Quantifying the heterogeneity and determinants of Ebola transmission using chains of transmission from the 10th DRC outbreak (2018-2020).
Context and objectives
Despite advances in vaccines and therapeutics, Ebola virus disease (EVD) mortality remains high, partly due to delayed care and limited understanding of in-hospital disease progression. This study characterises the longitudinal clinical course of EVD using landmark analyses at Days 0, 1, 3, and 7 of hospitalisation in a large retrospective cohort from the 10th EVD epidemic in the Democratic Republic of the Congo. Low cycle threshold values, unstable vital signs, dyspnoea, and neurological signs were consistently associated with mortality, while prior vaccination was protective. These findings mirror sepsis progression and provide the first time-dependent evidence base to guide early, goal-directed clinical intervention, systematic supportive care protocols, and rapid deployment of EVD-specific therapeutics in outbreak settings.
Our role
Coordination
Partners
- Ministry of health, DRC
Methodology
Retrospective cohort study of confirmed EVD patients admitted to Ebola Treatment Centres in North Kivu and Ituri, DRC (August 2018 - June 2020). Landmark analyses were conducted at Days 0, 1, 3, and 7 of hospitalisation, assessing 48-hour mortality using time-varying covariates (vital signs, symptoms, cycle threshold values, treatments) and fixed covariates (age, sex, vaccination status, admission timing). Missing data were managed through categorisation and subgroup analyses.
