{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T09:32:36Z","timestamp":1790501556532,"version":"4.1.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T00:00:00Z","timestamp":1605139200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T00:00:00Z","timestamp":1605139200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009401","name":"Medizinischen Fakult\u00e4t, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009401","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>A functioning Viral Haemorrhagic Fever (VHF) surveillance system in countries at risk for outbreaks can reduce early transmission in case of an outbreak. Surveillance performance depends on the application of suspect case definitions in daily clinical practice. Recommended suspect case criteria during outbreaks are designed for high sensitivity and include general symptoms, pyrexia, haemorrhage, epidemiological link and unexplained death in patients. Non-outbreak criteria are narrower, relying on the persistence of fever and the presence of haemorrhagic signs.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>This study ascertains VHF suspect case prevalence based on outbreak and non-outbreak criteria in a Guinean regional hospital for a period of three months. The study further describes clinical trajectories of patients who meet non-outbreak VHF suspect case criteria in order to discuss challenges in their identification. We used cross-sectional data collection at triage and emergency room to record demographic and clinical data of all admitted patients during the study period. For the follow-up study with description of diagnostic trajectories of VHF suspect cases, we used retrospective chart review.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The most common symptoms of all patients upon admission were fever, tiredness\/weakness and abdominal pain. 686 patients met EVD outbreak criteria, ten adult patients and two paediatric patients met study-specific non-outbreak VHF suspect case criteria. None of the suspect cases was treated as VHF suspect case and none tested positive for malaria upon admission. Their most frequent discharge diagnosis was unspecific gastrointestinal infection. The most common diagnostic measures were haemoglobin level and glycaemia for both adults and for children; of the requested examinations for hospitalized suspect cases, 36% were not executed or obtained. Half of those patients self-discharged against medical advice.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our study shows that the number of VHF suspect cases may vary greatly depending on which suspect case criteria are applied. Identification of VHF suspect cases seems challenging in clinical practice. We suggest that this may be due to the low use of laboratory diagnostics to support certain diagnoses and the non-application of VHF suspect case definitions in clinical practice. Future VHF suspect case management should aim to tackle such challenges in comparable hospital settings.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12879-020-05573-8","type":"journal-article","created":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T13:03:02Z","timestamp":1605186182000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Period prevalence and identification challenges of viral haemorrhagic fever suspect cases in a tertiary referral hospital in Guinea: a cross-sectional, retrospective study of triage and emergency room patient profiles"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4247-9588","authenticated-orcid":false,"given":"Manuel","family":"Raab","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa M.","family":"Pfadenhauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinh-Kim","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dansira","family":"Doumbouya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hoelscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guenter","family":"Froeschl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,11,12]]},"reference":[{"key":"5573_CR1","unstructured":"2014\u20132016 Ebola Outbreak in West Africa | History | Ebola (Ebola Virus Disease) | CDC. 2019. https:\/\/www.cdc.gov\/vhf\/ebola\/history\/2014-2016-outbreak\/index.html. Accessed 26 Apr 2019."},{"key":"5573_CR2","doi-asserted-by":"publisher","first-page":"1418","DOI":"10.1056\/NEJMoa1404505","volume":"371","author":"S Baize","year":"2014","unstructured":"Baize S, Pannetier D, Oestereich L, Rieger T, Koivogui L, Magassouba N, et al. Emergence of Zaire Ebola virus disease in Guinea. N Engl J Med. 2014;371:1418\u201325.","journal-title":"N Engl J Med"},{"key":"5573_CR3","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1056\/NEJMoa1411100","volume":"371","author":"Team WER","year":"2014","unstructured":"Team WER. Ebola virus disease in West Africa \u2014 the first 9 months of the epidemic and forward projections. N Engl J Med. 2014;371:1481\u201395.","journal-title":"N Engl J Med"},{"key":"5573_CR4","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/S1473-3099(18)30164-6","volume":"18","author":"TR Shoemaker","year":"2018","unstructured":"Shoemaker TR, Balinandi S, Tumusiime A, Nyakarahuka L, Lutwama J, Mbidde E, et al. Impact of enhanced viral haemorrhagic fever surveillance on outbreak detection and response in Uganda. Lancet Infect Dis. 2018;18:373\u20135.","journal-title":"Lancet Infect Dis"},{"key":"5573_CR5","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1056\/NEJMp1502918","volume":"372","author":"B Gates","year":"2015","unstructured":"Gates B. The next epidemic \u2014 lessons from Ebola. N Engl J Med. 2015;372:1381\u20134.","journal-title":"N Engl J Med"},{"key":"5573_CR6","doi-asserted-by":"publisher","first-page":"2662","DOI":"10.1016\/S0140-6736(17)32092-5","volume":"390","author":"DM Pigott","year":"2017","unstructured":"Pigott DM, Deshpande A, Letourneau I, Morozoff C, Reiner RC, Kraemer MUG, et al. Local, national, and regional viral haemorrhagic fever pandemic potential in Africa: a multistage analysis. Lancet. 2017;390:2662\u201372.","journal-title":"Lancet."},{"key":"5573_CR7","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1089\/15303660160025903","volume":"1","author":"DG Bausch","year":"2001","unstructured":"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;1:269\u201381.","journal-title":"Vector-Borne Zoonotic Dis"},{"key":"5573_CR8","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1056\/NEJMsr1513109","volume":"375","author":"Team WER","year":"2016","unstructured":"Team WER. After Ebola in West Africa \u2014 unpredictable risks. Preventable Epidemics N Engl J Med. 2016;375:587\u201396.","journal-title":"Preventable Epidemics N Engl J Med"},{"key":"5573_CR9","volume-title":"Clinical management of patients with viral haemorrhagic fever: a pocket guide for front-line health workers: interim emergency guidance for country adaption","author":"World Health Organization","year":"2016","unstructured":"World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for front-line health workers: interim emergency guidance for country adaption. Geneva, Switzerland: WHO; 2016."},{"key":"5573_CR10","doi-asserted-by":"publisher","first-page":"69","DOI":"10.4103\/0974-777X.93765","volume":"4","author":"NR Vanessa","year":"2012","unstructured":"Vanessa NR, Matthias B. Infection control during Filoviral hemorrhagic fever outbreaks. J Glob Infect Dis. 2012;4:69\u201374.","journal-title":"J Glob Infect Dis"},{"key":"5573_CR11","doi-asserted-by":"publisher","unstructured":"Hartley M-A, Young A, Tran A-M, Okoni-Williams HH, Suma M, Mancuso B, et al. Predicting Ebola infection: a malaria-sensitive triage score for Ebola virus disease. PLoS Negl Trop Dis. 2017;11. https:\/\/doi.org\/10.1371\/journal.pntd.0005356.","DOI":"10.1371\/journal.pntd.0005356"},{"key":"5573_CR12","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1016\/j.annemergmed.2015.07.024","volume":"66","author":"M Waxman","year":"2015","unstructured":"Waxman M. Triage in the time of Ebola: research across the Plexiglas partition. Ann Emerg Med. 2015;66:294\u20136.","journal-title":"Ann Emerg Med"},{"key":"5573_CR13","doi-asserted-by":"publisher","first-page":"1792","DOI":"10.3201\/eid2311.170171","volume":"23","author":"S Oza","year":"2017","unstructured":"Oza S, Sesay AA, Russell NJ, Wing K, Boufkhed S, Vandi L, et al. Symptom- and laboratory-based Ebola risk scores to differentiate likely Ebola infections. Emerg Infect Dis. 2017;23:1792\u20139.","journal-title":"Emerg Infect Dis"},{"key":"5573_CR14","first-page":"359","volume":"32","author":"S Pittalis","year":"2009","unstructured":"Pittalis S, Fusco FM, Lanini S, Nisii C, Puro V, Lauria FN, et al. Case definition for Ebola and Marburg haemorrhagic fevers: a complex challenge for epidemiologists and clinicians. New Microbiol. 2009;32:359\u201367.","journal-title":"New Microbiol"},{"key":"5573_CR15","doi-asserted-by":"publisher","first-page":"S810","DOI":"10.1093\/infdis\/jir299","volume":"204 suppl_3","author":"MG Kortepeter","year":"2011","unstructured":"Kortepeter MG, Bausch DG, Bray M. Basic Clinical and Laboratory Features of Filoviral Hemorrhagic Fever. J Infect Dis. 2011;204 suppl_3:S810\u20136.","journal-title":"J Infect Dis"},{"key":"5573_CR16","doi-asserted-by":"publisher","first-page":"1821","DOI":"10.1093\/cid\/civ202","volume":"60","author":"M Barry","year":"2015","unstructured":"Barry M, Tour\u00e9 A, Traor\u00e9 FA, Sako F-B, Sylla D, Kpamy DO, et al. Clinical predictors of mortality in patients with Ebola virus disease. Clin Infect Dis. 2015;60:1821\u20134.","journal-title":"Clin Infect Dis"},{"key":"5573_CR17","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/S1473-3099(17)30234-7","volume":"17","author":"A Rojek","year":"2017","unstructured":"Rojek A, Horby P, Dunning J. Insights from clinical research completed during the West Africa Ebola virus disease epidemic. Lancet Infec Dis. 2017;17:280\u201392.","journal-title":"Lancet Infec Dis."},{"key":"5573_CR18","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1093\/cid\/civ792","volume":"62","author":"LD Racsa","year":"2016","unstructured":"Racsa LD, Kraft CS, Olinger GG, Hensley LE. Viral hemorrhagic fever diagnostics. Clin Infect Dis. 2016;62:214\u20139.","journal-title":"Clin Infect Dis"},{"key":"5573_CR19","volume-title":"Technical guidelines for integrated disease surveillance in the African region, 2nd Edition","author":"World Health Organization","year":"2011","unstructured":"World Health Organization. Technical guidelines for integrated disease surveillance in the African region, 2nd Edition. 2011."},{"key":"5573_CR20","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1186\/s12889-019-6636-1","volume":"19","author":"C Njuguna","year":"2019","unstructured":"Njuguna C, Jambai A, Chimbaru A, Nordstrom A, Conteh R, Latt A, et al. Revitalization of integrated disease surveillance and response in Sierra Leone post Ebola virus disease outbreak. BMC Public Health. 2019;19:364.","journal-title":"BMC Public Health"},{"key":"5573_CR21","volume-title":"D\u00e9finitions de Cas de principales Maladies et Ev\u00e8nements sous Surveillance - 2018","author":"Ministry of Health, Guinea, World Health Organization","year":"2018","unstructured":"Ministry of Health, Guinea, World Health Organization. D\u00e9finitions de Cas de principales Maladies et Ev\u00e8nements sous Surveillance - 2018. 2018."},{"key":"5573_CR22","unstructured":"IBM Corp. Released 2017. IBM SPSS statistics for windows, version 25.0. Armonk, NY: IBM Corp. https:\/\/www.ibm.com\/support\/pages\/how-cite-ibm-spss-statistics-or-earlier-versions-spss."},{"key":"5573_CR23","unstructured":"World Health Organization. WHO country cooperation strategy at a glance. Guinea: World Health Organization; 2015. https:\/\/apps.who.int\/iris\/handle\/10665\/246211."},{"key":"5573_CR24","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.socscimed.2016.11.016","volume":"172","author":"RA Blair","year":"2017","unstructured":"Blair RA, Morse BS, Tsai LL. Public health and public trust: survey evidence from the Ebola virus disease epidemic in Liberia. Soc Sci Med. 2017;172:89\u201397.","journal-title":"Soc Sci Med"},{"key":"5573_CR25","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0224511","volume":"14","author":"P Richards","year":"2019","unstructured":"Richards P, Mokuwa E, Welmers P, Maat H, Beisel U. Trust, and distrust, of Ebola treatment centers: a case-study from Sierra Leone. PLoS One. 2019;14:e0224511.","journal-title":"PLoS One"},{"key":"5573_CR26","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1056\/NEJMp1508413","volume":"373","author":"RS Dhillon","year":"2015","unstructured":"Dhillon RS, Kelly JD. Community trust and the Ebola endgame. N Engl J Med. 2015;373:787\u20139.","journal-title":"N Engl J Med"},{"key":"5573_CR27","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/S1473-3099(19)30063-5","volume":"19","author":"P Vinck","year":"2019","unstructured":"Vinck P, Pham PN, Bindu KK, Bedford J, Nilles EJ. Institutional trust and misinformation in the response to the 2018\u201319 Ebola outbreak in north Kivu, DR Congo: a population-based survey. Lancet Infec Dis. 2019;19:529\u201336.","journal-title":"Lancet Infec Dis"},{"key":"5573_CR28","unstructured":"Renaud B, Grange N. Guide de prise en charge maladies infectieuse \u00e0 potentiel \u00e9pid\u00e9mique dans les CTEPI. Conakry: Agence National de S\u00e9curit\u00e9 Sanitaire Guin\u00e9e; 2016."},{"key":"5573_CR29","volume-title":"Une m\u00e9decine inhospitali\u00e8re : Les Difficiles Relations entre soignants et soign\u00e9s dans cinq capitales d\u2019Afrique de l\u2019Ouest","author":"J-PO de Sardan","year":"2003","unstructured":"de Sardan J-PO, Jaffr\u00e9 Y. Une m\u00e9decine inhospitali\u00e8re : Les Difficiles Relations entre soignants et soign\u00e9s dans cinq capitales d\u2019Afrique de l\u2019Ouest. Paris: Karthala; 2003."}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-020-05573-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12879-020-05573-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-020-05573-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,12]],"date-time":"2020-11-12T13:03:56Z","timestamp":1605186236000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-020-05573-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,12]]},"references-count":29,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["5573"],"URL":"https:\/\/doi.org\/10.1186\/s12879-020-05573-8","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,12]]},"assertion":[{"value":"8 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 October 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 November 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethical approval for this study was granted by the Guinean Ethics Committee for Research in Health (opinion number 103\/CNERS\/18) and the Ethics Committee for Medical Research at the Ludwig-Maximilians-Universit\u00e4t (LMU), Munich (opinion number 18\u2013834). Before its implementation, the study was presented to the regional health authorities and the HRN\u2019Z directorate who both consented to its implementation. As part of the hospital\u2019s routine aggregate data collection, no informed consent was asked from patients upon admission for the cross-sectional data collection. Informed consent to access data from patient files was obtained from the post-hoc screened hospitalized patients as well as the parents of paediatric suspect cases.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare to have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"838"}}