Abstract
BackgroundEbola is one of the most virulent human viral diseases, with a case fatality ratio between 25% to 90%. The 2014 West African outbreaks are the largest and worst in history. There is no specific treatment or effective/safe vaccine against the disease. Hence, control efforts are restricted to basic public health preventive (non-pharmaceutical) measures. Such efforts are undermined by traditional/cultural belief systems and customs, characterized by general mistrust and skepticism against government efforts to combat the disease. This study assesses the roles of traditional customs and public healthcare systems on the disease spread.MethodsA mathematical model is designed and used to assess population-level impact of basic non-pharmaceutical control measures on the 2014 Ebola outbreaks. The model incorporates the effects of traditional belief systems and customs, along with disease transmission within health-care settings and by Ebola-deceased individuals. A sensitivity analysis is performed to determine model parameters that most affect disease transmission. The model is parameterized using data from Guinea, one of the three Ebola-stricken countries. Numerical simulations are performed and the parameters that drive disease transmission, with or without basic public health control measures, determined. Three effectiveness levels of such basic measures are considered.ResultsThe distribution of the basic reproduction number (mathcal {R}_{0}) for Guinea (in the absence of basic control measures) is such that mathcal {R}_{0}in ;[0.77,1.35], for the case when the belief systems do not result in more unreported Ebola cases. When such systems inhibit control efforts, the distribution increases to mathcal {R}_{0}in ;[1.15,2.05]. The total Ebola cases are contributed by Ebola-deceased individuals (22%), symptomatic individuals in the early (33%) and latter (45%) infection stages. A significant reduction of new Ebola cases can be achieved by increasing health-care workers’ daily shifts from 8 to 24 hours, limiting hospital visitation to 1 hour and educating the populace to abandon detrimental traditional/cultural belief systems.ConclusionsThe 2014 outbreaks are controllable using a moderately-effective basic public health intervention strategy alone. A much higher (>50%) disease burden would have been recorded in the absence of such intervention. 2000 Mathematics Subject Classifications 92B05, 93A30, 93C15.
Highlights
Ebola is one of the most virulent human viral diseases, with a case fatality ratio between 25% to 90%
The population of individuals in the community consists of individuals visiting loved ones in health-care facilities and the rest of the general public
When the number of Ebola-infected cremated/buried individuals is chosen as the response function, the key parameters (Figure 8b) are the escape rate from hospitalization of symptomatic individuals, the fraction of symptomatic individuals who recovered in hospital (f ), the fraction of symptomatic individuals who recovered in the community (h) and the traditional/cultural/custom beliefs modification parameters of the community and the health-care workers. These results further emphasize the sensitivity of the simulation results on the response function chosen. These results show that a basic public health strategy that, in addition to the three aspects identified under the worst-case scenario (i.e., decrease φC to a value less than unity, increase recovery rate and decrease transmission rate), ensures that hospitalized people do not harbor detrimental traditional beliefs, will minimize the hospital escape rate, reduce the number and duration of visits in hospitals etc., which will be very effective in curtailing the spread of Ebola virus (EBOV)
Summary
Ebola is one of the most virulent human viral diseases, with a case fatality ratio between 25% to 90%. Control efforts are restricted to basic public health preventive (non-pharmaceutical) measures. Such efforts are undermined by traditional/cultural belief systems and customs, characterized by general mistrust and skepticism against government efforts to combat the disease. The largest, and most devastating, outbreak of EVD is the 2014 epidemic in three West African countries (Guinea, Liberia and Sierra Leone). This EVD outbreak (believed to have started in Guinea in March 2014 [2]) is the first to have occurred in West Africa [4]
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