African Ebola Virus Disease Outbreak Research Articles

Corneal and Conjunctival Abnormalities in a Cohort of Survivors from the Western African Ebola Virus Disease Outbreak

PurposeTo characterize corneal and conjunctival abnormalities (CCAs) and their impact on visual acuity in a cohort of survivors from the Western African Ebola virus disease (EVD) outbreak. DesignA post hoc analysis of 121 patients, who had previously undergone screening for the Ebola Virus Persistence in Ocular Tissues and Fluids study, was performed. MethodsPatients underwent a comprehensive ophthalmic exam at the Lowell and Ruth Gess Eye Hospital in Freetown, Sierra Leone. Demographic (including age, sex, and the number of days spent in the Ebola treatment unit and examination (such as visual acuity, and ocular complications) data were collected and used for the analysis. Visual acuity was either uncorrected or corrected with spectacles. Descriptive and inferential statistical analyses were performed, and a p-value < 0.05 was considered statistically significant. ResultsA total of 242 eyes (121 patients) were included in this study. The mean age was 31.5 ± 16.1 years, and 70% were female. Of 242 eyes, 28 (11.5%) eyes of 15 patients (12.4%) presented with at least one or more corneal or conjunctival abnormalities. Within eyes that demonstrated CCAs, the findings included dry eye (28.6% of eyes), band keratopathy (25% of eyes), and corneal scar (21.4% of eyes). Corneal edema was found in 14.3% of eyes, while pterygium and epithelial bullae were each found in 7.1% of affected eyes. Patients without CCAs had better visual acuity compared to patients with CCAs although the difference was not statistically significant (0.82 ± 1.17 vs 1.01 ± 1.29, p=0.4). A subset of patients with CCAs also reported ocular symptoms including eye pain, light sensitivity, excessive tearing, and blurry vision. ConclusionIn this post hoc analysis, we observed CCAs in 12% of EVD survivors. These findings highlight the potential for corneal and conjunctival sequelae during EVD survivorship and the need for ongoing ophthalmic care for this vulnerable population.

Factors associated with death in patients admitted with Ebola virus disease to Ebola Treatment Units in Guinea, Sierra Leone, and Liberia – December 2013 to March 2016

Background The 2013-2016 West African Ebola Virus Disease (EVD) outbreak resulted in 28,600 cases and 11,300 deaths officially reported to the World Health Organization. Previous studies investigating factors associated with death had conflicting findings, interventions showing promising outcomes had small sample sizes, studies were often single- or dual-country based and most focused on laboratory-confirmed EVD and not on clinically-suspected EVD. We used the Ebola data platform of the Infectious Disease Data Observatory (IDDO) to review individual patient records to assess factors associated with death, and particularly whether there were differences between laboratory-confirmed and clinically-suspected cases. Methods This was a cohort study involving analysis of secondary data in the IDDO database. The study population included all patients classified as having either clinically-suspected or laboratory-confirmed EVD, admitted to 22 Ebola Treatment Units (ETU) in Guinea, Liberia and Sierra Leone between December 2013 and March 2016. Baseline characteristics and treatments were documented along with ETU exit outcomes. Factors associated with death were investigated by multivariable modified Poisson regression. Results There were 14,163 patients, of whom 6,208 (43.8%) were laboratory-confirmed and 7,955 (56.2%) were clinically-suspected. Outcomes were not recorded in 2,889 (20.4%) patients. Of the 11,274 patients with known outcomes, 4,090 (36.3%) died: 2,956 (43.6%) with laboratory-confirmed EVD and 1,134 (18.8%) with clinically-suspected EVD. The strongest risk factor for death was confirmed disease status. Patients with laboratory-confirmed disease had 2.9 times higher risk of death compared to clinically-suspected patients, after adjusting for other co-variables. Other factors significantly associated with death included a higher risk for patients aged ≥60 years and a lower risk for patients in Sierra Leone. Conclusions Although laboratory-confirmed patients admitted to ETUs fared worse than clinically-suspected patients, the latter still had a substantial risk of death and more attention needs to be paid to this group in future EVD outbreaks.

Disease Control and Ebola in West Africa: a Qualitative Evidence Synthesis

Aims: The West African Ebola Virus Disease (EVD) outbreak of 2014-2016 was the most disastrous EVD epidemic in history. We aimed to investigate and provide unique theoretical insights which could help inform future responses to EVD outbreaks. Methods: After searching five key databases in May 2021 and February 2022 (Medline, Embase, PubMed, Scopus and Cumulative Index of Nursing and Allied Health Literature (CINAHL)), 412 papers were collected. Following abstract and full text screening, 35 papers were identified for inclusion. Coded data was synthesised in accordance with the protocol set out by Thomas and Hardon. Findings: Regarding geographical context, most fieldwork underpinning included studies was conducted within Western Urban Area in Sierra Leone, suggesting that some geographical discrepancy exists within the literature base. In terms of quality, some issues were identified regarding researcher reflexivity, ethical procedures and data analysis. Following thematic synthesis, it was found that beliefs and/or practices relating to distrust, fear, socio-cultural considerations and denial hindered engagement with control measures. By contrast, experiencing the virus first-hand and engaging with survivors prompted the uptake of such measures. Building from these findings, we then proposed an amendment to Barry Hewlett’s Evolutionary Cultural Anthropology (ECA) framework, shedding light on the determinants of such beliefs and/or practices. Conclusion: Our review provides a systematic mapping of which beliefs and/or practices either promoted or hindered response efforts during the outbreak as well as an authentic and holistic way of understanding why such beliefs and/or practices emerged, by synthesising Hewlett’s ECA framework with our findings. By drawing from our cross contextual analysis, health professionals throughout West Africa and beyond could use this work in further reflecting on and guiding the implementation of control measures prior or during future EVD outbreaks.

Evaluation and comparison of three virucidal agents on inactivation of Nipah virus

Modern human activity is profoundly changing our relationship with microorganisms with the startling rise in the rate of emerging infectious diseases. Nipah virus together with Ebola virus and SARS-CoV-2 are prominent examples. Since COVID-19 and the West African Ebola virus disease outbreak, different chemical disinfectants have been developed for preventing the direct spread of viruses and their efficacy has also been evaluated. However, there are currently no published efficacy studies for the chemical disinfection of Nipah virus. In this study, the virucidal efficacy of three disinfectants (Micro-Chem Plus detergent disinfectant cleaner, FWD and Medical EtOH) against Nipah virus was evaluated in quantitative suspension tests including. Our results showed that the > 4 log reduction achieved for all products in inactivating Nipah virus in 15 s. Even, 19% ethanol was able to inactivate Nipah virus when applied for at least 8 min contact time. Comparative analysis displayed virucidal efficacy of each of the evaluated disinfectants against SARS-CoV-2, Ebola virus and Nipah virus, with only minor differences in working concentrations and contact times required for complete inactivation. We expect that our study can assist in decontamination in healthcare settings and high level biosafety laboratories and can be beneficial to control for emerging enveloped viruses.

Post-Ebola sequelae among Ebola child survivors in Sierra Leone

BackgroundThere are limited data regarding the long-term health effects of child survivors of the 2013-2016 West African Ebola virus disease (EVD) outbreak. Here, we assess post-Ebola sequelae among EVD child survivors by comparing the self-reported symptoms between EVD child survivors and their close household contacts over one year after the end of the outbreak.MethodsEVD child survivors(n=159) and their close contacts(n=303) were enrolled in Western and Eastern Sierra Leone. Demographics and self-reported symptoms data were collected using an interviewer-administered questionnaire. We compared a list of self-reported symptoms between EVD child survivors and their close household contacts using backward stepwise logistic regression.ResultsEVD child survivors were more likely to be orphans compared to their close contacts. Musculoskeletal, ocular, auditory and neurological symptoms were more prevalent among Ebola child survivors than their close contacts (p<0.001). Joint pain and headache were the most common self-reported symptoms in EVD child survivors and their close contacts. Joint pain (AOR=2.633; 95 % CI:1.31-5.28, p=0.006), eye pain (AOR=4.56;95 %CI: 2.16-9.64, p<0.001), hearing loss (AOR=3.85; 95 %CI: 1.15-12.87, p=0.029), memory impairment (AOR=7.76;0.95 %CI: 1.34-45.01 p=0.022), mood changes (AOR=5.07; 95 %CI: 2.35-10.94, p<0.001) were more common among survivors than their contacts.ConclusionsOur data suggest that EVD child survivors have higher odds than their close contacts of suffering from musculoskeletal, ophthalmic, auditory and neurological impairment more than a year after the end of the EVD outbreak. Routine screening, treatment and monitoring of these symptoms is required to prevent long-term disability among EVD child survivors.

Implementation of the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) study: Lessons learned for vision health systems strengthening in Sierra Leone.

BackgroundFollowing the West African Ebola virus disease (EVD) outbreak of 2013–2016 and more recent EVD outbreaks in the Democratic Republic of Congo, thousands of EVD survivors are at-risk for sequelae including uveitis, which can lead to unremitting inflammation and vision loss from cataract. Because of the known risk of Ebola virus persistence in ocular fluid and the need to provide vision-restorative, safe cataract surgery, the Ebola Virus Persistence in Ocular Tissues and Fluids (EVICT) Study was implemented in Sierra Leone. During implementation of this multi-national study, challenges included regulatory approvals, mobilization, community engagement, infection prevention and control, and collaboration between multiple disciplines. In this report, we address the multifacted approach to address these challenges and the impact of implementation science research to address an urgent clinical subspecialty need in an outbreak setting.Methodology/Principal findingsGiven the patient care need to develop a protocol to evaluate ocular fluid for Ebola virus RNA persistence prior to cataract surgery, as well as protocols to provide reassurance to ophthalmologists caring for EVD survivors with cataracts, the EVICT study was designed and implemented through the work of the Ministry of Health, Sierra Leone National Eye Programme, and international partnerships. The EVICT study showed that all 50 patients who underwent ocular fluid sampling at 19 and 34 months, respectively, tested negative for Ebola virus RNA. Thirty-four patients underwent successful cataract surgery with visual acuity improvement. Here we describe the methodology for study implementation, challenges encountered, and key issues that impacted EVD vision care in the immediate aftermath of the EVD outbreak. Key aspects of the EVICT study included defining the pertinent questions and clinical need, partnership alignment with key stakeholders, community engagement with EVD survivor associations, in-country and international regulatory approvals, study site design for infection prevention and control, and thorough plans for EVD survivor follow-up care and monitoring. Challenges encountered included patient mobilization owing to transportation routes and distance of patients in rural districts. Strong in-country partnerships and multiple international organizations overcame these challenges so that lessons learned could be applied for future EVD outbreaks in West and Central Africa including EVD outbreaks that are ongoing in Guinea and Democratic Republic of Congo.Conclusions/SignificanceThe EVICT Study showed that cataract surgery with a protocol-driven approach was safe and vision-restorative for EVD survivors, which provided guidance for EVD ophthalmic surgical care. Ophthalmologic care remains a key aspect of the public health response for EVD outbreaks but requires a meticulous, yet partnered approach with international and local in-country partners. Future efforts may build on this framework for clinical care and to improve our understanding of ophthalmic sequelae, develop treatment paradigms for EVD survivors, and strengthen vision health systems in resource-limited settings.

Meta-analysis of predictive symptoms for Ebola virus disease.

IntroductionOne of the leading challenges in the 2013–2016 West African Ebola virus disease (EVD) outbreak was how best to quickly identify patients with EVD, separating them from those without the disease, in order to maximise limited isolation bed capacity and keep health systems functioning.MethodologyWe performed a systematic literature review to identify all published data on EVD clinical symptoms in adult patients. Data was dual extracted, and random effects meta-analysis performed for each symptom to identify symptoms with the greatest risk for EVD infection.ResultsSymptoms usually presenting late in illness that were more than twice as likely to predict a diagnosis of Ebola, were confusion (pOR 3.04, 95% CI 2.18–4.23), conjunctivitis (2.90, 1.92–4.38), dysphagia (1.95, 1.13–3.35) and jaundice (1.86, 1.20–2.88). Early non-specific symptoms of diarrhoea (2.99, 2.00–4.48), fatigue (2.77, 1.59–4.81), vomiting (2.69, 1.76–4.10), fever (1.97, 1.10–4.52), muscle pain (1.65, 1.04–2.61), and cough (1.63, 1.24–2.14), were also strongly associated with EVD diagnosis.ConclusionsThe existing literature fails to provide a unified position on the symptoms most predictive of EVD, but highlights some early and late stage symptoms that in combination will be useful for future risk stratification. Confirmation of these findings across datasets (or ideally an aggregation of all individual patient data) will aid effective future clinical assessment, risk stratification tools and emergency epidemic response planning.

Learning from the Epidemiological Response to the 2014/15 Ebola Virus Disease Outbreak

A large international response was needed to bring the 2014/15 West African Ebola virus disease outbreak under control. This study sought to learn lessons from this epidemic to strengthen the response to future outbreaks of international significance by identifying priorities for future epidemiology training and response. Epidemiologists who were deployed to West Africa were recruited through a snowball sampling method and surveyed using an online anonymous questionnaire. Associations between demographics, training, qualifications, and role while in-country were explored alongside respondents’ experience during deployment. Of 128 responses, 105 met the inclusion criteria. Respondents originated from 25 countries worldwide, for many (62%), this was their first deployment abroad. The most common tasks carried out while deployed were surveillance, training, contact tracing, and cluster investigation. Epidemiologists would value more detailed predeployment briefings including organizational aspects of the response. Gaps in technical skills reported were mostly about geographical information systems; however, epidemiologists identified the need for those deployed in future to have greater knowledge about roles and responsibilities of organizations involved in the response, better cultural awareness, and leadership and management skills. Respondents felt that the public health community must improve the timeliness of the response in future outbreaks and strengthen collaboration and coordination between organizations.

Caring for patients with Ebola virus disease: Are U.S. biocontainment centers ready for the next outbreak?

The 2014 West African Ebola virus disease (EVD) outbreak is the largest and deadliest EVD epidemic to date, resulting in fivefold more cases than all other outbreaks combined. This outbreak was particularly devastating to healthcare workers in West Africa and resulted in several EVD patients being medically evacuated for treatment in the U.S. and Europe. Governmental agencies provide recommendations for triaging and testing patients with EVD, however best laboratory practices are still unknown and are very resource dependent.

Development of a screening eye clinic for Ebola virus disease survivors: Lessons learned and rapid implementation at ELWA Hospital in Monrovia, Liberia 2015.

BackgroundIn the wake of the West African Ebola virus disease (EVD) outbreak of 2014–2016, thousands of EVD survivors began to manifest a constellation of systemic and ophthalmic sequelae. Besides systemic arthralgias, myalgias, and abdominal pain, patients were developing uveitis, a spectrum of inflammatory eye disease leading to eye pain, redness, and vision loss. To investigate this emerging eye disease, resources and equipment were needed to promptly evaluate this sight-threatening condition, particularly given our identification of Ebola virus in the ocular fluid of an EVD survivor during disease convalescence.Methodology/Principal findingsA collaborative effort involving ophthalmologists, infectious disease specialists, eye care nurses, and physician leadership at Eternal Love Winning Africa (ELWA) Hospital in Liberia led to the development of a unique screening eye clinic for EVD survivors to screen, treat, and refer patients for more definitive care. Medications, resources, and equipment were procured from a variety of sources including discount websites, donations, purchasing with humanitarian discounts, and limited retail to develop a screening eye clinic and rapidly perform detailed ophthalmologic exams. Findings were documented in 96 EVD survivors to inform public health officials and eye care providers of the emerging disease process. Personal protective equipment was tailored to the environment and implications of EBOV persistence within intraocular fluid.Conclusions/SignificanceA screening eye clinic was feasible and effective for the rapid screening, care, and referral of EVD survivors with uveitis and retinal disease. Patients were screened promptly for an initial assessment of the disease process, which has informed other efforts within West Africa related to immediate patient care needs and our collective understanding of EVD sequelae. Further attention is needed to understand the pathogensis and treatment of ophthalmic sequelae given recent EVD outbreaks in West Africa and ongoing outbreak within Democratic Republic of Congo.

Adherence to Universal Travel Screening in the Emergency Department During Epidemic Ebola Virus Disease

BackgroundDuring the 2014 West African Ebola Virus Disease (EVD) outbreak, the U.S. Centers for Disease Control and Prevention recommended that all emergency department (ED) patients undergo travel screening for risk factors of importing EVD. ObjectivesWe sought to determine the overall adherence rate to the recommended travel screening protocol and to identify factors associated with nonadherence to the protocol. MethodsWe conducted a multicenter, retrospective analysis of adherence to the travel screening program in an academic hospital and three affiliated community hospitals. A regression model identified patient and hospital factors associated with nonadherence. ResultsOf the 147,062 patients included for analysis, 93.7% (n = 137,834) had travel screenings completed. We identified several characteristics of patients that were most likely to be missed by the screening protocol—patients with low English proficiency, patients who arrive via ambulance or helicopter, and patients with more severe illness or injury based on initial triage acuity. ConclusionsThese findings should be used to improve adherence to the travel screening protocol for future emerging infectious disease threats.

Determining the Efficacy, Safety and Suitability of Disinfectants to Prevent Emerging Infectious Disease Transmission

The scale of the 2014–2017 West African Ebola Virus Disease outbreak overwhelmed the international response capacity. This has led to inconsistencies in international guidance documents, particularly around chlorine disinfection of surfaces and hands to prevent transmission. To provide evidence for the disinfection recommendations, three research strands were conducted: (1) impacts of chlorine chemistry; (2) efficacy of surface cleaning recommendations; and (3) safety and efficacy of handwashing recommendations. Strand 1 research found that the compound chemistry of the chlorine source has an impact on the chlorine solution shelf-life (&lt;1 day–30 days), with testing of chlorine solutions recommended to ensure accuracy. Strand 2 research found that surface cleaning with 0.5% chlorine solutions with a 15-min exposure time is efficacious in reducing transmission risk. Strand 3 research found that community handwashing with chlorine solutions is as safe and efficacious as handwashing with soap and water or sanitizer, which offers a benefit of reducing pathogens in the rinsing water. Using calcium hypochlorite as the chlorine source compound provided a particularly good performance in chemistry and handwashing studies. The research was successful at providing information to align with the inconsistent international guidelines. Further research is needed to proactively establish the efficacy, safety and suitability of disinfection for the seven viral pathogens that are considered likely to cause severe outbreaks with few/no medical countermeasures.

DNA-launched RNA replicon vaccines induce potent anti-Ebolavirus immune responses that can be further improved by a recombinant MVA boost

There are currently no licensed therapeutic treatment or preventive vaccines against Ebolavirus disease, and the 2013–2016 West African outbreak of Ebolavirus disease spread rapidly and resulted in almost 30,000 cases and more than 11,000 deaths. However, the devastating outbreak has spurred the development of novel Ebolavirus vaccines. Here, we demonstrate that alphavirus-based DNA-launched self-replicating RNA replicon vaccines (DREP) encoding either the glycoprotein (GP) gene or co-expressing the GP and VP40 genes of Sudan or Zaire Ebolavirus are immunogenic in mice inducing both binding and neutralizing antibodies as well as CD8 T cell responses. In addition, antibodies were cross-reactive against another Ebolavirus, although the specificity was higher for the vaccination antigen. DREP vaccines were more immunogenic than recombinant MVA vaccines expressing the same Ebolavirus antigens. However, a DREP prime followed by an MVA boost immunization regimen improved vaccine immunogenicity as compared to DREP and MVA homologous prime-boost immunizations. Moreover, we show that a bivalent approach targeting both Sudan and Zaire Ebolavirus can be employed without significant loss of immunity. This opens for further investigation of a pan-Ebolavirus or even a pan-filovirus vaccine.

Meta-Analysis of predictive symptoms for Ebola virus disease in West Africa

Background: One of the leading challenges in the West African Ebola virus disease (EVD) outbreak in 2014/15 was how best to quickly identify patients with Ebola, separating them from those without the disease. This meta-analysis aggregates all available data on symptom predictors for Ebola. This will enable quicker diagnosis of probable cases in resource-limited settings, and earlier stratification of patients as high-risk, permitting appropriate clinical and public health precautions to be taken. Methods & Materials: Identification of relevant existing literature was performed by an online search in MEDLINE and EMBASE for studies published from 1st January 1946 to 11th September 2017. The MESH headings (keywords) included “ebola” and “symptom*” or “clinical” or “predict*” or “suspect*”. The initial search on MEDLINE and EMBASE produced 4380 results. After exclusion criteria and further review, there were seven papers that met our criteria. For each predictive symptom investigated, EVD and non-EVD patients were aggregated across studies. We then used a random effects meta-analysis model in STATA. This provided a pooled odds ratio along with 95% confidence intervals and a p-value, for each symptom; with detailed forest plots. Results: Fatigue was the most predictive for Ebola (OR 3.29, 95% CI 1.89-5.71), with anorexia (OR 3.11, 95% CI 1.40-6.94), confusion (OR 3.04, 95 CI 2.18-4.23) diarrhoea (OR 3.02, 95% CI 1.89-4.85), conjunctivitis (OR 2.99, 95% CI 1.77-5.04), vomiting (OR 2.89, 95% CI 1.79-4.67), fever (OR 2.37, 95% CI 1.33-4.21), hiccups (OR 2.25, 95% CI 1.23-4.08) and dysphagia (OR 2.22, 95% CI 1.18-4.18) all more than twice as likely in Ebola cases. Chest pain, bleeding, and sore throat were not statistically significant predictors of Ebola. Conclusion: Existing literature fails to provide a unified position on the most predictive symptoms for Ebola. This analysis demonstrates that late presenting symptoms including confusion, anorexia, conjunctivitis and hiccups are predictive for Ebola. However, early non-specific symptoms of fatigue, fever, diarrhoea, vomiting were also highly predictive. These findings will aid effective future clinical assessment, risk stratification tools and emergency epidemic response.

Assessment of exposure and serostatus of contacts persons to Ebola virus disease cases in Guinea (Contactebogui study)

The West African Ebola virus disease (EVD) outbreak has resulted in 28,616 confirmed or suspected cases. Contact tracing and quarantine for 21 days were key actions. However, data on exposure to EVD cases, the proportion of antibodies to EBOV and of a- or pauci-symptomatic infection, as well as the presence of virus in body fluids of seropositive contact persons, remain scarce. The study aimed: –to quantify individual risk of exposure of contact persons to EVD cases; –to measure the presence of antibodies to EBOV; –to look for EBOV RNA in semen of adult seropositive men. Persons living in the same compounds than patients enrolled in a survivors’ cohort in Guinea in Conakry, Forecariah, Nzérékoré and Macenta (Postebogui) were invited to participate. After consent, a questionnaire detailing exposure to EVD cases was passed to establish a score of exposure and a history of vaccination with rVSV-ZEBOV vaccine was recalled. Antibodies to GP, NP and VP40 proteins were assessed using Luminex® and EBOV RNA in semen was analysed by PCR. As of September 30, 2017, 1721 individuals were enrolled (51% males, median age 22 years [17–32]) and have accumulated 3074 exposures. Overall, 18.5% declared to have been vaccinated and 80% were exposed to less than 3 EVD cases (median = 1 [1–2]). Zero to moderate risk exposure, one high-risk exposure and 2+ high-risk exposures per contacts person were estimated at 3%, 67% and 30%, respectively. Serology was available for 1716 contact persons: 53/1716 (3.1%) had antibodies to GP + NP, 32/1579 (2.0%) to GP + NP + VP40 and are strongly suspected to have been infected with EBV. In addition, 35/1579 (2.2%) patients had antibodies to NP + VP40, 78/1579 (4.9%) to GP + VP40 and 364 (23.0%) to a single antigen, GP (n = 267, 15.6%), NP (n = 79, 4.6%) or VP40 (n = 157/1579, 9.9%). A history of vaccination was associated with antibodies to GP (23.3% vs. 13.8%, P < 10−3). There was a trend with the number of high-risk exposures in GP + NP + VP40 (P = 0.003), GP + NP (P = 0.03), GP + VP40 (0.09) and NP + VP40 (P = 0.003). EBOV RT-PCR was negative in semen of the tested men. Among the contact persons, 3.3% had an antibody profile (GP + NP or GP + NP + VP) corresponding to an EVD infection suggesting a-/pauci-symptomatic infection but various other antibodies profiles were observed. A trend of the antibodies profiles with the number of high-risk exposures was observed. Among the individuals vaccinated with the GP vaccine, antibodies to GP were observed in 23%.

Active Monitoring of Travelers for Ebola Virus Disease-New York City, October 25, 2014-December 29, 2015.

The CDC recommended active monitoring of travelers potentially exposed to Ebola virus during the 2014 West African Ebola virus disease outbreak, which involved daily contact between travelers and health authorities to ascertain the presence of fever or symptoms for 21 days after the travelers' last potential Ebola virus exposure. From October 25, 2014, to December 29, 2015, the New York City Department of Health and Mental Hygiene (DOHMH) monitored 5,359 persons for Ebola virus disease, corresponding to 5,793 active monitoring events. Most active monitoring events were in travelers classified as low (but not zero) risk (n = 5,778; 99%). There were no gaps in contact with DOHMH of ≥2 days during 95% of active monitoring events. Instances of not making any contact with travelers decreased after CDC began distributing mobile telephones at the airport. Ebola virus disease-like symptoms or a temperature ≥100.0°F were reported in 122 (2%) active monitoring events. In the final month of active monitoring, an optional health insurance enrollment referral was offered for interested travelers, through which 8 travelers are known to have received coverage. Because it is possible that active monitoring will be used again for an infectious threat, the experience we describe might help to inform future such efforts.

Analysing published global Ebola Virus Disease research using social network analysis.

IntroductionThe 2014/2015 West African Ebola Virus Disease (EVD) outbreak attracted global attention. Numerous opinions claimed that the global response was impaired, in part because, the EVD research was neglected, although quantitative or qualitative studies did not exist. Our objective was to analyse how the EVD research landscape evolved by exploring the existing research network and its communities before and during the outbreak in West Africa.Methods/ Principal findingsSocial network analysis (SNA) was used to analyse collaborations between institutions named by co-authors as affiliations in publications on EVD. Bibliometric data of publications on EVD between 1976 and 2015 was collected from Thomson Reuters’ Web of Science Core Collection (WoS). Freely available software was used for network analysis at a global-level and for 10-year periods. The networks are presented as undirected-weighted graphs. Rankings by degree and betweenness were calculated to identify central and powerful network positions; modularity function was used to identify research communities. Overall 4,587 publications were identified, of which 2,528 were original research articles. Those yielded 1,644 authors’ affiliated institutions and 9,907 connections for co-authorship network construction. The majority of institutions were from the USA, Canada and Europe. Collaborations with research partners on the African continent did exist, but less frequently. Around six highly connected organisations in the network were identified with powerful and broker positions. Network characteristics varied widely among the 10-year periods and evolved from 30 to 1,489 institutions and 60 to 9,176 connections respectively. Most influential actors are from public or governmental institutions whereas private sector actors, in particular the pharmaceutical industry, are largely absent.Conclusion/ SignificanceResearch output on EVD has increased over time and surged during the 2014/2015 outbreak. The overall EVD research network is organised around a few key actors, signalling a concentration of expertise but leaving room for increased cooperation with other institutions especially from affected countries. Finding innovative ways to maintain support for these pivotal actors while steering the global EVD research network towards an agenda driven by agreed, prioritized needs and finding ways to better integrate currently peripheral and newer expertise may accelerate the translation of research into the development of necessary live saving products for EVD ahead of the next outbreak.

What Do We Know About Controlling Ebola Virus Disease Outbreaks?

The West African Ebola Virus Disease outbreak was unprecedented in size, dwarfing all previous outbreaks by some magnitude. Nearly, more than 28 000 people had been infected, with more than 11 000 deaths recorded. This review article will highlight some of the major public health and therapeutic advances realised during this outbreak, as well as pointing readers to key review articles on the different aspects of disease control. It will describe the multifaceted international response and detail how the response efforts allied traditional public health approaches and novel models of intervention. It will review the shift from a humanitarian response paradigm to real-time evidence-based decision making, including modelling of potential interventions, novel interventional treatment studies, and pragmatic vaccine trials.

The Understanding of Ebola Virus Disease (EVD) Among Medical Practitioners of Karachi, Pakistan.

The World Health Organization (WHO) has acknowledged the large West African Ebola virus disease (EVD) outbreak to be a community health disaster of global concern, and the spread of disease demands a synchronized response. Medical practitioners have an increased risk of contracting the disease as compared to others as they are directly exposed to patients’ blood or fluids. This study evaluated the knowledge of medical practitioners in Karachi regarding EVD. It was descriptive and exploratory in nature and took place over a period of 4 months, i.e., August 2016 to November 2016. The respondents were randomly selected by convenience sampling and surveyed with a 20-item questionnaire. Overall, 403 questionnaires were included in the study and a response rate of 80.6% was achieved. The majority (56.3%) considered themselves to be somewhat knowledgeable; females had more knowledge as compared to male (p < 0.003). More than 80% knew about the 2014 Ebola outbreak in West Africa. Interestingly, the findings revealed that respondents’ knowledge about diagnosis and identification of EVD is good. Respondents considered EVD a severe disease and emphasized on the need for protective measures when contacting affected patients. Interventions should be tailored to focus on areas where respondents showed a lack of knowledge about the disease.

Selection of a Biosafety Level 1 (BSL-1) surrogate to evaluate surface disinfection efficacy in Ebola outbreaks: Comparison of four bacteriophages.

The 2014 West African Ebola virus disease outbreak was the largest to date, and conflicting, chlorine-based surface disinfection protocols to interrupt disease transmission were recommended. We identified only one study documenting surface disinfection efficacy against the Ebola virus, showing a >6.6 log reduction after 5-minute exposure to 0.5% sodium hypochlorite (NaOCl) based on small-scale tests (Cook et al. (2015)). In preparation for future extensive, large-scale disinfection efficacy experiments, we replicated the Cook et al. experiment using four potential BSL-1 surrogates selected based on similarities to the Ebola virus: bacteriophages MS2, M13, Phi6, and PR772. Each bacteriophage was exposed to 0.1% and 0.5% NaOCl for 1, 5, and 10 minutes on stainless steel. MS2 and M13 were only reduced by 3.4 log and 3.5 log after a 10-minute exposure to 0.5% NaOCl, and would be overly conservative surrogates. Conversely, PR772 was too easily inactivated for surrogate use, as it was reduced by >4.8 log after only 1-minute exposure to 0.5% NaOCl. Phi6 was slightly more resistant than the Ebola virus, with 4.1 log reduction after a 5-minute exposure and not detected after a 10-minute exposure to 0.5% NaOCl. We therefore recommend Phi6 as a surrogate for evaluating the efficacy of chlorine-based surface disinfectants against the Ebola virus.