Ebola Virus Disease Cases Research Articles

Modeling the Impact of Vaccine Delivery on the 2018-2019 North Kivu & Ituri Ebola Outbreak

Background: The reemergence of Ebola in the Democratic Republic of Congo (DRC) has developed into the largest and most challenging Ebola Virus Disease (EVD) outbreak in the country's history. Violence has hindered response efforts, including the administration of the investigational EVD vaccine, rVSV-ZEBOV. During a crisis of this magnitude, decision-makers often look to predictive models to inform operational strategy. Methods: We used an agent-based model to forecast the additional EVD case burden in North Kivu & Ituri health zones, by the end of July 2019, at different levels of vaccine administration and contact-finding. Our model incorporated countermeasure strategies like social distancing, school closure, hospital isolation, and ring vaccination, while varying rates of contact-finding and vaccine administration to generate case incidence estimates. Findings: Our model estimated that if the response continues as-is, approximately 1,039 additional cases will occur between May 20th and July 31st, for a cumulative total of 2,688 EVD cases by the end of July. If vaccine administration were discontinued, we estimated a 13.4% higher incidence of EVD cases by the end of July. Increased contact-finding and vaccination administration resulted in 10.3% fewer additional EVD cases. Interpretation: Near real-time forecasting can generate potential outbreak trajectories dependent on the magnitude and success of public health response efforts. Although the ongoing vaccination campaign has reduced the overall number of EVD cases that would be expected in the ongoing outbreak, simultaneous delivery of other countermeasures at high rates is necessary to bring the outbreak to a close. While our projections should be interpreted cautiously due to evolving outbreak dynamics, the estimated magnitude can be used to inform public health response planning for the international community. Funding Statement: This study was funded by the Defense Threat Reduction Agency's (DTRA) Technical Reachback contract, (HDTRA1-09-D-0009-0003) and the contract to Virginia Polytechnic Institute and State University (HDTRA1-17-D-0023-0001). Declaration of Interests: All authors declare they have nothing to disclose.

Ebola Virus Disease in the year 2014-2015: Retrospective Study of Suspected Cases of Ebola Virus Disease at Intensive Care Unit of Tertiary Care Center

Ebola Virus Disease in the year 2014-2015: Retrospective Study of Suspected Cases of Ebola Virus Disease at Intensive Care Unit of Tertiary Care Center

The Ebola virus disease outbreak in Tonkolili district, Sierra Leone: a retrospective analysis of the Viral Haemorrhagic Fever surveillance system, July 2014-June 2015.

In Sierra Leone, the Ebola virus disease (EVD) outbreak occurred with substantial differences between districts with someone even not affected. To monitor the epidemic, a community event-based surveillance system was set up, collecting data into the Viral Haemorrhagic Fever (VHF) database. We analysed the VHF database of Tonkolili district to describe the epidemiology of the EVD outbreak during July 2014-June 2015 (data availability). Multivariable analysis was used to identify risk factors for EVD, fatal EVD and barriers to healthcare access, by comparing EVD-positive vs. EVD-negative cases. Key-performance indicators for EVD response were also measured. Overall, 454 EVD-positive cases were reported. At multivariable analysis, the odds of EVD was higher among those reporting contacts with an EVD-positive/suspected case (odds ratio (OR) 2.47; 95% confidence interval (CI) 2.44-2.50; P < 0.01) and those attending funeral (OR 1.02; 95% CI 1.01-1.04; P < 0.01). EVD cases from Kunike chiefdom had a lower odds of death (OR 0.22; 95% CI 0.08-0.44; P < 0.01) and were also more likely to be hospitalised (OR 2.34; 95% CI 1.23-4.57; P < 0.05). Only 25.1% of alerts were generated within 1 day from symptom onset. EVD preparedness and response plans for Tonkolili should include social-mobilisation activities targeting Ebola/knowledge-attitudes-practice during funeral attendance, to avoid contact with suspected cases and to increase awareness on EVD symptoms, in order to reduce delays between symptom onset to alert generation and consequently improve the outbreak-response promptness.

The Differential Impact of Violence on Ebola Virus Disease Transmission: A Mathematical Modeling Study of the 2018-2019 Outbreak in the Democratic Republic of the Congo

Background: Violence can impact Ebola virus disease (EVD) transmission in the current outbreak in the eastern Democratic Republic of the Congo (DRC). We hypothesized that violent events targeted against the Ebola response will be associated with more EVD transmission than untargeted events. Methods: We used a dynamic cohort of individuals who lived in Ebola-affected and unaffected health zones in DRC from April 2018 to August 2019. The time-varying exposure was the number of violent events, as defined by the Armed Conflict Location & Event Project (ACLED) database, that occurred in each health zone over a series of days. These violent events were categorized into vs. Ebola-untargeted, and further sub-categorized by civilians, military or politics, or protests. The outcome variable was the estimated daily reproduction number (Rest) by health zone, which was estimated from daily EVD case counts (from DRC Ministry of Health) by the Wallinga-Teunis method. We fit a linear time-series regression to model the relationship of violent events and R comparing EVD-affected and unaffected health zones. Findings: The average Rest was 1.06 (95% confidence interval [CI]: 1.02-1.11). We found an overall change in R of 0.035 (95% CI: 0.020-0.050) among Ebola-affected compared to unaffected health zones. Violent events targeting the Ebola response were associated with an increase in Rest of 0.098 (95% CI: 0.064-0.132) while untargeted, violent events had a smaller effect (0.022, 95% CI: 0.005-0.038). Additional analyses showed the increase in Rest was primarily driven by Ebola-targeted civilian events and, to a lesser extent, by Ebola-untargeted military, political, or protest events. Interpretation: These findings suggest that civilian acts of violence directly targeted against the Ebola response efforts had the largest impact on EVD transmission. To a lesser extent, untargeted military, political, or protest events also had an impact. Funding Statement: This work was supported by National Institute of Allergy and Infectious Disease (K08 grant number AI139361 to ETR; K23 grant number AI135037 to JDK) and National Institute of General Medical Sciences (R01 grant number GM130900 to TCP, JDK, and ETR). Declaration of Interests: The authors stated: None to declare. Ethics Approval Statement: The authors stated: Data were publicly available and de-identified, so ethics committee approval was not needed.

Stillbirths and neonatal deaths surveillance during the 2014-2015 Ebola virus disease outbreak in Sierra Leone.

To determine the rate of stillbirth and neonatal death reporting and testing for Ebola virus during the 2014-2015 Ebola virus disease (EVD) outbreak in Sierra Leone. A cross-sectional study was performed using information from the Sierra Leone National Ebola Laboratory database to identify stillbirths and neonatal deaths that had been tested for Ebola virus from July 2, 2014, to October 18, 2015. Outcomes included the percentage of all tested deaths attributable to stillbirths and neonatal deaths, the proportion of stillbirths and neonatal deaths attributable to Ebola virus, and the annualized rate of stillbirths and neonatal deaths. In total, 1726 stillbirths and 4708 neonatal deaths were tested for Ebola virus, representing 2.6% and 7.2% of the total deaths tested (n=65585), respectively. Of these, 25 stillbirths and neonatal deaths tested positive, accounting for 0.3% of EVD cases. In 2015, the annualized total number of reported stillbirths was higher than expected (3079 vs 1634), whereas reported neonatal deaths were lower (6351 vs 7770). Stillbirth and neonatal death reporting and testing improved over time. Systematic recording of these indicators might be used alongside retrospective surveillance to respond to the adverse effects of EVD on maternal and child health and guide response efforts for subsequent outbreaks.

Nursing Unit Communication During a US Public Health Emergency: Natural Experiment.

BackgroundIn the second half of 2014, the first case of Ebola virus disease (EVD) was diagnosed in the United States. During this time period, we were collecting data for the Measuring Network Stability and Fit (NetFIT) longitudinal study, which used social network analysis (SNA) to study relationships between nursing staff communication patterns and patient outcomes. One of the data collection sites was a few blocks away from where the initial EVD diagnosis was made. The EVD public health emergency during the NetFIT data collection time period resulted in the occurrence of a natural experiment.ObjectiveThe objectives of the NetFIT study were to examine the structure of nursing unit decision-making and information-sharing networks, identify a parsimonious set of network metrics that can be used to measure the longitudinal stability of these networks, examine the relationship between the contextual features of a unit and network metrics, and identify relationships between key network measures and nursing-sensitive patient-safety and quality outcomes. This paper reports on unit communication and outcome changes that occurred during the EVD natural disaster time period on the 10 hospital units that had data collected before, during, and after the crisis period.MethodsFor the NetFIT study, data were collected from nursing staff working on 25 patient care units, in three hospitals, and at four data collection points over a 7-month period: Baseline, Month 1, Month 4, and Month 7. Data collection was staggered by hospital and unit. To evaluate the influence of this public health emergency on nursing unit outcomes and communication characteristics, this paper focuses on a subsample of 10 units from two hospitals where data were collected before, during, and after the EVD crisis period. No data were collected from Hospital B during the crisis period. Network data from individual staff were aggregated to the nursing unit level to create 24-hour networks and three unit-level safety outcome measures—fall rate, medication errors, and hospital-acquired pressure ulcers—were collected.ResultsThis analysis includes 40 data collection points and 608 staff members who completed questionnaires. Participants (N=608) included registered nurses (431, 70.9%), licensed vocational nurses (3, 0.5%), patient care technicians (133, 21.9%), unit clerks (28, 4.6%), and monitor watchers (13, 2.1%). Changes in SNA metrics associated with communication (ie, average distance, diffusion, and density) were noted in units that had changes in patient safety outcome measures.ConclusionsUnits in the hospital site in the same city as the EVD case exhibited multiple changes in patient outcomes, network communication metrics, and response rates. Future research using SNA to examine the influence of public health emergencies on hospital communication networks and relationships to patient outcomes is warranted.

Transplacental transmission: A rare case of Ebola virus transmission.

During the mid-transmission period of the Ebola virus disease (EVD) outbreak in Sierra Leone, a 19-year-old pregnant woman, who was a petty trader in a health facility in Freetown, noticing no fetal movement for the past 3 days, reported to a health facility. Medical history and laboratory testing showed no abnormalities except that she was positive for sickle cell. She was not known to any surveillance team of having any epidemiological link to EVD case. She was induced with oral medications as well as IV infusion. EVD test showed that the fetus was positive to EVD with a high threshold value of 21, while the woman was negative for EVD with a threshold value of 42. The woman was positive to EVD IgG but negative to EVD IgM by ELISA technique. This is a rare EVD case in the period of medium transmission. We conclude that the woman may have come into contact with a low dose of virus not enough to cause a full blown EVD and that her immune system was able to stop the virus from further replication.

Vaccine Deployment and Ebola Transmission Dynamics Estimation in Eastern DR Congo

Background. Over the last 19 months, the Democratic Republic of the Congo has reported approximately 3000 cases of Ebola virus disease (EVD). Since August 2018, an experimental vaccine has been deployed to curb transmission. Methods. A generalizable data assembly algorithm was developed to automatically curate publicly available cumulative reported case count and vaccine deployment data from the Ministere de la Sante. The Incidence Decay and Exponential Adjustment model was then used to estimate basic and observed reproduction numbers associated with the outbreak for three health zones that have been most affected as well as for the country as a whole. Reproduction number estimates at the national level were paired with a sensitivity analysis to assess immunization rates and to project end-of-year case counts under three different transmission scenarios. Findings. Basic and observed reproduction number estimates at the national level range from 1.13 to 1.99 and from 1.06 to 1.34, respectively. These estimates suggest that approximately 2% to 20% of the affected population across the country has thus far been effectively immunized against EVD and that the outbreak would likely be 4–34 times greater in size today had the vaccine not been deployed. Assuming no changes in transmission dynamics, we estimate that the expected cumulative case count will range between 3479 and 4249 by late December 2019; alternative transmission dynamics scenarios result in lesser and greater case count estimates. Interpretation. Transmission dynamics associated with the outbreak suggest that though the experimental vaccine has likely helped curb the spread of EVD, the outbreak may continue into 2020. Data assembly algorithms like the one presented here will continue to prove useful as this outbreak and others like it persist. Funding. Research reported in this work was supported by the National Institutes of Health through an NIH Director’s New Innovator Award DP2-MD012722.

International Health Regulations, Ebola, and Emerging Infectious Diseases in Latin America and the Caribbean

The World Health Organization’s determination of the Ebola virus disease outbreak as a public health event of international concern prompted nonaffected countries to implement measures to prevent, detect, and manage the introduction of the virus in their territories. The outbreak provided an opportunity to assess the operational implementation of the International Health Regulations’ core capacities and health systems’ preparedness to handle a potential or confirmed case of Ebola virus disease. A public health framework implemented in Latin America and Caribbean countries encompassing preparatory self-assessments, in-country visits, and follow-up suggests that the region should increase efforts to consolidate and sustain progress on core capacities and health system preparedness to face public health events with national or international repercussions.

Public Health Resilience Checklist for High-Consequence Infectious Diseases-Informed by the Domestic Ebola Response in the United States.

The experiences of communities that responded to confirmed cases of Ebola virus disease in the United States provide a rare opportunity for collective learning to improve resilience to future high-consequence infectious disease events. Key informant interviews (n = 73) were conducted between February and November 2016 with individuals who participated in Ebola virus disease planning or response in Atlanta, Georgia; Dallas, Texas; New York, New York; or Omaha, Nebraska; or had direct knowledge of response activities. Participants represented health care; local, state, and federal public health; law; local and state emergency management; academia; local and national media; individuals affected by the response; and local and state governments. Two focus groups were then conducted in New York and Dallas, and study results were vetted with an expert advisory group. Participants focused on a number of important areas to improve public health resilience to high-consequence infectious disease events, including governance and leadership, communication and public trust, quarantine and the law, monitoring programs, environmental decontamination, and waste management. Findings provided the basis for an evidence-informed checklist outlining specific actions for public health authorities to take to strengthen public health resilience to future high-consequence infectious disease events.

Active Case Finding for Improved Ebola Virus Disease Case Detection in Nimba County, Liberia, 2014/2015: Lessons Learned

Objectives. Early case detection and isolation of patients infected with highly infectious diseases are crucial in the management and control of epidemics such as Ebola Virus Disease (EVD). In this paper, we share the lessons learned from implementation of active case finding as a strategy for improved EVD case detection in Nimba County, Liberia. Methods. We adopted the World Health Organization (WHO) active surveillance strategy to identify and report suspected EVD cases, follow up contacts of confirmed cases, and report community deaths. We identified, trained, and deployed 1060 Community Health Volunteers (CHVs) in 718 communities in Nimba County. The CHVs were supervised by 142 health workers within their catchment area. The health workers were supervised by the District Health Officers (DHOs). The DHOs reported to the County Health Team (CHT) who provided supportive supervision. Data collection was based on the EVD contact tracing and active case finding forms adopted from WHO. Data analysis was based on epi-weeks. Results. The number of EVD suspected cases increased by more than 75% following the initiation of active case finding. Average duration between symptom onset and case detection reduced from between three and five days to within 24 hours. Collection of oral swabs from dead bodies increased from two to 15 within the first week of active case finding strategy implementation. Reporting of other IDSR priority diseases and conditions also improved. Conclusion. Active case finding strategy in Nimba increased suspected EVD case detection and reduced the duration between onset of symptoms and detection of cases.

Knowledge, attitudes and practices of healthcare providers on suspected Ebola cases in Guinea

Developing a more resilient health system to Ebola Virus Disease (EVD) is a necessity in Guinea. This implies having information on the knowledge and practices that health staffs had during the preceding the EVD outbreak. The objective of this study was to compare the knowledge, attitudes and practices of routine healthcare providers on suspected EVD cases in the affected and non-affected districts in Guinea. A cross-sectional analytic study was conducted from December 6th to 30th, 2014 with health staffs and community health workers from 120 health facilities, in four health districts more affected by the EVD and four others less affected. Health staffs who declared being able to identify a suspected EVD case were represented more in the more affected districts (95.2%) than in the less affected districts (78.7%, P<0.01). The main practice towards a suspected case in the more affected districts was referral to the Ebola treatment centre (79.2%, versus 20% in the less affected districts, P<0.05), while in the less affected districts, cases were first tested for malaria prior to treatment or referral (3 cases out of 5). Community health workers who declared being able to identify a suspected EVD case were significantly more represented in the more affected districts (73%) than in the less affected districts (38.1%, P<0.001). This study suggests that health system managers should prioritize capacity building of health providers in EVD affected as well as in non-affected districts to ensure better preparation for and response to EVD outbreaks.

Contact tracing performance during the Ebola epidemic in Liberia, 2014-2015.

BackgroundDuring the Ebola virus disease (EVD) epidemic in Liberia, contact tracing was implemented to rapidly detect new cases and prevent further transmission. We describe the scope and characteristics of contact tracing in Liberia and assess its performance during the 2014–2015 EVD epidemic.Methodology/Principal findingsWe performed a retrospective descriptive analysis of data collection forms for contact tracing conducted in six counties during June 2014–July 2015. EVD case counts from situation reports in the same counties were used to assess contact tracing coverage and sensitivity. Contacts who presented with symptoms and/or died, and monitoring was stopped, were classified as “potential cases”. Positive predictive value (PPV) was defined as the proportion of traced contacts who were identified as potential cases. Bivariate and multivariate logistic regression models were used to identify characteristics among potential cases.We analyzed 25,830 contact tracing records for contacts who had monitoring initiated or were last exposed between June 4, 2014 and July 13, 2015. Contact tracing was initiated for 26.7% of total EVD cases and detected 3.6% of all new cases during this period. Eighty-eight percent of contacts completed monitoring, and 334 contacts were identified as potential cases (PPV = 1.4%). Potential cases were more likely to be detected early in the outbreak; hail from rural areas; report multiple exposures and symptoms; have household contact or direct bodily or fluid contact; and report nausea, fever, or weakness compared to contacts who completed monitoring.Conclusions/SignificanceContact tracing was a critical intervention in Liberia and represented one of the largest contact tracing efforts during an epidemic in history. While there were notable improvements in implementation over time, these data suggest there were limitations to its performance—particularly in urban districts and during peak transmission. Recommendations for improving performance include integrated surveillance, decentralized management of multidisciplinary teams, comprehensive protocols, and community-led strategies.

US State Public Health Departments Special Pathogen Planning.

US state public health departments played key roles in planning for and responding to confirmed and suspected cases of Ebola virus disease (EVD) during the 2014-2016 outbreak, including designating select hospitals as high-level isolation units (HLIUs) for EVD treatment in conjunction with the Centers for Disease Control and Prevention. To identify existing guidelines and perspectives of state health departments pertaining to the management and transport of patients with EVD and other highly hazardous communicable diseases (HHCDs). An electronic 8-question survey with subquestions was administered as a fillable PDF. The survey was distributed to publicly accessible e-mails of state health department employees. State epidemiologists, emergency preparedness directors, or chief medical officers from each of the 50 states and the District of Columbia were contacted; a representative from 36 states and the District of Columbia responded (73%). Descriptive statistics were used to identify the proportion of state health departments with various existing protocols. A majority of states reported that they would prefer patients confirmed with viral hemorrhagic fevers (eg, EVD, Marburg fever) and smallpox be transported to an HLIU for treatment rather than remain at the initial hospital of diagnosis. While most (89%) states had written guidelines for the safe transportation of patients with HHCDs, only 6 (16%) had written protocols for the management of accidents or other travel disruptions that may occur during HHCD transport within the state. Twenty-two state health departments (59%) had operationally exercised transport of a patient to an HLIU. Nearly half of states in the United States lack an HLIU, yet most prefer to have patients with HHCDs treated in high-level isolation. Recent budget cuts and uncertainty of future funding threaten the abilities of health departments to devote the necessary resources and staff to prepare for and deliver the desired care to HHCD cases. The lack of HLIUs in some states may complicate transport to a geographically proximate HLIU. Moreover, limited guidance on diseases that warrant high-level isolation may cause disagreement in HHCD patient placement between health departments, diagnosing facilities, and HLIUs.

Catching Chances: The Movement to Be on the Ground and Research Ready before an Outbreak.

After more than 28,000 Ebola virus disease cases and at least 11,000 deaths in West Africa during the 2014–2016 epidemic, the world remains without a licensed vaccine or therapeutic broadly available and demonstrated to alleviate suffering. This deficiency has been felt acutely in the two, short, following years with two Ebola virus outbreaks in the Democratic Republic of Congo (DRC), and a Marburg virus outbreak in Uganda. Despite billions of U.S. dollars invested in developing medical countermeasures for filoviruses in the antecedent decades, resulting in an array of preventative, diagnostic, and therapeutic products, none are available on commercial shelves. This paper explores why just-in-time research efforts in the field during the West Africa epidemic failed, as well as some recent initiatives to prevent similarly lost opportunities.

Serological Investigation of Laboratory-Confirmed and Suspected Ebola Virus Disease Patients During the Late Phase of the Ebola Outbreak in Sierra Leone.

This study aimed to investigate the serological characteristics of Ebola virus (EBOV) infection during the late phase of the Ebola outbreak in Sierra Leone. In total, 877 blood samples from 694 suspected Ebola virus disease (EVD) cases assessed from March to December 2015, were analyzed via real-time reverse transcription polymerase chain reaction (RT-PCR) for viral RNA and enzyme-linked immunosorbent assay (ELISA) and Luminex to detect antibodies against EBOV. Viral load and EBOV-specific IgM/IgG titers displayed a declining trend during March to December 2015. Viral RNA load decreased rapidly at earlier stages after disease onset, while EBOV-specific IgM and IgG still persisted in 58.1% (18/31) and 93.5% (29/31) of the confirmed EVD patients and in 3.8% (25/663) and 17.8% (118/663) of the RNA-negative suspected patients in the later phase, respectively. Dynamic analysis of longitudinally collected samples from eight EVD patients revealed typically reversed trends of declining viral load and increasing IgM and/or IgG titers in response to the EBOV infection. The present results indicate that certain populations of Sierra Leone developed immunity to an EBOV infection in the late phase of the outbreak, providing novel insights into the risk assessment of EBOV infections among human populations.

Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report

Outbreak response efforts for the 2014-15 Ebola virus disease epidemic in west Africa brought widespread transmission to an end. However, subsequent clusters of infection have occurred in the region. An Ebola virus disease cluster in Liberia in November, 2015, that was identified after a 15-year-old boy tested positive for Ebola virus infection in Monrovia, raised the possibility of transmission from a persistently infected individual. Case investigations were done to ascertain previous contact with cases of Ebola virus disease or infection with Ebola virus. Molecular investigations on blood samples explored a potential linkage between Ebola virus isolated from cases in this November, 2015, cluster and epidemiologically linked cases from the 2014-15 west African outbreak, according to the national case database. The cluster investigated was the family of the index case (mother, father, three siblings). Ebola virus genomes assembled from two cases in the November, 2015, cluster, and an epidemiologically linked Ebola virus disease case in July, 2014, were phylogenetically related within the LB5 sublineage that circulated in Liberia starting around August, 2014. Partial genomes from two additional individuals, one from each cluster, were also consistent with placement in the LB5 sublineage. Sequencing data indicate infection with a lineage of the virus from a former transmission chain in the country. Based on serology and epidemiological and genomic data, the most plausible scenario is that a female case in the November, 2015, cluster survived Ebola virus disease in 2014, had viral persistence or recurrent disease, and transmitted the virus to three family members a year later. Investigation of the source of infection for the November, 2015, cluster provides evidence of Ebola virus persistence and highlights the risk for outbreaks after interruption of active transmission. These findings underscore the need for focused prevention efforts among survivors and sustained capacity to rapidly detect and respond to new Ebola virus disease cases to prevent recurrence of a widespread outbreak. US Centers for Disease Control and Prevention, Defense Threat Reduction Agency, and WHO.

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%.

Development of Mobile Laboratory for Viral Hemorrhagic Fever Detection in Africa.

A mobile laboratory transportable on commercial flights was developed to enable local response to viral hemorrhagic fever outbreaks. The development progressed from use of mobile real-time reverse-transcription polymerase chain reaction to mobile real-time recombinase polymerase amplification. In this study, we describe various stages of the mobile laboratory development. A brief overview of mobile laboratory deployments, which culminated in the first on-site detection of Ebola virus disease (EVD) in March 2014, and their successful use in a campaign to roll back EVD cases in Conakry in the West Africa Ebola virus outbreak are described. The developed mobile laboratory successfully enabled local teams to perform rapid disgnostic testing for viral hemorrhagic fever.

Adherence to Ebola-specific malaria case management guidelines at health facilities in Guinea during the West African Ebola epidemic

BackgroundMalaria case management in the context of the 2014–2016 West African Ebola virus disease (EVD) epidemic was complicated by a similar initial clinical presentation of the two diseases. In September 2014, the World Health Organization (WHO) released recommendations titled, “Guidance on temporary malaria control measures in Ebola-affected countries”, which aimed at reducing the risk of EVD transmission and improving malaria outcomes. This guidance recommended malaria diagnostic testing of fever cases only if adequate personal protective equipment (PPE) was available, defined as examination gloves, face shield, disposable gown, boots, and head cover; otherwise presumptive anti-malarial treatment was recommended. The extent to which health workers adhered to these guidelines in affected countries has not been assessed.MethodsA cross-sectional survey was conducted in 118 health units in Guinea in November 2014 to produce a representative and probabilistic sample of health facilities and patients. Adherence to the EVD-specific malaria case management guidelines during the height of the EVD epidemic was assessed. Associations between case management practices and possible determinants were calculated using multivariate logistic regression, controlling for expected confounders and the complex sample design.ResultsMost (78%) facilities reported availability of examination gloves, but adequate PPE was available at only 27% of facilities. Only 28% of febrile patients received correct malaria case management per the WHO temporary malaria case management guidelines. The most common error was diagnostic testing in the absence of adequate PPE (45% of febrile patients), followed by no presumptive treatment in the absence of adequate PPE (14%). Having had a report of an EVD case at a health facility and health worker-reported participation in EVD-specific malaria trainings were associated with lower odds of diagnostic testing and higher odds of presumptive treatment.ConclusionsAdherence to guidance on malaria case management in EVD-affected countries was low at the height of the EVD epidemic in Guinea, and there was substantial malaria diagnostic testing in the absence of adequate PPE, which could have contributed to increased EVD transmission in the healthcare setting. Conversely, low presumptive treatment when diagnostic tests were not performed may have led to additional morbidity and mortality among malaria positive patients. National malaria control programs may consider preparing contingency plans for future implementation of temporary changes to malaria case management guidelines to facilitate uptake by health workers. Additional training on standard and transmission-based precautions should help health workers understand how to protect themselves in the face of emerging and unknown pathogens.