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  • 1
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    Elsevier
    In: Lancet
    Publication Date: 2018-07-01
    Description: Publication date: Available online 29 June 2018 Source: The Lancet Author(s): Ganesan Karthikeyan, Luiza Guilherme Acute rheumatic fever is caused by an autoimmune response to throat infection with Streptococcus pyogenes . Cardiac involvement during acute rheumatic fever can result in rheumatic heart disease, which can cause heart failure and premature mortality. Poverty and household overcrowding are associated with an increased prevalence of acute rheumatic fever and rheumatic heart disease, both of which remain a public health problem in many low-income countries. Control efforts are hampered by the scarcity of accurate data on disease burden, and effective approaches to diagnosis, prevention, and treatment. The diagnosis of acute rheumatic fever is entirely clinical, without any laboratory gold standard, and no treatments have been shown to reduce progression to rheumatic heart disease. Prevention mainly relies on the prompt recognition and treatment of streptococcal pharyngitis, and avoidance of recurrent infection using long-term antibiotics. But evidence for the effectiveness of either approach is not strong. High-quality research is urgently needed to guide efforts to reduce acute rheumatic fever incidence and prevent progression to rheumatic heart disease.
    Print ISSN: 0140-6736
    Electronic ISSN: 1474-547X
    Topics: Medicine
    Published by Elsevier
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  • 2
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    Elsevier
    In: Lancet
    Publication Date: 2018-07-01
    Description: Publication date: Available online 29 June 2018 Source: The Lancet Author(s): Joseph A Lewnard
    Print ISSN: 0140-6736
    Electronic ISSN: 1474-547X
    Topics: Medicine
    Published by Elsevier
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  • 3
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    Elsevier
    In: Lancet
    Publication Date: 2018-07-01
    Description: Publication date: Available online 29 June 2018 Source: The Lancet Author(s): Krisztián Bányai, Mary K Estes, Vito Martella, Umesh D Parashar Enteric viruses, particularly rotaviruses and noroviruses, are a leading cause of gastroenteritis worldwide. Rotaviruses primarily affect young children, accounting for almost 40% of hospital admissions for diarrhoea and 200 000 deaths worldwide, with the majority of deaths occurring in developing countries. Two vaccines against rotavirus were licensed in 2006 and have been implemented in 95 countries as of April, 2018. Data from eight high-income and middle-income countries showed a 49–89% decline in rotavirus-associated hospital admissions and a 17–55% decline in all-cause gastroenteritis-associated hospital admissions among children younger than 5 years, within 2 years of vaccine introduction. Noroviruses affect people of all ages, and are a leading cause of foodborne disease and outbreaks of gastroenteritis worldwide. Prevention of norovirus infection relies on frequent hand hygiene, limiting contact with people who are infected with the virus, and disinfection of contaminated environmental surfaces. Norovirus vaccine candidates are in clinical trials; whether vaccines will provide durable protection against the range of genetically and antigenically diverse norovirus strains remains unknown. Treatment of viral gastroenteritis is based primarily on replacement of fluid and electrolytes.
    Print ISSN: 0140-6736
    Electronic ISSN: 1474-547X
    Topics: Medicine
    Published by Elsevier
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  • 4
    Publication Date: 2018-07-01
    Description: Publication date: Available online 29 June 2018 Source: The Lancet Author(s): The Ebola Outbreak Epidemiology TeamAhmadouBarrySteveAhuka-MundekeYahayaAli AhmedYokouideAllarangarJulienneAnokoBrett NicholasArcherAaronAruna AbediJayshreeBagariaMarie Roseline DarnyckaBelizaireSangeetaBhatiaThéophileBokengeEmanueleBruniAnneCoriErnestDabireAmadou MouctarDialloBoubacarDialloChristl AnnDonnellyIlariaDorigattiTshewang ChodenDorjiAura RocioEscobar Corado WaeberIbrahima SocéFallNeil MFergusonRichard GarethFitzJohnGervais LeonFolefack TengomoPierre Bernard HenriFormentyAlphaFornaAnneFortinTiniGarskeKaty AMGaythorpeCelineGurryEstherHamblionMamoudouHarouna DjingareyChristopherHaskewStéphane Alexandre LouisHugonnetNatsukoImaiBenidoImpoumaGuylainKabongoOly IlungaKalengaEmerencienneKibangouTheresa Min-HyungLeeCharles OkotLukoyaOusmaneLySheilaMakiala-MandandaAugustinMambaPlacideMbala-KingebeniFranck Fortune RolandMboussouTamayiMlandaVitalMondonge MakumaOliverMorganAnastasieMujinga MulumbaPatrickMukadi KakoniDanielMukadi-BamulekaJean-JaquesMuyembeNdjoloko TambweBathéPatriciaNdumbi NgamalaRolandNgomGuillaumeNgoyPierreNouvelletJustusNsioKevin BabilaOusmanEmiliePeronJonathan AaronPolonskyMichael J.RyanAlhassaneTouréRodneyTownerGastonTshapendaReinhildeVan De WeerdtMariaVan KerkhoveAnnikaWendlandN'Da Konan MichelYaoZabulonYotiEtienneYumaGuyKalambayi KabambaJean de DieuLukwesa MwatiGiseleMbuyLeopoldLubulaAnnyMutomboOscarMavilaYyonneLayEmmaKitenge Background On May 8, 2018, the Government of the Democratic Republic of the Congo reported an outbreak of Ebola virus disease in Équateur Province in the northwest of the country. The remoteness of most affected communities and the involvement of an urban centre connected to the capital city and neighbouring countries makes this outbreak the most complex and high risk ever experienced by the Democratic Republic of the Congo. We provide early epidemiological information arising from the ongoing investigation of this outbreak. Methods We classified cases as suspected, probable, or confirmed using national case definitions of the Democratic Republic of the Congo Ministère de la Santé Publique. We investigated all cases to obtain demographic characteristics, determine possible exposures, describe signs and symptoms, and identify contacts to be followed up for 21 days. We also estimated the reproduction number and projected number of cases for the 4-week period from May 25, to June 21, 2018. Findings As of May 30, 2018, 50 cases (37 confirmed, 13 probable) of Zaire ebolavirus were reported in the Democratic Republic of the Congo. 21 (42%) were reported in Bikoro, 25 (50%) in Iboko, and four (8%) in Wangata health zones. Wangata is part of Mbandaka, the urban capital of Équateur Province, which is connected to major national and international transport routes. By May 30, 2018, 25 deaths from Ebola virus disease had been reported, with a case fatality ratio of 56% (95% CI 39–72) after adjustment for censoring. This case fatality ratio is consistent with estimates for the 2014–16 west African Ebola virus disease epidemic (p=0·427). The median age of people with confirmed or probable infection was 40 years (range 8–80) and 30 (60%) were male. The most commonly reported signs and symptoms in people with confirmed or probable Ebola virus disease were fever (40 [95%] of 42 cases), intense general fatigue (37 [90%] of 41 cases), and loss of appetite (37 [90%] of 41 cases). Gastrointestinal symptoms were frequently reported, and 14 (33%) of 43 people reported haemorrhagic signs. Time from illness onset and hospitalisation to sample testing decreased over time. By May 30, 2018, 1458 contacts had been identified, of which 746 (51%) remained under active follow-up. The estimated reproduction number was 1·03 (95% credible interval 0·83–1·37) and the cumulative case incidence for the outbreak by June 21, 2018, is projected to be 78 confirmed cases (37–281), assuming heterogeneous transmissibility. Interpretation The ongoing Ebola virus outbreak in the Democratic Republic of the Congo has similar epidemiological features to previous Ebola virus disease outbreaks. Early detection, rapid patient isolation, contact tracing, and the ongoing vaccination programme should sufficiently control the outbreak. The forecast of the number of cases does not exceed the current capacity to respond if the epidemiological situation does not change. The information presented, although preliminary, has been essential in guiding the ongoing investigation and response to this outbreak. Funding None.
    Print ISSN: 0140-6736
    Electronic ISSN: 1474-547X
    Topics: Medicine
    Published by Elsevier
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  • 5
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    Elsevier
    In: Lancet
    Publication Date: 2018-06-30
    Description: Publication date: 30 June–6 July 2018 Source: The Lancet, Volume 391, Issue 10140 Author(s): Adrienne O'Neil, Victor Sojo, Bianca Fileborn, Anna J Scovelle, Allison Milner
    Print ISSN: 0140-6736
    Electronic ISSN: 1474-547X
    Topics: Medicine
    Published by Elsevier
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  • 6
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    Elsevier
    In: Lancet
    Publication Date: 2018-06-30
    Description: Publication date: 30 June–6 July 2018 Source: The Lancet, Volume 391, Issue 10140 Author(s): The Lancet
    Print ISSN: 0140-6736
    Electronic ISSN: 1474-547X
    Topics: Medicine
    Published by Elsevier
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  • 7
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    Elsevier
    In: Lancet
    Publication Date: 2018-06-30
    Description: Publication date: 30 June–6 July 2018 Source: The Lancet, Volume 391, Issue 10140 Author(s): Bruce M Biccard
    Print ISSN: 0140-6736
    Electronic ISSN: 1474-547X
    Topics: Medicine
    Published by Elsevier
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  • 8
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    Elsevier
    In: Lancet
    Publication Date: 2018-06-30
    Description: Publication date: 30 June–6 July 2018 Source: The Lancet, Volume 391, Issue 10140 Author(s): Richard Horton
    Print ISSN: 0140-6736
    Electronic ISSN: 1474-547X
    Topics: Medicine
    Published by Elsevier
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  • 9
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    Elsevier
    In: Lancet
    Publication Date: 2018-06-30
    Description: Publication date: 30 June–6 July 2018 Source: The Lancet, Volume 391, Issue 10140 Author(s): Anuj Kapilashrami, Olena Hankivsky
    Print ISSN: 0140-6736
    Electronic ISSN: 1474-547X
    Topics: Medicine
    Published by Elsevier
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  • 10
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    Elsevier
    In: Lancet
    Publication Date: 2018-06-30
    Description: Publication date: 30 June–6 July 2018 Source: The Lancet, Volume 391, Issue 10140 Author(s): Sarah Ditum
    Print ISSN: 0140-6736
    Electronic ISSN: 1474-547X
    Topics: Medicine
    Published by Elsevier
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