Ebola Outbreak In West Africa Research Articles

Exploring the contribution of exposure heterogeneity to the cessation of the 2014 Ebola epidemic.

The unexpected early cessation of the recent West Africa Ebola outbreak demonstrated shortcomings of popular forecasting approaches and has not been fully understood yet. A popular hypothesis is that public health interventions mitigated the spread, such as ETUs and safe burials. We investigate whether risk heterogeneity within the population could serve as an alternative explanation. We introduce a model for spread in heterogeneous host population that is particularly well suited for early predictions due to its simplicity and ease of application. Furthermore, we explore the conditions under which the observed epidemic trajectory can be explained without taking into account the effect of public health interventions. While the obtained fits closely match the total case count time series, closer inspection of sub-population results made us conclude that risk heterogeneity is unlikely to fully explain the early cessation of Ebola; other factors such as behavioral changes and other interventions likely played a major role. More accurate predictions in a future scenario require models that allow for early sub-exponential growth, as well as access to additional data on patient occupation (risk level) and location, to allow identify local phenomena that influence spreading behavior.

CEPI: Driving Progress Toward Epidemic Preparedness and Response.

The Coalition for Epidemic Preparedness Innovations (CEPI) was formed in the aftermath of the 2014–2015 Ebola outbreak in west Africa to support the development of vaccines that could improve the world’s preparedness against outbreaks of epidemic infectious diseases. Since its launch in 2017, CEPI has mobilized more than US$750 million to support its mission to develop vaccines against agents such as Lassa virus, Middle East respiratory syndrome coronavirus, and Nipah virus, as well as several rapid-response vaccine platforms to accelerate response times to unexpected epidemic threats. CEPI has also played a leading role in fostering institutional partnerships between public- and private-sector organizations to optimize allocation of resources for vaccine development against its priority pathogens. CEPI’s priorities include diversification of its current vaccine research and development investment portfolio to include additional pathogens, such as Rift Valley fever and chikungunya; establishment of technical and regulatory pathways for vaccine development across CEPI’s portfolio; development of sustainable manufacturing solutions for vaccine candidates nearing completion of safety and immunogenicity testing in humans; and creation of investigational stockpiles of its vaccine candidates for use in emergency situations. This commentary provides an overview of the global health challenges CEPI was established to address and its achievements to date, and indicates priorities for funding and coordination in the coming years.

Forecasting the 2014 West African Ebola Outbreak.

In 2014-2015, a large Ebola outbreak afflicted Liberia, Guinea, and Sierra Leone. We performed a systematic review of 26 manuscripts, published between 2014 and April 2015, that forecasted the West African Ebola outbreak while it was occurring, and we derived implications for how results could be interpreted by policymakers. Forecasted case counts varied widely. An important determinant of forecast accuracy for case counts was how far into the future predictions were made. Generally, forecasts for less than 2 months into the future tended to be more accurate than those made for more than 10 weeks into the future. The exceptions were parsimonious statistical models in which the decay of the rate of spread of the pathogen among susceptible individuals was dealt with explicitly. The most important lessons for policymakers regarding future outbreaks, when using similar modeling results, are: 1) uncertainty of forecasts will be greater in the beginning of the outbreak; 2) when data are limited, forecasts produced by models designed to inform specific decisions should be used complementarily for robust decision-making (e.g., 2 statistical models produced the most reliable case-counts forecasts for the studied Ebola outbreak but did not enable understanding of interventions' impact, whereas several compartmental models could estimate interventions' impact but required unavailable data); and 3) timely collection of essential data is necessary for optimal model use.

Development of a multiplexed antigen detection immunoassay for detection of viral agents

Purpose: The spread of infectious disease continues to present a challenge for modern global public health initiatives, as was evidenced by the recent Ebola outbreak in West Africa. In disease outbreaks, diagnostics are the first line of defense in identifying the causative agent, treatment decisions, and control and prevention of future outbreaks. Methods & Materials: We designed a multiplexed immunoassay centered on detection of viral antigens in serum/plasma samples for EBOV, LASV, MARV, CCHFV, RVFV, alphaviruses, and flaviviruses. This flexible, immunoassay system, based on the MAGPIX® platform has faster sample-to-answer time over traditional methods and higher throughput, as assays can be multiplexed. Assays were developed and validated against live and inactivated viral supernatants and other antigen types. Inclusivity and exclusivity panels were run to ensure no crossreactivity between assays. Results: Each assay was able to detect the appropriate target, whether in inactivated, recombinant, and live agent form. Limits of detection were generated in plaque forming units (pfu) per ml of live agent. Limits of detection were also established for appropriate recombinant reagents when available, as these reagents serve as the positive controls for the multiplexed assays when deployed to overseas partners. Conclusion: Development of robust and sustainable immunoassays is important as they have great potential for use during outbreak events to provide a more complete picture of the presence of viral agents. Immunoassays are capable of providing further insight to shape outbreak response. The recent Ebola outbreak demonstrated the great sensitivity of RT-PCR, but often patients remained positive by PCR well after other symptoms subsided. An integrated diagnostic system that uses sensitive and specific RT-PCR in combination with higher throughput, multiplexed immunodiagnostic methods can provide the highest confidence in a diagnostic result.

Ebola West Africa, 2014-16: an analysis of a filovirus outbreak

Purpose: Zoonotic infections are those that can be transmitted between animals and humans. Approximately two-thirds of human infections are zoonoses and caused by microorganisms as diverse as viruses, bacteria, fungi and parasites. Many of the pathogens causing zoonoses are considered to be either emerging or novel agents. Health of humans is inextricably linked to the health of animals and the environment. More broadly, the environment not only encompasses physical, geographical, climatic, ecological, agricultural and veterinary dimensions, but also the social, cultural, political and religious factors that influence those human behaviors that shape it. Addressing the connections between health and the environment requires an urgent expansion of interdisciplinary collaborations and strong political and global will. Viral hemorrhagic fever agents pose serious challenges to human health due to the fact that: (i) Filovirus outbreaks are largely created by man and driven by human behavior, (ii) there is significant nosocomial (hospital) amplification of disease, (iii) there is an associated high morbidity and mortality, (iv) case management is difficult and, as yet, there are no commercially available vaccines and therapeutic agents, (v) prevention of infections is fraught with difficulties, and (vi) infection prevention and control strategies can be frustratingly unsuccessful. Methods & Materials: Case study approach. Results: The presentation focuses on the complexity of the 2014-16 West African Ebola outbreak in which there has been multi-country involvement (Guinea, Liberia and Sierra Leone) and is deemed to be the largest Ebola outbreak ever described. Challenges and controversies related to VHF outbreak responses, international health regulations, environmental and sociocultural factors, as well as lapses in infection prevention and control interventions are contextualized. Current knowledge gaps, and future research areas, are highlighted. Conclusion: The viral hemorrhagic fevers (VHFs) of Africa, and more specifically, filoviral infections provide the perfect illustration of the interconnected nature of man, microbe and the environment. With the increasing frequency of filovirus outbreak reports and the threat that filoviruses pose to local, national and global health, knowledge gaps need to be urgently addressed with high quality interdisciplinary research. For this, the One Heath approach provides the perfect platform.

Faith and Global Health Practice in Ebola and HIV Emergencies.

We examined the relationship between religion and health by highlighting the influences of religion on the response to the 2014 to 2016 Ebola outbreak and the global HIV epidemic. We recounted the influences of religion on burial practices developed as an infection control measure during the Ebola outbreak in West Africa. We also explored the influence of religion on community outreach and health education. We examined faith-based responses to the global HIV/AIDS pandemic, noting that religion conflicted with public health responses to HIV (e.g., justification for HIV-related stigma) or aligned with public health as a force for improved HIV responses (e.g., providing HIV services or providing social capital and cohesion to support advocacy efforts). We further discussed the similarities and differences between the influence of religion during the HIV/AIDS pandemic and the 2014 to 2016 Ebola outbreak. We then described lessons learned from Ebola and HIV/AIDS to better inform collaboration with religious actors.

The myth of the 1-day training: the effectiveness of psychosocial support capacity-building during the Ebola outbreak in West Africa.

In emergencies and resource-poor settings, non-specialists are increasingly being trained to provide psychosocial support to people in distress, with Psychological First Aid (PFA) one of the most widely-used approaches. This paper considers the effectiveness of short training programmes to equip volunteers to provide psychosocial support in emergencies, focusing particularly on whether the PFA training provided during the Ebola outbreak enabled non-specialists to incorporate the key principles into their practice. Semi-structured interviews were conducted in Sierra Leone and Liberia with 24 PFA trainers; 36 individuals who participated in PFA training; and 12 key informants involved in planning and implementing the PFA roll-out. Findings indicate that many PFA training-of-trainers were short and rarely included content designed to develop training skills. As a result, the PFA training delivered was of variable quality. PFA providers had a good understanding of active listening, but responses to a person in distress were less consistent with the guidance in the PFA training or with the principles of effective interventions outlined by Hobfoll et al. There are advantages to training non-specialists to provide psychosocial support during emergencies, and PFA has all the elements of an effective approach. However, the very short training programmes which have been used to train non-specialists in PFA might be appropriate for participants who already bring a set of relevant skills to the training, but for others it is insufficient. Government/NGO standardisation of PFA training and integration in national emergency response structures and systems could strengthen in-country capacity.

The World after Ebola: An Overview of Ebola Complications, Vaccine Development, Lessons Learned, Financial Losses, and Disease Preparedness.

The 2014-2016 Ebola outbreak in West Africa was the largest of its kind with 11,000 deaths and approximately 28,637 affected cases. The aim of the study was to analyze the global situation after the Ebola outbreak including Ebola complications, vaccine development, lessons learned, financial losses, and disease preparedness. We searched in PubMed, Google, and Google Scholar by using keywords Ebola virus, Ebola vaccine development and Ebola virus transmission, the world after Ebola, financial losses by Ebola outbreak, and disease preparedness. Ebola virus disease is a complex disorder associated with gastrointestinal, hepatic, renal, respiratory, cardiovascular, and neurological complications. Ebola virus persisted in the semen of male infected patients for 470 to 565 days, and the chances of viral transmission by sexual contacts remained high even after patient recovery. There are several reports of extreme socioneuropsychological disorders in Ebola survivors and Ebola healthcare workers. There is no Food and Drug Administration-approved drug or vaccine for Ebola. Many research groups are working to develop a vaccine against Ebola by using different biotechnology techniques. Some vaccine candidates, including replicating vesicular stomatitis virus and Chimpanzee adenovirus-3, have entered phase III clinical trials and are expected to receive clinical licensing in coming years. The West African Ebola epidemic caused a financial loss of $6 billion in Africa and an additional global economic loss of more than $12 billion. After the Ebola epidemic, four global commissions were established for disease preparedness. A proposition was also forwarded to the World Health Organization for the establishment of the Centre for Emergency Preparedness and Response for the disease management. The devastating Ebola epidemic opened the window for disease preparedness to face any future disease epidemic.

The myth of the 1-day training: the effectiveness of psychosocial support capacity-building during the Ebola outbreak in West Africa - ADDENDUM.

The myth of the 1-day training: the effectiveness of psychosocial support capacity-building during the Ebola outbreak in West Africa - ADDENDUM.

Estimating the economic impact of the 2014 Ebola virus outbreak in West Africa: an empirical approach

The 2014 Ebola outbreak in West Africa is one of the most devastating in history. The devastating nature of this epidemic drew worldwide attention as it spread across borders. This study therefore, aimed at evaluating the economic impact of the epidemic in countries affected. The study adopted an innovative methodology that captures the contemporaneous impact of the outbreak on key economic variables of interest. The results from the study revealed that in addition to the adverse impact of the Ebola disease, the isolation of countries affected by the epidemic contributed immensely in worsening their economic conditions. Thus, the study noted the need for strengthening healthcare systems, enhancing the capacity of health workers, non-restriction on the movement of persons and goods and the need for regional coordination of efforts in combating epidemic outbreaks in the future.

Centers for Disease Control and Prevention's Temporary Epidemiology Field Assignee program: Supporting state and local preparedness in the wake of Ebola.

Objectives:The Centers for Disease Control and Prevention launched the Temporary Epidemiology Field Assignee (TEFA) Program to help state and local jurisdictions respond to the risk of Ebola virus importation during the 2014–2016 Ebola Outbreak in West Africa. We describe steps taken to launch the 2-year program, its outcomes and lessons learned.Methods:State and local health departments submitted proposals for a TEFA to strengthen local capacity in four key public health preparedness areas: 1) epidemiology and surveillance, 2) health systems preparedness, 3) health communications, and 4) incident management. TEFAs and jurisdictions were selected through a competitive process. Descriptions of TEFA activities in their quarterly reports were reviewed to select illustrative examples for each preparedness area.Results:Eleven TEFAs began in the fall of 2015, assigned to 7 states, 2 cities, 1 county and the District of Columbia. TEFAs strengthened epidemiologic capacity, investigating routine and major outbreaks in addition to implementing event-based and syndromic surveillance systems. They supported improvements in health communications, strengthened healthcare coalitions, and enhanced collaboration between local epidemiology and emergency preparedness units. Several TEFAs deployed to United States territories for the 2016 Zika Outbreak response.Conclusion:TEFAs made important contributions to their jurisdictions’ preparedness. We believe the TEFA model can be a significant component of a national strategy for surging state and local capacity in future high-consequence events.

The Ebola 100 Project: A Flexible Approach to Collaborative Research

Abstract In order to collaborate on human subjects research, social scientists require flexible approaches that allow them to adhere to legal and ethical protections specific to their community or profession. Such flexibility is illustrated in the Ebola 100 Project (2018), a “voluntary, collaborative, multi-institutional, and international” anthropological research project that captured lessons learned about organizational responses to the West Africa Ebola outbreak of 2014–2015. The inclusive project comprised almost a dozen investigators from government and non-government organizations from several different countries. A few of the project's United States contributors worked as part of the Translational Research Group, a research facility housed under the Marine Corps culture center. These researchers had access to potential participants in the military and experience conducting qualitative research in compliance with Department of Defense human subjects protection regulations. One outcome of the inclusive and flexible design of the Ebola 100 Project is that it allows for participation from relatively under-represented populations in traditional anthropological research, such as United States military personnel. Upon completion of the Ebola 100 Project, researchers interested in analyzing the experiences and stories of individuals who responded to a global health emergency can access more than 100 interviews.

Effects of the 2014/2015 Ebola Outbreak on Malaria Management in Pregnant Women: A Comparative Study of an Ebola Affected and Unaffected Rural District of Guinea

This study aimed to measure the effects of Ebola outbreak on antenatal care attendance and malaria management in pregnant women in Guinea. A retrospective cross-sectional study was conducted in two rural malaria-endemic health districts: on the epicentre of the West African Ebola outbreak (Guéckédou) and the other spared by Ebola (Koubia). Data were compared over similar periods of high malaria transmission before, during and after the Ebola outbreak. There were substantial declines in antenatal care visits in Guéckédou, from a monthly average number of 7,208 before the outbreak to 3,151 (57% decrease) during and 2,843 visits (61% decrease) after it while this indicator increased across the same periods in Koubia. In Guéckédou, the number of SP first doses provided dropped from 2,566 before the outbreak to 1,263 (51% decrease) during and 1,010 (61% decrease) after the Ebola outbreak (P < 0.001) while in Koubia, the decline was by 13% and 24% during and after the outbreak from an average number of 499 doses before it (P < 0.001). Fever cases increased by 43% and 38% during and after the outbreak respectively in Guéckédou and by 28% during and 11% after the outbreak in Koubia. Untreated malaria cases represented 11% and 12% of confirmed malaria cases during and after the outbreak respectively compared to 3% before it in Guéckédou, while in Koubia no untreated case was seen across these periods. There is need to uphold malaria services during future outbreaks.

Crisis Frame Dynamics: Frame Diversity in News Media and the Role of Governmental Actors

This study aims to understand the dynamic evolvement of frames in news media coverage of the Ebola crisis (2014–2015) and their interplay with narratives put forth in press releases from governmental organizations (GOs). An automated content analysis was applied to U.S. newspapers and GOs’ press releases on the Ebola epidemic. Time series analyses illustrate how the scope of frames in news media becomes narrower (decreased diversity) with the presence of immediate and problem-focused crisis frames and wider (increased diversity) with more progressive frames. Additionally, the results imply that a level of shared interpretation (frame alignment) between media and GOs fosters the openness of news media for a variety of frames, which in turn might lead to a communicative shift that eases the crisis atmosphere.

Ebola: Es ist nicht nur die Krankheit – Herausforderungen beim Anpassen der humanitären Hilfe an ihren Kontext

The 2013 outbreak of Ebola in West Africa has highlighted the importance of adapting humanitarian responses to new socio-cultural contexts. The international humanitarian community was not only confronted with poor health infrastructure but also the challenge of local socio-cultural practices, which aggravated the spread of the Ebola virus. This paper discusses the Ebola crisis in Liberia from a socio-cultural perspective and highlights how the lack of information, neglect and criminalising of traditional practices, the history of civil war and the absence of trust in government limit the success of humanitarian assistance. This article provides an analysis of allows for an analysis of humanitarian assistance within the context of the increasing complexity of disasters and changing contexts.

Media Framing and the Threat of Global Pandemics: The Ebola Crisis in UK Media and Policy Response.

Pandemics pose new and difficult challenges. Risks associated with the spread of pandemics generate intense speculation in Western media. Taking the 2014–2015 Ebola outbreak as a case study, the article critically analyses how the risk of contagion in the US, Europe, and the UK has been constructed in UK media and policy discourse. Drawing on the importance of media framing in shaping a given problem definition, causal interpretation and treatment recommendation, the article critically assesses the impacts of the British newspaper framing of Ebola, questioning the rationale of a UK domestic political response based on containment and border screenings. The article also takes a comparative angle, engaging with constructions of previous pandemics. Underscoring the importance of a sociological analysis of these framings, the article critically reflects on the role of media communication in reproducing certain topoi, which reduce the scope for open public debate around best responses to a pandemic emergency.

Establishing China's National Standard for the Recombinant Adenovirus Type 5 Vector-Based Ebola Vaccine (Ad5-EBOV) Virus Titer.

The 2014 Ebola outbreak in West Africa brought great threat to public health worldwide. There was no approved antiviral therapy or vaccine available to control the disease at that time. Several kinds of Ebola vaccines were urgently under development across the world. Among these, the novel recombinant adenovirus type 5 vector-based Ebola vaccine (Ad5-EBOV)-the first Ebola vaccine based on the 2014 Zaire Guinea epidemic strain-was developed in China, and its safety and immunogenicity were demonstrated in China and Sierra Leone. The license to market the drug was approved on October 19, 2017, by the Chinese Food and Drug Administration. In order to standardize the test on the Ad5-EBOV virus titer, China's national standard substance for the virus titer of Ad5-EBOV was established according to the recommendations for the preparation, characterization, and establishment of international and other biological reference standards from the World Health Organization and Chinese Pharmacopoeia (third edition). The standard for the Ad5-EBOV virus titer was prepared with a volume of 0.5 mL per ampoule in lyophilized form. The samples of the standard, designated as A, B, C, D with different aims, were blinded and distributed to five laboratories to be collaboratively calibrated. The virus titer for this standard was determined with the antibody staining method according to the instructions in the Adeno-X™ Rapid Titer Kit. The homogeneity and stability of the standard substance were also satisfied. The virus titer standard value was 8.54 lg infectious units (IFU)/mL, and the 95% confidence interval was between 7.94 lg IFU/mL and 9.14 lg IFU/mL. This standard was approved by the Chinese national committee and is available on the National Institutes for Food and Drug Control Web site ( www.nifdc.org.cn ; lot no. 250019-201501).

Community health workers during the Ebola outbreak in Guinea, Liberia, and Sierra Leone.

The role of community health workers (CHWs) in the West Africa Ebola outbreak has been highlighted to advocate for increasing numbers of CHWs globally to build resilience, strengthen health systems, and provide emergency response capacity. However, the roles CHWs played, the challenges they faced, and their effectiveness during the outbreak are not well documented. This study assessed the impact of Ebola on community-based maternal, newborn, and child health (MNCH) services, documented the contribution of CHWs and other community-based actors to the Ebola response, and identified lessons learned to strengthen resilience in future emergencies. This mixed methods study was conducted in Guinea, Liberia, and Sierra Leone, with data collected in four Ebola-affected districts of each country. Qualitative data were collected through in-depth interviews and focus group discussions with stakeholders at national, district, and community levels. Quantitative program data were used to assess trends in delivery of community-based MNCH services. There was a sharp decline in MNCH service provision due to weak service delivery, confusion over policy, and the overwhelming nature of the outbreak. However, many CHWs remained active in their communities and were willing to continue providing services. When CHWs received clear directives and were supported, service provision rebounded. Although CHWs faced mistrust and hostility from community members because of their linkages to health facilities, the relationship between CHWs and communities proved resilient over time, and CHWs were more effectively able to carry out Ebola-related activities than outsiders. Traditional birth attendants, community health committees, community leaders, and traditional healers also played important roles, despite a lack of formal engagement or support. Service delivery weaknesses, especially related to supply chain and supervision, limited the effectiveness of community health services before, during, and after the outbreak. CHWs and other community-level actors played important roles during the Ebola outbreak. However, maintenance of primary care services and the Ebola response were hampered because community actors were engaged late in the response and did not receive sufficient support. In the future, communities should be placed at the forefront of emergency preparedness and response plans and they must be adequately supported to strengthen service delivery.

Identifying potential uses of crowdsourcing in global health, conflict, and humanitarian settings: an adapted CHNRI (Child Health and Nutrition Initiative) exercise.

BackgroundCrowdsourcing, outsourcing problems and tasks to a crowd, has grown exponentially since the term was coined a decade ago. Being a rapid and inexpensive approach, it is particularly amenable to addressing problems in global health, conflict and humanitarian settings, but its potential has not been systematically assessed. We employed the Child Health and Nutrition Research Initiative’s (CHNRI) method to generate a ranked list of potential uses of crowdsourcing in global health and conflict.Process94 experts in global health and crowdsourcing submitted their ideas, and 239 ideas were scored. Each expert scored ideas against three of seven criteria, which were tailored specifically for the exercise. A relative ranking was calculated, along with an Average Expert Agreement (AEA).FindingsOn a scale from 0-100, the scores assigned to proposed ideas ranged from 80.39 to 42.01. Most ideas were related to problem solving (n = 112) or data generation (n = 91). Using health care workers to share information about disease outbreaks to ensure global response had the highest score and agreement. Within the top 15, four additional ideas related to containing communicable diseases, two ideas related to using crowdsourcing for vital registration and two to improve maternal and child health. The top conflict ideas related to epidemic responses and various aspects of disease spread. Wisdom of the crowds and machine learning scored low despite being promising in literature.InterpretationsExperts were invited to generate ideas during the Ebola crisis and to score during reports of Zika, which may have affected the scoring. However, crowdsourcing’s rapid, inexpensive characteristics make it suitable for addressing epidemics. Given that many ideas reflected Sustainable Development Goals (SDGs), crowdsourcing may be an innovative solution to achieving some of the SDGs.

Ebola and the airplane – securing mobility through regime interactions and legal adaptation

AbstractThis article concentrates on a particular controversy during the 2014 Ebola outbreak in West Africa; the mass cancellation of flights to and from affected countries. This occurred despite authoritative advice against such restrictions from the World Health Organization (WHO). During a public health emergency such as Ebola, the airplane sits at a site of regulatory uncertainty as it falls within the scope of two specialist and overlapping domains of international law; the WHO International Health Regulations (2005) and the Convention on International Civil Aviation. We explore how legal technicalities and objects, by promoting functional interactions between these two specialized regimes of law, were utilized to deal with this uncertainty. We show how the form and function of these mundane tools had a significant impact; assimilating aviation further into the system of global health security as well as instrumentalizing the aircraft as a tool of disease surveillance. This encounter of regimes was law creating, resulting in new international protocols and standards designed to enable the resumption of flights in and out of countries affected by outbreaks. This article therefore offers significant and original insights into the hidden work performed by legal techniques and tools in dealing with regime overlap. Our findings contribute to the wider international law literature on fragmentation and enrich our understanding of the significance of relational regime interactions in international law.