Abstract
Interim results from the Guinea Ebola ring vaccination trial suggest high efficacy of the rVSV-ZEBOV vaccine. These findings open the door to the use of ring vaccination strategies in which the contacts and contacts of contacts of each index case are promptly vaccinated to contain future Ebola virus disease outbreaks. To provide a numerical estimate of the effectiveness of ring vaccination strategies we introduce a spatially explicit agent-based model to simulate Ebola outbreaks in the Pujehun district, Sierra Leone, structurally similar to previous modelling approaches. We find that ring vaccination can successfully contain an outbreak for values of the effective reproduction number up to 1.6. Through an extensive sensitivity analysis of parameters characterising the readiness and capacity of the health care system, we identify interventions that, alongside ring vaccination, could increase the likelihood of containment. In particular, shortening the time from symptoms onset to hospitalisation to 2–3 days on average through improved contact tracing procedures, adding a 2km spatial component to the vaccination ring, and decreasing human mobility by quarantining affected areas might contribute increase our ability to contain outbreaks with effective reproduction number up to 2.6. These results have implications for future control of Ebola and other emerging infectious disease threats.
Highlights
The 2014–15 Ebola virus disease (EVD) epidemic in West Africa was the largest Ebola outbreak ever documented with a total of 28,646 cases and 11,323 deaths reported as of March 30, 2016 [1, 2]
The rVSV-ZEBOV vaccine was developed during the course of the epidemic and underwent a clinical trial demonstrating 100% efficacy when vaccinating contacts and contacts of contacts of confirmed Ebola cases
Through a modelling study on a region of Sierra Leone, we provide numerical estimates for the effectiveness of ring vaccination: we show that outbreaks with moderate transmission potential, with no more than 1.6 secondary cases generated by an index case on average, can be successfully contained; more extensive vaccination(e.g., including spatial rings around index cases) and reinforcement of the healthcare system would increase the likelihood of containment even if the virus were more transmissible than in the past
Summary
The 2014–15 Ebola virus disease (EVD) epidemic in West Africa was the largest Ebola outbreak ever documented with a total of 28,646 cases and 11,323 deaths reported as of March 30, 2016 [1, 2]. I.e., clusters, were defined as the contacts and contacts of contacts of confirmed EVD cases. Ring vaccination strategies were instrumental in the elimination of local outbreaks of smallpox during the eradication phase [5]. Modelling results highlighted the time from symptom onset to case isolation and the fraction of contacts identified by contact tracing as the most important factors determining the success of ring vaccination strategies. Questions remain about whether a ring vaccination strategy can be effective in containing EVD outbreaks, such as the EVD flare-up observed in West Africa in 2016 [2]
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