Ebola Cases Research Articles

Building Resilient Health Systems: Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak

Developing countries are characterized by high rates of mortality and morbidity. A potential contributing factor is the low utilization of health systems, stemming from the low perceived quality of care delivered by health personnel. This factor may be especially critical during crises, when individuals choose whether to cooperate with response efforts and frontline health personnel. We experimentally examine efforts aimed at improving health worker performance in the context of the 2014–15 West African Ebola crisis. Roughly two years before the outbreak in Sierra Leone, we randomly assigned two accountability interventions to government-run health clinics — one focused on community monitoring and the other gave status awards to clinic staff. We find that over the medium run, prior to the Ebola crisis, both interventions led to improvements in utilization of clinics and patient satisfaction with the health system. In addition, child health outcomes improved substantially in the catchment areas of community monitoring clinics. During the crisis, the interventions also led to higher reported Ebola cases, as well as lower mortality from Ebola — particularly in areas with community monitoring clinics. We explore three potential mechanisms: the interventions (1) increased the likelihood that patients reported Ebola symptoms and sought care; (2) unintentionally increased Ebola incidence; or (3) improved surveillance efforts. We find evidence consistent with the first: by building trust and confidence in health workers, and improving the perceived quality of care provided by clinics prior to the outbreak, the interventions encouraged patients to report and receive treatment. Our results suggest that accountability interventions not only have the power to improve health systems during normal times, but can additionally make health systems resilient to crises that may emerge over the longer run.

Building Resilient Health Systems: Experimental Evidence from Sierra Leone and the 2014 Ebola Outbreak

Underuse of health systems and a lack of confidence in their quality contribute to high rates of mortality in the developing world. How individuals perceive health systems may be especially critical during epidemics, when they choose whether to cooperate with response efforts and frontline health workers. Can improving the perceived quality of healthcare promote community health and ultimately, help to contain epidemics? We leverage a field experiment to answer this question in the context of Sierra Leone and the 2014 West Africa Ebola crisis. Two years before the outbreak, we randomly assigned two accountability interventions to government-run health clinics – one focused on community monitoring and the other conferred non-financial awards to clinic staff. These interventions delivered immediate benefits under conditions. Even prior to the Ebola crisis, both interventions increased clinic utilization and satisfaction with healthcare, and community monitoring additionally improved child health, leading to 38 percent fewer deaths of children under five. Later, during the crisis, the interventions also increased reporting of Ebola cases by 62 percent, and significantly reduced Ebola-related deaths. Evidence on mechanisms suggests that the interventions improved confidence in the health system, encouraging patients to report Ebola symptoms and receive medical care. These results indicate that promoting accountability not only has the power to improve health systems during normal times, but can also make them more resilient to crises that emerge over the longer run. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Ebola Virus Disease Outbreak - Democratic Republic of the Congo, August 2018-November 2019.

On August 1, 2018, the Democratic Republic of the Congo Ministry of Health (DRC MoH) declared the tenth outbreak of Ebola virus disease (Ebola) in DRC, in the North Kivu province in eastern DRC on the border with Uganda, 8 days after another Ebola outbreak was declared over in northwest Équateur province. During mid- to late-July 2018, a cluster of 26 cases of acute hemorrhagic fever, including 20 deaths, was reported in North Kivu province.* Blood specimens from six patients hospitalized in the Mabalako health zone and sent to the Institut National de Recherche Biomédicale (National Biomedical Research Institute) in Kinshasa tested positive for Ebola virus. Genetic sequencing confirmed that the outbreaks in North Kivu and Équateur provinces were unrelated. From North Kivu province, the outbreak spread north to Ituri province, and south to South Kivu province (1). On July 17, 2019, the World Health Organization designated the North Kivu and Ituri outbreak a public health emergency of international concern, based on the geographic spread of the disease to Goma, the capital of North Kivu province, and to Uganda and the challenges to implementing prevention and control measures specific to this region (2). This report describes the outbreak in the North Kivu and Ituri provinces. As of November 17, 2019, a total of 3,296 Ebola cases and 2,196 (67%) deaths were reported, making this the second largest documented outbreak after the 2014-2016 epidemic in West Africa, which resulted in 28,600 cases and 11,325 deaths.† Since August 2018, DRC MoH has been collaborating with partners, including the World Health Organization, the United Nations Children's Fund, the United Nations Office for the Coordination of Humanitarian Affairs, the International Organization of Migration, The Alliance for International Medical Action (ALIMA), Médecins Sans Frontières, DRC Red Cross National Society, and CDC, to control the outbreak. Enhanced communication and effective community engagement, timing of interventions during periods of relative stability, and intensive training of local residents to manage response activities with periodic supervision by national and international personnel are needed to end the outbreak.

Ebola virus disease: are you up to date?

While the risk of seeing cases of Ebola in general practice in the UK remains low, Daniel Beese and Gail Beckett explain the importance of keeping up to date with what to do in light of the recent disease outbreak in the Democratic Republic of Congo In July 2019, an outbreak of Ebola in the Democratic Republic of Congo was declared a Public Health Emergency of International Concern by the World Health Organization. During the last major outbreak, only a few patients with Ebola were cared for by the NHS, but media interest was high and public anxiety widespread. The fear of infection saw much time and effort put into developing a plethora of guidance, policies and protocols to prevent and control any potential risk of spread. As it is now 4 years since the last outbreak, it is an opportune time to review response arrangements.

Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline, Sinead Walsh and Oliver Johnson

Reviewed by: Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline by Sinead Walsh and Oliver Johnson Clement Masakure BOOK REVIEW of Walsh, Sinead, and Oliver Johnson. 2018. Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline. London: Zed Press. 422 pp. On 25 May 2014, officials in Sierra Leone confirmed their first Ebola case, and from 2014 to 2016, hospital staff in various capacities, different nongovernmental organizations, and government agencies battled the ensuing epidemic. In total, 11,310 people died, and more than 10,000 survivors were severely affected by the disease. This was one of the worst outbreaks of Ebola in history. Sinead Walsh and Oliver Johnson, authors of the book Getting to Zero: A Doctor and a Diplomat on the Ebola Frontline, were at the heart of efforts to contain the outbreak, and they provide a fascinating account of the struggle against it. Getting to Zero is a story of how a diplomat, a medical doctor without much experience in tropical medicine, and indigenous hospital workers (including security guards) mobilized whatever resources were at their disposal to manage the outbreak, nursing the sick and the infirm. It is a narrative about humanitarian agencies in their local and international manifestations, just as it is a story that emphasizes the potential impact of diseases on national, regional, and international security and peace. When the first case of Ebola was confirmed, Sierra Leonean health infrastructure was not ready for what was to come. Indeed, a key issue that conditioned the response to the outbreak was the nature of the national public health infrastructure, which made it difficult for Johnson and his team to handle the initial outbreak effectively. Worse, the main hospital in Freetown was poorly resourced, and it experienced numerous problems with a demotivated staff. That Johnson and his team transformed the emergency unit into an isolation ward that became the center of Ebola management and containment, even though they had limited resources at their disposal, points to the dedication and sacrifices they made in providing care to patients. [End Page 147] The responses were conditioned by a complex set of issues, including relations between international organizations and the central government and international concerns that the outbreak might extend beyond West Africa. For political reasons, the Sierra Leone government responded slowly to the challenge, significantly delaying the containment of the outbreak. The authors highlight how international organizations failed to provide coordinated responses. Only after it became clear that the outbreak could become an international emergency, with massive implications for international security and peace, did more sustained and coordinated responses come from international organizations, such as the World Health Organization. In weaving this story, the authors rely not just on their direct experiences and on documents from organizations involved in the response to it, but use eighty-five interviews of survivors and local health workers. By including local voices within the narrative, they manage to bring to the fore the role of ordinary folk in managing the outbreak. Among the high-profile people they interviewed were the president of Sierra Leone and the secretary general of the United Nations. This methodology enabled the authors to make a nuanced examination of the outbreak and to offer important recommendations for health professionals, humanitarian workers, and institutions that might face such an emergency in the future. Indeed, significant lessons for managing future outbreaks can be drawn from this case. Most importantly, local communities played a key role in the response. As the authors argue, "Only the communities of Sierra Leone were ever going to be able to bring the Ebola epidemic under control" (340). There is no doubt that without the participation of local communities, efforts at containing the epidemic would have failed to meet their goals. In broad terms, the authors highlight the need, on the part of international workers and international organizations, to empathize with and respect the communities with which they work, if ever they need programs to succeed. Another lesson to be gained from the book revolves around leadership and coordination of responses to epidemics. For the authors, it was the nature of leadership—local, governmental, international—that "was central as to why...

Evaluation of Infection Prevention and Control Readiness at Frontline Health Care Facilities in High-Risk Districts Bordering Ebola Virus Disease-Affected Areas in the Democratic Republic of the Congo - Uganda, 2018.

Infection prevention and control (IPC) in health care facilities is essential to protecting patients, visitors, and health care personnel from the spread of infectious diseases, including Ebola virus disease (Ebola). Patients with suspected Ebola are typically referred to specialized Ebola treatment units (ETUs), which have strict isolation and IPC protocols, for testing and treatment (1,2). However, in settings where contact tracing is inadequate, Ebola patients might first seek care at general health care facilities, which often have insufficient IPC capacity (3-6). Before 2014-2016, most Ebola outbreaks occurred in rural or nonurban communities, and the role of health care facilities as amplification points, while recognized, was limited (7,8). In contrast to these earlier outbreaks, the 2014-2016 West Africa Ebola outbreak occurred in densely populated urban areas where access to health care facilities was better, but contact tracing was generally inadequate (8). Patients with unrecognized Ebola who sought care at health care facilities with inadequate IPC initiated multiple chains of transmission, which amplified the epidemic to an extent not seen in previous Ebola outbreaks (3-5,7). Implementation of robust IPC practices in general health care facilities was critical to ending health care-associated transmission (8). In August 2018, when an Ebola outbreak was recognized in the Democratic Republic of the Congo (DRC), neighboring countries began preparing for possible introduction of Ebola, with a focus on IPC. Baseline IPC assessments conducted in frontline health care facilities in high-risk districts in Uganda found IPC gaps in screening, isolation, and notification. Based on findings, additional funds were provided for IPC, a training curriculum was developed, and other corrective actions were taken. Ebola preparedness efforts should include activities to ensure that frontline health care facilities have the IPC capacity to rapidly identify suspected Ebola cases and refer such patients for treatment to protect patients, staff members, and visitors.

Use of a mobile application for Ebola contact tracing and monitoring in northern Sierra Leone: a proof-of-concept study

BackgroundThe 2014–2016 Ebola epidemic in West Africa was the largest Ebola epidemic to date. Contact tracing was a core surveillance activity. Challenges with paper-based contact tracing systems include incomplete identification of contacts, delays in communication and response, loss of contact lists, inadequate data collection and transcription errors.The aim of this study was to design and evaluate an electronic system for tracing contacts of Ebola cases in Port Loko District, Sierra Leone, and to compare this with the existing paper-based system. The electronic system featured data capture using a smartphone application, linked to an alert system to notify the District Ebola Response Centre of symptomatic contacts.MethodsThe intervention was a customised three-tier smartphone application developed using Dimagi’s CommCare platform known as the Ebola Contact Tracing application (ECT app). Eligible study participants were all 26 Contact Tracing Coordinators (CTCs) and 86 Contact Tracers (CTs) working in the 11 Chiefdoms of Port Loko District during the study period (April–August 2015). Case detection was from 13th April to 17th July 2015. The CTCs and their CTs were provided with smartphones installed with the ECT app which was used to conduct contact tracing activities. Completeness and timeliness of contact tracing using the app were compared with data from April 13th-June 7th 2015, when the standard paper-based system was used.ResultsFor 25 laboratory-confirmed cases for whom paper-based contact tracing was conducted, data for only 39% of 408 contacts were returned to the District, and data were often incomplete. For 16 cases for whom app-based contact tracing was conducted, 63% of 556 contacts were recorded as having been visited on the app, and the median recorded duration from case confirmation to first contact visit was 70 h.ConclusionThere were considerable challenges to conducting high-quality contact tracing in this setting using either the paper-based or the app-based system. However, the study demonstrated that it was possible to implement mobile health (mHealth) in this emergency setting. The app had the benefits of improved data completeness, storage and accuracy, but the challenges of using an app in this setting and epidemic context were substantial.

Ebola in eastern DRC

Ebola in eastern DRC

First Ebola case in African border metropolis could be a ‘game-changer,’ WHO leader warns

First Ebola case in African border metropolis could be a ‘game-changer,’ WHO leader warns

Precision Global Health - The case of Ebola: a scoping review.

BackgroundThe 2014-2016 Ebola outbreak across West Africa was devastating, acting not only as a wake-up call for the global health community, but also as a catalyst for innovative change and global action. Improved infectious disease monitoring is the stepping-stone toward better disease prevention and control efforts, and recent research has revealed the potential of digital technologies to transform the field of global health. This scoping review aimed to identify which digital technologies may improve disease prevention and control, with regard to the 2014-2016 Ebola outbreak in West Africa.MethodsA search was conducted on PubMed, EBSCOhost and Web of Science, with search dates ranging from 2013 (01/01/2013) – 2017 (13/06/2017). Data was extracted into a summative table and data synthesized through grouping digital technology domains, using narrative and graphical methods.FindingsThe scoping review identified 82 full-text articles, and revealed big data (48%, n = 39) and modeling (26%, n = 21) technologies to be the most utilized within the Ebola outbreak. Digital technologies were mainly used for surveillance purposes (90%, n = 74), and key challenges were related to scalability and misinformation from social media platforms.InterpretationDigital technologies demonstrated their potential during the Ebola outbreak through: more rapid diagnostics, more precise predictions and estimations, increased knowledge transfer, and raising situational awareness through mHealth and social media platforms such as Twitter and Weibo. However, better integration into both citizen and health professionals’ communities is necessary to maximise the potential of digital technologies.

Developing a Personal Protective Equipment Selection Matrix for Preventing Occupational Exposure to Ebola Virus.

In response to the 2014 Ebola outbreak in West Africa and resulting cases in the United States, the Occupational Safety and Health Administration developed a personal protective equipment selection matrix to help employers protect workers from exposure to Ebola virus in the event of additional US cases. Now, the world's second largest Ebola outbreak on record continues to expand in the Democratic Republic of Congo, where more than 70 Ebola-infected healthcare workers serve as reminders of the importance of robust infection prevention measures in keeping infectious disease responders from becoming victims themselves. Toward facilitating preparedness for cases associated with the ongoing or future outbreaks, this article discusses the matrix of personal protective equipment recommendations. The matrix applies to a variety of job tasks in health care, laboratories, waste handling, janitorial services, travel and transportation, and other sectors where workers may be exposed to the Ebola virus during outbreak events. A discussion of the information sources and decision-making process for developing the matrix forms the basis of the recommendations. The article then emphasizes challenges and considerations for formulating the matrix, including identifying information sources to help characterize occupational exposures, aligning recommendations among stakeholders with varying viewpoints, and balancing worker protections with feasibility concerns. These considerations highlight issues that remain relevant for preparedness efforts ahead of future US cases of Ebola or other emerging infectious diseases.

Health care workers’ awareness and infection control practices about Ebola virus disease in Hajj 2015

BackgroundSaudi Arabia being a major pilgrimage center with an annual turnover of millions of pilgrims from all over the world has a high risk for transmission of infections; Ebola virus disease (EVD) being one of them. Health care workers (HCWs) are particularly vulnerable to these infections. The objectives of this research were to assess the overall knowledge and infection control practices of HCWs about EVD, and to evaluate and compare the role of pre deployment Hajj training of HCWs assigned Hajj duties with those HCWs who did not receive this training. MethodsThrough a comparative cross sectional study design a randomly selected representative sample of HCWs who performed Hajj duties in 2015 were compared with those who were not part of Hajj. Participants were taken from different Makkah and Jeddah region hospitals. A validated self-administered questionnaire was used to assess EVD awareness of 1216 HCWs. Chi square test was applied to check the association between the two groups using SPSS 22. ResultsOverall, medical practitioners had a higher level of knowledge (76.5%) about EVD (in-terms of average correct answers) compared to nurses (59.6%) and other HCWs (56.7%). There was relatively poor knowledge about the EVD management, the Ebola cases fatality rate and the risk of the health care workers from this infectious disease. However, it was obvious that the HCWs who performed Hajj duties and underwent pre-deployment training had more knowledge and better practices about EVD compared to the Non Hajj HCWs and the difference was statistically significant (p < 0.001). ConclusionThis study concludes that even though the HCWs were well aware about EVD but there was a lack of practice. As infection control routine trainings are limited, gaps have been identified in knowledge and practice of infection control.

Sexual transmission and the probability of an end of the Ebola virus disease epidemic

The criteria of zero Ebola cases defined by the World Health Organization did not explicitly account for the sexual transmission and led to multiple recrudescent events in West Africa from 2015 to 2016, partly indeed caused by sexual transmission from survivors. We devised a statistical model to compute the probability of the end of an Ebola virus disease epidemic, accounting for sexual transmission and under-ascertainment of cases. Analyzing the empirical data in Guinea, Liberia and Sierra Leone, the performance of the proposed model was compared with the existing criteria comprising a fixed waiting time of 42 days since the last case testing negative or burial. We showed that the waiting time can vary depending on the sexual behaviors of survivors and their adherence to refraining from unprotected sex is likely one of the key factors in determining the absence of additional cases after declaration. If the proportional weight of sexual transmission among all secondary transmission events was substantial, ascertaining the end could even require waiting 1 year from the purported last case. While our proposed method offers an objectively interpretable probability of the end of an epidemic, it highlights that the computation requires a good knowledge of sexual contact.

HIV prevalence in suspected Ebola cases during the 2014\u20132016 Ebola epidemic in Sierra Leone

BackgroundThe 2014–2016 Ebola virus epidemic in West Africa was the largest outbreak of Ebola virus disease (EVD) in history. Clarifying the influence of other prevalent diseases such as human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) will help improve treatment and supportive care of patients with EVD.Case presentationWe examined HIV and hepatitis C virus (HCV) antibody prevalence among suspected EVD cases from the Sierra Leone-China Friendship Biological Safety Laboratory during the epidemic in Sierra Leone. HIV and HCV antibodies were tested in 678 EVD-negative samples by enzyme-linked immunosorbent assay. A high HIV prevalence (17.6%) and low HCV prevalence (0.22%) were observed among the suspected cases. Notably, we found decreased HIV positive rates among the suspected cases over the course of the epidemic. This suggests a potentially beneficial effect of an improved public health system after assistance from the World Health Organization and other international aid organizations.ConclusionsThis EVD epidemic had a considerable impact on the public health system and influenced the prevalence of HIV found among suspected cases in Sierra Leone, but also provided an opportunity to establish a better surveillance network for infectious diseases.

Assessing reporting delays and the effective reproduction number: The Ebola epidemic in DRC, May 2018–January 2019

On August 1, 2018, the Democratic Republic of Congo declared its 10th and largest outbreak of Ebola inflicting North Khivu and Ituri provinces. The spread of Ebola to Congolese urban centers along with deliberate attacks on the health care workers has hindered epidemiological surveillance activities, leading to substantial reporting delays. Reporting delays distort the epidemic incidence pattern misrepresenting estimates of epidemic potential and the outbreak trajectory. To assess the impact of reporting delays, we conducted a real-time analysis of the dynamics of the ongoing Ebola outbreak in the DRC using epidemiological data retrieved from the World Health Organization Situation Reports and Disease Outbreak News. We analyzed temporal trends in reporting delays, epidemic curves of crude and reporting-delay adjusted incidences and changes in the effective reproduction number, Rt. As of January 15, 2019, 663 Ebola cases have been reported in the Democratic Republic of Congo. The average reporting delay exhibited 81.1% decline from a mean of 17.4 weeks (95% CI 13–24.1) in May, 2018 to 3.3 weeks (95% CI 2.7–4.2) in September, 2018 (F-test statistic = 44.9, p = 0.0067). The Ebola epidemic has shown a two-wave pattern with the first surge in cases occurring between July 30 and August 13, 2018 and the second on September 24, 2018. During the last 4 generation intervals, the trend in the mean Rt has exhibited a slight decline (rho = −0.37, p < 0.001), fluctuating around 0.9 (range: 0–1.8). Our most recent estimate of R is at 0.9 (95% CI: 0.4, 1.1) during the last generation interval. Our most recent analysis of the Ebola outbreak in DRC indicates that the Ebola virus still active although transmission is characterized by a low fluctuating reproduction number. Yet, this pattern does not imply that the epidemic can be easily controlled particularly in the context of unstable epidemiological surveillance efforts hindered by unpredictable local violence.

“If you suspect a case of Ebola... free call 177”:

Nos últimos anos, tenho me debruçado sobre as questões sociais que circundam a epidemia de Ebola no Oeste Africano, mais precisamente em Serra Leoa. De outubro de 2015 a janeiro de 2016 viajei para a região, fazendo trabalho de campo tanto na capital de Serra Leoa (Freetown) quanto nos demais distritos do país. Em todo o país existiam ckeckpoints, instrumento do controle dos corpos. Além disso, por todas as cidades eram comum cartazes e outdoors mobilizando a população a se manter atenta a casos de Ebola, sugerindo inclusive “denúncias” como: “If you suspect of someone with Ebola, call 177”. Desta maneira, é notório o uso de uma linguagem militar para tratar da epidemia. Porém, a militarização não encontra-se apenas nas metáforas, partindo para o contexto das práticas diárias como ameaças, privações de liberdade como lockdowns, quarentenas e até prisões. Ou seja, o controle da epidemia sempre esteve diretamente ligado à militarização da saúde.

Surveillance in the field: Over-identification of Ebola suspect cases and its contributing factors in West African at-risk contexts

ABSTRACTDuring an Ebola outbreak, the WHO recommends that health professionals consider people as suspect cases (SCs) when they show key signs such as the sudden onset of high fever or specific symptoms after having had contact with a suspect or confirmed Ebola case. SCs should then get care, be isolated and be reported to health authorities until the Ebola virus disease is confirmed through a lab test. This exploratory study aims to understand this identification process in the field based on a qualitative analysis of the diagnosis and therapeutic itineraries of 19 SCs in Cote d’Ivoire and Senegal (2014–2015). Results indicate that the main criteria for SC identification at the field level were fever (understood broadly) and provenance from a highly affected country (applied indiscriminately). WHO criteria were not followed in at least 9 of the 19 cases. Several medical, social and cultural factors favour over-identification of people as SCs, including relativism in defining ‘high fever’, placism, humanitarian or securitarian bias, issues in categorising SC's contact cases, and the context of fear. To avoid undue categorisation and its possible harmful social effects, the WHO definition should be implemented more carefully in various contexts and with greater consideration for ethical issues, while prioritising diagnosis strategies with higher specificity.

Resources needed for US CDC\u2019s support to the response to post-epidemic clusters of Ebola in West Africa, 2016

BackgroundWest African countries Liberia, Sierra Leone, and Guinea experienced the largest and longest epidemic of Ebola virus disease from 2014 to 2016; after the epidemic was declared to be over, Liberia, Guinea, and Sierra Leone still experienced Ebola cases/clusters. The United States Centers for Disease Control and Prevention (US CDC) participated in the response efforts to the latter Ebola clusters, by assisting with case investigation, contact identification, and monitoring. This study aims to estimate the cost to the US CDC of responding to three different Ebola clusters after the end of the Ebola epidemic in 2015: i) Sierra Leone, Tonkolili (Jan 2016, 2 Ebola cases, 5 affected regions); ii) Guinea, Nzerekore (Mar-May 2016, 10 Ebola cases, 2 affected regions); iii) Liberia, Somali Drive (Mar 2016, 3 Ebola cases, 1 affected region).Main textAfter interviewing team members that had participated in the response, we estimated total costs (expressed in 2016 US Dollars [USD]), where total costs correspond to travel costs, deployed personnel costs, costs to prepare for deployment, procurement and interagency collaboration costs, among others. We also estimated cost per cluster case (corresponding to the total costs divided by the total number of cluster cases); and cost per case-affected-region (equal to the total costs divided by the product of the number of cases times the number of regions affected). We found that the response cost varied sixteenfold between USD 113 166 in Liberia and USD 1 764 271 in Guinea, where the main cost drivers were travel and personnel costs. The cost per cluster case varied tenfold between 37 722 in Liberia (three cases) and USD 347 226 in Sierra Leone, and the cost per case-affected-region varied threefold between USD 37 722 in Liberia and USD 88 214 in Guinea.ConclusionsCosts vary with the characteristics of each cluster, with those spanning more regions and cases requiring more resources for case investigation and contact identification and monitoring. These data will assist policy makers plan for similar post-epidemic responses.

American Ebola Story: frames in U.S. National Newspapers

ABSTRACTThe 2014 Ebola epidemic saw the first symptomatic and fatal cases of Ebola in the United States. Concurrently, news coverage in U.S. media about Ebola increased. Research has shown that media’s framing of events influences public perception and understanding. To address framing of the Ebola epidemic in the U.S. media, researchers conducted a content analysis of newspaper articles reporting on the Ebola epidemic during the U.S. contact tracing period from September 30 to December 2, 2014 (n = 718). The top three circulating U.S. national newspapers were used in the analysis. The results show that the human interest, conflict, and action frames had the highest presence across newspaper articles, whereas the presence of attribution of responsibility, morality, and economic frames was lower. This study furthers knowledge of U.S. news media framing and coverage of new public health emergencies, and how newspapers may drive audience understanding and perception of the 2014 Ebola epidemic. This study also discusses implications of the findings and suggests directions for future research.

And Ghana was scared: Media Representations of the Risk of an Ebola Outbreak in Ghana.

IntroductionThe 2014 Ebola virus outbreak in parts of West Africa marked the 25th occurrence of the disease since its discovery in 1976. While earlier outbreaks in Central and Eastern Africa had limited geographical extension and little media coverage, news media interest in the 2014 epidemic was remarkably high. In countries like Ghana, where the risk of imported infection was estimated to be among the highest, news coverage for the epidemic proliferated. This study aimed to describe and analyze the central themes which characterized media representations of the risk of Ebola outbreak in Ghana.MethodA quantitative content analysis (CA) was employed to study news media reportage of the risk of Ebola outbreak in Ghana. Two daily newspapers, the Daily Graphic and Today were sampled. An online search for Ebola news stories in the selected newspapers was conducted, and all hits with Ebola downloaded and screened. A total of 332 articles were retrieved and 156 articles met the inclusion criteria. Three independent coders carried out the coding using identical story analysis form.ResultsIn the course of the 2014 Ebola epidemic in parts of West Africa, the Daily Graphic and Today newspapers in Ghana published 332 stories about the epidemic. Of this number, the study analyzed 156 news articles which met the inclusion criteria. The analysis found that, media coverage for the risk of Ebola outbreak in Ghana reflected nine salient themes: concerns about the Ghana’s preparedness, support for Ghana’s preparation, public education on Ebola virus, assurances on Ghana’s readiness, suspected cases of Ebola, effects of Ebola, critique of Ebola risk handling, Misinformation and other.ConclusionAnalysis of news media coverage for the threat of Ebola outbreak in Ghana revealed nine important themes. These themes, contributed to an understanding of the broad impact of the recent Ebola outbreak on various sectors of the population.