Ujian online ipengling (nov.2014)Name of file: Ebola Virus Disease in West AfricaAmbillah soal berikut ini beserta file artikel jurnalnya. Sebab, setelah setengah jam tayang, soal dan filenya akan ditutup dan silahkan mengupload jawaban di folder yang telah ditentukan. Jangan mengupload jawaban di folder yang lain atau di email.(Waktu pengerjaan 19.30-21.30, Rab, 5 Nov.2014) Setelah waktu ini folder akan ditutup. Tidak diperkenankan saling mengcopy jawaban antar teman. Jawablah pertanyaan berikut ini tepat di bawah ini pertanyaan (sertakan pertanyaannya). Pertanyaan berikut seluruhnya mengacu/merujuk pada file Ebola Virus Disease in West Africa. Pada waktu upload jawaban sertakan dengan pertnyaannya dengan kata lain jawaban harap ditaruh di bawah setiap pertanyaan dengan disertai copy jawaban tersebut di bawahnya dari teks asli artikel tersebut.1. Kapan dan oleh siapa dinyatakan bahwa penyakit yang disebabkan ebola sebagai wabah darurat internasional? 2. Apakah kepanjangan EVD?3. Jika tanpa penanganan yang baik menjelang 2 Nov.2014 berapa jumlah kasus yang dapat terjadi di tiga negara Afrika Barat utama dan total keseluruhan? 4. Berapa mayoritas usia pasien dan berapa persen lelakinya? 5. Jika tanpa perbaikan pengobatan yang drastis apa yang akan terjadi per minggu pada beberapa bulan mendatang terhadap pasien EVD?6. Kapan dan di mana epidemi ebola dimulai?7. Ebola dapat menular dengan cara apa? Ada 5 cara untuk mengurangi penularan ebola yaitu....................., ........................, ........................, ........................, dan ........................8. Sebelum di Afrika Barat, ebola telah menyerang negara Afrika lainnya. Negara itu bernama apa? Di distrik apa? Periode Tahun berapa? Berapa jumlah kasusnya?9. Sebutkan minimum 5 ciri ornag yang terkena ebola!10. Apa yang dimaksud dengan doubling time dalam kasus ebola ini? Berapa lama doubling time penyakit ebola di tiga negara Afrika Barat yaitu Guinea, Liberia, dan Sierra Leone?11. Ada 4 faktor risiko potensial yang digunakan untuk mencari keterkaitannya dengan wabah ebola. Empat faktor risiko itu apa saja?12. Data kasus ebola diperoleh dengan dua cara di empat negara Afrika? Dua cara itu ialah ....................... dan ..................................13. Selama 8 bulan ada berapa kasus ebola yang telah dilaporkan kepada WHO? .....................14. Berdasarkan Tabel 1 berapa lelaki yang terkena ebola dan berapa persen? Berapa yang mati dan berapa persen?15. Di antara kelompok umur yang dilaporkan, dari kelompok umu berapa dan jumlah pasien terbanyak yang terserang ebola dan berapa persen?

n engl j med 371;16 nejm.org october 16, 2014 1481The new englandjournal of medicineestablished in 1812 october 16, 2014 vol. 371 no. 16Ebola Virus Disease in West Africa The First 9 Monthsof the Epidemic and Forward ProjectionsWHO Ebola Response Team*AbstractAddress reprint requests to Dr. ChristlDonnelly at c.donnelly@imperial.ac.ukor Dr. Christopher Dye at dyec@who.int.*The authors (members of the WorldHealth Organization [WHO] Ebola Responseteam who contributed to this article)are listed in the Appendix.This article was published on September 23,2014, at NEJM.org.N Engl J Med 2014;371:1481-95DOI: 10.1056/NEJMoa1411100Copyright . 2014 World Health Organization.BackgroundOn March 23, 2014, the World Health Organization (WHO) was notified of an outbreakof Ebola virus disease (EVD) in Guinea. On August 8, the WHO declared theepidemic to be a public health emergency of international concern.MethodsBy September 14, 2014, a total of 4507 probable and confirmed cases, including2296 deaths from EVD (Zaire species) had been reported from five countries inWest Africa Guinea, Liberia, Nigeria, Senegal, and Sierra Leone. We analyzed adetailed subset of data on 3343 confirmed and 667 probable Ebola cases collectedin Guinea, Liberia, Nigeria, and Sierra Leone as of September 14.ResultsThe majority of patients are 15 to 44 years of age (49.9% male), and we estimate thatthe case fatality rate is 70.8% (95% confidence interval [CI], 69 to 73) among personswith known clinical outcome of infection. The course of infection, includingsigns and symptoms, incubation period (11.4 days), and serial interval (15.3 days),is similar to that reported in previous outbreaks of EVD. On the basis of the initialperiods of exponential growth, the estimated basic reproduction numbers (R0) are1.71 (95% CI, 1.44 to 2.01) for Guinea, 1.83 (95% CI, 1.72 to 1.94) for Liberia, and2.02 (95% CI, 1.79 to 2.26) for Sierra Leone. The estimated current reproductionnumbers (R) are 1.81 (95% CI, 1.60 to 2.03) for Guinea, 1.51 (95% CI, 1.41 to 1.60)for Liberia, and 1.38 (95% CI, 1.27 to 1.51) for Sierra Leone; the correspondingdoubling times are 15.7 days (95% CI, 12.9 to 20.3) for Guinea, 23.6 days (95% CI,20.2 to 28.2) for Liberia, and 30.2 days (95% CI, 23.6 to 42.3) for Sierra Leone. Assumingno change in the control measures for this epidemic, by November 2, 2014,the cumulative reported numbers of confirmed and probable cases are predicted tobe 5740 in Guinea, 9890 in Liberia, and 5000 in Sierra Leone, exceeding 20,000 intotal.ConclusionsThese data indicate that without drastic improvements in control measures, thenumbers of cases of and deaths from EVD are expected to continue increasing fromhundreds to thousands per week in the coming months.The New England Journal of MedicineDownloaded from nejm.org on November 3, 2014. For personal use only. No other uses without permission.Copyright 2014 Massachusetts Medical Society. All rights reserved.Th e new england journal o f medicine1482 n engl j med 371;16 nejm.org october 16, 2014A s of September 14, 2014, a total of4507 confirmed and probable cases ofEbola virus disease (EVD), as well as 2296deaths from the virus, had been reported fromfive countries in West Africa Guinea, Liberia,Nigeria, Senegal, and Sierra Leone. In terms ofreported morbidity and mortality, the currentepidemic of EVD is far larger than all previousepidemics combined. The true numbers of casesand deaths are certainly higher. There are numerousreports of symptomatic persons evadingdiagnosis and treatment, of laboratory diagnosesthat have not been included in national databases,and of persons with suspected EVD who wereburied without a diagnosis having been made.1The epidemic began in Guinea during December2013,2 and the World Health Organization(WHO) was officially notified of the rapidlyevolving EVD outbreak on March 23, 2014. OnAugust 8, the WHO declared the epidemic to bea public health emergency of international concern.3 By mid-September, 9 months after thefirst case occurred, the numbers of reportedcases and deaths were still growing from weekto week despite multinational and multisectoralefforts to control the spread of infection.1 Theepidemic has now become so large that the threemost-affected countries Guinea, Liberia, andSierra Leone face enormous challenges in implementingcontrol measures at the scale requiredto stop transmission and to provide clinicalcare for all persons with EVD.Because Ebola virus is spread mainly throughcontact with the body fluids of symptomaticpatients, transmission can be stopped by a combinationof early diagnosis, contact tracing, patientisolation and care, infection control, andsafe burial.1 Before the current epidemic in WestAfrica, outbreaks of EVD in central Africa hadbeen limited in size and geographic spread,typically affecting one to a few hundred persons,mostly in remote forested areas.4 The largestprevious outbreak occurred in the districts ofGulu, Masindi, and Mbarara in Uganda.5 Thisoutbreak, which generated 425 cases over thecourse of 3 months from October 2000 to January2001,6 was controlled by rigorous applicationof interventions to minimize further transmission delivered through the local health caresystem, with support from international partners.5,7,8We now report on the clinical and epidemiologiccharacteristics of the epidemic in Guinea,Liberia, Nigeria, and Sierra Leone during thefirst 9 months of the epidemic (as of September,14, Senegal had reported only a single case). Wedocument trends in the epidemic thus far andproject expected case numbers for the comingweeks if control measures are not enhanced.MethodsSurveillanceFull details of the methods, along with sensitivityand uncertainty analyses, are provided in SupplementaryAppendix 1, available with the full textof this article at NEJM.org; a summary is providedhere. Case definitions for EVD have beenreported previously by the WHO.9 In brief, a suspectedcase is illness in any person, alive or dead,who has (or had) sudden onset of high fever andhad contact with a person with a suspected,probable, or confirmed Ebola case or with a deador sick animal; any person with sudden onset ofhigh fever and at least three of the followingsymptoms: headache, vomiting, anorexia or lossof appetite, diarrhea, lethargy, stomach pain,aching muscles or joints, difficulty swallowing,breathing difficulties, or hiccupping; or any personwho had unexplained bleeding or who diedsuddenly from an unexplained cause. A probablecase is illness in any person suspected to haveEVD who was evaluated by a clinician or any personwho died from suspected Ebola and had anepidemiologic link to a person with a confirmedcase but was not tested and did not have laboratoryconfirmation of the disease. A probable orsuspected case was classified as confirmed whena sample from the person was positive for Ebolavirus in laboratory testing.Clinical and demographic data were collectedwith the use of a standard case investigation form(see Supplementary Appendix 1) on confirmed,probable, and suspected EVD cases identifiedthrough clinical care, including hospitalization,and through contact tracing in Guinea, Liberia,Nigeria, and Sierra Leone. To create the fullestpossible picture of the unfolding epidemic, thesedata were supplemented by information collectedin informal case reports, by data from diagnosticlaboratories, and from burial records. Thedata recorded for each case included the districtof residence, the district in which the diseasewas reported, the patients age, sex, and signsThe New England Journal of MedicineDownloaded from nejm.org on November 3, 2014. For personal use only. No other uses without permission.Copyright 2014 Massachusetts Medical Society. All rights reserved.Ebola Virus Disease in West African engl j med 371;16 nejm.org october 16, 2014 1483and symptoms, the date of symptom onset andof case detection, the name of the hospital, thedate of hospitalization, and the date of death ordischarge. A subgroup of case patients providedinformation on potentially infectious contactswith other persons who had Ebola virus disease,including possible exposure at funerals. Wepresent here the results from analyses of detaileddata on individual confirmed and probablecases recorded by each country in databasesprovided to the WHO as of September 14, 2014;analyses of confirmed and probable cases, togetherwith suspected cases, are provided inSupplementary Appendix 1.Ethical ConsiderationsThis study is based on data collected during surveillanceand response activities for EVD inGuinea, Liberia, Nigeria, and Sierra Leone. Allinformation on individual patients has been anonymizedfor presentation.Clinical Manifestations and Case Fatality RateWe report on the frequency of symptoms in patientswith confirmed and probable EVD casesoverall and by country. We evaluated potentialrisk factors for a fatal outcome, including sex,age group (