Manson Unit, Médecins sans Frontières, London, UK; MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
Centre for Longitudinal Studies, University College London, London, UK.
Lancet Infect Dis. 2020 Nov;20(11):1324-1338. doi: 10.1016/S1473-3099(20)30193-6. Epub 2020 Jun 25.
Ebola virus disease case definition is a crucial surveillance tool to detect suspected cases for referral and as a screening tool for clinicians to support admission and laboratory testing decisions at Ebola health facilities. We aimed to assess the performance of the WHO Ebola virus disease case definitions and other screening scores.
In this systematic review and meta-analysis, we searched PubMed, Scopus, Embase, and Web of Science for studies published in English between June 13, 1978, and Jan 14, 2020. We included studies that estimated the sensitivity and specificity of WHO Ebola virus disease case definitions, clinical and epidemiological characteristics (symptoms at admission and contact history), and predictive risk scores against the reference standard (laboratory-confirmed Ebola virus disease). Summary estimates of sensitivity and specificity were calculated using bivariate and hierarchical summary receiver operating characteristic (when four or more studies provided data) or random-effects meta-analysis (fewer than four studies provided data).
We identified 2493 publications, of which 14 studies from four countries (Sierra Leone, Guinea, Liberia, and Angola) were included in the analysis. 12 021 people with suspected disease were included, of whom 4874 were confirmed as positive for Ebola virus infection. Six studies explored the performance of WHO case definitions in non-paediatric populations, and in all of these studies, suspected and probable cases were combined and could not be disaggregated for analysis. The pooled sensitivity of the WHO Ebola virus disease case definitions from these studies was 81·5% (95% CI 74·1-87·2) and pooled specificity was 35·7% (28·5-43·6). History of contact or epidemiological link was a key predictor for the WHO case definitions (seven studies) and for risk scores (six studies). The most sensitive symptom was intense fatigue (79·0% [95% CI 74·4-83·0]), assessed in seven studies, and the least sensitive symptom was pain behind the eyes (1·0% [0·0-7·0]), assessed in three studies. The performance of fever as a symptom varied depending on the cutoff used to define fever.
WHO Ebola virus disease case definitions perform suboptimally to identify cases at both community level and during triage at Ebola health facilities. Inclusion of intense fatigue as a key symptom and contact history could improve the performance of case definitions, but implementation of these changes will require effective collaboration with, and trust of, affected communities.
Médecins sans Frontières.
埃博拉病毒病病例定义是一种重要的监测工具，用于发现疑似病例以进行转诊，并作为临床医生支持埃博拉卫生机构入院和实验室检测决策的筛选工具。我们旨在评估世界卫生组织（WHO）埃博拉病毒病病例定义和其他筛选评分的性能。
在这项系统评价和荟萃分析中，我们在 1978 年 6 月 13 日至 2020 年 1 月 14 日期间在 PubMed、Scopus、Embase 和 Web of Science 上搜索了以英文发表的研究。我们纳入了估计 WHO 埃博拉病毒病病例定义、临床和流行病学特征（入院时的症状和接触史）以及预测风险评分对参考标准（实验室确诊的埃博拉病毒病）的敏感性和特异性的研究。使用双变量和分层汇总受试者工作特征（当四项或更多研究提供数据时）或随机效应荟萃分析（少于四项研究提供数据）计算敏感性和特异性的汇总估计值。
我们确定了 2493 篇出版物，其中来自四个国家（塞拉利昂、几内亚、利比里亚和安哥拉）的 14 项研究被纳入分析。共有 12021 人患有疑似疾病，其中 4874 人被确认为埃博拉病毒感染阳性。六项研究探讨了 WHO 病例定义在非儿科人群中的表现，在所有这些研究中，疑似病例和可能病例都被合并，无法进行分析。这些研究中 WHO 埃博拉病毒病病例定义的合并敏感性为 81.5%（95%CI 74.1-87.2），合并特异性为 35.7%（28.5-43.6）。接触史或流行病学联系是 WHO 病例定义（七项研究）和风险评分（六项研究）的关键预测因素。最敏感的症状是剧烈疲劳（79.0%[95%CI 74.4-83.0%]），在七项研究中评估，最不敏感的症状是眼后疼痛（1.0%[0.0-7.0%]），在三项研究中评估。发热作为症状的表现取决于用于定义发热的临界值。
WHO 埃博拉病毒病病例定义在社区层面和埃博拉卫生机构分诊时识别病例的效果不佳。将剧烈疲劳作为关键症状并结合接触史可以提高病例定义的性能，但实施这些改变需要与受影响社区进行有效的合作并获得其信任。
无国界医生组织。
