Abstract
Ebola virus disease (EVD) in health workers (HWs) has been a major challenge during the 2014-2015 outbreak. We examined factors associated with Ebola virus exposure and mortality in HWs in Kenema District, Sierra Leone. We analyzed data from the Sierra Leone National Viral Hemorrhagic Fever Database, contact tracing records, Kenema Government Hospital (KGH) staff and Ebola Treatment Unit (ETU) rosters, and burial logs. From May 2014 through January 2015, 600 cases of EVD originated in Kenema District, including 92 (15%) HWs, 66 (72%) of whom worked at KGH. Among KGH medical staff and international volunteers, 18 of 62 (29%) who worked in the ETU developed EVD, compared with 48 of 83 (58%) who worked elsewhere in the hospital. Thirteen percent of HWs with EVD reported contact with EVD patients, while 27% reported contact with other infected HWs. The number of HW EVD cases at KGH declined roughly 1 month after implementation of a new triage system at KGH and the opening of a second ETU within the district. The case fatality ratio for HWs and non-HWs with EVD was 69% and 74%, respectively. The cluster of HW EVD cases in Kenema District is one of the largest ever reported. Most HWs with EVD had potential virus exposure both inside and outside of hospitals. Prevention measures for HWs must address a spectrum of infection risks in both formal and informal care settings as well as in the community.
Highlights
Ebola virus disease (EVD) in health workers (HWs) has been a major challenge during the 2014–2015 outbreak
Nosocomial transmission has led to major morbidity and mortality in prior and current EVD outbreaks [2,3,4,5,6,7,8,9]
To better understand how HWs became infected, as well as factors associated with infection, we explored potential sources of exposure and clinical variables of EVD in HWs in Kenema District, with a focus on Kenema Government Hospital (KGH)
Summary
We analyzed data from the Sierra Leone National Viral Hemorrhagic Fever Database, contact tracing records, Kenema Government Hospital (KGH) staff and Ebola Treatment Unit (ETU) rosters, and burial logs. We analyzed data for suspected, probable, and confirmed EVD cases in HWs in Kenema District between 1 May 2014 and. We included cases in non-HWs in Kenema District, as well as cases that were transferred to KGH for treatment from other districts in Sierra Leone during this period. We defined an HW as anyone who worked in a healthcare facility or engaged in healing practices (eg, traditional healers) and clinical staff as persons who have traditional patient-care roles and routinely have direct contact with patients (eg, doctors, nurses, and laboratory technicians). Laboratory confirmation of EVD was performed following established protocols [17, 18]
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