{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,7]],"date-time":"2026-06-07T09:28:33Z","timestamp":1780824513401,"version":"3.54.1"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,10,24]],"date-time":"2018-10-24T00:00:00Z","timestamp":1540339200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R03AI132801"],"award-info":[{"award-number":["R03AI132801"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012299","name":"Warren Alpert Medical School, Brown University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100012299","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2019,1]]},"abstract":"Abstract<\/jats:title>Objective<\/jats:title>Fluid loss during Ebola virus disease (EVD<\/jats:styled-content>) infections from gastrointestinal dysfunction leads to volume depletion. It is possible that high environmental temperatures may exacerbate volume depletion or interfere with the provision of medical care by providers in full personal protective equipment. We investigated the effect of environmental temperature on case fatality.<\/jats:p><\/jats:sec>Methods<\/jats:title>The International Medical Corps (IMC<\/jats:styled-content>) operated five Ebola Treatment Units (ETU<\/jats:styled-content>s) in Liberia and Sierra Leone during the 2014\u20132016 epidemic. Demographic and outcomes variables for 465 patients with EVD<\/jats:styled-content> were sourced from a de\u2010identified, quality\u2010checked clinical database collected by IMC<\/jats:styled-content>. Daily environmental temperature data for Liberia and Sierra Leone were collected from a publicly available database (Weather Underground). Mean daily environmental temperatures were averaged across each patient's ETU<\/jats:styled-content> stay and environmental temperature thresholds were determined. Multiple logistic regression was utilised, with forward variable selection and threshold for entry of P<\/jats:italic> < 0.1. Statistical significance was defined as P<\/jats:italic> < 0.05. The following variables were analysed as potential confounders: age, sex, ETU<\/jats:styled-content>, length of ETU<\/jats:styled-content> operation and date of treatment.<\/jats:p><\/jats:sec>Results<\/jats:title>Case fatality was 57.6% among patients diagnosed with EVD<\/jats:styled-content>. Analysis of case fatality across environmental temperature quintiles indicated a threshold effect; the optimal threshold for average environmental temperature during a patient's ETU<\/jats:styled-content> stay was determined empirically to be 27.4 \u00b0<\/jats:bold>C (81.3 \u00b0<\/jats:bold>F). Case fatality was significantly greater for patients with average environmental temperatures above the threshold (70.4%) vs<\/jats:italic>. below (52.0%) (P<\/jats:italic> < 0.001). In multiple regression, patients with average environmental temperature above the threshold during their ETU<\/jats:styled-content> stay were significantly more likely to die than patients below the threshold (aOR<\/jats:styled-content> = 2.5, 95% CI<\/jats:styled-content> 1.6\u20133.8, P<\/jats:italic> < 0.001). This trend was observed only among patients treated in white tent ETU<\/jats:styled-content>s, and not in ETU<\/jats:styled-content>s with aluminium roofs.<\/jats:p><\/jats:sec>Discussion<\/jats:title>These findings suggest that an average environmental temperature above 27.4 \u00b0<\/jats:bold>C (81.3 \u00b0<\/jats:bold>F) during patients\u2019 ETU<\/jats:styled-content> stay is associated with greater risk of death among patients with EVD<\/jats:styled-content>. Further studies should investigate this effect. These results have potential implications for reducing case fatality through improved ETU<\/jats:styled-content> construction or other temperature control methods within ETU<\/jats:styled-content>s during future outbreaks.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13166","type":"journal-article","created":{"date-parts":[[2018,10,11]],"date-time":"2018-10-11T14:42:25Z","timestamp":1539268945000},"page":"23-30","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Environmental temperature and case fatality of patients with Ebola virus disease in Sierra Leone and Liberia, 2014\u20132015: a retrospective cohort study"],"prefix":"10.1111","volume":"24","author":[{"given":"Jillian L.","family":"Peters","sequence":"first","affiliation":[{"name":"Warren Alpert Medical School of Brown University Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel K.","family":"Cho","sequence":"additional","affiliation":[{"name":"Brown University Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam R.","family":"Aluisio","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Brown University Alpert Medical School Providence RI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen B.","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Incident Management System Ministry of Health Monrovia Liberia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses B. F.","family":"Massaquoi","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative Monrovia Liberia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Foday","family":"Sahr","sequence":"additional","affiliation":[{"name":"Sierra Leone Ministry of Defense Freetown Sierra Leone"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiromi M.","family":"Perera","sequence":"additional","affiliation":[{"name":"International Medical Corps Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam C.","family":"Levine","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Brown University Alpert Medical School Providence RI USA"},{"name":"International Medical Corps Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,10,24]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Centers for Disease Control and Prevention (CDC).Outbreaks Chronology: Ebola Virus Disease.https:\/\/www.cdc.gov\/vhf\/ebola\/outbreaks\/history\/chronology.html."},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw601"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/srep41613"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-16-00186"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw725"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2016-000070"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2015.03.011"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30112-3"},{"key":"e_1_2_6_10_1","first-page":"e0005700","article-title":"The natural history of acute Ebola virus disease among patients managed in five Ebola treatment units in West Africa: a retrospective cohort study","volume":"11","author":"Skrable K","year":"2017","journal-title":"PLoS NTD"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix290"},{"key":"e_1_2_6_12_1","unstructured":"World Maps of K\u00f6ppen\u2010Geiger Climate Classification.World Map of the K\u00f6ppen\u2010Geiger Climate Classification Updated.http:\/\/koeppen-geiger.vu-wien.ac.at\/present.htm."},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/jramc-2015-000541"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/1060028014561227"},{"key":"e_1_2_6_15_1","unstructured":"Centers for Disease Control and Prevention (CDC).Ebola Virus Disease Information for Clinicians in U.S. Healthcare Settings.https:\/\/www.cdc.gov\/vhf\/ebola\/healthcare-us\/preparing\/clinicians.html."},{"key":"e_1_2_6_16_1","unstructured":"BrayM ChertowDS.Treatment and prevention of Ebola virus disease \u2010 UpToDate.https:\/\/www-uptodate-com.revproxy.brown.edu\/contents\/treatment-and-prevention-of-ebola-virus-disease?source=see_link§ionName=Prognosticfactors&anchor=H132411\u2010 H132411."},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1371\/currents.outbreaks.b494f2c6a396c72ec24cb4142765bb95"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1518587113"},{"key":"e_1_2_6_19_1","unstructured":"Central Intelligence Agency (CIA).The World Fact book \u2010 Sierra Leone.https:\/\/www.cia.gov\/library\/publications\/the-world-factbook\/geos\/sl.html."},{"key":"e_1_2_6_20_1","unstructured":"Central Intelligence Agency (CIA).The World Fact book \u2010 Liberia.https:\/\/www.cia.gov\/library\/publications\/the-world-factbook\/geos\/li.html."},{"key":"e_1_2_6_21_1","unstructured":"HanC.Breaking New Ground: A Different Approach to Building Ebola Clinics in Liberia. 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