documento de datos sobre el posicionamiento prono]
El evitar la ventilación mecánica no invasiva
Ventilación mecánica invasiva
Haz click en cada sección para obtener un resumen de cada estrategia al transportar pacientes con el COVID -19.
10-15-20
�Estrategias para la asistencia respiratoria
Cánula nasal
Ventilación mecánica
no invasiva
Ventilación invasiva
La aflicción respiratoria de pacientes con el COVID-19
puede intensificarse rápidamente, incluso en manera de
horas. Con respecto a la asistencia respiratoria, la primera
línea de defensa es la siguiente:
Cánula nasal
Cánula nasal de alto flujo
Posicionamiento prono temprano
10-15-20
08-03-20
Modificaciones de
dispositivos de VMNI
para uso con VI
Referencias
�Estrategias para la asistencia respiratoria
Cánula nasal
Ventilación mecánica
no invasiva
Ventilación invasiva
Modificaciones de
dispositivos de VMNI
para uso con VI
Ventilación mecánica no invasiva (VMNI)
¿Que es?
Ventilación mecánica no invasiva (VMNI):
Provee la asistencia a las vías altas respiratorias en caso de fallo o
insuficiencia respiratoria.
Conlleva el uso de cubre bocas, mascarilla nasal, o cascos burbuja de oxigeno.
Emplea un ajuste fijo, pero permite el escape de cierta cantidad de aire lo cual
genera aerosol.
¿Porque evitar la ventilación mecánica no invasiva con respecto a pacientes
con COVID-19?
En comparación con el método tradicional y el método de alto flujo, el VMNI
demuestra una baja probabilidad cumulativa de supervivencia.1 Algunas otras
razones de porque evitar el uso de VMNI son las siguientes:
Una inhabilidad de proveer protección de ventilación pulmonar de
manera constante y fiable.
Generacion de aerosol.
El alto grado de encepalopatia podria causar la inhabilidad de
proteger las vías respiratorias.
Aunque es posible, lograr posición prona es mas difícil cuando
se usa el VMNI.
10-15-20
08-03-20
Referencias
�Estrategias para la asistencia respiratoria
Cánula nasal
Ventilación mecánica
no invasiva
Ventilación invasiva
Modificaciones de
dispositivos de VMNI
para uso con VI
Estrategias de ventilación para la ventilación mecánica invasive
Incremento paulatino
Estrategia de protección pulmonar – metas de cuidado
Volumen corriente: 6cc/kg del peso ideal corporal
Meta de presión meseta: < 30 cm agua
Meta de presión de distensión: > 17 cm de agua
Hipoxia aceptada (O2 arriba de 88%)
Hipercapnia aceptable (CO2 entre 55-60 mm Hg)
Posicionamiento prono
Prematura: incluyendo con pacientes respirando
espontáneamente y en cánula nasal de alto flujo
Prolongada: > 16hr/dia
Requerimiento calculado al dia: Verificar el P/F < 150,
PEEp de 10 cm de agua, y Fio2 de 60%.
Valoración de PEEP – Enfoque individual
Considere el posible uso de una valoración de PEEP de menor
agresividad. Un PEEP alto puede causar que pacientes con
alta presión alveolar empeoren, especialmente aquellos con
hipovolemia.
10-15-20
08-03-20
Referencias
�Estrategias para la asistencia respiratoria
Cánula nasal
Ventilación mecánica
no invasiva
Ventilación invasiva
Modificaciones de
dispositivos de VMNI
para uso con VI
Estrategias de ventilación para ventilación invasiva
Incremento paulatino
La sedación y el bloqueo neuromuscular
Niveles altos de sedante podría ser necesarios
Los pacientes portan un elevavado grado de ventilación disincronica La meta es recrear la sincronía y prevenir daños
Hay una necesidad constante de obtener un grado de -4 en la escala
RASS de agitación-sedación (fentanyl, propofol, ketamine, Versed).
El bloqueo neuromuscular
Oxido nítrico inhalado (ON)
Los pacientes con hipoxemia refractaria podrían responder
positivamente al ON inhalado.
Oxigenación por membrana extracorporal (OMEC)
Los pacientes podrían requerir evaluación con respecto a OMEC.
10-15-20
08-03-20
Referencias
�Estrategias para la asistencia respiratoria
Ventilación mecánica
no invasiva
Cánula nasal
Ventilación invasiva
Modificaciones de
dispositivos de VMNI
para uso con VI
Las modificaciones de BiPAP para uso con ventilación mecánica invasiva
Fugas: El hacer uso de un tubo endotraqueal en lugar de una mascarilla podría
incrementar la cantidad de volumen transmitido con precisión ya que limitaría fugas.
Aerosoles: Los dispositivos de ventilación mecánica no invasiva (VMNI) utilizan
un puerto de escape que exhala gases y el cual debe de incluir un filtro para así
reducir el riesgo de que el personal medico sea expuesto a aerosoles.
Humidificación: Es preferible utilizar la humidificación activa para los pacientes
con COVID-19 pero es posible utilizar filtros pasivos de intercambio de calor y
humedad si es necesario
Flujo: Si tu tienes un dispositivo con capacidad de combinar oxigeno a alto
flujo, esta seria la mejor opción para adquirir FiO2 y alto flujo al minuto.
Instrucciones:
Utilizar un modo de ventilación el cual postule una tasa de
respiración obligatoria al igual que el tiempo inspiratorio.
Active las alarmas.
Tener precaución con respecto a diferencia de la gradiente de presión ya que IPAP y EPAP
son ajustadas separadamente para alcanzar los volúmenes y gradiente de presión requerida.
Mientras que los ventiladores de salas de emergencias (ICU) ajustan la meta de volumen con
cada inhalación y exhalación, los dispositivos de ventilación mecánica no invasiva (VMNI) hacen
uso de un algoritmo que ajusta el promedio de respiración atreves de varios ciclos de
inhalaciones y exhalación y por lo tanto se ajustan mas lento.
10-15-20
08-03-20
Referencias
�Estrategias para la asistencia respiratoria
Cánula nasal
Ventilación mecánica
no invasiva
Ventilación invasiva
Modificaciones de
dispositivos de VMNI
para uso con VI
Referencias
Modificaciones de dispositivos de anestesia para el uso con la ventilación mecánica no invasiva
Consideraciones sobre el personal medico docente
Debe de tomarse en cuenta el entrenamiento del personal medico con respecto a la iniciación,
el cambio de parámetros, y las rondas.
Planificar para la disponibilidad del personal medico con capacidades de anestesia y/o
equipos con capacitación cruzada en medias básicas y respuesta de primeros auxilios como
terapeutas respiratorios.
Contemplar el colocar pacientes los cuales usan dispositivos de anestesia en grupos
geográficamente cercanos para limitar el movimiento del personal medico.
Consideraciones sobre el equipo medico
Con intención de ser completamente monitoreados: prender alarmas y ajustar las opciones
de los dispositivos.
Las alarmas no alteran la configuración: a pesar de los sistemas de advertencia
perteneciente a los dispositivos, no existe un compensador automático de fugas además
de que los modelos de válvulas espontaneas podrían no tener modos de respaldo.
Permite la respiración continua: controlar el nivel de dióxido de carbono y la condensación
(funciona de manera mejor la humidificación pasiva con alternación de calentamiento.) utilice
un contendor para colectar agua y mantenga un suplemento adecuado de absorbentes de
dióxido de carbono.
Es preferible utilizar la humidificación pasiva: la humidificación activa podría llevar a un exceso de humedad.
�
Calibración diaria es requerida (un máximo de 72 horas es aceptables): durante la calibración se asume la perdida de organización
de datos, la reducción en el acertamiento de la evaluación, y la necesidad de tener disponible equipo alterno de ventilación.
No es posible ventilar presión excesiva a atmosfera a menos que P> 110 cm H20: Asegurarse de la sincronía con
respecto al paciente.
10-15-20
08-03-20
�Estrategias para la asistencia respiratoria
Cánula nasal
Ventilación mecánica
no invasiva
Ventilación invasiva
Modificaciones de
dispositivos de VMNI
para uso con VI
Referencias, recursos, y guías de ayuda
Sociedad americana de anestesiólogos:
10-15-20
08-03-20
Referencias
�
Guide
Document providing operation or response information, general guidance documents.
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Estrategias para la asistencia respiratoria
Subject
The topic of the resource
Elementos en Español
Description
An account of the resource
This printable flyer infographic is a Spanish language version of "<a href="https://repository.netecweb.org/items/show/1361">Respiratory Support Strategies</a>." It covers different topics in respiratory support strategies.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2020-10-15
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2019-nCoV
Airborne Transmission
Clinical Care
Coronavirus
COVID-19
Español
Not updated
R-T&C
Respirator
Respiratory Pathogen
Spanish
Treatment and Care
-
https://repository.netecweb.org/files/original/8b99e5fa2c9b120e7061a1568875de26.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Muster, Viktoria, Thomas Gary, Reinhard B. Raggam, Albert WÖlfler, and Marianne Brodmann. 2021. "Pulmonary embolism and thrombocytopenia following ChAdOx1 vaccination." The Lancet.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00871-0/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00871-0/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Pulmonary embolism and thrombocytopenia following ChAdOx1 vaccination
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Clinical Picture of a Pulmonary embolism and thrombocytopenia following ChAdOx1 vaccination in a 51-year-old woman
Creator
An entity primarily responsible for making the resource
Muster, Viktoria, Thomas Gary, Reinhard B. Raggam, Albert WÖlfler, and Marianne Brodmann.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-04-14
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2019-nCoV
Clinical Care
Complications
Coronavirus
COVID-19
Outcomes
R-Res&Pub
R-T&C
Vaccine Study
-
https://repository.netecweb.org/files/original/3add1cea3e2c7c3f24687e8109194130.png
3f501528330a5195fcab9cad4e0bb714
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Bayas, Antonios, Martina Menacher, Monika Christ, Lars Behrens, Andreas Rank, and Markus Naumann. 2021. "Bilateral superior ophthalmic vein thrombosis, ischaemic stroke, and immune thrombocytopenia after ChAdOx1 nCoV-19 vaccination." The Lancet.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00872-2/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00872-2/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Bilateral superior ophthalmic vein thrombosis, ischaemic stroke, and immune thrombocytopenia after ChAdOx1 nCoV-19 vaccination
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
Clinical Picture of Bilateral superior ophthalmic vein thrombosis, ischaemic stroke, and immune thrombocytopenia after ChAdOx1 nCoV-19 vaccination in a 55-year-old woman
Creator
An entity primarily responsible for making the resource
Bayas, Antonios, Martina Menacher, Monika Christ, Lars Behrens, Andreas Rank, and Markus Naumann.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-04-14
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2025-09-27
Contributor
An entity responsible for making contributions to the resource
2022-09-27 - general asset review - Treatment & Care group
2019-nCoV
Clinical Care
Complications
Coronavirus
COVID-19
Outcomes
R-Res&Pub
R-T&C
Vaccine Study
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Guetl, Katharina, Thomas Gary, Reinhard B. Raggam, Johannes Schmid, Albert Wölfler, and Marianne Brodmann. 2021. "SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia treated with immunoglobulin and argatroban." The Lancet.
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Free online on Lancet site.
URL
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01238-1/fulltext
Read Online
Online location of the resource.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01238-1/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
SARS-CoV-2 vaccine-induced immune thrombotic thrombocytopenia treated with immunoglobulin and argatroban
Subject
The topic of the resource
Research
Description
An account of the resource
A 50-year-old woman attended our emergency department with a 3-day history of severe back pain and a severe headache. 10 days earlier she had received the first dose of vaccine against SARS-CoV-2—ChAdOx1 nCoV-19 (AstraZeneca). The patient had no significant medical history—specifically no personal or family history of venous thromboembolism. She was not pregnant, she did not take an oral contraceptive, and did not have a hormone-eluting intrauterine device in situ.
Creator
An entity primarily responsible for making the resource
Guetl, Katharina, Thomas Gary, Reinhard B. Raggam, Johannes Schmid, Albert Wölfler, and Marianne Brodmann.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021-06-11
Type
The nature or genre of the resource
Publication
2019-nCoV
Case Study
Clinical Care
Coronavirus
COVID-19
R-Res&Pub
-
https://repository.netecweb.org/files/original/0273c7748f58fd289bd729f7927f9e89.png
07a6c38b053cb68867c3624a96ccf222
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://netec.org/2022/06/30/a-clinicians-reference-guide-to-lassa-virus/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
A Clinicians Reference Guide to Lassa Virus
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
This blog post provides a Clinical Perspective on Lassa Virus from NETEC experts.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-06-30
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-10
Contributor
An entity responsible for making contributions to the resource
2024-03-28 by J. Mundy – not yet reviewed asset – bumping first review 1 year
Blog
Clinical Care
Lassa
-
https://repository.netecweb.org/files/original/e474bb66c2d8c273bd561440c89cd91f.pdf
5614859e9a1d3f9940d359b509d63f29
PDF Text
Text
International Journal of Infectious Diseases 119 (2022) 187–200
Contents lists available at ScienceDirect
International Journal of Infectious Diseases
journal homepage: www.elsevier.com/locate/ijid
Review
Lassa Virus Infection: a Summary for Clinicians
Vanessa Raabe a,∗∗, Aneesh K Mehta b, Jared D. Evans c,∗ , On behalf of the following
members of the State of the Science Working Group of the National Emerging Special
Pathogens Training and Education Center (NETEC) Special Pathogens Research Network
(SPRN), Adam Beitscher d, Nahid Bhadelia e, David Brett-Major f, Theodore J Cieslak f,
Richard T Davey g, Jared D Evans h, Maria G Frank d, Peter Iwen f, Mark G Kortepeter i,
Corri Levine j, Susan McLellan j, Aneesh K Mehta k, Lauren Sauer f, Erica S Shenoy m,
Kimon Zachary m
d
Denver Health Medical Center, Denver, CO
Boston University Hospital, Boston, MA
f
University of Nebraska Medical Center, Omaha, NE
g
National Institute of Allergy and Infectious Diseases, Bethesda, MD
h
Johns Hopkins Applied Physics Laboratory, Laurel, MD
i
Uniformed Services University of the Health Sciences, Bethesda, MD
j
University of Texas Medical Branch, Galveston, TX
k
Emory University, Atlanta, GA
l
New York University Grossman School of Medicine, New York, NY
m
Massachusetts General Hospital, Boston, MA
a
New York University Grossman School of Medicine, New York, NY
b
Emory University School of Medicine, Atlanta, GA
c
Johns Hopkins Applied Physics Laboratory, Laurel, MD
e
a r t i c l e
i n f o
Article history:
Received 18 February 2022
Revised 1 April 2022
Accepted 3 April 2022
Keywords:
Lassa virus
Lassa fever
antiviral therapy
antiviral countermeasure
vaccine
viral hemorrhagic fever
a b s t r a c t
Objectives: This summary on Lassa virus (LASV) infection and Lassa fever disease (LF) was developed
from a clinical perspective to provide clinicians with a condensed, accessible understanding of the current literature. The information provided highlights pathogenesis, clinical features, and diagnostics emphasizing therapies and vaccines that have demonstrated potential value for use in clinical or research
environments.
Methods: We conducted an integrative literature review on the clinical and pathological features, vaccines, and treatments for LASV infection, focusing on recent studies and in vivo evidence from humans
and/or non-human primates (NHPs), when available.
Results: Two antiviral medications with potential benefit for the treatment of LASV infection and 1 for
post-exposure prophylaxis were identified, although a larger number of therapeutic candidates are currently being evaluated. Multiple vaccine platforms are in pre-clinical development for LASV prevention,
but data from human clinical trials are not yet available.
Conclusion: We provide succinct summaries of medical countermeasures against LASV to give the busy
clinician a rapid reference. Although there are no approved drugs or vaccines for LF, we provide condensed information from a literature review for measures that can be taken when faced with a suspected
infection, including investigational treatment options and hospital engineering controls.
© 2022 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.
This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/)
∗
Corresponding authors: Jared D. Evans, PhD, Johns Hopkins Applied Physics Laboratory, Research and Exploratory Development Department, School of Medicine,
11100 Johns Hopkins Rd., Laurel, MD 20732, (240) 758-8133
∗∗
Vanessa Raabe, MD, New York University Grossman, 430 E 29th Street, ACLS
West Tower, 3rd Floor, New York, NY 10016, 646-754-2682.
E-mail
addresses:
Vanessa.Raabe@nyulangone.org
(V.
Raabe),
aneesh.mehta@emory.edu (A.K. Mehta), jared.evans@jhuapl.edu (J.D. Evans).
Introduction
Lassa virus (LASV) is an enveloped, segmented RNA virus in
the family Arenaviridae, genus Mammarenavirus. This virus is classified in the Old World mammarenavirus complex that circulates
https://doi.org/10.1016/j.ijid.2022.04.004
1201-9712/© 2022 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND
license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
�V. Raabe, A.K. Mehta, J.D. Evans et al.
International Journal of Infectious Diseases 119 (2022) 187–200
in West and Central Africa and is closely related to lymphocytic
choriomeningitis virus, Mopeia virus, and Lujo virus (Klitting et al.,
2020). A total of 7 lineages have been identified, 4 of which are
found in Nigeria; 1 in Mali and Cote d’Ivoire, 1 in Togo, and 1 in
Sierra Leone, Guinea, and Liberia (Ehichioya et al., 2019; Forni and
Sironi, 2020). The genetic variation between strains is as high as
27% at the nucleoprotein level and 15% at the amino acid level
(Bowen et al., 20 0 0). This diversity may account for some of the
variability in clinical presentation and present challenges for diagnostic assays and vaccines. Most human infections with LASV result from the rodent-to-human transmission, although human-tohuman infection may occur, especially in health care settings. A
large proportion of human infections are asymptomatic or unrecognized; however, a minority result in a potentially severe symptomatic disease, known as Lassa fever (LF). LF is difficult to diagnose clinically, as symptoms resemble many other common infections in the region, such as influenza, malaria, and typhoid fever. In
locations where undiagnosed febrile diseases are common, various
diagnostic assays are available to confirm the diagnosis. Vaccines
against LASV are in development but are not approved for use and
have not yet been widely studied in humans. Historically, ribavirin,
a small molecule direct-acting antiviral drug, has been used for
treatment and post-exposure prophylaxis against LF. Other novel
products, including favipiravir, remain the subject of investigational
studies. Finally, new therapeutic options, such as monoclonal antibodies, are being pursued in animal models, including non-human
primates (NHPs).
targets for medical countermeasures against LASV. We present an
overview of these processes to provide a mechanistic context for
potential therapeutics. For a more complete review, see study by
Loureiro et al., 2019. The LASV glycoprotein studs the virus envelope and is cleaved into 2 smaller peptides, which bind the
host cellular receptor alpha-dystroglycan, which is expressed in
a broad range of tissues (Cao et al., 1998; Herrador et al., 2019;
Spiropoulou et al., 2002). Alternative receptors include T-cell immunoglobulin and mucin domain 1, Tyro3, dendritic cell-specific
intercellular adhesion molecule-grabbing nonintegrin, liver and
lymph node sinusoidal endothelial calcium-dependent lectin, and
Axl (Brouillette et al., 2018; Fedeli et al., 2018; Shimojima et al.,
2012). Virus entry can also occur through macropinocytosis, where
the glycoprotein complex binds to endosomal lysosomal-associated
lembrane protein 1 (LAMP1) for virus fusion with subsequent
genome release into the cytoplasm, although LAMP1-independent
virus fusion may occur (Israeli et al., 2017; Jae et al., 2014;
Li et al., 2016; Markosyan et al., 2021). Previous work has discovered small molecules that inhibit LASV entry or membrane fusion in vitro, but none have advanced to clinical testing for LF
(Herring et al., 2021; Hulseberg et al., 2019; Markosyan et al., 2021;
Nunberg and York, 2012; Shankar et al., 2016; Takenaga et al.,
2021; Wang P. et al., 2018; Zhang et al., 2019; Zhang et al.,
2020). Genome replication is carried out by virally encoded polymerase, nucleoprotein, and the Z protein (Loureiro et al., 2012).
Viral genome replication is the main target for existing antiviral
therapies for LF, including ribavirin and favipiravir. However, other
virus-host protein interactions have been identified during replication that could be targeted for therapeutics. The DEAD-Box RNA
Helicase 3 (DDX3), which is involved in multiple steps in RNA
metabolism and cell cycle control, interacts with the LASV nucleoprotein (Chang et al., 2006; Lai et al., 2010; Loureiro et al., 2018).
DDX3 is believed to play a role in LASV replication; when DDX3
is decreased in cell culture, LASV replication is greatly diminished
(Loureiro et al., 2018). LASV is packaged in a stepwise process
through an endoplasmic reticulum to Golgi transition, ending in
a budding event at the cell membrane requiring cellular factors
tumor susceptibility gene 101, vacuolar protein sorting-associated
protein 4A, and vacuolar protein sorting-associated protein 4B
(Urata et al., 2006). Countermeasures that interfere with posttranslational protein modification or the LASV Z protein, which
plays a critical role in viral budding from the cellular membrane,
are in development but not yet in pre-clinical testing (Andrei and
De Clercq, 1990; Lee et al., 2011; McLay et al., 2013; Xu et al.,
2021).
Immune cells, such as dendritic cells and macrophages, may
be directly infected by LASV without an expression or upregulation of immune costimulatory molecules, which leads to poor proinflammatory cytokine expression and T-cell activation (Baize et al.,
20 09; Mahanty et al., 20 03; Pannetier et al., 2014; Pannetier et al.,
2011). Type I interferons play an important role in limiting LASV
replication and aid in viral clearance. However, similar to many
pathogenic viruses, LASV has strategies to evade the innate immune response (Baize et al., 2006; Yun et al., 2012; Qi et al., 2010;
Schaeffer et al., 2018). The LASV Z protein can inhibit molecules
associated with viral RNA detection, such as retinoic acid-inducible
gene I signaling and melanoma differentiation-associated protein 5 (Huang et al., 2020; Xing et al., 2015). The LASV nucleoprotein can block nuclear factor-κ B transcription activity, limiting the expression of antiviral immune responses, suppressing
type I interferon production, and inhibiting natural killer cell responses (Rodrigo et al., 2012; Carnec et al., 2011; Qi et al., 2010;
Russier et al., 2014). The L protein and nucleoprotein produced
by LASV, in addition, prevent double-stranded RNA from accumulating in cells and block interferon regulatory factor 3 from
translocating into the nucleus, circumventing RNA detection mech-
Methods
A focused literature review was conducted emphasizing recent updates in medical countermeasures from 2016 to 2021, although older studies were also included where relevant. Bibliography scans were also completed on review articles. Medical countermeasures against LASV used in human clinical research or NHP
studies were the focus of this review.
This review is one in a series of articles on the management
of severe diseases caused by emerging viral pathogens, including
Marburg, Crimean Congo hemorrhagic fever, LF, Nipah, smallpox,
and South American Hemorrhagic Fever viruses (Frank et al., 2021;
Kortepeter et al., 2020). Viruses were selected by the members of
the State of the Science Working Group of the Special Pathogens
Research Network within the National Emerging Special Pathogens
Training and Education Center (NETEC). The NETEC is funded by
the Assistant Secretary of Preparedness and Response and the Centers for Disease Control and Prevention to improve public health
and health care systems in the United States to respond effectively to individuals infected with suspected or confirmed special
pathogens. Criteria used to select the pathogens for review included the following: relative rarity of the diseases, high infectivity and communicability, severity of the illness, potential to cause
large-scale outbreaks, the potential need for specialized infection
control management based on their historic ability to cause nosocomial infection in the hospital or field setting, and their paucity
or lack of licensed countermeasures.
After the publication of this article, updated information on the
management of LF will be made available on the NETEC website:
www.netec.org.
Clinical Features
Incubation period: The incubation period for LF is 2 to 21 days
following exposure (Asogun et al., 2019; Jahrling P. B. and Peters C.
J., 1984).
Pathogenesis: The interactions between LASV and cellular proteins involved in viral entry and replication represent potential
188
�V. Raabe, A.K. Mehta, J.D. Evans et al.
International Journal of Infectious Diseases 119 (2022) 187–200
anisms that normally contribute to interferon production in the
setting of viral infection (Hastie et al., 2011; Hastie et al., 2012;
Jiang et al., 2013; Mateer et al., 2020). Although NHPs who survive
LF demonstrate early interferon responses and activated T-cells, fatal cases have delayed interferon production and poor T-cell activation (Baize et al., 2009). Although cellular immune responses
play a critical role in recovery from LASV infection, there is evidence that shows that T-cells also contribute to disease pathology
(Flatz et al., 2010; Oestereich et al., 2016a; Port et al., 2020). Interventions that modulate the immune system response to assist
with LASV control or dampen immune-mediated damage represent
a possible future area of medical countermeasures research for LF.
However, to date, clinical studies of immunological interventions
have been limited to antibody-based therapeutics and vaccines.
Clinical spectrum of infection: Human LASV infection results in
a wide spectrum of clinical outcomes from asymptomatic to fatal
viral hemorrhagic fever. The manifestations of LF are variable and
resemble those of other commonly encountered infections, such as
influenza, malaria, rickettsia, typhoid fever, and other viral hemorrhagic fevers such as Ebola virus disease. Acute symptoms associated with LF may include abdominal pain, abnormal bleeding,
anorexia, arthralgia, back or chest pain, conjunctivitis, cough, diarrhea, difficulty breathing, dizziness, dysuria, facial edema, fatigue,
fever, headache, malaise, myalgia, nausea, pharyngitis (often exudative), vomiting, and weakness (Bausch et al., 2001; Ilori et al.,
2019; Ipadeola et al., 2020, Jeffs, 2006; McCormick et al., 1987a;
Richmond and Baglole, 2003; Samuels et al., 2020; Shehu et al.,
2018). Pharyngitis is recognized as a distinctive symptom that can
distinguish LF from other endemic diseases, occurring in 70% of
a well-described hospital cohort (McCormick et al., 1987a). Severe cases may develop facial edema in the absence of peripheral edema (McCormick et al., 1987a). LASV can invade the central nervous system (Gunther et al., 2001; Johnson et al., 1987;
Okokhere P. O. et al., 2018). In severe cases, neurological symptoms such as altered consciousness, seizures, and tremors have
been reported, and hearing loss is the most common reported
focal neurologic deficit (Cummins et al., 1992; McCormick et al.,
1987a; Okokhere P. et al., 2018; Okokhere P. O. et al., 2018). In children, LF may present with “swollen baby syndrome” characterized
by abdominal distension, bleeding, and diffuse edema, which has
been reported in children up to 9 years of age and carries an estimated case fatality rate of 83% (Monson et al., 1987). The most
common symptoms associated with pediatric LF among hospitalized patients in Sierra Leone, with prevalence in ≥50% of patients,
were cough, vomiting, headache, sore throat, pain, and facial/neck
edema. In contrast, fever and bleeding were present in ≤50% of
hospitalized pediatric patients (Samuels et al., 2020). Congenital
LASV infection, defined as symptom onset ≤5 days after delivery,
has been reported (Monson et al., 1987).
Clinical course: Similar to other viral hemorrhagic fevers, LF
symptoms evolve over the course of the illness. Early symptoms
include fever, chills, malaise, and muscle aches, whereas abdominal pain, back pain, cough, diarrhea, headache, joint pain, sore
throat, and vomiting frequently develop during days 3 to 5 of illness (Frame et al., 1970; McCormick et al., 1987a; Monath et al.,
1974). Severe illness, including hypotension and shock, may occur
as early as the end of the first week of illness (McCormick et al.,
1987a). Among survivors, recovery is generally observed in the second and third weeks after the onset of illness (McCormick et al.,
1987a, Monath et al., 1974).
Mortality risk factors: Recent analyses of the literature suggest
the case fatality rate of LF in humans is approximately 30% in patients who present to health care environments (Kenmoe et al.,
2020; Merson et al., 2021). Pregnant women have increased odds
of death, with an overall odds ratio of 2.86 for death compared
with non-pregnant women with LF and an odds ratio of over
5 when presenting in the third trimester (Kayem et al., 2020;
Price et al., 1988). Approximately 90% of pregnancies are lost
among pregnant women with LF (Wauquier et al., 2020). A number of other markers have been correlated with poor outcomes,
including elevated serum aspartate aminotransferase levels, elevated clinical scores (National Early Warning Score Version 2 ≥ 7),
high viremia (≥103.6 median tissue culture infectious dose50 /mL or
cycle threshold values ≤30), older age (≥45 years), the presence
of acute kidney injury (Kidney Disease-Improving Global Outcome
grade ≥ 2; stage ≥ 2 acute kidney injury in children), and infection with LASV strains circulating in Nigeria (Adetunji et al., 2021;
Asogun et al., 2012; Duvignaud et al., 2021; McCormick et al., 1986;
Okokhere P. et al., 2018). Hospitalized children with LF in Sierra
Leone with positive antigen tests experience high mortality (63%)
(Samuels et al., 2020).
Pathology: Like other viral hemorrhagic fever viruses, LASV distributes widely in the body, including the brain, parotid and submandibular glands, lymphoid tissue, mucosal tissue, lungs, heart,
liver, spleen, pancreas, adrenal glands, kidney, bladder, testis, ovary,
endometrium, placenta, breast, bone marrow, vascular endothelial cells, mesothelial cells, serosal membranes, and skeletal muscle (Hensley et al., 2011; Shieh et al., 2021; Stein et al., 2021;
Walker et al., 1975). Thrombocytopenia and transient lymphopenia
can occur, along with a monocytosis during the second week of infection (Baize et al., 2009; Fisher-Hoch et al., 1988; Hensley et al.,
2011). Pleural and pericardial effusion have been observed in human cases (Edington and White, 1972; McCormick et al., 1987a;
Monath et al., 1974). Pathological findings associated with LASV
infection may include organ necrosis, hemorrhage, edema, interstitial pneumonia, and inflammation, including vasculitis (Baize et al.,
2009; Callis et al., 1982; Fisher-Hoch and McCormick, 1987;
Hensley et al., 2011; Stein et al., 2021; Walker et al., 1982;
Walker et al., 1975; Winn and Walker, 1975). Hearing loss may
occur because of damage to cochlear hair cells and the auditory nerve or perivascular inflammation in the ear, which has
been demonstrated in mouse models of LF (Huynh et al., 2020;
Yun et al., 2015).
Sequelae: Long-term sequela have been reported after LASV infection, including sensorineural hearing loss (in as many as 1 in
3 confirmed, symptomatic LASV infections in some settings), ophthalmological abnormalities, difficulty speaking, hair loss, and balance problems, including cerebellar ataxia (Cummins et al., 1990;
Ezeomah et al., 2019; Ficenec et al., 2020; Ibekwe et al., 2011;
Li et al., 2020; McCormick et al., 1987a; World Health Organization, 2017b). Delayed onset paraparesis after LF has been reported
(Duvignaud et al., 2020). Spontaneous abortion or fetal demise
after birth occurs commonly among pregnant patients with LF
(McCormick et al., 1987a; Monson et al., 1987; Price et al., 1988). In
studies from Nigeria, survivors with severe acute kidney injury, including those who required hemodialysis, recovered renal function
to normal levels (Okokhere 2018, Lancet ID). Social isolation and
stigmatization among LF survivors remain problematic in recovery
efforts (Ficenec et al., 2020; Usifoh et al., 2019).
Diagnostic testing: Although whole blood may also be used,
collection of blood, preferably in ethylenediaminetetraacetic acid
(EDTA) tubes, is recommended for Lassa diagnostic testing. Personal protective equipment should be worn when performing
phlebotomy, including long-sleeved gowns or disposable coverall
suits, a face mask, goggles or a face shield, rubber boots/shoe
covers, and gloves. Following collection, samples should be enclosed in a second plastic, leak-proof container. Unless local
Lassa diagnostic testing is available, specimens will need to be
shipped to a national, regional, or international reference laboratory capable of performing Lassa diagnostic testing. Detailed
guidance regarding the safe collection and preparation of blood
samples from individuals with suspected Lassa infection for
189
�V. Raabe, A.K. Mehta, J.D. Evans et al.
International Journal of Infectious Diseases 119 (2022) 187–200
transport and shipping to reference laboratories for diagnostic
testing may be found at https://www.who.int/publications/i/
item/how- to- safely- collect- blood- samples- by- phlebotomy- frompatients- suspected- to- be- infected- with- lassa- fever, https://www.
who.int/publications/i/item/9789241549608, and https://www.who.
int/images/default-source/health-topics/lassa-fever/how-to-safelyship- human- blood- samples- from- lassa.tmb- 479v.png?sfvrsn=
6bb3dab3_6. Appropriate national public health authorities should
be notified of suspected LASV infections, if not already notified, at
the time Lassa diagnostic testing is arranged.
Comprehensive reviews of diagnostic assays for LASV have
been published recently elsewhere (Happi et al., 2019; Raabe and
Koehler, 2017). In brief, multiple laboratory modalities may be used
to directly detect LASV infection, including nucleoprotein antigen
detection assays, nucleic acid amplification technology, immunohistochemistry, and, in settings where high biocontainment laboratory facilities exist, viral culture may be considered. LASV infection may also be indirectly diagnosed by serological testing, such
as enzyme-linked immunosorbent assays. A rapid lateral flow assay for LASV nucleoprotein has received a Conformitè Europëenne
(CE) mark that approves the test for use in the European Union,
but it is not approved by the United States Food and Drug Administration (FDA). Each LASV diagnostic assay modality is subject to
limitations, and the timing of specimen collection may influence
the accuracy of testing. Viral yield is highest early in infection and
declines during the second week, which may affect antigen testing
and culture (Johnson et al., 1987). However, the opposite is true
of serological assays, which may yield negative results in the first
week of illness before developing LASV antibodies (Bausch et al.,
20 0 0; Jahrling et al., 1985b; Johnson et al., 1987). The sensitivity of genomic detection through nucleic acid amplification testing
may be decreased if the strain of LASV has a poor match with test
primers (Olschlager et al., 2010). Serologic assays also can experience this challenge. More recently, diagnostic assays using CRISPRCas13a have been developed for LASV infection but are speciesspecific and clade-specific (Barnes et al., 2020). Combinations of
reverse transcription-polymerase chain reaction (PCR) assays with
post-PCR oligonucleotide microarrays for broad viral hemorrhagic
fever diagnostics, including LF, are in development (Olschläger and
Günther, 2012; Yao et al., 2021). Similar to other testing modalities,
nucleic acid testing is more sensitive than rapid lateral flow assays,
particularly when the viral load is lower, as indicated by higher
cycle threshold values by reverse transcription-PCR (Boisen et al.,
2020). The selection of the appropriate diagnostic assay should be
customized based on case management objectives and diagnostic
setting. In some circumstances, using a combination of modalities,
such as viral antigen detection and serological assays, may increase
the diagnostic yield (Bausch et al., 20 0 0).
Testing for LASV may be performed on throat swabs in addition to blood samples. In a study of hospitalized patients, 34%
had positive throat swabs for LASV in the first 12 days of illness,
whereas the virus was only detectable in 13% of samples collected
between days 13 to 24 of illness (Johnson et al., 1987). Detection of LASV in throat swabs is more common among patients
with viremia, but may still be detectable in 14% of patients without viremia (Johnson et al., 1987). The virus that causes LF may
sometimes be detectable in urine samples (Monath et al., 1974).
Among patients with symptoms suggestive of meningitis, the virus
may be detectable in the central nervous system (Johnson et al.,
1987). In cases of suspected LF in the United States, diagnostic testing should be coordinated with local public health officials to arrange for sample evaluation in an appropriate diagnostic facility.
Outside of the United States, the diagnostic testing arrangements
should be coordinated with national, regional, or international reference laboratories in conjunction with appropriate public health
authorities.
Potential Treatment or Prophylaxis Countermeasures
Pre-exposure prophylaxis: Hemorrhagic fevers due to arenaviruses, including LASV, were declared high priority diseases by
the World Health Organization in 2017 (World Health Organization, 2017a). There are currently no licensed vaccines against LASV
infection, although multiple candidates are in clinical development.
Two vaccine candidates, a DNA-based vaccine and a measles virusbased vaccine, have completed phase I studies in humans (ClinicalTrials.gov NCT03805984 and NCT04055454, respectively); however, the results of these vaccine trials are not yet available. A recombinant vesicular stomatitis virus-based vaccine expressing the
LASV glycoprotein, which demonstrated 100% protection against
clinical disease in NHPs, recently entered phase I human clinical trials (ClinicalTrials.gov NCT04794218) (Geisbert et al., 2005,
Marzi et al., 2015; Safronetz et al., 2015). A live attenuated Mopeia
virus-based vaccine known as ML29 also demonstrated 100% protection against symptomatic LF in NHPs and is safe in immunocompromised NHPs. It is anticipated to enter human clinical trials
soon (Lukashevich et al., 2008; Zapata et al., 2013).
Multiple vaccine candidates demonstrate improved survival
from the LASV challenge in NHPs, including the vaccine candidates in human clinical trials. These vaccine candidates encompass
a broad spectrum of platforms, including DNA-based vaccines administered with electroporation, measles virus-vectored vaccines,
Mopeia virus-vectored vaccines, attenuated rabies-vectored vaccines, vaccinia-vectored vaccines, and vesicular stomatitis virusvectored vaccines (Carnec et al., 2018; Cashman et al., 2017;
Cross et al., 2020; Fisher-Hoch et al., 1989; Geisbert et al.,
2005; Jiang et al., 2019; Jiang et al., 2021; Kurup et al., 2021;
Lukashevich et al., 2008; Marzi et al., 2015; Mateo et al., 2019;
Mateo et al., 2021; Safronetz David et al., 2015) (Table 1 ).
Table 2 .
LASV-specific immune responses elicited by these vaccines vary,
even among those that confer a survival benefit. Vaccine-induced
generation of neutralizing antibody and T-cell responses have been
demonstrated for DNA-based, measles virus-vectored, and vesicular
stomatitis virus-vectored vaccines (Cross et al., 2020; Jiang et al.,
2019; Jiang et al., 2021; Mateo et al., 2021). Other vaccine designs,
such as Mopeia virus-vectored vaccines, have been noted to generate predominantly cellular immune responses (Lukashevich et al.,
2005).
Multiple additional vaccine candidates are in pre-clinical development and have demonstrated improved survival or generation of LASV-specific immunogenicity in guinea pig, rabbit, and/or mouse models, but not NHPs, to date. These
include adenovirus-vectored, inactivated rabies virus-vectored,
modified vaccinia Ankara-vectored, single-cycle viral replicon
particle-based, viral-like particle-based, and yellow fever virusvectored vaccines (Abreu-Mota et al., 2018; Branco et al., 2010;
Bredenbeek et al., 2006; Cashman et al., 2013; Fischer et al.,
2021; Goicochea et al., 2012; Jiang et al., 2011; Kainulainen et al.,
2018; Kainulainen Markus H. et al., 2019; Kennedy et al., 2019;
Maruyama et al., 2019; Muller et al., 2020; Salvato et al., 2019;
Wang M. et al., 2018; Wang M. et al., 2021).
Post-exposure prophylaxis: The post-exposure prophylaxis typically considered for individuals with high-risk exposure to LASV is
ribavirin (Bausch et al., 2010). Ribavirin is a guanosine analog with
broad-spectrum antiviral activity. The true effectiveness of ribavirin
as post-exposure prophylaxis has not been calculated, as the rate
of secondary transmission of infection after exposure is unknown.
When used for post-exposure prophylaxis, adverse events such as
changes in mood, dizziness, fatigue, fever, headaches, nausea, and
weakness, are common; therefore, considerations of risks versus
benefits are important (Crowcroft et al., 2004; Hadi et al., 2010;
Isa et al., 2016). Ribavirin should be administered with food as a
190
�Vaccine platform
Manufacturer or
source/contact
Adenovirus vector
DNA vaccine with
electroporation
Human trials
NHP studies
Two vaccine candidates:
1. Adenovirus 5 expressing LASV glycoprotein
2. Adenovirus 5 expressing LASV nucleoprotein
Inovio
Pharmaceuticals
Inactivated rabies
virus vector
191
Measles virus
vector
Description
Two vaccine candidates:
1. Codon-optimized DNA vaccine expressing LASV
glycoprotein
2. Codon-optimized DNA vaccine expressing LASV
glycoprotein complex precursor, Ebola
glycoprotein, and Marburg glycoprotein
Phase I completed,
results not yet
available
[NCT03805984]
NHPs receiving 2 or 3 doses of DNA vaccine
expressing only LASV glycoprotein had 100%
survival and no clinical signs of infection after
LASV challenge (Cashman et al., 2017, Jiang et al.,
2019). Combination LASV, Ebola, and Marburg
DNA vaccine elicits neutralizing antibodies and
T-cell responses in NHPs, although data not yet
available on protection from LASV viral
challenge.(Jiang et al., 2021)
An inactivated, codon-optimized recombinant
rabies-Lassa virus adjuvanted with a TLR-4
agonist
Themis Bioscience
Two vaccine candidates using the Schwarz
measles vaccine platform:
1. Recombinant measles virus expressing LASV
glycoprotein and nucleoprotein
2. Recombinant measles virus expressing LASV
glycoprotein and Z protein
Multiple vaccine candidates:
1. Attenuated recombinant Mopeia virus
(MOPEVAC). expressing LASV glycoprotein
2. Live Mopeia virus
3. Attenuated reassortant Mopeia/Lassa virus
expressing Mopeia virus L protein and LASV S
protein, nucleoprotein, and glycoprotein (ML29)
Rabies virus vector
Multiple vaccine candidates:
1. Attenuated rabies vaccine strain SAD-B19
expressing LASV glycoprotein
2. Tetravalent attenuated rabies vaccine strain
SAD-B19 expressing LASV, Ebola virus, Sudan
virus, and Marburg virus glycoproteins
100% protection against death and clinical
signs of infection among guinea pigs
receiving 2 doses of either vaccine
candidate (Maruyama et al., 2019)
Guinea pigs who received 3 doses of
vaccine did not develop clinical signs of
infection and 100% survived LASV
challenge (Cashman et al., 2013)
100% survival and protection against
clinical signs of infection in guinea pigs
and BALB/c mice, but no protection
against clinical illness or death in BALB/c
Fcγ knockout mice (Abreu-Mota et al.,
2018)
Phase I completed,
results not yet
available
[NCT04055454]
NHPs receiving the candidate expressing LASV
glycoprotein and nucleoprotein occasionally
developed clinical signs of infection after LASV
challenge, although less than control animals,
whereas those receiving the candidate expressing
the LASV glycoprotein and Z protein had
significant clinical illness. All NHPs receiving
either vaccine candidate survived LASV
challenge.(Mateo et al., 2019, Mateo et al., 2021)
MOPEVAC – Clinical signs of infection were
observed after LASV challenge in 1 study but not
another. All NHPs in both studies survived
(Carnec et al., 2018, Mateo et al., 2019)
Live Mopeia virus – No clinical signs of infection
and 100% survival in 2 vaccinated NHPs
challenged with LASV, although both developed
LASV viremia (Fisher-Hoch et al., 1989)
ML29 – No clinical signs of infection and 100%
survival among single-dose NHPs challenged with
LASV (Lukashevich et al., 2008)
ML29 – Guinea pigs who received 1 dose
of vaccine did not develop clinical signs of
infection and had 100% survival after
LASV challenge (Lukashevich et al., 2005).
CBA/J mice receiving 1 dose of vaccine
had 100% survival after LASV challenge
(Goicochea et al., 2012)
IgG antibodies to LASV glycoprotein observed for
both monovalent and tetravalent vaccine
candidates in NHPs (Kurup et al., 2021)
(continued on next page)
International Journal of Infectious Diseases 119 (2022) 187–200
Mopeia virus
vector
Other animal studies
V. Raabe, A.K. Mehta, J.D. Evans et al.
Table 1
Vaccine candidates for Lassa fever
�Vaccine platform
Manufacturer or
source/contact
Viral replicon
particle
Description
Three vaccine candidates:
1. LASV-based single-cycle viral replicon particle
with wild type L and S segments
2. LASV-based single-cycle viral replicon particle
with a nullified nucleoprotein exonuclease on the
S segment
3. Both wild-type LASV glycoprotein genes and a
LASV glycoprotein gene with a C-terminal
deletion substituted for structural genes in a
Venezuelan equine encephalitis viral replicon
particle
Three vaccine candidates:
1. Recombinant New York Board of Health
vaccinia virus expressing LASV glycoprotein
2. Modified Vaccinia Ankara expressing LASV
nucleoprotein
3. Modified Vaccinia Ankara expressing LASV
glycoprotein and Z protein
Vaccinia virus
vector
Human trials
NHP studies
100% protection from clinical signs of
infection and death in guinea pig models
who received 1 dose of any viral-replicon
particle vaccine candidate
(Kainulainen et al., 2018,
Kainulainen M. H. et al., 2019,
Wang M. et al., 2018)
NHPs vaccinated with a single dose of the New
York Board of Health vaccinia virus-based
candidate experienced clinical signs of infection
after LASV challenge and vesicular lesions after
vaccination, but had 100% survival
(Fisher-Hoch et al., 1989)
192
Vesicular
stomatitis virus
vector
Yellow fever virus
vector
Two candidates:
1. Four strains of recombinant vesicular stomatitis
virus combined in 1 vaccine expressing
glycoproteins from 2 Ebola viruses, Marburg
virus, and LASV
2. Recombinant vesicular stomatitis virus with
the LASV glycoprotein inserted in place of the
vesicular stomatitis virus glycoprotein
Two vaccine candidates:
1. Viral-like particles containing LASV
glycoprotein, nucleoprotein, and Z protein
2. Viral-like particles expressing only LASV
glycoprotein adjuvanted with a
squalene-containing water-in-oil adjuvant
Recombinant yellow fever 17D strain expressing
LASV glycoprotein
Combination vaccine - NHPs receiving 2 doses of
vaccine had 100% survival and no clinical signs of
infection after LASV challenge (Cross et al., 2020)
Single strain vaccine – No clinical signs of
infection and 100% survival in NHPs who received
a single vaccine dose (Geisbert et al., 2005,
Marzi et al., 2015)
Guinea pigs immunized with 1 or 2 doses
of the modified Vaccinia Ankara candidate
expressing LASV nucleoprotein had 100%
survival and protection against clinical
signs of infection (Kennedy et al., 2019)
CBA/J mice immunized intramuscularly
with 1 dose of the Vaccinia Ankara
candidate expressing LASV glycoprotein,
and Z protein provided 100% protection
against death from intracerebral challenge
with a Mopeia/Lassa reassortant virus
(Salvato et al., 2019)
Single strain vaccine – No clinical signs of
infection and 100% protection in guinea
pigs receiving a single dose of vaccine
(Safronetz David et al., 2015)
The vaccine candidate containing 3 LASV
proteins is able to generate LASV-specific
IgG antibodies in mice. Efficacy in mice
not yet established (Branco et al., 2010)
The vaccine candidate expressing solely
LASV glycoprotein is able to elicit
neutralizing antibodies to 5 LASV lineages
in rabbits (Muller et al., 2020)
Guinea pigs receiving a single vaccine
dose developed clinical symptoms of
infection on LASV challenge but had
80-83% survival (Bredenbeek et al., 2006,
Jiang et al., 2011)
International Journal of Infectious Diseases 119 (2022) 187–200
Viral-like particle
1. Profectus
Biosciences; 2.
International AIDS
Vaccine Initiative
Other animal studies
V. Raabe, A.K. Mehta, J.D. Evans et al.
Table 1 (continued)
�Treatment
Brand name and
manufacturer or
source/contact
NHP studies
Guanosine
nucleoside analog
McCormick JB, King IJ, Webb PA,
et al.: Lassa fever. Effective therapy
with ribavirin. N Engl J Med. 1986,
314:20-6.
10.1056/NEJM198601023140104
Favipiravir
Favipiravir: MediVector
(USA)
Avigan: Toyama Chemical
(Japan)
Avifavir: ChemRAR Group
(Russia)
Areplivir: Promomed
(Russia)
FabiFlu: Glenmark (India)
Favipira: Beacon
Pharmaceuticals (India)
Generic:
Purine nucleoside
analog
Bausch DG, Hadi CM, Khan SH, Lertora JJ: Review of the
literature and proposed guidelines for the use of oral
ribavirin as post-exposure prophylaxis for Lassa fever. Clin
Infect Dis. 2010, 51:1435-41. 10.1086/657315
Case/Field Studies:
Ilori EA, Furuse Y, Ipadeola OB, et al.: Epidemiologic and
clinical features of Lassa fever outbreak in Nigeria, January
1-May 6, 2018. Emerg Infect Dis. 2019, 25:1066-74.
10.3201/eid2506.181035
Haas WH, Breuer T, Pfaff G, et al.: Imported Lassa fever in
Germany: surveillance and management of contact persons.
Clin Infect Dis. 2003, 36:1254-8. 10.1086/374853
Ajayi NA, Nwigwe CG, Azuogu BN, et al.: Containing a Lassa
fever epidemic in a resource-limited setting: outbreak
description and lessons learned from Abakaliki, Nigeria
(January-March 2012). Int J Infect Dis. 2013, 17:e1011-6.
10.1016/j.ijid.2013.05.015
Shaffer JG, Grant DS, Schieffelin JS, et al.: Lassa fever in
post-conflict Sierra Leone. PLoS Negl Trop Dis. 2014, 8:e2748.
10.1371/journal.pntd.0002748
Buba MI, Dalhat MM, Nguku PM, et al.: Mortality among
confirmed Lassa fever cases during the 2015-2016 outbreak
in Nigeria. Am J Public Health. 2018, 108:262-4.
10.2105/AJPH.2017.304186
Schmitz H, Köhler B, Laue T, et al.: Monitoring of clinical and
laboratory data in 2 cases of imported Lassa fever. Microbes
Infect. 2002, 4:43-50. 10.1016/s1286- 4579(01)01508- 8
Phase I safety trial
NCT04907682
Other animal studies
Rosenke K, Feldmann H, Westover
JB, Hanley PW, Martellaro C,
Feldmann F, et al. Use of
Favipiravir to Treat Lassa Virus
Infection in Macaques. Emerg
Infect Dis 2018;24(9):1696-9.
10.3201/eid2409.180233
(continued on next page)
International Journal of Infectious Diseases 119 (2022) 187–200
Human trials
Copegus: Genentech
Rebetol: Merck Sharp &
Dome
Ribasphere: Kadmon
Pharmaceuticals
Generic: Sandoz
Generic: Teva
193
Description
Ribavirin
V. Raabe, A.K. Mehta, J.D. Evans et al.
Table 2
Therapeutic candidates for Lassa fever
�V. Raabe, A.K. Mehta, J.D. Evans et al.
Table 2 (continued)
Treatment
Brand name and
manufacturer or
source/contact
Ribavirin-Favipiravir
combination
Description
Human trials
Raabe VN, Kann G, Ribner BS, et al.: Favipiravir and ribavirin
treatment of epidemiologically linked cases of Lassa fever.
Clin Infect Dis. 2017, 65:855-9. 10.1093/cid/cix406
Frame JD, Verbrugge GP, Gill RG, Pinneo L: The use of Lassa
fever convalescent plasma in Nigeria. Trans R Soc Trop Med
Hyg. 1984, 78:319-24. 10.1016/0035- 9203(84)90107- x
Jahrling PB, Frame JD, Rhoderick JB, Monson MH. Endemic
Lassa fever in Liberia. IV. Selection of optimally effective
plasma for treatment by passive immunization. Trans R Soc
Trop Med Hyg 1985a;79(3):380-4.
10.1016/0035-9203(85)90388-8
Convalescent plasma
Donors from recovered
infections
Convalescent
plasma
Stampidene
Stampidene: Hughes
Institute and Paradigm
Pharmaceuticals (USA)
Nucleoside reverse
transcriptase
inhibitor
Other animal studies
Mire CE, Cross RW, Geisbert JB,
Borisevich V, Agans KN, Deer DJ, et al.
Human-monoclonal-antibody therapy
protects nonhuman primates against
advanced Lassa fever. Nat Med
2017;23(10):1146-9. 10.1038/nm.4396
Jahrling PB, Peters CJ. Passive antibody
therapy of Lassa fever in cynomolgus
monkeys: importance of neutralizing
antibody and Lassa virus strain. Infect
Immun 1984;44(2):52833.10.1128/iai.44.2.528-533.1984
Jahrling PB, Peters CJ, Stephen EL.
Enhanced treatment of Lassa fever by
immune plasma combined with
ribavirin in cynomolgus monkeys. J
Infect Dis 1984;149(3):420-7.
10.1093/infdis/149.3.420
Uckun FM, Petkevich AS, Vassilev
AO, Tibbles HE, Titov L.
Correction: Stampidine prevents
mortality in an experimental
mouse model of viral hemorrhagic
fever caused by Lassa virus. BMC
Infect Dis. 2004 Jun 1;4:14.
10.1186/1471-2334-4-14
International Journal of Infectious Diseases 119 (2022) 187–200
Arevirumab-3: Zalgen Labs
(USA)
194
Arevirumab-3
Guanosine and
purine nucleoside
analog
Cocktail of 3
monoclonal
antibodies raised
against Lassa fever
virus
NHP studies
�V. Raabe, A.K. Mehta, J.D. Evans et al.
International Journal of Infectious Diseases 119 (2022) 187–200
proposed 10-day course consisting of a 35 mg/kg loading dose followed by 15 mg/kg 3 times daily (Bausch et al., 2010).
ers (Cummins et al., 1991; Frame et al., 1984; McCormick et al.,
1986). Non-human primate data suggest that a combination of ribavirin therapy with convalescent plasma may be more effective
at preventing fatal LF compared with either administered alone
(Jahrling et al., 1984).
Monoclonal antibodies are in development for LF treatment.
A combination of 3 human monoclonal antibodies known as
Arevirumab-3 has been shown to provide protection against lethal
LF disease in NHPs, even when given up to 8 days after infection,
and data suggest that 2 human monoclonal antibody cocktails are
also effective at preventing lethality in NHPs (Mire et al., 2017;
Cross et al., 2019). Based on the efficacy of human monoclonal antibodies for the treatment of LF in NHPs, consideration should be
given to their use in treating human patients with LF.
Treatment
The application of systems of care for sepsis and critical illness
remains the mainstay of LF management, as in other viral hemorrhagic fevers. Patients with LF may experience fluid and electrolyte
imbalances, co-infections, exacerbations of co-morbidities, and secondary organ damage, such as kidney and lung injury, which must
be proactively managed.
Along with post-exposure prophylaxis, ribavirin is also the most
frequently used antiviral medication for treatment of confirmed LF.
Several publications suggest that ribavirin administration within
the first 6 days after the onset of fever and in appropriate care settings may reduce case mortality to as low as 5% (Dahmane et al.,
2014; Jahrling et al., 1984; McCormick et al., 1986). NHP study
data support that the benefit of ribavirin is dependent on treatment initiation early in the course of illness and prolongs survival by reducing the amount of infectious virus (Dahmane et al.,
2014; Jahrling et al., 1980; Jahrling et al., 1984; Lingas et al.,
2021). A recent meta-analysis and retrospective analyses of preexisting datasets suggest that ribavirin reduces mortality for individuals with elevated aspartate aminotransferase levels but is potentially harmful in those without elevated aspartate aminotransferase (Eberhardt et al., 2019; Salam et al., 2021). A retrospective
study of pediatric patients with LF in Sierra Leone did not show
a significant survival benefit associated with ribavirin treatment
(Samuels et al., 2020).
Ribavirin carries a risk of hemolytic anemia, and worsening
anemia has been documented in both humans and NHPs with LF
after treatment (Jahrling et al., 1984; McCormick et al., 1986). In
addition, rigors have been reported among patients with LF treated
with this drug (Fisher-Hoch et al., 1992). Since ribavirin is teratogenic and embryotoxic, the risks of treatment for pregnant and
breastfeeding women should be carefully weighed against potential mortality benefits (Ferm et al., 1978; Kochhar et al., 1980).
Favipiravir (6-fluoro-3-hydroxy-2-pyrazine carboxamide) is an
oral viral RNA polymerase inhibitor that has been licensed for the
treatment of influenza in Japan. Treatment with this antiviral drug
has been shown to improve survival from LASV infection in mice,
guinea pigs, and NHPs and to decrease infectious virus levels in
NHPs (Lingas et al., 2021; Madelain et al., 2020; Oestereich et al.,
2016b; Rosenke et al., 2018; Safronetz D. et al., 2015). A synergistic effect from the combination of ribavirin and favipiravir has also
been observed in mouse models, although data have not shown
improved survival or decreased viremia in NHPs compared with
monotherapy (Madelain et al., 2020; Oestereich et al., 2016b). The
use of the combination of ribavirin and favipiravir for treatment
of LF has been described in 2 individuals, both of whom survived
in the setting of receiving rapid, proactive LF treatment in specialized biocontainment units (Raabe et al., 2017). Similar to ribavirin, favipiravir should be avoided in pregnant and breastfeeding women because of teratogenicity and embryotoxicity in animal
models, along with excretion in breast milk (Nagata et al., 2015).
Convalescent plasma has shown some benefit in improving survival from LF in animal models, including NHPs, but success was
dependent on the dose used and the match of neutralizing antibodies to the LASV strain causing infection (Jahrling et al., 1985a;
Jahrling P B and Peters C J, 1984; Jahrling et al., 1984). Neutralizing antibodies against LASV often take several months to develop after natural infection, indicating that recently recovered individuals may not be suitable for convalescent plasma donation
(Jahrling et al., 1985a). Data from human convalescent treatment
series have shown survival benefits in some studies but not in oth-
Infection Prevention and Control Recommendations
Patients with LASV infection should optimally be managed
in a biocontainment unit to prevent secondary person-to-person
spread using appropriate infection control measures because of
the high degree of mortality associated with infection. To date,
secondary transmission of LASV infection from cases cared for
in non-endemic countries remains low, although cases among
health care workers have been reported during LASV outbreaks
in Africa (Grahn et al., 2018; Ilori et al., 2019; Kraft et al., 2020;
Lehmann et al., 2017; Raabe et al., 2017; Wolf et al., 2020).
When available, the patient should be placed in a singlepatient room containing private bathroom facilities. Negative
pressure should be used, when available, to facilitate the safe
performance of aerosol-generating procedures if clinically indicated. Liquid waste management needs may be high as
these patients can produce high volumes of stool. Access to
the patient room should be regulated, restricting contact to
only approved health care personnel using appropriate personal protective equipment for contact and droplet precautions.
Personal protective equipment used for Lassa patient management is similar to that recommended for Ebola (https://www.
who.int/publications/i/item/WHO- HIS- SDS- 2014.4- Rev.1,
https:
//www.who.int/publications/i/item/9789241549608, and https:
//assets.publishing.service.gov.uk/government/uploads/system/
uploads/attachment_data/file/534002/Management_of_VHF_A.pdf).
It should include 2 pairs of gloves, a fluid-resistant, disposable gown or coverall, a waterproof apron, head, and neck
coverings, a face mask or respirator, eye protection, and waterproof boots/shoe covers. Airborne precautions should be
used if procedures that generate aerosols are anticipated to be
performed, including using a respirator. Donning and doffing
protocols for personal protective equipment should be used to
minimize the risk of contamination, and frequent hand hygiene
should be performed. When possible, using sharps and aerosolgenerating procedures should be avoided; appropriate sharps
disposal units should be readily accessible in the patient room.
Guidelines developed for the management of other viral hemorrhagic fever infections such as Ebola virus disease, available at
https://www.who.int/publications/i/item/9789241549608,
https:
//assets.publishing.service.gov.uk/government/uploads/system/
uploads/attachment_data/file/534002/Management_of_VHF_A.pdf,
and https://www.cdc.gov/vhf/ebola/clinicians/evd/infection-control.
html, are appropriate for use in managing patients with LASV
infection. Procedures involving potential exposures to body fluids,
such as phlebotomy, should be coordinated to provide appropriate diagnostic and therapeutic management with the minimum
number of potentially high-risk interventions.
Appropriate protective equipment should be used by laboratory workers performing diagnostic assays on samples collected
from patients with suspected LASV infections, including using
195
�V. Raabe, A.K. Mehta, J.D. Evans et al.
International Journal of Infectious Diseases 119 (2022) 187–200
a fluid-resistant or fluid-impermeable disposable gown, masks,
or respirators, and eye protection. Biosafety class II or I cabinets
should be used to perform laboratory assays when available.
The risks of each procedure to generate aerosols should be
assessed and the use of N95-respirators considered if procedures generating aerosols cannot be avoided. Safety measures
such as the use of sealed containers or closed tube systems
should be used when possible to maximize laboratory safety.
Plans should be developed for the appropriate decontamination of equipment after use. Laboratory guidance developed for
viral hemorrhagic fevers (https://www.who.int/publications/i/
item/WHO- HIS- SDS- 2014.4- Rev.1, https://www.cdc.gov/vhf/ebola/
laboratory- personnel/safe- specimen- management.html, and https:
//assets.publishing.service.gov.uk/government/uploads/system/
uploads/attachment_data/file/534002/Management_of_VHF_A.pdf)
is appropriate for use with samples from patients with LASV
infection. Autopsies should not routinely be performed because
of transmission risk. If necessary, autopsies on patients with LF
should only be performed at designated centers with experience
using appropriate infection control precautions for performing
high-risk autopsies.
African wood mouse (Hylomyscus pamfi), the Guinea multimammate mouse (Mastomys erythroleucus), the typical striped grass
mouse (Lemniscomys striatus), Dalton’s mouse (Praomys daltoni),
Forest soft-furred mouse (Praomys rostratus), Misonne’s soft-furred
mouse (Praomys misonnei), the African pygmy mouse (Mus minutoides), Baoule’s mouse (Mus baoulei), the black rat (Rattus rattus),
and some shrew species (Crocidura species) (Fichet-Calvet et al.,
2014; Olayemi et al., 2016; Olayemi et al., 2018; Yadouleton et al.,
2019). A meta-analysis suggests the prevalence of LASV infection is
3.2% among various rodents in West Africa (Kenmoe et al., 2020).
LASV genetic material was detectable in 10 of 88 rodent dropping
samples collected from 3 villages in Guinea (Wood et al., 2021).
Transmission: Most human LASV infections occur through
transmission from rodent reservoirs by direct contact or exposure to rodent excreta rather than human-to-human transmission, although human super-spreader events have been described
(Andersen et al., 2015; Kafetzopoulou et al., 2019; Lo Iacono et al.,
2015). Although direct inoculation may occur as a result of a bite
or scratch, indirect inoculation is believed to be more common.
LASV is shed in rodent excreta and humans may become infected
by inhaling aerosolized excreta or ingesting rodent-contaminated
food items. Most human infections are reported during the dry
season (Bausch et al., 2001; Redding et al., 2021). Human-tohuman transmission can occur after exposure to blood, tissue, secretions, or excretions of an infected individual or through contaminated equipment (Fisher-Hoch et al., 1995). The virus can be
detected in genital fluids, although it is unknown whether infection can occur through sexual contact with an infected or recently
infected individual (Raabe et al., 2017). The estimated basic reproduction number (R0 ) of LF varies between 1.1 to 1.8 (Wang J. et al.,
2021).
Human infections: Symptomatic disease after infection with
LASV is known as LF, which is endemic in parts of western and
central Africa, in particular in rural forested regions. Studies have
estimated that there are 10 0,0 0 0 to 50 0,0 0 0 cases of LF in Africa
per year, with approximately 5,0 0 0 to 10,0 0 0 deaths (Asogun et al.,
2019; McCormick, 1987). Other models predict that nearly 90 0,0 0 0
humans are infected with LASV annually (Basinski et al., 2021).
One older study in Sierra Leone demonstrated that in 1 area,
10%-16% of all hospital admissions were associated with LF, indicating a significant health care burden in high-incidence regions
(McCormick et al., 1987a). Seroprevalence studies in focused communities have found seropositivity rates as high as 52% in Sierra
Leone, 55% in Guinea, and 21% in Nigeria (Lukashevich et al., 1993;
McCormick et al., 1987b; Tomori et al., 1988). A recent metaanalysis suggested the overall prevalence of LASV seropositivity to
be 8.7% among humans in sub-Saharan Africa with a higher prevalence of 11.1%-19.6% among health care workers (Kenmoe et al.,
2020; Shaibu et al., 2021). At least 37 primary cases of LF associated with international travel, which led to 4 secondary instances of transmission among non-travelers, have been reported
in non-endemic countries (Wolf et al., 2020; World Health Organization, 2022).
Summary and Recommendations
LF remains a persistent public health threat in West Africa. Although difficult to distinguish from other etiologies of febrile illnesses on clinical symptoms alone, various testing options are now
available to aid with the diagnosis of infection. Multiple promising
vaccines are in development for prevention, although still in the
early stages of human clinical trials, and none are currently approved for use.
As with other viral hemorrhagic fevers, applying systems of care
appropriate to critically ill patient management remains the mainstay of treatment of LF. Early initiation of antiviral therapeutics
may confer some survival benefits. Historically, ribavirin has been
the mainstay of antiviral therapy for LASV infections. A newer antiviral medication, favipiravir, shows potential benefit in animals
and has been combined with ribavirin therapy to treat 2 human
cases of LF. Studies of convalescent plasma have shown mixed results, which may relate to varying amounts of neutralizing antibodies present. Monoclonal antibody therapy for LASV infection is
in development, and early data from NHP studies show promising
results for preventing death from LF.
Boxes (to consider for inside the article as a separate online
resource)
Box 1: The Pathogen
Lassa fever is a viral hemorrhagic fever pathogen classified as
a member of the Bunyavirales order of viruses in the family Arenaviridae, genus Mammarenavirus. The enveloped virion particle
contains 2 single-stranded RNA segments that encode 4 proteins
through ambisense transcription (Lukashevich et al., 1984). LASV
strains demonstrate significant genetic diversity, with variations of
up to 32% at a nucleotide level in the L RNA strand and 25% in the
S RNA strand (Andersen et al., 2015; Bowen et al., 20 0 0). LASVs
fall into 7 confirmed genetic lineages (Forni and Sironi, 2020;
Ibukun, 2020; Manning et al., 2015; Whitmer et al., 2018).
Conflict of Interest
No potential author conflicts of interest are noted.
Funding
Box 2: Epidemiology
Research reported in this publication was supported by the Department of Health and Human Services Office of the Assistant
Secretary for Preparedness and Response under award number 5
U3REP170552-003-02.
Animal hosts: The main reservoir of LASV is Mastomys natalensis, the natal multimammate mouse (Demby et al., 2001). Other
rodents have been identified as carrying the virus, including the
196
�V. Raabe, A.K. Mehta, J.D. Evans et al.
International Journal of Infectious Diseases 119 (2022) 187–200
Disclaimers
Carnec X, Baize S, Reynard S, Diancourt L, Caro V, Tordo N, et al. Lassa virus nucleoprotein mutants generated by reverse genetics induce a robust type I interferon response in human dendritic cells and macrophages. Journal of virology 2011;85(22):12093–7; Carnec X, Mateo M, Page A, Reynard S, Hortion J,
Picard C, et al. A vaccine platform against arenaviruses nased on a recombinant hyperattenuated Mopeia virus expressing heterologous glycoproteins. J Virol 2018;92(12).
Cashman KA, Broderick KE, Wilkinson ER, Shaia CI, Bell TM, Shurtleff AC, et al. Enhanced efficacy of a codon-optimized DNA vaccine encoding the glycoprotein
precursor gene of Lassa virus in a guinea pig disease model when delivered by
dermal electroporation. Vaccines (Basel) 2013;1(3):262–77.
Cashman KA, Wilkinson ER, Shaia CI, Facemire PR, Bell TM, Bearss JJ, et al. A
DNA vaccine delivered by dermal electroporation fully protects cynomolgus
macaques against Lassa fever. Hum Vaccines Immunother 2017;13(12):2902–11.
Chang PC, Chi CW, Chau GY, Li FY, Tsai YH, Wu JC, et al. DDX3, a DEAD box RNA
helicase, is deregulated in hepatitis virus-associated hepatocellular carcinoma
and is involved in cell growth control. Oncogene 2006;25(14):1991–2003.
Cross RW, Hastie KM, Mire CE, Robinson JE, Geisbert TW, Branco LM, et al. Antibody
therapy for Lassa fever. Current Opinion in Virology 2019;37:97–104.
Cross RW, Xu R, Matassov D, Hamm S, Latham TE, Gerardi CS, et al. Quadrivalent
VesiculoVax vaccine protects nonhuman primates from viral-induced hemorrhagic fever and death. J Clin Invest 2020;130(1):539–51.
Crowcroft NS, Meltzer M, Evans M, Shetty N, Maguire H, Bahl M, et al. The
public health response to a case of Lassa fever in London in 20 0 0. J Infect
2004;48(3):221–8.
Cummins D, Bennett D, Fisher-Hoch SP, Farrar B, Machin SJ, McCormick JB.
Lassa fever encephalopathy: clinical and laboratory findings. J Trop Med Hyg
1992;95(3):197–201.
Cummins D, Bennett D, Machin SJ. Exchange transfusion of a patient with fulminant
Lassa fever. Postgrad Med J 1991;67(784):193–4.
Cummins D, McCormick JB, Bennett D, Samba JA, Farrar B, Machin SJ, et al. Acute
sensorineural deafness in Lassa fever. JAMA 1990;264(16):2093–6.
Dahmane A, van Griensven J, Van Herp M, Van den Bergh R, Nzomukunda Y, Prior J,
et al. Constraints in the diagnosis and treatment of Lassa Fever and the effect on mortality in hospitalized children and women with obstetric conditions in a rural district hospital in Sierra Leone. Trans R Soc Trop Med Hyg
2014;108(3):126–32.
Demby AH, Inapogui A, Kargbo K, Koninga J, Kourouma K, Kanu J, et al. Lassa fever
in Guinea: II. Distribution and prevalence of Lassa virus infection in small mammals. Vector Borne Zoonotic Dis 2001;1(4):283–97.
Duvignaud A, Doutchi M, Abejegah C, Etafo I, Jaspard M, Serra B, et al. Delayed-onset paraparesis in Lassa fever: A case report. Int J Infect Dis 2020;92:49–52.
Duvignaud A, Jaspard M, Etafo IC, Gabillard D, Serra B, Abejegah C, et al. Lassa
fever outcomes and prognostic factors in Nigeria (LASCOPE): a prospective cohort study. Lancet Glob Health 2021;9(4):E469–EE78.
Eberhardt KA, Mischlinger J, Jordan S, Groger M, Gunther S, Ramharter M. Ribavirin
for the treatment of Lassa fever: A systematic review and meta-analysis. Int J
Infect Dis 2019;87:15–20.
Edington GM, White HA. The pathology of Lassa fever. Trans R Soc Trop Med Hyg
1972;66(3):381–9.
Ehichioya DU, Dellicour S, Pahlmann M, Rieger T, Oestereich L, Becker-Ziaja B, et al.
Phylogeography of Lassa virus in Nigeria. Journal of virology 2019;93(21).
Ezeomah C, Adoga A, Ihekweazu C, Paessler S, Cisneros I, Tomori O, et al. Sequelae of Lassa fever: Postviral cerebellar ataxia. Open Forum Infect Dis
2019;6(12):ofz512.
Fedeli C, Torriani G, Galan-Navarro C, Moraz ML, Moreno H, Gerold G, et al. Axl Can
Serve as Entry Factor for Lassa Virus Depending on the Functional Glycosylation
of Dystroglycan. J Virol 2018;92(5).
Ferm VH, Willhite C, Kilham L. Teratogenic effects of ribavirin on hamster and rat
embryos. Teratology 1978;17(1):93–101.
Ficenec SC, Percak J, Arguello S, Bays A, Goba A, Gbakie M, et al. Lassa fever induced hearing loss: The neglected disability of hemorrhagic fever. Int J Infect
Dis 2020;100:82–7.
Fichet-Calvet E, Becker-Ziaja B, Koivogui L, Günther S. Lassa serology in natural
populations of rodents and horizontal transmission. Vector Borne Zoonotic Dis
2014;14(9):665–74.
Fischer RJ, Purushotham JN, van Doremalen N, Sebastian S, Meade-White K, Cordova K, et al. ChAdOx1-vectored Lassa fever vaccine elicits a robust cellular and
humoral immune response and protects guinea pigs against lethal Lassa virus
challenge. NPJ vaccines 2021;6(1):32.
Fisher-Hoch S, McCormick JB, Sasso D, Craven RB. Hematologic dysfunction in Lassa
fever. J Med Virol 1988;26(2):127–35.
Fisher-Hoch SP, Gborie S, Parker L, Huggins J. Unexpected adverse reactions during
a clinical trial in rural West Africa. Antiviral Res 1992;19(2):139–47.
Fisher-Hoch SP, McCormick JB. Pathophysiology and treatment of Lassa fever. Curr
Top Microbiol Immunol 1987;134:231–9.
Fisher-Hoch SP, McCormick JB, Auperin D, Brown BG, Castor M, Perez G, et al. Protection of rhesus monkeys from fatal Lassa fever by vaccination with a recombinant vaccinia virus containing the Lassa virus glycoprotein gene. Proc Natl Acad
Sci U S A 1989;86(1):317–21.
Fisher-Hoch SP, Tomori O, Nasidi A, Perez-Oronoz GI, Fakile Y, Hutwagner L, et al.
Review of cases of nosocomial Lassa fever in Nigeria: the high price of poor
medical practice. BMJ 1995;311(7009):857–9.
Flatz L, Rieger T, Merkler D, Bergthaler A, Regen T, Schedensack M, et al. T cell-dependence of Lassa fever pathogenesis. PLoS pathogens 2010;6(3) -e.
The content and views expressed in this manuscript are the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response or
the Department of Defense, nor are they intended to represent the
views of the authors’ individual institutions.
Ethical Approval
The work described herein was solely a review of the literature
and, as such, did not need Institutional Review Board or Animal
Use Committee approvals.
REFERENCES
Abreu-Mota T, Hagen KR, Cooper K, Jahrling PB, Tan G, Wirblich C, et al. Non-neutralizing antibodies elicited by recombinant Lassa-Rabies vaccine are critical for
protection against Lassa fever. Nat Commun 2018;9(1):4223.
Adetunji AE, Ayenale M, Akhigbe I, Akerele LO, Isibor E, Idialu J, et al. Acute kidney injury and mortality in pediatric Lassa fever versus question of access to
dialysis. Int J Infect Dis 2021;103:124–31.
Andersen KG, Shapiro BJ, Matranga CB, Sealfon R, Lin AE, Moses LM, et al.
Clinical sequencing uncovers origins and evolution of Lassa virus. Cell
2015;162(4):738–50.
Andrei G, De Clercq E. Inhibitory effect of selected antiviral compounds on arenavirus replication in vitro. Antiviral Res 1990;14(4-5):287–99.
Asogun DA, Adomeh DI, Ehimuan J, Odia I, Hass M, Gabriel M, et al. Molecular diagnostics for lassa fever at Irrua specialist teaching hospital, Nigeria:
lessons learnt from two years of laboratory operation. PLoS Negl Trop Dis
2012;6(9):e1839.
Asogun DA, Gunther S, Akpede GO, Ihekweazu C, Zumla A. Lassa fever: Epidemiology, clinical features, diagnosis, management and prevention. Infect Dis Clin
North Am 2019;33(4):933–51.
Baize S, Marianneau P, Loth P, Reynard S, Journeaux A, Chevallier M, et al.
Early and strong immune responses are associated with control of viral
replication and recovery in lassa virus-infected cynomolgus monkeys. J Virol
2009;83(11):5890–903.
Baize S, Pannetier D, Faure C, Marianneau P, Marendat I, MC Georges-Courbot, et al.
Role of interferons in the control of Lassa virus replication in human dendritic
cells and macrophages. Microbes Infect 2006;8(5):1194–202.
Barnes KG, Lachenauer AE, Nitido A, Siddiqui S, Gross R, Beitzel B, et al. Deployable
CRISPR-Cas13a diagnostic tools to detect and report Ebola and Lassa virus cases
in real-time. Nat Commun 2020;11(1):4131.
Basinski AJ, Fichet-Calvet E, Sjodin AR, Varrelman TJ, Remien CH, Layman NC, et al.
Bridging the gap: Using reservoir ecology and human serosurveys to estimate
Lassa virus spillover in West Africa. PLoS Comput Biol 2021;17(3).
Bausch DG, Demby AH, Coulibaly M, Kanu J, Goba A, Bah A, et al. Lassa fever
in Guinea: I. Epidemiology of human disease and clinical observations. Vector
Borne Zoonotic Dis 2001;1(4):269–81.
Bausch DG, Hadi CM, Khan SH, Lertora JJ. Review of the literature and proposed
guidelines for the use of oral ribavirin as postexposure prophylaxis for Lassa
fever. Clin Infect Dis 2010;51(12):1435–41.
Bausch DG, Rollin PE, Demby AH, Coulibaly M, Kanu J, Conteh AS, et al. Diagnosis
and clinical virology of Lassa fever as evaluated by enzyme-linked immunosorbent assay, indirect fluorescent-antibody test, and virus isolation. J Clin Microbiol 20 0 0;38(7):2670–7.
Boisen ML, Uyigue E, Aiyepada J, Siddle KJ, Oestereich L, Nelson DKS, et al. Field
evaluation of a Pan-Lassa rapid diagnostic test during the 2018 Nigerian Lassa
fever outbreak. Sci Rep 2020;10(1):8724.
Bowen MD, Rollin PE, Ksiazek TG, Hustad HL, Bausch DG, Demby AH, et al. Genetic
diversity among Lassa virus strains. J Virol 20 0 0;74(15):6992–7004.
Branco LM, Grove JN, Geske FJ, Boisen ML, Muncy IJ, Magliato SA, et al. Lassa virus–
like particles displaying all major immunological determinants as a vaccine candidate for Lassa hemorrhagic fever. Virol J 2010;7:279.
Bredenbeek PJ, Molenkamp R, Spaan WJ, Deubel V, Marianneau P, Salvato MS, et al.
A recombinant Yellow Fever 17D vaccine expressing Lassa virus glycoproteins.
Virol J 2006;345(2):299–304.
Brouillette RB, Phillips EK, Patel R, Mahauad-Fernandez W, Moller-Tank S, Rogers KJ,
et al. TIM-1 Mediates Dystroglycan-Independent Entry of Lassa Virus. J Virol
2018;92(16).
Callis RT, Jahrling PB, DePaoli A. Pathology of Lassa virus infection in the rhesus
monkey. Am J Trop Med Hyg 1982;31(5):1038–45.
Cao W, Henry MD, Borrow P, Yamada H, Elder JH, Ravkov EV, et al. Identification
of alpha-dystroglycan as a receptor for lymphocytic choriomeningitis virus and
Lassa fever virus. Science 1998;282(5396):2079–81.
197
�V. Raabe, A.K. Mehta, J.D. Evans et al.
International Journal of Infectious Diseases 119 (2022) 187–200
Forni D, Sironi M. Population structure of Lassa mammarenavirus in West Africa.
Viruses 2020;12(4):437.
Frame JD, Baldwin Jr JM, Gocke DJ, Troup JM. Lassa fever, a new virus disease of
man from West Africa. I. Clinical description and pathological findings. Am J
Trop Med Hyg 1970;19(4):670–6.
Frame JD, Verbrugge GP, Gill RG, Pinneo L. The use of Lassa fever convalescent
plasma in Nigeria. Trans R Soc Trop Med Hyg 1984;78(3):319–24.
Frank MG, Beitscher A, Webb CM. Raabe V, members of the Medical Countermeasures Working Group of the National Emerging Special Pathogens T, Education
Center’s Special Pathogens Research N. South American Hemorrhagic Fevers: A
summary for clinicians. Int J Infect Dis 2021;105:505–15.
Geisbert TW, Jones S, Fritz EA, Shurtleff AC, Geisbert JB, Liebscher R, et al. Development of a new vaccine for the prevention of Lassa fever. PLoS Med
2005;2(6):e183.
Goicochea MA, Zapata JC, Bryant J, Davis H, Salvato MS, Lukashevich IS. Evaluation
of Lassa virus vaccine immunogenicity in a CBA/J-ML29 mouse model. Vaccine
2012;30(8):1445–52.
Grahn A, Brave A, Tolfvenstam T, Studahl M. Absence of nosocomial transmission
of imported Lassa fever during use of standard barrier nursing methods. Emerg
Infect Dis 2018;24(6):978–87.
Gunther S, Weisner B, Roth A, Grewing T, Asper M, Drosten C, et al. Lassa fever
encephalopathy: Lassa virus in cerebrospinal fluid but not in serum. J Infect Dis
2001;184(3):345–9.
Hadi CM, Goba A, Khan SH, Bangura J, Sankoh M, Koroma S, et al. Ribavirin for Lassa
fever postexposure prophylaxis. Emerg Infect Dis 2010;16(12):2009–11.
Happi AN, Happi CT, Schoepp RJ. Lassa fever diagnostics: Past, present, and future.
Curr Opin Virol 2019;37:132–8.
Hastie KM, Kimberlin CR, Zandonatti MA, MacRae IJ, Saphire EO. Structure of
the Lassa virus nucleoprotein reveals a dsRNA-specific 3� to 5� exonuclease activity essential for immune suppression. Proc Natl Acad Sci U S A
2011;108(6):2396–401.
Hastie KM, King LB, Zandonatti MA, Saphire EO. Structural basis for the dsRNA
specificity of the Lassa virus NP exonuclease. PLoS One 2012;7(8):e44211.
Hensley LE, Smith MA, Geisbert JB, Fritz EA, Daddario-DiCaprio KM, Larsen T, et al.
Pathogenesis of Lassa fever in cynomolgus macaques. Virol J 2011;8:205.
Herrador A, Fedeli C, Radulovic E, Campbell KP, Moreno H, Gerold G, et al. Dynamic
Dystroglycan Complexes Mediate Cell Entry of Lassa Virus. mBio 2019;10(2).
Herring S, Oda JM, Wagoner J, Kirchmeier D, O’Connor A, Nelson EA, et al. Inhibition
of arenaviruses by combinations of orally available approved drugs. Antimicrob
Agents Chemother 2021;65(4).
Huang Q, Liu X, Brisse M, Ly H, Liang Y. Effect of strain variations on Lassa virus Z
protein-mediated human RIG-I inhibition. Viruses 2020;12(9).
Hulseberg CE, Fénéant L, Szymańska-de Wijs KM, Kessler NP, Nelson EA, Shoemaker CJ, et al. Arbidol and other low-molecular-weight drugs that inhibit Lassa
and Ebola viruses. J Virol 2019;93(8).
Huynh T, Gary JM, Welch SR, Coleman-McCray J, Harmon JR, Kainulainen MH, et al.
Lassa virus antigen distribution and inflammation in the ear of infected strain
13/N Guinea pigs. Antiviral Res 2020;183.
Ibekwe TS, Okokhere PO, Asogun D, Blackie FF, Nwegbu MM, Wahab KW, et al.
Early-onset sensorineural hearing loss in Lassa fever. Eur Arch Otorhinolaryngol 2011;268(2):197–201.
Ibukun FI. Inter-lineage variation of Lassa virus glycoprotein epitopes: A challenge
to Lassa virus vaccine development. Viruses 2020;12(4).
Ilori EA, Furuse Y, Ipadeola OB, Dan-Nwafor CC, Abubakar A, Womi-Eteng OE, et al.
Epidemiologic and clinical features of Lassa fever outbreak in Nigeria, January
1-May 6, 2018. Emerg Infect Dis 2019;25(6):1066–74.
Ipadeola O, Furuse Y, Ilori EA, Dan-Nwafor CC, Akabike KO, Ahumibe A, et al. Epidemiology and case-control study of Lassa fever outbreak in Nigeria from 2018
to 2019. J Infect 2020;80(5):578–606.
Isa SE, Okwute A, Iraoyah KO, Nathan SY, Simji GS, Okolo MO, et al. Postexposure
prophylaxis for Lassa fever: Experience from a recent outbreak in Nigeria. Niger
Med J 2016;57(4):246–50.
Israeli H, Cohen-Dvashi H, Shulman A, Shimon A, Diskin R. Mapping of the Lassa
virus LAMP1 binding site reveals unique determinants not shared by other old
world arenaviruses. PLoS Pathog 2017;13(4).
Jae LT, Raaben M, Herbert AS, Kuehne AI, Wirchnianski AS, Soh TK, et al.
Lassa virus entry requires a trigger-induced receptor switch. Science
2014;344(6191):1506–10.
Jahrling PB, Frame JD, Rhoderick JB, Monson MH. Endemic Lassa fever in Liberia. IV.
Selection of optimally effective plasma for treatment by passive immunization.
Trans R Soc Trop Med Hyg 1985a;79(3):380–4.
Jahrling PB, Hesse RA, Eddy GA, Johnson KM, Callis RT, Stephen EL. Lassa virus infection of rhesus monkeys: pathogenesis and treatment with ribavirin. J Infect
Dis 1980;141(5):580–9.
Jahrling PB, Niklasson BS, McCormick JB. Early diagnosis of human Lassa fever by
ELISA detection of antigen and antibody. Lancet 1985b;1(8423):250–2.
Jahrling PB, Peters CJ. Passive antibody therapy of Lassa fever in cynomolgus monkeys: importance of neutralizing antibody and Lassa virus strain. Infect Immun
1984;44(2):528–33.
Jahrling PB, Peters CJ, Stephen EL. Enhanced treatment of Lassa fever by immune plasma combined with ribavirin in cynomolgus monkeys. J Infect Dis
1984;149(3):420–7.
Jeffs B. A clinical guide to viral haemorrhagic fevers: Ebola, Marburg and Lassa. Trop
Doct 2006;36(1):1–4.
Jiang J, Banglore P, Cashman KA, Schmaljohn CS, Schultheis K, Pugh H, et al. Immunogenicity of a protective intradermal DNA vaccine against lassa virus in
cynomolgus macaques. Hum Vaccin Immunother 2019;15(9):2066–74.
Jiang J, Ramos SJ, Bangalore P, Elwood D, Cashman KA, Kudchodkar SB, et al. Multivalent DNA vaccines as a strategy to combat multiple concurrent epidemics:
Mosquito-borne and hemorrhagic fever viruses. Viruses 2021;13(3).
Jiang X, Dalebout TJ, Bredenbeek PJ, Carrion Jr R, Brasky K, Patterson J, et al.
Yellow fever 17D-vectored vaccines expressing Lassa virus GP1 and GP2 glycoproteins provide protection against fatal disease in guinea pigs. Vaccine
2011;29(6):1248–57.
Jiang X, Huang Q, Wang W, Dong H, Ly H, Liang Y, et al. Structures of arenaviral
nucleoproteins with triphosphate dsRNA reveal a unique mechanism of immune
suppression. J Biol Chem 2013;288(23):16949–59.
Johnson KM, McCormick JB, Webb PA, Smith ES, Elliott LH, King IJ. Clinical virology
of Lassa fever in hospitalized patients. J Infect Dis 1987;155(3):456–64.
Kafetzopoulou LE, Pullan ST, Lemey P, Suchard MA, Ehichioya DU, Pahlmann M,
et al. Metagenomic sequencing at the epicenter of the Nigeria 2018 Lassa fever
outbreak. Science 2019;363(6422):74–7.
Kainulainen MH, Spengler JR, Welch SR, Coleman-McCray JD, Harmon JR, Klena JD,
et al. Use of a scalable replicon-particle vaccine to protect against lethal Lassa
virus infection in the guinea pig model. J Infect Dis 2018;217(12):1957–66.
Kainulainen MH, Spengler JR, Welch SR, Coleman-McCray JD, Harmon JR,
Scholte FEM, et al. Protection from lethal Lassa disease can be achieved both before and after virus exposure by administration of single-cycle replicating Lassa
virus replicon particles. J Infect Dis 2019;220(8):1281–9.
Kainulainen MH, Spengler JR, Welch SR, Coleman-McCray JD, Harmon JR,
Scholte FEM, et al. Protection From Lethal Lassa Disease Can Be Achieved Both
Before and After Virus Exposure by Administration of Single-Cycle Replicating
Lassa Virus Replicon Particles. J Infect Dis 2019;220(8):1281–9.
Kayem ND, Benson C, Aye CYL, Barker S, Tome M, Kennedy S, et al. Lassa fever in
pregnancy: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg
2020;114(5):385–96.
Kenmoe S, Tchatchouang S, Ebogo-Belobo JT, Ka’e AC, Mahamat G, Guiamdjo
Simo RE, et al. Systematic review and meta-analysis of the epidemiology of
Lassa virus in humans, rodents and other mammals in sub-Saharan Africa. PLoS
Negl Trop Dis 2020;14(8).
Kennedy EM, Dowall SD, Salguero FJ, Yeates P, Aram M, Hewson R. A vaccine based
on recombinant modified Vaccinia Ankara containing the nucleoprotein from
Lassa virus protects against disease progression in a guinea pig model. Vaccine
2019;37(36):5404–13.
Klitting R, Mehta SB, Oguzie JU, Oluniyi PE, Pauthner MG, Siddle KJ, et al. Lassa virus
genetics. Curr Top Microbiol Immunol 2020.
Kochhar DM, Penner JD, Knudsen TB. Embryotoxic, teratogenic, and metabolic effects of ribavirin in mice. Toxicol Appl Pharmacol 1980;52(1):99–112.
Kortepeter MG, Dierberg K, Shenoy ES, Cieslak TJ. Medical Countermeasures Working Group of the National Ebola T, Education Center’s Special Pathogens Research N. Marburg virus disease: A summary for clinicians. Int J Infect Dis
2020;99:233–42.
Kraft CS, Mehta AK, Varkey JB, Lyon GM, Vanairsdale S, Bell S, et al. Serosurvey
on healthcare personnel caring for patients with Ebola virus disease and Lassa
virus in the United States. Infect Control Hosp Epidemiol 2020;41(4):385–90.
Kurup D, Fisher CR, Scher G, Yankowski C, Testa A, Keshwara R, et al. Tetravalent
Rabies-vectored filovirus and Lassa fever vaccine induces long-term immunity
in nonhuman primates. J Infect Dis 2021;224(6):995–1004.
Lai MC, Chang WC, Shieh SY, Tarn WY. DDX3 regulates cell growth through translational control of cyclin E1. Mol Cell Biol 2010;30(22):5444–53.
Lee AM, Pasquato A, Kunz S. Novel approaches in anti-arenaviral drug development.
Virology 2011;411(2):163–9.
Lehmann C, Kochanek M, Abdulla D, Becker S, Boll B, Bunte A, et al. Control measures following a case of imported Lassa fever from Togo, North Rhine Westphalia, Germany, 2016. Euro Surveill 2017;22(39).
Li AL, Grant D, Gbakie M, Kanneh L, Mustafa I, Bond N, et al. Ophthalmic manifestations and vision impairment in Lassa fever survivors. PLoS One 2020;15(12).
Li S, Sun Z, Pryce R, Parsy ML, Fehling SK, Schlie K, et al. Acidic pH-induced conformations and LAMP1 binding of the Lassa virus glycoprotein spike. PLoS Pathog
2016;12(2).
Lingas G, Rosenke K, Safronetz D, Guedj J. Lassa viral dynamics in non-human primates treated with favipiravir or ribavirin. PLoS Comput Biol 2021;17(1).
Lo Iacono G, Cunningham AA, Fichet-Calvet E, Garry RF, Grant DS, Khan SH,
et al. Using modelling to disentangle the relative contributions of zoonotic
and anthroponotic transmission: the case of lassa fever. PLoS Negl Trop Dis
2015;9(1):e3398.
Loureiro ME, D’Antuono A, Levingston Macleod JM, López N. Uncovering viral
protein-protein interactions and their role in arenavirus life cycle. Viruses
2012;4(9):1651–67.
Loureiro ME, D’Antuono A, López N. Virus-host interactions involved in Lassa virus
entry and genome replication. Pathogens (Basel, Switzerland) 2019;8(1).
Loureiro ME, Zorzetto-Fernandes AL, Radoshitzky S, Chi X, Dallari S, Marooki N,
et al. DDX3 suppresses type I interferons and favors viral replication during arenavirus infection. PLoS pathogens 2018;14(7).
Lukashevich IS, Carrion Jr R, Salvato MS, Mansfield K, Brasky K, Zapata J, et al.
Safety, immunogenicity, and efficacy of the ML29 reassortant vaccine for Lassa
fever in small non-human primates. Vaccine 2008;26(41):5246–54.
Lukashevich IS, Clegg JC, Sidibe K. Lassa virus activity in Guinea: distribution of
human antiviral antibody defined using enzyme-linked immunosorbent assay
with recombinant antigen. J Med Virol 1993;40(3):210–17.
Lukashevich IS, Patterson J, Carrion R, Moshkoff D, Ticer A, Zapata J, et al. A live
attenuated vaccine for Lassa fever made by reassortment of Lassa and Mopeia
viruses. J Virol 2005;79(22):13934–42.
198
�V. Raabe, A.K. Mehta, J.D. Evans et al.
International Journal of Infectious Diseases 119 (2022) 187–200
Lukashevich IS, Stelmakh TA, Golubev VP, Stchesljenok EP, Lemeshko NN. Ribonucleic acids of Machupo and Lassa viruses. Arch Virol 1984;79(3-4):189–203.
Madelain V, Duthey A, Mentre F, Jacquot F, Solas C, Lacarelle B, et al. Ribavirin does
not potentiate favipiravir antiviral activity against Ebola virus in non-human
primates. Antiviral Res 2020;177.
Mahanty S, Hutchinson K, Agarwal S, McRae M, Rollin PE, Pulendran B. Cutting
edge: impairment of dendritic cells and adaptive immunity by Ebola and Lassa
viruses. J Immunol 2003;170(6):2797–801.
Manning JT, Forrester N, Paessler S. Lassa virus isolates from Mali and the Ivory
Coast represent an emerging fifth lineage. Front Microbiol 2015;6:1037.
Markosyan RM, Marin M, Zhang Y, Cohen FS, Melikyan GB. The late endosome-resident lipid bis(monoacylglycero)phosphate is a cofactor for Lassa virus fusion.
PLoS Pathog 2021;17(9).
Maruyama J, Mateer EJ, Manning JT, Sattler R, Seregin AV, Bukreyeva N, et al. Adenoviral vector-based vaccine is fully protective against lethal Lassa fever challenge in Hartley guinea pigs. Vaccine 2019;37(45):6824–31.
Marzi A, Feldmann F, Geisbert TW, Feldmann H, Safronetz D. Vesicular stomatitis virus-based vaccines against Lassa and Ebola viruses. Emerg Infect Dis
2015;21(2):305–7.
Mateer EJ, Maruyama J, Card GE, Paessler S, Huang C. Lassa virus, but not highly
pathogenic new world arenaviruses, restricts immunostimulatory double-stranded RNA accumulation during infection. J Virol 2020;94(9):e02006–19.
Mateo M, Reynard S, Carnec X, Journeaux A, Baillet N, Schaeffer J, et al. Vaccines inducing immunity to Lassa virus glycoprotein and nucleoprotein protect
macaques after a single shot. Sci Transl Med 2019;11(512).
Mateo M, Reynard S, Journeaux A, Germain C, Hortion J, Carnec X, et al. A single-shot Lassa vaccine induces long-term immunity and protects cynomolgus
monkeys against heterologous strains. Sci Transl Med 2021;13(597).
McCormick JB. Epidemiology and control of Lassa fever. Curr Top Microbiol Immunol
1987;134:69–78.
McCormick JB, King IJ, Webb PA, Johnson KM, O’Sullivan R, Smith ES, et al. A case–
control study of the clinical diagnosis and course of Lassa fever. J Infect Dis
1987a;155(3):445–55.
McCormick JB, King IJ, Webb PA, Scribner CL, Craven RB, Johnson KM, et al. Lassa
fever. N Engl J Med 1986;314(1):20–6.
McCormick JB, Webb PA, Krebs JW, Johnson KM, Smith ES. A prospective study of
the epidemiology and ecology of Lassa fever. J Infect Dis 1987b;155(3):437–44.
McLay L, Ansari A, Liang Y, Ly H. Targeting virulence mechanisms for the prevention
and therapy of arenaviral hemorrhagic fever. Antiviral Res 2013;97(2):81–92.
Merson L, Bourner J, Jalloh S, Erber A, Salam AP, Flahault A, et al. Clinical characterization of Lassa fever: A systematic review of clinical reports and research to
inform clinical trial design. PLoS Negl Trop Dis 2021;15(9).
Mire CE, Cross RW, Geisbert JB, Borisevich V, Agans KN, Deer DJ, et al. Human-monoclonal-antibody therapy protects nonhuman primates against advanced Lassa
fever. Nat Med 2017;23(10):1146–9.
Monath TP, Maher M, Casals J, Kissling RE, Cacciapuoti A. Lassa fever in the
Eastern Province of Sierra Leone, 1970-1972. II. Clinical observations and
virological studies on selected hospital cases. Am J Trop Med Hyg
1974;23(6):1140–9.
Monson MH, Cole AK, Frame JD, Serwint JR, Alexander S, Jahrling PB. Pediatric Lassa
fever: A review of 33 Liberian cases. Am J Trop Med Hyg 1987;36(2):408–15.
Muller H, Fehling SK, Dorna J, Urbanowicz RA, Oestereich L, Krebs Y, et al. Adjuvant formulated virus-like particles expressing native-like forms of the Lassa
virus envelope surface glycoprotein are immunogenic and induce antibodies
with broadly neutralizing activity. NPJ vaccines 2020;5(1):71.
Nagata T, Lefor AK, Hasegawa M, Ishii M. Favipiravir: A New Medication
for the Ebola Virus Disease Pandemic. Disaster Med Public Health Prep
2015;9(1):79–81.
Nunberg JH, York J. The curious case of arenavirus entry, and its inhibition. Viruses
2012;4(1):83–101.
Oestereich L, Ludtke A, Ruibal P, Pallasch E, Kerber R, Rieger T, et al. Chimeric mice
with competent hematopoietic immunity reproduce key features of severe Lassa
fever. PLoS Pathog 2016a;12(5).
Oestereich L, Rieger T, Ludtke A, Ruibal P, Wurr S, Pallasch E, et al. Efficacy of favipiravir alone and in combination with ribavirin in a lethal, immunocompetent
mouse model of Lassa fever. J Infect Dis 2016b;213(6):934–8.
Okokhere P, Colubri A, Azubike C, Iruolagbe C, Osazuwa O, Tabrizi S, et al. Clinical and laboratory predictors of Lassa fever outcome in a dedicated treatment
facility in Nigeria: a retrospective, observational cohort study. Lancet Infect Dis
2018;18(6):684–95.
Okokhere PO, Erameh CO, Alikah F, Akhideno PE, Iruolagbe CO, Osazuwa OO, et al.
Acute Lassa virus encephalitis with Lassa virus in the cerebrospinal fluid but
absent in the blood: A case report with a positive outcome. Case Rep Neurol
2018;10(2):150–8.
Olayemi A, Cadar D, Magassouba NF, Obadare A, Kourouma F, Oyeyiola A, et al. New
Hosts of The Lassa Virus. Sci Rep 2016;6:25280.
Olayemi A, Oyeyiola A, Obadare A, Igbokwe J, Adesina AS, Onwe F, et al. Widespread
arenavirus occurrence and seroprevalence in small mammals. Nigeria. Parasit
Vectors 2018;11(1):416.
Olschläger S, Günther S. Rapid and specific detection of Lassa virus by reverse transcription-PCR coupled with oligonucleotide array hybridization. J Clin Microbiol
2012;50(7):2496–9.
Olschlager S, Lelke M, Emmerich P, Panning M, Drosten C, Hass M, et al. Improved
detection of Lassa virus by reverse transcription-PCR targeting the 5� region of
S RNA. J Clin Microbiol 2010;48(6):2009–13.
Pannetier D, Reynard S, Russier M, Carnec X, Baize S. Production of CXC and CC
chemokines by human antigen-presenting cells in response to Lassa virus or
closely related immunogenic viruses, and in cynomolgus monkeys with lassa
fever. PLoS neglected tropical diseases 2014;8(1):e2637.
Pannetier D, Reynard S, Russier M, Journeaux A, Tordo N, Deubel V, et al. Human dendritic cells infected with the nonpathogenic Mopeia virus induce
stronger T-cell responses than those infected with Lassa virus. Journal of virology 2011;85(16):8293–306.
Port JR, Wozniak DM, Oestereich L, Pallasch E, Becker-Ziaja B, Muller J, et al. Severe
human Lassa gever is characterized by nonspecific T-cell activation and lymphocyte homing to inflamed tissues. J Virol 2020;94(21).
Price ME, Fisher-Hoch SP, Craven RB, McCormick JB. A prospective study of maternal and fetal outcome in acute Lassa fever infection during pregnancy. BMJ
1988;297(6648):584–7.
Qi X, Lan S, Wang W, Schelde LM, Dong H, Wallat GD, et al. Cap binding and immune evasion revealed by Lassa nucleoprotein structure. Nature
2010;468(7325):779–83.
Raabe V, Koehler J. Laboratory diagnosis of Lassa fever. J Clin Microbiol
2017;55(6):1629–37.
Raabe VN, Kann G, Ribner BS, Morales A, Varkey JB, Mehta AK, et al. Favipiravir and
ribavirin treatment of epidemiologically linked cases of Lassa fever. Clin Infect
Dis 2017;65(5):855–9.
Redding DW, Gibb R, Dan-Nwafor CC, Ilori EA, Yashe RU, Oladele SH, et al. Geographical drivers and climate-linked dynamics of Lassa fever in Nigeria. Nat
Commun 2021;12(1):5759.
Richmond JK, Baglole DJ. Lassa fever: Epidemiology, clinical features, and social consequences. BMJ 2003;327(7426):1271–5.
Rodrigo WW, Ortiz-Riano E, Pythoud C, Kunz S, de la Torre JC, Martinez-Sobrido L.
Arenavirus nucleoproteins prevent activation of nuclear factor kappa B. J Virol
2012;86(15):8185–97.
Rosenke K, Feldmann H, Westover JB, Hanley PW, Martellaro C, Feldmann F, et al.
Use of Favipiravir to Treat Lassa Virus Infection in Macaques. Emerg Infect Dis
2018;24(9):1696–9.
Russier M, Reynard S, Carnec X, Baize S. The exonuclease domain of Lassa virus nucleoprotein is involved in antigen-presenting-cell-mediated NK cell responses.
Journal of virology 2014;88(23):13811–20.
Safronetz D, Mire C, Rosenke K, Feldmann F, Haddock E, Geisbert T, et al. A recombinant vesicular stomatitis virus-based Lassa fever vaccine protects guinea
pigs and macaques against challenge with geographically and genetically distinct Lassa viruses. PLoS Negl Trop Dis 2015;9(4) -e.
Safronetz D, Rosenke K, Westover JB, Martellaro C, Okumura A, Furuta Y, et al. The
broad-spectrum antiviral favipiravir protects guinea pigs from lethal Lassa virus
infection post-disease onset. Sci Rep 2015;5:14775.
Salam AP, Cheng V, Edwards T, Olliaro P, Sterne J, Horby P. Time to reconsider the
role of ribavirin in Lassa fever. PLoS Negl Trop Dis 2021;15(7).
Salvato MS, Domi A, Guzmán-Cardozo C, Medina-Moreno S, Zapata JC, Hsu H, et al.
A Single Dose of Modified Vaccinia Ankara Expressing Lassa Virus-like Particles Protects Mice from Lethal Intra-cerebral Virus Challenge. Pathogens (Basel,
Switzerland) 2019;8(3):133.
Samuels RJ, Moon TD, Starnes JR, Alhasan F, Gbakie M, Goba A, et al. Lassa fever
among children in Eastern province, Sierra Leone: A 7-year retrospective analysis (2012-2018). Am J Trop Med Hyg 2020;104(2):585–92.
Schaeffer J, Carnec X, Reynard S, Mateo M, Picard C, Pietrosemoli N, et al. Lassa
virus activates myeloid dendritic cells but suppresses their ability to stimulate
T cells. PLoS pathogens 2018;14(11).
Shaibu JO, Salu OB, Amoo OS, Idigbe I, Musa AZ, Ezechi OC, et al. Immunological
screening of Lassa Virus among health workers and contacts of patients of Lassa
fever in Ondo State. Immunobiology 2021;226(3).
Shankar S, Whitby LR, HE Casquilho-Gray, York J, Boger DL, Nunberg JH.
Small-molecule fusion inhibitors bind the pH-sensing stable signal peptide-GP2 subunit interface of the Lassa virus envelope glycoprotein. J Virol
2016;90(15):6799–807.
Shehu NY, Gomerep SS, Isa SE, Iraoyah KO, Mafuka J, Bitrus N, et al. Lassa fever
2016 outbreak in Plateau State, Nigeria-The changing epidemiology and clinical
presentation. Front Public Health 2018;6:232.
Shieh WJ, Demby A, Jones T, Goldsmith CS, Rollin PE, Ksiazek TG, et al. Pathology
and pathogenesis of Lassa fever: Novel immunohistochemical findings in fatal
cases and clinico-pathologic correlation. Clin Infect Dis 2021.
Shimojima M, Stroher U, Ebihara H, Feldmann H, Kawaoka Y. Identification of cell
surface molecules involved in dystroglycan-independent Lassa virus cell entry. J
Virol 2012;86(4):2067–78.
Spiropoulou CF, Kunz S, Rollin PE, Campbell KP, Oldstone MBA. New World arenavirus clade C, but not clade A and B viruses, utilizes alpha-dystroglycan as its
major receptor. J Virol 2002;76(10):5140–6.
Stein DR, Warner BM, Audet J, Soule G, Siragam V, Sroga P, et al. Differential pathogenesis of closely related 2018 Nigerian outbreak clade III Lassa virus isolates.
PLoS Pathog 2021;17(10).
Takenaga T, Zhang Z, Muramoto Y, Fehling SK, Hirabayashi A, Takamatsu Y, et al.
CP100356 hydrochloride, a P-glycoprotein inhibitor, inhibits Lassa virus entry: implication of a candidate pan-mammarenavirus entry inhibitor. Viruses
2021;13(9).
Tomori O, Fabiyi A, Sorungbe A, Smith A, McCormick JB. Viral hemorrhagic
fever antibodies in Nigerian populations. Am J Trop Med Hyg 1988;38(2):
407–410.
Urata S, Noda T, Kawaoka Y, Yokosawa H, Yasuda J. Cellular factors required for
Lassa virus budding. J Virol 2006;80(8):4191–5.
199
�V. Raabe, A.K. Mehta, J.D. Evans et al.
International Journal of Infectious Diseases 119 (2022) 187–200
Usifoh SF, Odigie AE, Ighedosa SU, Uwagie-Ero EA, Aighewi IT. Lassa Fever-associated Stigmatization among Staff and Students of the University of Benin, Nigeria. J Epidemiol Glob Health 2019;9(2):107–15.
Walker DH, McCormick JB, Johnson KM, Webb PA, Komba-Kono G, Elliott LH,
et al. Pathologic and virologic study of fatal Lassa fever in man. Am J Pathol
1982;107(3):349–56.
Walker DH, Wulff H, Lange JV, Murphy FA. Comparative pathology of Lassa virus
infection in monkeys, guinea-pigs, and Mastomys natalensis. Bull World Health
Organ 1975;52(4-6):523–34.
Wang J, Zhao S, Chen X, Huang Z, Chong MKC, Guo Z, et al. The reproductive number of Lassa fever: A systematic review. J Travel Med 2021;28(3).
Wang M, Jokinen J, Tretyakova I, Pushko P, Lukashevich IS. Alphavirus vector-based
replicon particles expressing multivalent cross-protective Lassa virus glycoproteins. Vaccine 2018;36(5):683–90.
Wang M, Li R, Li Y, Yu C, Chi X, Wu S, et al. Construction and immunological evaluation of an adenoviral vector-based vaccine candidate for Lassa fever. Viruses
2021;13(3).
Wang P, Liu Y, Zhang G, Wang S, Guo J, Cao J, et al. Screening and identification of Lassa virus entry inhibitors from an FDA-approved drug library. J Virol
2018;92(16).
Wauquier N, Couffignal C, Manchon P, Smith E, Lungay V, Coomber M, et al. High
heart rate at admission as a predictive factor of mortality in hospitalized patients with Lassa fever: An observational cohort study in Sierra Leone. J Infect
2020;80(6):671–93.
Whitmer SLM, Strecker T, Cadar D, Dienes HP, Faber K, Patel K, et al. New lineage
of Lassa virus, Togo, 2016. Emerg Infect Dis 2018;24(3):599–602.
Winn Jr WC, Walker DH. The pathology of human Lassa fever. Bull World Health
Organ 1975;52(4-6):535–45.
Wolf T, Ellwanger R, Goetsch U, Wetzstein N, Gottschalk R. Fifty years of imported
Lassa fever: a systematic review of primary and secondary cases. J Travel Med
2020;27(4).
Wood R, Bangura U, Mariën J, Douno M, Fichet-Calvet E. Detection of Lassa virus in
wild rodent feces: Implications for Lassa fever burden within households in the
endemic region of Faranah. Guinea. One Health 2021;13.
World Health Organization. 2017 Annual review of diseases prioritized under the
research and development blueprint. Geneva, Switzerland: World Health Organization; 2017a.
World Health Organization. Lassa fever; 2017b Available from: https://www.who.
int/news-room/fact-sheets/detail/lassa-fever [Accessed 10 June 2021].
World Health Organization. Lassa fever – United Kingdom of Great Britain and
Northern Ireland. Disease Outbreak News 2022.
Xing J, Ly H, Liang Y. The Z proteins of pathogenic but not nonpathogenic arenaviruses inhibit RIG-I-like receptor-dependent interferon production. J Virol
2015;89(5):2944–55.
Xu X, Peng R, Peng Q, Wang M, Xu Y, Liu S, et al. Cryo-EM structures of Lassa
and Machupo virus polymerases complexed with cognate regulatory Z proteins
identify targets for antivirals. Nat Microbiol 2021;6(7):921–31.
Yadouleton A, Agolinou A, Kourouma F, Saizonou R, Pahlmann M, Bedié SK,
et al. Lassa Virus in Pygmy Mice, Benin, 2016-2017. Emerg Infect Dis
2019;25(10):1977–9.
Yao W, Yang Z, Lou X, Mao H, Yan H, Zhang Y. Simultaneous detection of Ebola
virus and pathogens associated with hemorrhagic fever by an oligonucleotide
microarray. Front Microbiol 2021;12.
Yun NE, Poussard AL, Seregin AV, Walker AG, Smith JK, Aronson JF, et al.
Functional interferon system is required for clearance of lassa virus. J Virol
2012;86(6):3389–92.
Yun NE, Ronca S, Tamura A, Koma T, Seregin AV, Dineley KT, et al. Animal model
of sensorineural hearing loss associated with Lassa virus infection. J Virol
2015;90(6):2920–7.
Zapata JC, Poonia B, Bryant J, Davis H, Ateh E, George L, et al. An attenuated Lassa
vaccine in SIV-infected rhesus macaques does not persist or cause arenavirus
disease but does elicit Lassa virus-specific immunity. Virol J 2013;10:52.
Zhang G, Cao J, Cai Y, Liu Y, Li Y, Wang P, et al. Structure-activity relationship optimization for lassa virus fusion inhibitors targeting the transmembrane domain
of GP2. Protein Cell 2019;10(2):137–42.
Zhang X, Tang K, Guo Y. The antifungal isavuconazole inhibits the entry of lassa
virus by targeting the stable signal peptide-GP2 subunit interface of lassa virus
glycoprotein. Antiviral Res 2020;174.
200
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Publication
A peer reviewed publication.
Citation
Citation information for the publication itself.
Raabe, V., A. K. Mehta, and J. D. Evans. 2022. "Lassa Virus Infection: a Summary for Clinicians." Int J Infect Dis 119:187-200. doi: 10.1016/j.ijid.2022.04.004.
Abstract
<p><strong>Objectives</strong></p>
<p class="section-paragraph">This summary on Lassa virus (LASV) infection and Lassa fever disease (LF) was developed from a clinical perspective to provide clinicians with a condensed, accessible understanding of the current literature. The information provided highlights pathogenesis, clinical features, and diagnostics emphasizing therapies and vaccines that have demonstrated potential value for use in clinical or research environments.</p>
<p><strong>Methods</strong></p>
<p class="section-paragraph">We conducted an integrative literature review on the clinical and pathological features, vaccines, and treatments for LASV infection, focusing on recent studies and <em>in vivo</em> evidence from humans and/or non-human primates (NHPs), when available.</p>
<p><strong>Results</strong></p>
<p class="section-paragraph">Two antiviral medications with potential benefit for the treatment of LASV infection and 1 for post-exposure prophylaxis were identified, although a larger number of therapeutic candidates are currently being evaluated. Multiple vaccine platforms are in pre-clinical development for LASV prevention, but data from human clinical trials are not yet available.</p>
<p><strong>Conclusion</strong></p>
<p class="section-paragraph">We provide succinct summaries of medical countermeasures against LASV to give the busy clinician a rapid reference. Although there are no approved drugs or vaccines for LF, we provide condensed information from a literature review for measures that can be taken when faced with a suspected infection, including investigational treatment options and hospital engineering controls.</p>
<p><strong>Keywords</strong></p>
<ul>
<li>Lassa virus</li>
<li>Lassa fever</li>
<li>antiviral therapy</li>
<li>antiviral countermeasure</li>
<li>vaccine</li>
<li>viral hemorrhagic fever</li>
</ul>
Accessibility
Information on accessibility of the document(s), such as university log-in necessary, request form, open access, etc.
Open Access on journal site. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/ ).
URL
https://pubmed.ncbi.nlm.nih.gov/35395384/
Read Online
Online location of the resource.
https://www.ijidonline.com/article/S1201-9712(22)00205-3/fulltext
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Lassa Virus Infection: a Summary for Clinicians
Subject
The topic of the resource
General
Description
An account of the resource
This summary on Lassa virus (LASV) infection and Lassa fever disease (LF) was developed from a clinical perspective to provide clinicians with a condensed, accessible understanding of the current literature. The information provided highlights pathogenesis, clinical features, and diagnostics emphasizing therapies and vaccines that have demonstrated potential value for use in clinical or research environments.
Creator
An entity primarily responsible for making the resource
Science Working Group of the National Emerging Special Pathogens Training and Education Center (NETEC) Special Pathogens Research Network (SPRN)
Source
A related resource from which the described resource is derived
Vanessa Raabe, Aneesh K Mehta, Jared D Evans
Date
A point or period of time associated with an event in the lifecycle of the resource
2022-04-05
Type
The nature or genre of the resource
Publication
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-07-25
Contributor
An entity responsible for making contributions to the resource
2024-03-28 by J. Mundy – not yet reviewed asset – bumping first review 1 year
Clinical Care
Lassa
R-Res&Pub
-
https://repository.netecweb.org/files/original/bd56d080570241072e03dfe99bddee02.png
4d72780f2d14275212db5c1df814d031
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://netec.org/2023/02/24/a-clinicians-reference-guide-to-marburg-virus-disease/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
A Clinicians Reference Guide to Marburg Virus Disease
Subject
The topic of the resource
Treatment & Care
Description
An account of the resource
This NETEC blog post reviews 10 Takeaways for Clinicians for Marburg Virus Disease (MVD), MVD Therapeutics and Vaccine Candidates, and additional resources.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-02-24
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-02-24
Clinical Care
Marburg
R-T&C
Therapeutics
-
https://repository.netecweb.org/files/original/c833d4c5e1e862cd13e73555d0b90caf.png
a2b405ff56fb777b17f2c76d63c53b35
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Discover
Description
An account of the resource
<div style="background-color:#c7e5f8;">
<h2 style="background-color:#c7e5f8;"><span style="font-size:80%;line-height:24px;"><a href="https://repository.netecweb.org/exhibits/show/ncov/ncov"><button>COVID-19 Update</button></a><a href="https://repository.netecweb.org/news#Map"><button>Outbreak Map</button></a><a href="https://repository.netecweb.org/news#News"><button>Newsfeed</button></a><a href="https://repository.netecweb.org/exhibits/show/monkeypox/monkeypox"><button>Monkeypox 2021</button></a><a href="https://repository.netecweb.org/exhibits/show/drcebola2018/drcebola2018"><button>2020 Ebola Update</button></a><a href="https://repository.netecweb.org/ebolatimeline"><button>Ebola Timeline</button></a><a href="https://repository.netecweb.org/exhibits/show/mers/mers"><button>MERS</button></a><a href="https://repository.netecweb.org/exhibits/show/aerosol/aerosol"><button>Airborne Transmission</button></a></span></h2>
<h2 style="background-color:#c7e5f8;">Discover Background Data and Resources:</h2>
<ul><li>
<p><span style="line-height:24px;">Get introduced to NETEC through the interactive timeline of special pathogens below.* This timeline describes some significant special pathogen events in recent history.</span></p>
</li>
<li>
<p><span style="line-height:24px;">Find out more about the 2014 Ebola outbreak and the development of the ASPR/CDC-supported network of healthcare facilities preparing for the next outbreak through <em><a href="/ebolatimeline"><button>the Ebola timeline</button></a>.</em></span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">This NETEC Repository helps to provide training and educational resources to prepare for future special pathogen events. </span></p>
</li>
</ul><ul><li>
<p><span style="line-height:24px;">Explore the files BELOW THE TIMELINE to <em><strong>discover and learn</strong></em> more about Ebola and other Special Pathogens, an overview of special pathogens, clinically managing patients affected, and readying healthcare teams and systems to keep everyone safe.</span></p>
</li>
</ul><h2 style="background-color:#c7e5f8;">Timeline of Special Pathogens:</h2>
<a href="#click">Skip timeline</a>
<p style="margin-bottom:0;"><iframe width="100%" height="635" style="border:1px solid #000000;" src="https://cdn.knightlab.com/libs/timeline3/latest/embed/index.html?source=1AQiHJEzkhEi71uIi7wTWWgSFRwR6wRbRyfhbASrw3Ig&font=Default&lang=en&initial_zoom=2&height=650" title="Timeline of Special Pathogens"></iframe></p>
<h2 style="background-color:#c7e5f8;"><span style="font-size:70%;">*Click for <a href="/timeline2access"><button>a screen reader accessible table of this timeline</button></a>. </span></h2>
</div>
Hyperlink
A link, or reference, to another resource on the Internet.
URL
https://netec.org/2023/02/10/what-you-need-to-know-about-nipah-virus/
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
What You Need to Know about Nipah Virus
Subject
The topic of the resource
General
Description
An account of the resource
This NETEC blog post discusses what Nipah Virus is, signs and symptoms of Nipah Virus Infection, clinical care for patients infected with Nipah Virus, recommended Personal Protective Equipment (PPE), infection control measures for Nipah Virus Infection, testing, and additional resources.
Creator
An entity primarily responsible for making the resource
NETEC
Date
A point or period of time associated with an event in the lifecycle of the resource
2023-02-10
Coverage
The spatial or temporal topic of the resource, the spatial applicability of the resource, or the jurisdiction under which the resource is relevant
2024-02-10
Clinical Care
Infection Prevention and Control
Laboratory Testing
Nipah (NiV)
Personal Protective Equipment (PPE)
R-T&C