Ebola Virus Outbreak Research Articles

Scarcity of research on breastfeeding and Ebola diseases is placing the lives of women and infants at risk: a call to specific action.

Ebola virus outbreaks causing viral haemorrhagic fever occur predominantly in regions with high fertility, where breastfeeding is the only safe infant feeding option. Yet, there is a dearth of evidence to inform recommendations and decision making for breastfeeding mothers. Specific gaps in knowledge include whether or for how long replicable virus is present in breastmilk, whether mother-to-infant viral transmission can occur through breastmilk, and whether the interruption of breastfeeding would be beneficial if both mother and infant are infected. Furthermore, despite vaccine availability, there is no evidence regarding safety in mother-infant pairs. This inadequacy of evidence is long recognised, but a pathway to necessary knowledge has not previously been outlined. This Health Policy summarises existing data and delineates research priorities and methods to provide a research roadmap to protect breastfeeding women and their infants through research, rather than systematically excluding them, with the desire to protect them from theoretical risks of research in the context of Ebola.

Analysis of Sustainable Development Policies of Marampa Mining Ltd. and Understanding Their Effects on Society – Environment and Human Resources of Sierra Leone (West Africa)

Sierra Leone, a country situated on the western side of the African continent has its own enriched history of tribes, British colonization, slave trade, Ebola virus outbreak, blood diamonds and mining. This country was under civil war for twelve long years (1991 to 2002). Due to the political turbulence the economy of the country has also suffered largely. Most of the population is still depending upon traditional unorganized agriculture. Sierra Leone is extremely rich in minerals and natural resources. In recent decades, the mining industry has risen and is handsomely contributing to the country’s economy. Marampa Mines Ltd. is one of such organization that is extracting the iron ore from the Lunsar town of the Port Loko district of Sierra Leone. This study aims to shed light on the organization's activities in three key areas: social, environmental, and human resources. The concept of sustainable development serves as the foundation for this research, and the organization's actions are evaluated accordingly. Notably, this study is conducted independently, without influence from the state of Sierra Leone or the Gerald Group. While it is acknowledged that mining activities inevitably lead to degradation, it is the state's and capitalists' moral and legal responsibility to strike a balance between economic and environmental concerns. This study is one of the few to focus on Sierra Leone and is expected to inspire further research and investigation.

Vaccination Strategies for Ebola in the Democratic Republic of Congo: The WHO-Ebola Modeling Collaboration.

Assess the effectiveness of ring vaccination in controlling an Ebola virus outbreak in the Democratic Republic of Congo. This analysis focuses on two areas of the Democratic Republic of Congo, Beni and Butembo/Katwa, which were affected during the 2018-2020 Ebola outbreak. To simulate Ebola virus transmission, we used a spatially explicit agent-based model with households, health care facilities, and Ebola treatment units. Model parameters were calibrated using data collected under the ring-vaccination expanded-access protocol implemented during the outbreak. The model was used to estimate the impact of the deployed ring vaccination strategy, compared to what would have happened if there had been no ring vaccination. The impact of alternative vaccination strategies (mass vaccination, targeted geographic vaccination, and ring-plus) was evaluated as well. Compared to a hypothetical scenario where vaccination was not implemented, ring vaccination was estimated to have averted 54.3% (SD, 32.5%) and 62.7% (SD, 23.2%) of potential cases in Beni and Butembo/Katwa, respectively. Under ring vaccination, the average number of averted cases per 1000 vaccine doses administered was 15.1 (SD, 16.8) and 27.8 (SD, 22.9), in Beni and Butembo/Katwa, respectively. In terms of number of averted cases per vaccine dose, ring vaccination was estimated to be more efficient than any of the other evaluated vaccination strategies. Despite some level of social instability, ring vaccination with the rVSV-ZEBOV vaccine was highly effective during the 2018-2020 Ebola outbreak in the Democratic Republic of Congo. As compared to alternative vaccination strategies, ring vaccination was estimated to be the most efficient.

Perceived drivers of the Ebola virus disease outbreak in Mubende and Kassanda districts, Uganda: a qualitative study

IntroductionDuring the most recent Ebola virus disease (EVD) outbreak in Uganda, a cluster of community deaths with epidemiological linkages to the first reported case were identified to have occurred in...

Marburg Virus Medical Countermeasures.

Among the Filoviridae, Marburg virus (MARV) is a biological threat for which no licensed vaccines or therapeutics are currently available. In contrast, we have licensed products for Ebola virus (EBOV), another member of the Filoviridae family. The availability of licensed medical countermeasures (MCMs) for EBOV provides an opportunity to test a key objective of many pandemic preparedness plans, which is to apply some of the same technological approaches demonstrated to be successful for one agent, EBOV, to a second agent, MARV. This chapter will discuss (1) lessons learned from EBOV outbreak responses and MCM development that are applicable to MARV MCM development, (2) the likely concept of operations for using vaccines and therapeutics against MARV, and (3) target product profiles based on the concept of operations. Finally, we will discuss the current status of the MCM pipeline for MARV and next steps to advance these countermeasures to licensure.

The Development of Ebola Virus Outbreaks: A Review of Epidemiological Trends, Clinical Features, and Treatment Advances.

The Ebola virus, a filovirus that causes human Ebola virus disease (EVD), has caused multiple epidemics in the African continent for about 50 years. Wild animals were the source from which the virus was transmitted to humans, and it spread among people through direct contact. The majority of Ebola outbreaks occurred in African nations, particularly in Sudan, the Democratic Republic of the Congo (DRC), Uganda, and Gabon. Although EVD is a lethal disease, it has posed a challenge to human efforts to comprehend its etiology, epidemiology, pathophysiology, pathogenesis, and the best methods for treatment and prevention. This review aims to present the history of Ebola epidemics in Africa, each subtype that caused an outbreak, the development of therapies and vaccines, and the significance of travel regulations.

Evidence of repeated zoonotic pathogen spillover events at ecological boundaries.

Anthropogenic modifications to the landscape have altered several ecological processes worldwide, creating new ecological boundaries at the human/wildlife interface. Outbreaks of zoonotic pathogens often occur at these ecological boundaries, but the mechanisms behind new emergences remain drastically understudied. Here, we test for the influence of two types of ecosystem boundaries on spillover risk: (1) biotic transition zones such as species range edges and transitions between ecoregions and (2) land use transition zones where wild landscapes occur in close proximity to heavily impacted areas of high human population density. Using ebolavirus as a model system and an ensemble machine learning modeling framework, we investigated the role of likely reservoir (bats) and accidental host (primates) range edges and patterns of land use (defined using SEDAC categories) on past spillover events. Our results show that overlapping species range edges and heightened habitat diversity increase ebolavirus outbreaks risk. Moreover, we show that gradual transition zones, represent by high proportion of rangelands, acts as a buffer to reduces outbreak risks. With increasing landscape changes worldwide, we provide novel ecological and evolutionary insights into our understanding of zoonotic pathogen emergence and highlight the risk of aggressively developing ecological boundaries.

A metapopulation model with exit screening measure for the 2014–2016 West Africa Ebola virus outbreak

We construct a new metapopulation model for the transmission dynamics and control of the Ebola Virus Disease (EVD) in an environment characterized by considerable migrations and travels of people. It is an extended SEIR model modified by the addition of Quarantine and Isolated compartments to account for travelers who undergo the exit screening. The model is well-fitted by using the reported cases from the neighboring countries Guinea, Liberia and Sierra Leone where the 2014–2016 Ebola outbreak simultaneously arose. We show that the unique disease-free equilibrium (DFE) of the model is unstable or locally asymptotically stable (LAS) depending on whether the control reproduction number is larger or less than unity. In the latter case, we prove that the DFE is globally asymptotically stable (GAS) provided that the exit screening is 100% negative. We also prove the GAS of the DFE by introducing more explicit thresholds, thanks to which the existence of at least one boundary equilibrium is established. We design two new nonstandard finite difference (NSFD) schemes, which preserve the dynamics of the continuous model. Numerical simulations that support the theory highlight that exit screening is useful to mitigate the infection. They also suggest that the disease is controlled or the explicit threshold is less than unity provided that the migration and the exit screening parameters are above a critical value.

The European Mobile Laboratory: key insights from a decade of outbreak response

Abstract EMLab has responded to emergencies including the West Africa Ebola virus outbreak (2014-2016), the COVID-19 pandemic, and outbreaks of yellow fever, Marburg virus, and Lassa fever. It has deployed mobile labs and experts to many countries, including Guinea, Liberia, Sierra Leone, Nigeria, Uganda, the Democratic Republic of the Congo, Germany, and Greece. With accumulated experience from each deployment, EMLab’s diagnostic expertise has evolved beyond RT-PCR and serological testing to include basic point-of-care tests, haematology, and genomic surveillance capacities, also focusing on interoperability with other response capacities such as EMTs. Critical to mission success, the organization works closely with the WHO and GOARN, and was certified in 2023 as an official German response capacity within the European Civil Protection Pool. The two-year continuous deployment from 2014-2016 was pivotal in shaping EMLab’s evolution, also leading to significant capacity-building efforts in West Africa. In Guinea, for example, a surveillance network of three diagnostic laboratories has been established and successfully detected cases of viral haemorrhagic fevers, including the re-emergence of Ebola virus and the first reported case of Marburg virus in Guinea in 2021. Ultimately, EMLab’s extensive experience demonstrates that effective public health emergency response requires constant evolution, strategic partnerships, and a commitment to building local capacities, paving the way for a more resilient and prepared global health community.

2022 Sudan Ebolavirus Outbreak in Uganda: Modelling Case Burden and Outbreak Duration.

In September 2022, an outbreak of Sudan virus (SUDV) was confirmed in Uganda. Following the first case report, we developed an individual based modelling platform (IBM-SUDV) to estimate the burden of cases and deaths, as well as the duration of the unfolding SUDV outbreak, using different scenarios. Modelled projections were within the range of cases and deaths ultimately observed.

The Role of Community Beliefs and Practices on the Spread of Ebola in Uganda, September 2022.

On September 20, 2022, Uganda declared an Sudan Virus Disease (SVD) outbreak in Mubende District. Another eight districts were infected September-November 2022. We examined how Ugandan community beliefs and practices spread Sudan Ebola Virus (SUDV) in 2022. A qualitative study was conducted in Mubende, Kassanda, and Kyegegwa districts in February 2023. Nine focus group discussions and six key informant interviews were held. We investigated whether community beliefs and practices contributed to spreading Sudan Ebola Virus (SUDV). Interviews were recorded, translated, transcribed, and thematically analyzed. The community deaths, later found to be due to Sudan Virus Disease(SVD), were often attributed to witchcraft or poisoning. Key informants reported that SVD patients often sought traditional healers or spiritual leaders before or after formal healthcare failed. They also found that traditional healers treated SVD patients without precautions. Religious leaders praying for SVD patients and their symptomatic contacts, SVD patients hiding in friends' homes, and exhuming SVD patients from safe and dignified burials to allow traditional burials were other themes. Diversity in community beliefs and culture likely contributed to spreading the 2022 Ugandan SVD outbreak. Public health systems, traditional healers, and religious leaders can help Uganda control ebolavirus outbreaks by identifying socially acceptable and scientifically supported infection control methods.

Feasibility Assessment of a Novel Isolation Care Tent in Uganda During the 2022 Sudan ebolavirus Outbreak.

This case study describes a feasibility assessment of a novel isolation care tent used in health facilities in Uganda during the 2022 Sudan ebolavirus outbreak. The Isolation System for Treatment and Agile Response to High-Risk Infections Model 1B (ISTARI 1B) is a single-occupancy, portable, negative-pressure isolation tent designed for the safe delivery of standard care to patients with a communicable disease, including Ebola disease (Sudan). At the request of the Uganda Ministry of Health, the Makerere University Infectious Diseases Institute and University of Nebraska Medical Center partnered to evaluate 7 health facilities across 4 districts in Uganda for infrastructure, case management, and infection prevention and control (IPC) capacity relevant to isolation care and ISTARI 1B use. A 3-day workshop was held with IPC leaders to provide familiarization and hands-on experience with the ISTARI 1B, delineate appropriate use scenarios in Ugandan healthcare settings, contextualize ISTARI 1B use in case management and IPC workflows, develop a framework for site assessment and implementation readiness, and consider ongoing monitoring, assessment, and intervention tools. Workshop participants performed a comprehensive site assessment and mock deployment of the ISTARI 1B. In this case study, we describe lessons learned from health facility assessments and workshop outcomes and offer recommendations to support successful ISTARI 1B implementation. Use scenarios and implementation strategies were identified across facility levels, including tools for site assessment, training, risk communication, and ongoing quality and safety monitoring.

Effectiveness of rVSV-ZEBOV vaccination during the 2018–20 Ebola virus disease epidemic in the Democratic Republic of the Congo: a retrospective test-negative study

The recombinant vesicular stomatitis virus-Zaire Ebola virus (rVSV-ZEBOV) vaccine is the only WHO prequalified vaccine recommended for use to respond to outbreaks of Ebola virus (species Zaire ebolavirus) by WHO's Strategic Advisory Group of Experts on Immunization. Despite the vaccine's widespread use during several outbreaks, no real-world effectiveness estimates are currently available in the literature. We conducted a retrospective test-negative analysis to estimate effectiveness of rVSV-ZEBOV vaccination against Ebola virus disease during the 2018-20 epidemic in the Democratic Republic of the Congo, using data on suspected Ebola virus disease cases collected from Ebola treatment centres. Those eligible for inclusion had an available Ebola virus RT-PCR result, available key data, were eligible for vaccination during the outbreak, and had symptom onset aligning with the period in which a ring-vaccination protocol was in use. After imputing missing data, each individual confirmed by RT-PCR to be Ebola virus disease-positive (defined as a case) was matched to one individual negative for Ebola virus disease (control) by sex, age, health zone, and month of symptom onset. Effectiveness was estimated from the odds ratio of being vaccinated (≥10 days before symptom onset) versus being unvaccinated among cases and controls, after adjusting for the matching factors. The imputation, matching and effectiveness estimation, was repeated 500 times. 1273 (4·8%) of 26 438 eligible individuals were positive for Ebola virus disease (cases) and 25 165 (95·2%) were negative (controls). 40 (3·1%) cases and 1271 (5·1%) controls were reported as being vaccinated at least 10 days before symptom onset. After selecting individuals who reported exposure to an individual with Ebola virus disease within the 21 days before symptom onset and matching, the analysis datasets comprised a median of 309 cases and 309 controls. 10 days or more after vaccination, the effectiveness of rVSV-ZEBOV against Ebola virus disease was estimated to be 84% (95% credible interval 70-92). This analysis is the first to provide estimates of the real-world effectiveness of the rVSV-ZEBOV vaccine against Ebola virus disease, amid the widespread use of the vaccine during a large Ebola virus disease outbreak. Our findings confirm that rVSV-ZEBOV is highly protective against Ebola virus disease and support its use during outbreaks, even in challenging contexts such as in the eastern Democratic Republic of the Congo. Médecins Sans Frontières. For the French translation of the abstract see Supplementary Materials section.

“Bats Who Harm” and “Bats Who May Be Harmed”: The Interspecies Politics of Virus Sampling

Abstract The 2013–2016 Ebola virus outbreak in West Africa galvanized a quest for more knowledge with regards to the ecology of the disease. In its immediate aftermath, research initiatives, at the junction of biosecurity and One Health, were mounted to elucidate the circulation of the Ebola virus and other emergent pathogens through sampling local wildlife, in particular bats. The article investigates the knowledge, affects, and practices mitigating care and risk in encounters between human animals and potentially contaminated nonhuman animals. Grounded in an ethnography of the labor of wildlife sampling by Guinean veterinarians, it adopts an interspecies perspective on the One Health laboratory, a place where relations between animals and humans are inflected by a postcolonial, gendered, and anthropocentric imbalance of power. It argues that, rather than blurring interspecies boundaries, scientific care for sampled bats may cement hierarchies, with consequences for samplers and animals.

Prevalence of and factors associated with anxiety, depression and post-traumatic stress disorder among Sudan ebolavirus disease survivors and family members, Uganda, January 2023: a cross-sectional study

BackgroundCommunities affected by Ebola disease (EBOD) may face resulting increases in mental health disorders. We evaluated the prevalence of and factors associated with mental health disorders among persons affected by the 2022 Sudan virus disease (SVD) outbreak in Uganda.MethodsWe conducted a cross-sectional study among SVD survivors and family members of survivors and fatal cases from 15–31 January 2023. We included only laboratory-confirmed SVD survivors and family members who lived with or cared for confirmed SVD patients during their illness. The Hospital Anxiety and Depression Scale was used to evaluate anxiety and depression. The post-traumatic stress disorder (PTSD) checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition was used to evaluate PTSD. Modified Poisson regression was used to determine factors associated with each mental health disorder.ResultsWe enrolled 54 survivors and 82 family members; median age was 30 years (range, 15–73) and 54% were female. The prevalence of anxiety (55%) and depression (50%) was higher than PTSD (17%). The prevalence of all mental health disorders was similar between survivors and family members. Household size was associated with both anxiety and PTSD. Number of SVD deaths in the household was associated with depression.ConclusionApproximately two-thirds of SVD survivors and family members of patients in the 2022 outbreak in Uganda had ≥ 1 mental health disorders shortly after the outbreak ended. Strengthening mental health services during and after Ebola virus outbreaks for survivors and family members of patients may enhance the quality of outbreak response.

Serological evidence of zoonotic filovirus exposure among bushmeat hunters in Guinea

Human Ebola virus (EBOV) outbreaks caused by persistent EBOV infection raises questions on the role of zoonotic spillover in filovirus epidemiology. To characterise filovirus zoonotic exposure, we collected cross-sectional serum samples from bushmeat hunters (n = 498) in Macenta Prefecture Guinea, adjacent to the index site of the 2013 EBOV-Makona spillover event. We identified distinct immune signatures (20/498, 4.0%) to multiple EBOV antigens (GP, NP, VP40) using stepwise ELISA and Western blot analysis and, live EBOV neutralisation (5/20; 25%). Using comparative serological data from PCR-confirmed survivors of the 2013-2016 EBOV outbreak, we demonstrated that most signatures (15/20) were not plausibly explained by prior EBOV-Makona exposure. Subsequent data-driven modelling of EBOV immunological outcomes to remote-sensing environmental data also revealed consistent associations with intact closed canopy forest. Together our findings suggest exposure to other closely related filoviruses prior to the 2013-2016 West Africa epidemic and highlight future surveillance priorities.

Fruit–frugivore dependencies are important in Ebolavirus outbreaks in Sub‐Saharan Africa

Ebolaviruses have the ability to infect a wide variety of species, with many African mammals potentially serving either as primary reservoirs or secondary amplifying hosts. Previous work has shown that frugivorous bats and primates are often associated with spillover and outbreaks. Yet the role that patterns of biodiversity, either of mammalian hosts or of common fruiting species such as Ficus (figs, fruit resources used by a wide variety of species), play in driving outbreak risk remains unclear. We investigated what factors most directly influence Ebolavirus outbreak risk in Sub‐Saharan Africa by using a phylogenetically informed path analysis to compare a wide array of potential models (path diagrams) of spatial dynamics. We considered mammalian frugivore richness, cercopithecid and hominid primate richness, richness of pteropodid (fruit) bats, the spatial distribution of species that have tested positive for Ebolavirus antibodies in the wild, Ficus habitat suitability, and environmental conditions (mean annual and variability in temperature and rainfall). The proximate factors that most influenced whether a given host species range contained a site of a previous outbreak event were 1) habitat suitability for Ficus and 2) the diversity of cercopithecid primates. Frugivore richness overall (including bats, primates, and a few other mammals) and the richness of bats in the family Pteropodidae had a strong effect on which species tested positive for Ebolavirus antibodies, but did not influence outbreak risk directly in pathways explored. We interpret this as evidence that foraging around Ficus and frugivorous mammals (such as cercopithecid primates which are commonly hunted for food) play a prominent role in driving outbreaks into human communities, relative to other factors we considered which influence outbreak risk more indirectly.

Ad26.ZEBOV, MVA-BN-Filo Ebola virus disease vaccine regimen plus Ad26.ZEBOV booster at 1 year versus 2 years in health-care and front-line workers in the Democratic Republic of the Congo: secondary and exploratory outcomes of an open-label, randomised, phase 2 trial

Health-care providers and front-line workers are at risk of contracting Ebola virus disease during an Ebola virus outbreak and consequently of becoming drivers of the disease. We aimed to assess the long-term immunogenicity of the Ad26.ZEBOV, MVA-BN-Filo vaccine regimen and the safety of and immune memory response to an Ad26.ZEBOV booster vaccination at 1 year or 2 years after the first dose in this at-risk population. This open-label, single-centre, randomised, phase 2 trial was conducted at one study site within a hospital in Boende, Democratic Republic of the Congo. Adult health-care providers and front-line workers, excluding those with a known history of Ebola virus disease, were vaccinated with a two-dose heterologous regimen administered at a 56-day interval via a 0·5 mL intramuscular injection in the deltoid muscle, comprising Ad26.ZEBOV as the first dose and MVA-BN-Filo as the second dose. After the initial vaccination on day 1, participants were randomly assigned (1:1) via randomisation envelopes, opened in a sequential order, to receive an Ad26.ZEBOV booster vaccination at 1 year (group 1) or 2 years (group 2) after the first dose. We present the secondary and exploratory objectives of the trial-results of the primary objective have been published elsewhere. We measured immunogenicity at six timepoints per group as geometric mean concentrations (GMCs) of Ebola virus glycoprotein-specific IgG binding antibodies, using the Filovirus Animal Non-Clinical Group ELISA. We assessed serious adverse events occurring up to 6 months after the last dose and local and systemic solicited and unsolicited adverse events reported for 7 days after the booster vaccination. Antibody responses were analysed per protocol, serious adverse events per full analysis set (FAS), and adverse events for all boosted FAS participants. This trial is registered as completed on ClinicalTrials.gov (NCT04186000). Between Dec 18, 2019, and Feb 8, 2020, 699 health-care providers and front-line workers were enrolled and 698 were randomly assigned (350 to group 1 and 348 to group 2 [FAS]); 534 (77%) participants were male and 164 (23%) were female. 319 in group 1 and 317 in group 2 received the booster. 29 (8%) in group 1 and 26 (7%) in group 2 did not complete the study, mostly due to loss to follow-up or moving out of the study area. In both groups, injection-site pain or tenderness (87 [27%] of 319 group 1 participants vs 90 [28%] of 317 group 2 participants) and headache (91 [29%] vs 93 [29%]) were the most common solicited adverse events related to the investigational product. One participant (in group 2) had a related serious adverse event after booster vaccination (fever of ≥40·0°C). Before booster vaccination, Ebola virus glycoprotein-specific IgG binding antibody GMCs were 279·9 ELISA units (EU) per mL (95% CI 250·6-312·7) in 314 group 1 participants (1 year after first dose) and 274·6 EU/mL (242·1-311·5) in 310 group 2 participants (2 years after first dose). These values were 5·2 times higher in group 1 and 4·9 times higher in group 2 than before vaccination on day 1. 7 days after booster vaccination, these values increased to 10 781·6 EU/mL (9354·4-12 426·4) for group 1 and 10 746·9 EU/mL (9208·7-12 542·0) for group 2, which were approximately 39 times higher than before booster vaccination in both groups. 1 year after booster vaccination in 299 group 1 participants, a GMC that was 7·6-times higher than before booster vaccination was still observed (2133·1 EU/mL [1827·7-2489·7]). Overall, the vaccine regimen and booster dose were well tolerated. A similar and robust humoral immune response was observed for participants boosted 1 year and 2 years after the first dose, supporting the use of the regimen and flexibility of booster dose administration for prophylactic vaccination in at-risk populations. Innovative Medicines Initiative 2 Joint Undertaking and Coalition for Epidemic Preparedness Innovations.

Evaluating the risk of conflict on recent Ebola outbreaks in Guinea and the Democratic Republic of the Congo.

Reducing Ebola virus transmission relies on the ability to identify cases and limit contact with infected bodily fluids through biosecurity, safe sex practices, safe burial and vaccination. Armed conflicts can complicate outbreak detection and interventions due to widespread disruption to governments and populations. Guinea and the Democratic Republic of the Congo (DRC) have historically reported the largest and the most recent Ebola virus outbreaks. Understanding if conflict played a role in these outbreaks may help in identifying key risks factors to improve disease control. We used data from a range of publicly available data sources for both Ebola virus cases and conflict events from 2018 to 2021 in Guinea and the DRC. We fitted these data to conditional logistic regression models using the Self-Controlled Case Series methodology to evaluate the magnitude in which conflict increased the risk of reported Ebola virus cases in terms of incidence rate ratio. We re-ran the analysis sub-nationally, by conflict sub-event type and tested any lagged effects. Conflict was significantly associated with an increased risk of reported Ebola virus cases in both the DRC and Guinea in recent outbreaks. The effect was of a similar magnitude at 1.88- and 1.98-times increased risk for the DRC and Guinea, respectively. The greatest effects (often higher than the national values) were found in many conflict prone areas and during protest/riot-related conflict events. Conflict was influential in terms of Ebola virus risk from 1week following the event and remained important by 10weeks. Extra vigilance is needed following protests and riot-related conflict events in terms of Ebola virus transmission. These events are highly disruptive, in terms of access to transportation and healthcare and are often in urban areas with high population densities. Additional public health messaging around these types of conflict events, relating to the risks and clinical symptoms may be helpful in reducing transmission. Future work should aim to further understand and quantify conflict severity and intensity, to evaluate dose-response relationships in terms of disease risk.

The perception of COVID-19 pandemic response and factors associated with non-utilization of face masks in communities with previous exposure to Ebola virus outbreak, Liberia, 2020: A mixed-method study

The perception of COVID-19 pandemic response and factors associated with non-utilization of face masks in communities with previous exposure to Ebola virus outbreak, Liberia, 2020: A mixed-method study