Ebola Virus Disease Outbreak Research Articles

Development of a Skills-Based IPC Supervisor Course During the 2018-19 DRC Ebola Virus Disease Outbreak

Background: With >3,000 cases and 2,000 deaths, the current outbreak of Ebola virus disease (EVD) in the Democratic Republic of the Congo (DRC) is the second-largest reported EVD outbreak in history. Healthcare-associated transmission of EVD has been a persistent amplifier of transmission due, in part, to fragility of the healthcare system, lack of basic infection prevention and control (IPC) infrastructure, and large number of healthcare facilities (HCFs). A central component of the strategy to rapidly strengthen IPC in HCFs is the provision of IPC supervisors to oversee standardized risk assessments and improvements and provide mentorship to HCF staff. To support these activities, we designed skills based training for IPC supervisors. Methods: Staff recruited by the Ministry of Health (MoH) to strengthen IPC are part of an outbreak-specific cadre known as IPC supervisors. IPC supervisors, who originally lacked technical knowledge and mentoring experience, were trained to provide technical support and mentorship to staff at HCFs, with the objective of improving IPC-related processes and behaviors. A competency-based training course was designed by conducting informal assessments of IPC supervisors during daily tasks to identify areas for performance improvement. We developed competencies based on activities designated for IPC supervisors according to MoH guidelines. We planned an iterative training rollout to allow for continuous, real-time modifications based on lessons learned throughout the implementation phase. Results: Although IPC supervisors displayed technical knowledge of IPC recommendations, we observed large gaps in implementation. IPC supervisors frequently failed to recognize behaviors that are high-risk for infection transmission. In addition, IPC supervisors lacked the ability to develop prioritized action plans and to implement interventions aimed at rapidly improving IPC practices. The course, designed as an interactive, skills-based training, is rooted in instructional design principles and addresses 4 key competencies: risk recognition and prioritization, IPC assessment completion, action plan development, and effective leadership and communication. The course will be pilot tested in the DRC to an audience of 25 IPC supervisors. Conclusions: In an outbreak setting, strong mentorship and problem-solving skills are needed to support effective implementation of IPC quality improvement. Trainings that are informed by field experiences and teach problem-solving, coaching, and communication skills are critical and can be developed rapidly. The strategy employed by the Ministry of Health to rapidly achieve IPC capacitation at HCFs might be adapted for use in future outbreaks.Funding: NoneDisclosures: None

Infection Prevention and Control Capacity Building During 2018–2019 Democratic Republic of Congo Ebola Virus Disease Outbreak

Background: As of July 1, 2019, ~18% of all cases in the Ebola virus disease (EVD) outbreak in the Democratic Republic of Congo (DRC) were healthcare-associated (ie, nosocomial) infections (HAIs) and healthcare worker (HCW) infections. Although progress has been achieved, gaps remained in infection prevention and control (IPC), specifically, a need to reinforce standardized, evidence-based IPC practices to effectively address HAIs. The Ministry of Health (MOH), in collaboration with partners, developed an IPC tool kit consisting of >70 documents (ie, terms of reference, standard operating procedures, training modules, etc) to improve HCW IPC knowledge and practices at healthcare facilities among staff. The tool kit incorporated international IPC standards, DRC-specific experiences, and best practices. Thus, it serves as a technical and operational package, covering general guidance (standard precautions) and EVD specific issues. Methods: A decentralized rollout approach was used to disseminate the tool kit content at the various health-system levels over several months. Initially, national-level training of trainers was held, followed by subnational-level training of IPC supervisors and key IPC implementers, and lastly, training of healthcare facility (HCF) IPC focal persons. The 5-day training adhered to the MOH standard of 60% theory and 40% practice. Participants completed evaluations before and after training; changes in knowledge between the pre- and posttraining tests were analyzed and the results of the statistical tests were reported (P < .05 was considered statistically significant). Results: In total, 294 IPC supervisors were trained across 7 subnational commissions. Data were analyzed for 138 participants. Participants were 60.9% IPC supervisors, 8% WASH supervisors, and 31% others. MOH representation was 52.9% The average results before the test were 66% (19.8 of 30), the average posttest results were 72% (21.6 of 30)—a significant improvement. The worst-performing pretest IPC domain was IPC approach, and facility closure was the worst performing for posttest. As of November 11, 15.7% of all cases were HAIs. Conclusions: The IPC training program initiated during an outbreak can increase knowledge and potentially improve practices and confidence. An association with the downward HAI trend is yet to be validated. The MOH anticipates that this tool kit will be the go-to resource for future Ebola outbreaks and that it will be incorporated into the preservice medical curriculum to ensure a resilient heath system.Funding: NoneDisclosures: None

Access to Alcohol-Based Hand Rub Is Associated With Improved Hand Hygiene in an Ebola-Threatened District of Western Uganda

Background: Ebola virus disease (EVD) is highly transmissible and has a high mortality rate. During outbreaks, EVD can spread across international borders. Inadequate hand hygiene places healthcare workers (HCWs) at increased risk for healthcare-associated infections, including EVD. In high-income countries, alcohol-based hand rub (ABHR) can improve hand hygiene compliance among HCWs in healthcare facilities (HCF). We evaluated local production and district-wide distribution of a WHO-recommended ABHR formulation and associations between ABHR availability in HCF and HCW hand hygiene compliance. Methods: The evaluation included 30 HCF in Kabarole District, located in Western Uganda near the border with the Democratic Republic of the Congo, where an EVD outbreak has been ongoing since August 2018. We recorded baseline hand hygiene practices before and after patient contact among 46 healthcare workers across 20 HCFs in August 2018. Subsequently, in late 2018, WHO/UNICEF distributed commercially produced ABHR to all 30 HCFs in Kabarole as part of Ebola preparedness efforts. In February 2019, our crossover evaluation distributed 20 L locally produced ABHR to each of 15 HCFs. From June 24–July 5, 2019, we performed follow-up observations of hand hygiene practices among 68 HCWs across all 30 HCFs. We defined hand hygiene as handwashing with soap or using ABHR. We conducted focus groups with healthcare workers at baseline and follow-up. Results: We observed hand hygiene compliance before and after 203 and 308 patient contacts at baseline and follow-up, respectively. From baseline to follow-up, hand hygiene compliance before patient contact increased for ABHR use (0% to 17%) and handwashing with soap (0% to 5%), for a total increase from 0% to 22% (P < .0001). Similarly, hand hygiene after patient contact increased from baseline to follow-up for ABHR use (from 3% to 55%), and handwashing with soap decreased (from 12% to 7%), yielding a net increase in hand hygiene compliance after patient contact from 15% to 62% (P < .0001). Focus groups found that HCWs prefer ABHR to handwashing because it is faster and more convenient. Conclusions: In an HCF in Kabarole District, the introduction of ABHR appeared to improve hand hygiene compliance. However, the confirmation of 3 EVD cases in Uganda 120 km from Kabarole District 2 weeks before our follow-up hand hygiene observations may have influenced healthcare worker behavior and hand hygiene compliance. Local production and district-wide distribution of ABHR is feasible and may contribute to improved hand hygiene compliance among healthcare workers.Funding: NoneDisclosures: Mohammed Lamorde, Contracted Research - Janssen Pharmaceutica, ViiV, Mylan

Status of Infection Prevention and Control in Selected Hospitals in Sierra Leone

Background: Improved infection prevention and control (IPC) reduces healthcare-associated infections (HAIs). Following the Ebola virus disease (EVD) outbreak in West Africa (2014–2016), Sierra Leone made substantial investments in strengthening IPC in health facilities. The WHO identified 8 core components of IPC and developed an accompanying assessment framework (IPCAF) to monitor IPC capacity and progress. The IPCAF reflects the 8 WHO core components of IPC. The core component constitute a consistent universal outline that supports guidance to healthcare decision makers and service providers at national and international levels. We conducted an in-depth assessment of IPC practices in Sierra Leone using the IPCAF tool. Methods: This assessment was conducted in in July 2019 over a 2-week period. Data were collected through interview with IPC focal persons as well as observations and corroboration of document and immediate feedback on findings given to facilities through brief exit meetings. All areas of the facility were assessed (ie, all wards, operation theatres, laboratories maternity units, sterile service departments, waste management units, etc). The main objective was to identify the gaps and challenges faced by health facilities. Each component was scored based on the responses and observations, with the scores ranging from zero to 100 and the maximum score was 800. The IPCAF allocated hospitals to 4 different “IPC levels”: inadequate, basic, intermediate, and advanced. Results: Moreover, 13 hospitals were assessed, including 12 primary level hospitals and 1 secondary level hospital. The median score was 367. 5 (IQR, 110), which corresponds to a basic level of IPC. Primary-level hospitals scored higher (median, 373; IQR, 112.5) compared to secondary-level hospitals (median, 280; IQR, 0). The lowest score was in healthcare-associated infection surveillance (median, 0; IQR, 5), and the highest score was in the built environment, availability of materials, and equipment to support IPC (median, 62.5; IQR, 22.5). Conclusions: The assessment provides a baseline of the status of IPC in Sierra Leone in the post-EVD period using the IPCAF tool. These results can be used to guide healthcare facilities and policy makers in developing strategies for IPC quality improvement projects to improve low-performing healthcare facilities. Significant gaps were observed in key IPC areas, especially in secondary-level health facilities. There is need to establish national surveillance for healthcare-associated infections, to institutionalize monitoring of IPC practices, and to ensure an appropriate staffing–workload ratio in health facilities.Funding: NoneDisclosures:If I am presenting research funded by a commercial company, the information presented will be based on generally accepted scientific principals and methods, and will not promote the commercial interest of the Funding: company. DisagreeAnna MarutaIf I am discussing specific healthcare products or services, I will use generic names to extent possible. If I need to use trade names, I will use trade names from several companies when available, and not just trade names from any single company.DisagreeChristiana Kallon

Investigation of Ebolavirus exposure in pigs presented for slaughter in Uganda.

In 2008, an outbreak of Reston ebolavirus (RESTV) in pigs in the Philippines expanded our understanding of the host range of ebolaviruses. Subsequent experimental infections with the human‐pathogenic species Zaire ebolavirus (EBOV) confirmed that pigs are susceptible to African species of ebolaviruses. Pig keeping has become an increasingly important livelihood strategy throughout parts of sub‐Saharan Africa, driven by increasing demand for pork. The growth in pig keeping is particularly rapid in Uganda, which has the highest per capita pork consumption in East Africa and a history of sporadic human outbreaks of Ebola virus disease (EVD). Using a systematic sampling protocol, we collected sera from 658 pigs presented for slaughter in Uganda between December 2015 and October 2016. Forty‐six pigs (7%) were seropositive based on ELISA tests at two different institutions. Seropositive pigs had antibodies that bound to Sudan NP (n = 27), Zaire NP (Kikwit; n = 8) or both NPs (n = 11). Sera from 4 of the ELISA‐positive pigs reacted in Western blot (EBOV NP = 1; RESTV NP = 2; both NPs = 2), and one sample had full neutralizing antibody against Sudan ebolavirus (SUDV) in virus neutralization tests. Pigs sampled in June 2016 were significantly more likely to be seropositive than pigs sampled in October 2016 (p = .03). Seropositive pigs were sourced from all regions except Western region. These observed temporal and spatial variations are suggestive of multiple introductions of ebolaviruses into the pig population in Uganda. This is the first report of exposure of pigs in Uganda to ebolaviruses and the first to employ systematic abattoir sampling for ebolavirus surveillance during a non‐outbreak period. Future studies will be necessary to further define the role pigs play (if any) in ebolavirus maintenance and transmission so that potential risks can be mitigated.

Distribution of household disinfection kits during the 2014-2015 Ebola virus outbreak in Monrovia, Liberia: The MSF experience.

During the initial phase of the 2014–2016 Ebola virus disease (EVD) outbreak in Monrovia, Liberia, all hospitals’ isolation capacities were overwhelmed by the sheer caseload. As a stop-gap measure to halt transmission, Medecins sans Frontieres (MSF) distributed household disinfection kits to those who were at high risk of EVD contamination. The kit contained chlorine and personal protective materials to be used for the care of a sick person or the handling of a dead body. This intervention was novel and controversial for MSF. This paper shed the light on this experience of distribution in Monrovia and assess if kits were properly used by recipients. Targeted distribution was conducted to those at high risk of EVD (relatives of confirmed EVD cases) and health staff. Mass distributions were also conducted to households in the most EVD affected urban districts. A health promotion strategy focused on the purpose and use of the kit was integrated into the distribution. Follow-up phone calls to recipients were conducted to enquire about the use of the kit. Overall, 65,609 kits were distributed between September and November 2014. A total of 1,386 recipients were reached by phone. A total of 60 cases of sickness and/or death occurred in households who received a kit. The majority of these (46, 10%) were in households of relatives of confirmed EVD cases. Overall, usage of the kits was documented in 56 out of 60 affected households. Out of the 1322 households that did not experience sickness and/or death after the distribution, 583 (44%) made use of elements of the kit, mainly (94%) chlorine for hand-washing. At the peak of an EVD outbreak, the distribution of household disinfection kits was feasible and kits were appropriately used by the majority of recipients. In similar circumstances in the future, the intervention should be considered.

A biaryl sulfonamide derivative as a novel inhibitor of filovirus infection

Ebolaviruses and marburgviruses, members of the family Filoviridae, are known to cause fatal diseases often associated with hemorrhagic fever. Recent outbreaks of Ebola virus disease in West African countries and the Democratic Republic of the Congo have made clear the urgent need for the development of therapeutics and vaccines against filoviruses. Using replication-incompetent vesicular stomatitis virus (VSV) pseudotyped with the Ebola virus (EBOV) envelope glycoprotein (GP), we screened a chemical compound library to obtain new drug candidates that inhibit filoviral entry into target cells. We discovered a biaryl sulfonamide derivative that suppressed in vitro infection mediated by GPs derived from all known human-pathogenic filoviruses. To determine the inhibitory mechanism of the compound, we monitored each entry step (attachment, internalization, and membrane fusion) using lipophilic tracer-labeled ebolavirus-like particles and found that the compound efficiently blocked fusion between the viral envelope and the endosomal membrane during cellular entry. However, the compound did not block the interaction of GP with the Niemann-Pick C1 protein, which is believed to be the receptor of filoviruses. Using replication-competent VSVs pseudotyped with EBOV GP, we selected escape mutants and identified two EBOV GP amino acid residues (positions 47 and 66) important for the interaction with this compound. Interestingly, these amino acid residues were located at the base region of the GP trimer, suggesting that the compound might interfere with the GP conformational change required for membrane fusion. These results suggest that this biaryl sulfonamide derivative is a novel fusion inhibitor and a possible drug candidate for the development of a pan-filovirus therapeutic.

Characteristics of Ebola Virus Disease Survivor Blood and Semen in Liberia: Serology and Reverse Transcription Polymerase Chain Reaction (RT-PCR).

Ebola virus (EBOV), species Zaire ebolavirus, may persist in the semen of male survivors of Ebola virus disease (EVD). We conducted a study of male survivors of the 2014-2016 EVD outbreak in Liberia and evaluated their immune responses to EBOV. We report here findings from the serologic testing of blood for EBOV-specific antibodies, molecular testing for EBOV in blood and semen, and serologic testing of peripheral blood mononuclear cells (PBMCs) in a subset of study participants. We tested for EBOV RNA in blood by quantitative reverse transcription polymerase chain reaction (qRT-PCR), and for anti-EBOV-specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies by enzyme-linked immunosorbent assay (ELISA) for 126 study participants. We performed PBMC analysis on a subgroup of 26 IgG-negative participants. All 126 participants tested negative for EBOV RNA in blood by qRT-PCR. The blood of 26 participants tested negative for EBOV-specific IgG antibodies by ELISA. PBMCs were collected from 23/26 EBOV IgG-negative participants. Of these, 1/23 participants had PBMCs that produced anti-EBOV-specific IgG antibodies upon stimulation with EBOV-specific glycoprotein (GP) and nucleoprotein (NP) antigens. The blood of EVD survivors, collected when they did not have symptoms meeting the case definition for acute or relapsed EVD, is unlikely to pose a risk for EBOV transmission. We identified 1 IgM/IgG negative participant who had PBMCs that produced anti-EBOV-specific antibodies upon stimulation. Immunogenicity following acute EBOV infection may exist along a spectrum, and absence of antibody response should not be exclusionary in determining an individual's status as a survivor of EVD.

Bibliometric Analysis of Ebola Research Indexed in Web of Science and Scopus (2010-2020).

Background Within the past decade, Africa has faced several recurrent outbreaks of Ebola virus disease (EVD), including the 2014-2016 outbreak in West Africa and the recent 2018-2020 Kivu outbreak in the Democratic Republic of Congo. The study thus aimed at quantifying and mapping the scientific output of EVD research published within 2010-2020 though a bibliometric perspective. Methods EVD-related publications from 2010 to 2020 were retrieved from the Web of Science (WoS) and Scopus databases by using the keywords ‘Ebola', ‘Ebola Virus Disease', ‘Ebolas', and ‘ebolavirus'. Biblioshiny software (using R-studio cloud) was used to categorise and evaluate authors', countries' and journals' contribution. VOSviewer was used for network visualisation. Results According to the used search strategy, a total of 3865 and 3848 EVD documents were published in WoS and Scopus, respectively. The average citation per document was 16.1 (WoS) and 16.3 (Scopus). The results show an overall increase in the publication trend within the study period. The leading countries in EVD research were the USA and UK, with over 100 papers in both databases, including Nigeria and South Africa. NIAID and CDC-USA were the most influential institutions, while “Infectious Diseases” and “Medicine” were the most decisive research fields. The most contributing authors included Feldmann H and Qiu XG with over 60 papers in each database, while Journal of Infectious Diseases was the most crucial journal. The most cited article was from Aylward et al. published in 2014, while recent years displayed a keyword focus on “double-blind”, “efficacy”, “ring vaccination” and “drug effect”. Conclusion This bibliometric analysis provides an updated historical perspective of progress in EVD research and has highlighted the role played by various stakeholders. However, the contribution of African countries and institutions is not sufficiently reflected, implying a need for increased funding and focus on EVD research for effective prevention and control.

Barriers to maternal health services during the Ebola outbreak in three West African countries: a literature review

IntroductionThe Ebola virus disease (EVD) outbreak in West Africa, affecting Guinea, Liberia and Sierra Leone from 2014 to 2016, was a substantial public health crisis with health impacts extending past...

Challenges of ongoing Covid and Ebola epidemics amidst violence and other epidemics in DR Congo

The world has seen outbreaks of emergency and re-emergency of infectious diseases very often in the past years, many of them with devastating consequences for low-income countries with fragile or nonexistent health system, covid-19 being by now the last of a long series of global challenges. Although it is a huge challenge for the whole world, one country is facing it together with a current Ebola outbreak plus violence and some other diseases. The Democratic Republic of Congo is facing the immediate effects of both epidemics as illness and death, however its consequences at the political and economic level are usually more complex and may be protracted. Following the debate on why poor countries remain poor, it is maybe useful to rethink poverty and inequality keeping in mind Amartya Sen's seminal concepts: development must comprise freedom and respect for human rights and institutions at the price of fostering a vicious circle of (re)emerging diseases and structural violence. Ebola epidemics, that usually face some challenges when they happen alone, now together with malaria, measles, plague and covid, on top of violence in some areas, the disease sees its protocols harmed: for covid the orientation is to stay isolated, for Ebola the response includes tracking contacts. What means coming with a team to field to do the mapping in the middle of a confinement. The surveillance for such many epidemics on top of violence and humanitarian crisis makes the Democratic Republic of Congo one of the most worrying countries in terms of consequences of the Covid outbreak.Key messages Study of the association between the Covid, Ebola virus disease outbreak and the at-risk population living in the conflict zone in Eastern Democratic Republic of Congo.The study presents the difficulties that the population encountered in the face of restrictions imposed by armed groups to reach health services during an Ebola outbreak, in a conflict zone.

Do memories of the Ebola virus disease outbreak influence post-Ebola health seeking behaviour in Gu\xe9ck\xe9dou district (epicentre) in Guinea? A cross-sectional study of children with febrile illness

BackgroundThe 2013–2015 Ebola Virus Disease (EVD) outbreak in Guinea resulted in community mistrust that influenced health care service utilization. This study aimed to assess whether EVD-related memories affect post-outbreak health-seeking behaviours for children under 5 years of age with febrile illnesses in Guéckédou district, Guinea.MethodsThis cross-sectional study was conducted by surveying caregivers of children under 5 years of age in the sub-district most affected by the EVD outbreak (Guèndembou) and the least affected sub-district (Bolodou) in Guéckédou district. Memories of the outbreak were referred to as EVD-related fears in the post-EVD period, which was based on a series of questions regarding current feelings.ResultsWhile the majority of caregivers sought care for their children with febrile illness in both districts, a statistically significantly higher proportion of caregivers in Guèndembou sought care, compared to caregivers in Bolodou.. More caregivers in Guèndembou (19.9%; n = 39) reported the death of family members or friends due to EVD compared to Bolodou (6.9%; n = 14; P < 0.001). The mean EVD fear score of caregivers was significantly higher in Guèndembou (3.0; SD: 3.0) than in Bolodou (2.0; SD: 1.1) (p < 0.001). Caregivers with a fear score above the median were 1.68 times more likely to seek care than those whose fear score was equal to or below the median; however, this difference was not statistically significant. Caregivers who reported family members’ or friends’ death due to EVD were also more likely to seek care (AOR = 2.12; 95%CI: 0.91–4.91), however, with no statistical significance. Only residing in the EVD-most affected sub-district of Guèndembou (AOR = 1.74; 95%CI: 1·09–2.79) was positively associated with seeking care.ConclusionsThis study reveals that community members in the rural district of Guéckédou still live with fear related to EVD nearly 2 years after the outbreak. It calls for more efforts in the health domain to preserve communities’ key values and address the psychosocial effect of EVD in rural Guinea.

Guidance materials from 2014 to 2019 on nutritional care for Ebola patients in Ebola Treatment Units: an analysis.

To evaluate the inclusion and exclusion of nutritional content in guidance materials related to nutritional care for hospitalised Ebola Virus Disease (EVD) patients of any age with the aim to provide recommendations for future revised nutritional care guidelines in Ebola Treatment Units (ETU). Qualitative and quantitative analyses of ETU protocols and other guidance materials were conducted. Materials were obtained from practitioners, their organisations and governments active in EVD outbreaks since 2014. Guinea, Liberia, Sierra Leone and Democratic Republic of Congo. Guidance materials showed a wide variety of topics. Most contained information on different feeding phases during illness, the use of specialised products, what and how to feed children aged 0-23 months, and meal and snack frequency for different age groups. Most materials lacked guidance on how to assess or accommodate patients' dietary preferences, how to obtain feedback on nutritional care from patients or how to assess whether patients need feeding support. These aspects are particularly relevant to prevent deterioration of the patients' nutritional status. There was limited guidance on operational aspects of food preparation and provision. Since 2014, numerous materials have been developed by organisations and governments on nutritional support in ETU. Although every EVD outbreak response must be contextualised because of the complexity of EVD and its case management, it is important to resolve technical differences and to provide comprehensive and more practical guidance. The findings of this study may inform future revised guidelines from normative UN organisations and governments of countries affected by EVD.

The impact of the Ebola crisis on mortality and welfare in Liberia.

This study assesses the impact of Ebola virus disease (EVD) outbreak on individual and total welfare in Liberia during 2014/15. By combining mortality and household consumption data, it estimates how much individuals would be hypothetically willing to pay to avoid the EVD-induced increase in age- and sex-specific mortality rates. The results suggest that the total welfare loss associated with EVD-related mortality ranges from $90 to $190 million, which is comparable to estimates based on the economic costs of EVD alone. In addition, the estimates lie between those derived from the cost-of-illness and value of statistical life approaches applied in previous works. This suggests that incorporating additional information on age- and sex-specific mortality, as well as individual consumption levels, provides a more accurate estimation of the welfare loss due to EVD-related mortality.

Psychological First Aid in Time of COVID-19

Psychological First Aid in Time of COVID-19

Institutionalized data quality assessments: a critical pathway to improving the accuracy of integrated disease surveillance data in Sierra Leone

BackgroundPublic health agencies require valid, timely and complete health information for early detection of outbreaks. Towards the end of the Ebola Virus Disease (EVD) outbreak in 2015, the Ministry of Health and Sanitation (MoHS), Sierra Leone revitalized the Integrated Disease Surveillance and Response System (IDSR). Data quality assessments were conducted to monitor accuracy of IDSR data.MethodsStarting 2016, data quality assessments (DQA) were conducted in randomly selected health facilities. Structured electronic checklist was used to interview district health management teams (DHMT) and health facility staff. We used malaria data, to assess data accuracy, as malaria was endemic in Sierra Leone. Verification factors (VF) calculated as the ratio of confirmed malaria cases recorded in health facility registers to the number of malaria cases in the national health information database, were used to assess data accuracy. Allowing a 5% margin of error, VF < 95% were considered over reporting while VF > 105 was underreporting. Differences in the proportion of accurate reports at baseline and subsequent assessments were compared using Z-test for two proportions.ResultsBetween 2016 and 2018, four DQA were conducted in 444 health facilities where 1729 IDSR reports were reviewed. Registers and IDSR technical guidelines were available in health facilities and health care workers were conversant with reporting requirements. Overall data accuracy improved from over- reporting of 4.7% (VF 95.3%) in 2016 to under-reporting of 0.2% (VF 100.2%) in 2018. Compared to 2016, proportion of accurate IDSR reports increased by 14.8% (95% CI 7.2, 22.3%) in May 2017 and 19.5% (95% CI 12.5–26.5%) by 2018. Over reporting was more common in private clinics and not- for profit facilities while under-reporting was more common in lower level government health facilities. Leading reasons for data discrepancies included counting errors in 358 (80.6%) health facilities and missing source documents in 47 (10.6%) health facilities.ConclusionThis is the first attempt to institutionalize routine monitoring of IDSR data quality in Sierra Leone. Regular data quality assessments may have contributed to improved data accuracy over time. Data compilation errors accounted for most discrepancies and should be minimized to improve accuracy of IDSR data.

Impact of the Ebola virus disease outbreak (2014\u20132016) on tuberculosis surveillance activities by Guinea\u2019s National Tuberculosis Control Program: a time series analysis

BackgroundMost countries in Subsaharan Africa have well-established National Tuberculosis Control Programs with relatively stable routine performances. However, major epidemiological events may result in significant disruptions. In March 2014, the World Health Organization announced the outbreak of Ebola virus disease in Guinea, a country with a high incidence of TB and HIV. Our study aimed to assess the impact of the Ebola virus disease outbreak on TB notification, treatment, and surveillance, using main indicators.MethodsThis is a retrospective cohort study that compared TB trends using surveillance data from the periods before (2011–2013), during (2014–2016), and after (2017–2018) Ebola virus disease outbreak. A time-series analysis was conducted to investigate the linkages between the decline in TB notification and the Ebola virus disease outbreak through cross-correlation. The lag in the cross-correlation test was evaluated using ANCOVA type II delayed variable dependent model. The surveillance system was assessed using TB surveillance standards and benchmarks and vital registration systems recommended by WHO, compared with those of 2015 during the Ebola virus disease.ResultsThe rate of reporting of TB declined from 120 cases per 100,000 in 2011 to 100 cases per 100,000 in 2014, at the peak of the Ebola virus disease outbreak. The time-series cross-correlation test of all notified cases of TB and Ebola showed a significant lag of − 0.4 (40%), reflecting a drop in the rate of notification (F-value = 5.7 [95% CI: 0.2–21.3]). The Ebola virus disease had no negative impact on patient treatment outcomes (F-value = 1.3 [95% CI: 0.0–8.8]). Regarding the surveillance system, five out of 13 WHO standards and benchmarks were met following their evaluation in 2019, after the Ebola virus disease outbreak, compared to three in 2015.ConclusionMajor epidemics such as the Ebola virus disease outbreak may have a significant impact on well-established TB control programs as shown in the example of Guinea. Sudden disruptions of routine performance may lead programs to improve their surveillance system. The experience acquired in the fight against EVD and the investments made should make it possible to prepare the health system in a coherent manner for the other probable episodes.

Contextual, Social and Epidemiological Characteristics of the Ebola Virus Disease Outbreak in Likati Health Zone, Democratic Republic of the Congo, 2017.

While the clinical, laboratory and epidemiological investigation results of the Ebola outbreak in Likati Health Zone, Democratic Republic of the Congo (DRC) in May 2017 have been previously reported, we provide novel commentary on the contextual, social, and epidemiological characteristics of the epidemic. As first responders with the outbreak Surveillance Team, we explain the procedures that led to a successful epidemiological investigation and ultimately a rapid end to the epidemic. We discuss the role that several factors played in the trajectory of the epidemic, including traditional healers, insufficient knowledge of epidemiological case definitions, a lack of community-based surveillance systems and tools, and remote geography. We also demonstrate how a collaborative Rapid Response Team and implementation of community-based surveillance methods helped counter contextual challenges during the Likati epidemic and aid in identifying and reporting suspected cases and contacts in remote and rural settings. Understanding these factors can hinder or help in the rapid detection, notification, and response to future epidemics in the DRC.

EBOLA VIRUS DISEASE PREPAREDNESS IN COUNTRIES BORDERING DEMOCRATIC REPUBLIC OF CONGO: LESSONS FROM WEST AFRICAN OUTBREAK.

Background:Ebola virus disease ravaged three West African countries in the wake of 2014 which was seen as the deadliest Ebola Virus Disease (EVD) outbreak in history. Several lessons were taken out of the West African outbreak one of which is the lack of preparedness by countries in the region.Materials and Methods:This paper looked at the mistakes of the West African outbreak and reports how such mistakes were corrected in the current outbreak going on in the Democratic Republic of Congo (DRC). Preparedness efforts are currently taking place in countries bordering DRC which included quick detection and response to an eventual EVD event.Results:This paid off on several occasions when cases from DRC to Uganda were quickly detected and response was as quick as possible. Preparedness carried out in Countries bordering DRC included setting up of Rapid Response Team (RRT) and training of these teams both at country and regional level. All members of the RRT were trained in all areas of readiness which included community engagement, laboratory, logistics, surveillance, case management, sample collection, packaging and shipment as well as Infection Prevention and Control (IPC).Conclusion:These trainings have led to readiness to an eventual EVD event. Countries now have the ability to respond quickly with better Emergency Operation Centre (EOC) for EVD.

Modeling the 2014-2015 Ebola Virus Disease Outbreaks in Sierra Leone, Guinea, and Liberia with Effect of High- and Low-risk Susceptible Individuals.

Ebola virus disease (EVD) is a rare but fatal disease of humans and other primates caused by Ebola viruses. Study shows that the 2014-2015 EVD outbreak causes more than 10,000 deaths. In this paper, we propose and analyze a deterministic model to study the transmission dynamics of EVD in Sierra Leone, Guinea, and Liberia. Our analyses show that the model has two equilibria: (1) the disease-free equilibrium (DFE) which is locally asymptotically stable when the basic reproduction number ([Formula: see text]) is less than unity and unstable if it is greater than one, and (2) an endemic equilibrium (EE) which is globally asymptotically stable when [Formula: see text] is greater than unity. Furthermore, the backward bifurcation occurs, a coexistence between a stale DFE and a stable EE even if the [Formula: see text] is less than unity, which makes the disease control more strenuous and would depend on the initial size of subpopulation. By fitting to reported Ebola cases from Sierra Leone, Guinea, and Liberia in 2014-2015, our model has captured the epidemic patterns in all three countries and shed light on future Ebola control and prevention strategies.