correspondence
still presents a huge challenge as we move into
the second year of the epidemic in West Africa.
WHO Ebola Response Team
A list of authors (members of the WHO Ebola Response Team
who contributed to this letter, in alphabetic order) is available
with the full text of this letter at NEJM.org.
Supported by the Medical Research Council, the Bill and Me-
linda Gates Foundation, the Models of Infectious Disease Agent
Study of the National Institute of General Medical Sciences
(National Institutes of Health), the Health Protection Research
Units of the National Institute for Health Research, European
Union PREDEMICS consortium, Wellcome Trust, Fogarty Inter-
national Center, and World Health Organization.
Ebola in Freetown Area, Sierra Leone —
A Case Study of 581 Patients
To the Editor: Schieffelin et al. (Nov. 27 issue)1
reported on 106 patients with Ebola virus disease
who were treated in Kenema, Sierra Leone, in May
and June 2014. Here we report similar data on the
631 patients with Ebola virus disease, as confirmed
by polymerase-chain-reaction assay, who were
admitted to the Ebola treatment center at the
Hastings Police Training School near Freetown,
Sierra Leone, on or after September 20, 2014 (the
date on which the first patients were admitted to
that center). The 31% case fatality rate at Hast-
ings is lower than the 74% rate reported by
Schieffelin et al.
As of December 7, 2014, a total of 50 of the
631 patients with laboratory-confirmed Ebola vi-
rus disease were still inpatients at Hastings, and
581 had either died or been discharged after
testing negative for the Ebola virus in follow-up
laboratory tests. In total, 183 of the 581 patients
for whom a final disposition is known died,
representing a case fatality rate of 31.5%; among
the patients who died, 38 were dead on arrival
and the other 145 died after admission. We have
observed a decreasing case fatality rate among
inpatients at Hastings, from 47.7% among the
first 151 patients (September 20 to October 13),
to 31.7% among the next 126 patients with a
final disposition (October 14 to November 4), to
23.4% among the next 304 patients (November 5
to December 7).
The most common symptoms reported at ad-
mission were fatigue, anorexia, fever, vomiting
and nausea, diarrhea, muscle pain, joint pain, and
n engl j med 372;6 nejm.org february 5, 2015
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Disclosure forms provided by the authors are available with
the full text of this letter at NEJM.org.
This letter was published on December 24, 2014, at NEJM.org.
1. WHO Ebola Response Team. Ebola virus disease in West
Africa — the first 9 months of the epidemic and forward projec-
tions. N Engl J Med 2014;371:1481-95.
2. Ebola response roadmap — situation report. Geneva: World
Health Organization (http://www.who.int/csr/disease/ebola/
situation-reports/en/).
3. UN Mission for Ebola Emergency Response (UNMEER). Ex-
ternal situation report (http://www.un.org/ebolaresponse/index
.shtml#&panel1-1).
DOI: 10.1056/NEJMc1414992
headache. On average, patients were admitted
3 or 4 days after the onset of symptoms. The
inpatients who died usually did so within 3 or
4 days after admission; survivors usually were
hospitalized for about 2 weeks.
Our current treatment protocol is as follows (for
additional details, see Table S1 in the Supplemen-
tary Appendix, available with the full text of this
letter at NEJM.org): For 72 hours after admission,
all patients receive 1 g of ceftriaxone intravenous-
ly every 12 hours and 500 mg of metronidazole
intravenously every 8 hours, as well as 500 ml of
Ringer’s lactate every 8 or 12 hours and 500 ml
of dextrose saline (5% and 0.9%, respectively) in-
travenously every 8 or 12 hours. All patients also
receive 10 mg of vitamin K and 160 mg of arte-
mether intramuscularly immediately on admis-
sion, as well as a 20-mg zinc sulfate tablet daily,
a 400-mg ibuprofen tablet every 12 hours, and
10 mg of metoclopramide intravenously as need-
ed for nausea or vomiting. After the first 3 days,
continuing therapy includes a 400-mg metroni-
dazole tablet every 8 hours for 7 days, a 500-mg
cefuroxime tablet every 12 hours for 5 days,
an artesunate–lumefantrine combination-therapy
tablet daily for 3 days, a 400-mg ibuprofen tab-
let every 12 hours, and one capsule of Immuno-
Boost nutrition supplement (Novopharm Formu-
lations) daily. Oral rehydration solution and juice
drinks are given freely. It is unclear why the case
fatality rate is decreasing at Hastings. We are
unable to assess any individual component of
the treatments we used, since we applied a
587
 The n e w e ng l a n d j o u r na l
package of interventions. The effectiveness of
this treatment approach will need to be validated
with clinical research at other Ebola treatment
facilities.
All data were collected under government mandate as part of
an active public health surveillance initiative. The data included
in this letter were anonymized before analysis.
Rashid Ansumana, M.Sc.
Mercy Hospital Research Laboratory
Bo, Sierra Leone
Kathryn H. Jacobsen, Ph.D., M.P.H.
George Mason University
Fairfax, VA
kjacobse@gmu.edu
Foday Sahr, M.B., Ch.B., D. Sc.
34 Military Hospital at Wilberforce
Freetown, Sierra Leone
and Others
A complete list of authors is available with the full text of this
letter at NEJM.org.
Disclosure forms provided by the authors are available with
the full text of this letter at NEJM.org.
This letter was published on December 24, 2014, at NEJM.org.
1. Schieffelin JS, Shaffer JG, Goba A, et al. Clinical illness and
outcomes in patients with Ebola in Sierra Leone. N Engl J Med
2014;371:2092-100.
DOI: 10.1056/NEJMc1413685
Correspondence Copyright © 2014, 2015 Massachusetts Medical Society.
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corrections
A New Era for the Treatment of Hyperkalemia? (January 15,
2015;372:275-7). In the first paragraph (page 275), the first
sentence should have given the potassium concentration with-
in human cells as approximately 140 mmol per liter, rather
than 70 mmol per liter. In the reference list (page 277), the
authors of the first article cited should have been Burnell JM,
Villamil MF, Uyeno BT, Scribner BH, rather than Burnell JM,
Scribner BH, Uyeno BT, Villamil MF. The article is correct at
NEJM.org.
Interactive Perspective: Drug Development and FDA Approval,
1938–2013 (June 26, 2014;370:e39). The order of authors was
incorrect; Dr. Darrow should have been listed first, and Dr.
Kesselheim second. The article is correct at NEJM.org.
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9th World Congress on Controversies
in Neurology
The congress will be held in Budapest, Hungary, March
26–28.
Contact ComtecMed, 53 Rothschild Blvd., P.O. Box 68, Tel
Aviv, 6100001, Israel; or call (972) 3 5666166; or fax (972) 3
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FIRST INTERNATIONAL CRITICAL CARE MEDICINE
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The conference will be held in Da Nang, Vietnam, April
13–17. It is presented by the Vietnam Association of Emergency,
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is supported by the Society of Critical Care Medicine.
Contact Dr. Carl Bartecchi, 615 Dittmer Ave., Pueblo, CO
81005 or Dr. Hoang Huu Hieu, Intensive Care Unit, Da Nang
Hospital, 50-52 Nguyen Van Linh St., Da Nang, Vietnam; or
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International Academy of Cardiology Annual
Scientific Sessions 2015
The “20th World Congress on Heart Disease” will be held in
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8777; or fax (310) 659 4781; or e-mail klimedco@ucla.edu; or
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