Ebola Outbreak In West Africa Research Articles

Nurses' experiences of their decision-making process when participating in clinical trials during the 2014-2016 West African Ebola crisis.

Due to the absence of a licenced vaccine or drug for treatment of Ebola patients during the 2014-2016 West Africa outbreak, frontline nurses were at increased risk of exposure. Hence, they were prioritized to participate in clinical trials to receive experimental therapeutics. To our knowledge no study has explored the nurses' experiences of their decision-making process when volunteering in clinical trials using unproven agents, which is the purpose of this qualitative study. This study, part of a larger Ebola study, thematically analyzed the interview data of nine nurses recruited from Sierra Leone, Guinea and Liberia; of which four joined a convalescent plasma trial and five a vaccine trial. In their decision-making process to partake in a clinical trial, nurses identified two distinct decision points: the initial commitment followed by the point of no return when they presented themselves to participate. Each of these decisions were influenced by risk versus benefits calculations, and contextual factors. Results showed the need for more health education and communication around the unproven agents in order for nurses to make informed decisions.

The necessity for intra-action reviews during the COVID-19 pandemic

After the 2014–16 Ebola outbreak in West Africa, WHO proposed a blueprint list of priority diseases for research and development, based on their epidemic potential or the absence of countermeasures.1 Among this list is disease X,1 representing the emergence of a disease previously unknown to humans that could result in a serious global health emergency. COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is disease X.

COVID-19, Public Authority and Enforcement

The securitization of health is not a new phenomenon. However, global responses to the 2014–2016 Ebola outbreak in West Africa reveal the extent to which epidemic preparedness and response is now s...

The Negotiation of Expertise by the United Nations Peacebuilding Architecture in Reaction to the Ebola Outbreak in West Africa

ABSTRACT Peacebuilding has expanded beyond its traditional purview, and now includes responses to a range of crisis situations. This article studies the reaction of the UN Peacebuilding Architecture to the outbreak of the Ebola Disease Virus in West Africa in 2014, one of such unprecedented threats to peacebuilding. Drawing on expertise studies, my argument is that the UN Peacebuilding Architecture has the potential to successfully function as bureaucratic entities without a field presence. At the same time, the reaction to the Ebola outbreak illustrates a dissonance between policy actions and the reasoning of the perceived challenges and solutions.

Optimizing Pandemic Preparedness and Response Through Health Information Systems: Lessons Learned From Ebola to COVID-19.

Strengthening health systems and maintaining essential service delivery during health emergencies response is critical for early detection and diagnosis, prompt treatment, and effective control of pandemics, including the novel coronavirus disease 2019 (COVID-19). Health information systems (HIS) developed during recent Ebola outbreaks in West Africa and the Democratic Republic of the Congo (DRC) provided opportunities to collect, analyze, and distribute data to inform both day-to-day and long-term policy decisions on outbreak preparedness. As COVID-19 continues to sweep across the globe, HIS and related technological advancements remain vital for effective and sustained data sharing, contact tracing, mapping and monitoring, community risk sensitization and engagement, preventive education, and timely preparedness and response activities. In reviewing literature of how HIS could have further supported mitigation of these Ebola outbreaks and the ongoing COVID-19 pandemic, 3 key areas were identified: governance and coordination, health systems infrastructure and resources, and community engagement. In this concept study, we outline scalable HIS lessons from recent Ebola outbreaks and early COVID-19 responses along these 3 domains, synthesizing recommendations to offer clear, evidence-based approaches on how to leverage HIS to strengthen the current pandemic response and foster community health systems resilience moving forward.

Evolution of Healthcare-Associated Infections and Antibiotic Resistance Programs in US Health Departments, 2009–2018

Background: Domestically, the integration of public health into healthcare-associated infection (HAI) and antibiotic resistance (AR) prevention activities represents a major development. We describe CDC Funding: of public health HAI/AR programs through the Epidemiology and Laboratory Capacity (ELC) cooperative agreement to improve local capacity to prevent HAIs and detect and contain the spread of AR threats. Methods: We reviewed ELC budget reports and program documents to summarize the evolution of funded activities and programs from 2009 to 2018. Results: In 2009, 51 programs (49 states, 2 cities and territories) received US$35.8 million through the American Recovery and Reinvestment Act for an initial 28-month period. These funds supported each jurisdiction to establish an HAI coordinator and a multidisciplinary HAI advisory group, coordinate and report HAI prevention efforts, conduct surveillance and report HAI data, and maintain an HAI plan; ~27 programs were also funded to coordinate multicenter HAI prevention collaboratives among acute-care hospitals. Through 2011, 188 state or local HAI/AR program positions were at least partially funded by the CDC. From 2011 to 2015, investments from the Affordable Care Act (~US$10–11 million annually) were used to maintain the HAI/AR programs, with some expansion of program goals related to non–acute-care settings and antibiotic stewardship. In 2015, following the Ebola outbreak in West Africa, supplemental ELC funds were awarded to 61 programs (50 states, 11 cities and territories) totaling US$85 million over 36 months. These awards marked an expansion of HAI/AR program activities to develop healthcare provider inventories, to conduct data-driven education and training, and to perform onsite infection control assessments in healthcare facilities. In 2016, through its AR Solutions Initiative, CDC invested US$57.3 million in Funding: to 57 programs (50 states, 7 cities and territories), expanding laboratory capacities for AR threat detection (via the AR Laboratory Network) and epidemiologic activities to rapidly contain novel and targeted multidrug-resistant organisms. As of 2018, >500 state or local HAI/AR program positions were at least partially funded by the CDC. Conclusions: State and local HAI/AR programs have grown substantially over the 10 years of their existence, as reflected in major increases in funding, staffing, scope, and partnerships. CDC investments and guidance have supported the development of HAI/AR epidemiology prevention and response capacity.Funding: NoneDisclosures: None

The Design and Implementation of an IPC Certificate Course: Experiences From Sierra Leone

Background: Trained infection prevention and control (IPC) practitioners are critical to reducing healthcare-associated infections (HAI) and improving patient safety. Despite having HAI rates 3 times higher than high-income countries, many low- and middle-income countries (LMICs) lack trained IPC professionals. During the 2014–2016 Ebola outbreak in West Africa, the Sierra Leone Ministry of Health and Sanitation (MoHS) recognized this need and appointed and trained IPC focal persons at all district hospitals. Following the outbreak, MoHS requested assistance from the US CDC to develop and implement a comprehensive IPC training program for IPC specialists. Methods: The CDC, alongside its partners, convened a multidisciplinary team to develop an IPC certificate course. ICAP led the curriculum development process using a “backwards design” approach, starting with development of competencies and learning objectives, then designing an evaluation framework and learning strategies, and finally, identifying course content. The curriculum was based on existing resources, primarily designed for high-income countries, which were adapted to the Sierra Leone context and aligned with national IPC policies and guidelines. Additionally, an IPC steering committee, led by MoHS, was established to provide national leadership and oversight and make country-level decisions regarding accreditation and career pathways for IPC specialists. Results: The course includes three 2-week workshops over 6 months consisting of classroom didactics and hands-on activities. Topics include standard and transmission-based precautions, microbiology, laboratory, HAI, quality improvement, leadership, and scientific writing. Between sessions, participants conduct IPC activities at their work site and share results during subsequent workshops. Participants receive electronic tablets, which contain course content, assessment tools, and references, to upload their work into a cloud-based storage system for facilitators to provide feedback. They also receive in-person mentorship and connect with peers through a group messaging platform to share lessons learned. Participants’ knowledge and skills are assessed using a before-and-after test and observing them perform IPC practices using standardized checklists. The first cohort of 25 participants will complete the course in November 2019. Conclusions: The IPC certificate course is the first comprehensive, competency-based IPC training in Sierra Leone. Successes, challenges, sustainability, and lessons learned remain to be determined; however, based on similar models, the course has the potential to significantly improve IPC in Sierra Leone. Additionally, it is a model that can be replicated in other resource-limited settings.Funding: NoneDisclosure:None

Evaluation of Autoclaving CAT: A Infectious Substance Packaging during the Ebola Crisis in the United States

Background: During the 2014 US Ebola crisis, an unprecedented amount of biohazardous waste was generated during patient care; healthcare facilities were overwhelmed by large volumes of waste. Few facilities had on-site waste treatment; therefore, waste was packaged and sent off site for incineration and disposal in Port Arthur, Texas, at a significant cost. Shipping this waste off site required the use of the US Department of Transportation (USDOT) Hazardous Materials (HMR 49 CFR) category A triple packaging for infectious substances. The most common treatment method for biohazardous waste in the United States is via commercial autoclaves. Because Category A waste packaging had not been tested to ensure effective treatment, we conducted autoclave efficacy studies to evaluate the various types of Category A packaging containing surrogate Ebola waste. If successful, this would potentially provide additional treatment options in the United States. Methods: Testing was conducted at commercial locations in 3 states: New York, Pennsylvania, and Florida. Various types of Category A packaging were obtained (Fig. 1). Waste loads were comprised of Ebola patient treatment material and included personal protective equipment, sharps containers, suction canisters, drapes, and associated items. Configured packaging was placed into autoclave bins to be processed. Each package tested included a biological indicator, a class 5 integrator. Where possible, thermocouples were added to record the thermoprofile of the waste. Initially, a modified cycle was tested (a prevacuum cycle followed by exposure to steam at 138°C for 60 minutes) and a postvacuum cycle. Cycle times were adjusted based upon initial results. Results: The initial New York autoclave was tested from a cold start (no vessel preheating) resulting in a failure to obtain efficacy (Fig. 1). Successful results were no growth in recovered biological indicators, acceptable color change in integrators, and reaching and holding temperatures >121°C for 30 minutes. After making modifications to treatment cycles, which included preheating of vessels, multiple prevacuum steps and a hold time of 60 minutes, successful results were achieved in testing conducted at the treatment plants in Pennsylvania and Florida. Conclusions: Commercial autoclaves can be effective in treating Category A biohazardous waste. Each autoclave considered for treatment requires a validation process using the types of packaging containing the waste, biological indicators, integrators, and thermocouples to present a complete assessment of the treatment process.Funding: Three companies provided support for this study: Approved Storage & Waste Hauling, Daniels International, and ProMed Solutions.Disclosures: Edward Krisiunas reports contracted research for Future Health Care Systems, Daniels Sharpsmart, and ProMed Solutions.

A non-parametric Hawkes model of the spread of Ebola in west Africa

ABSTRACT Recently developed methods for the non-parametric estimation of Hawkes point process models facilitate their application for describing and forecasting the spread of epidemic diseases. We use data from the 2014 Ebola outbreak in West Africa to evaluate how well a simple Hawkes point process model can forecast the spread of Ebola virus in Guinea, Sierra Leone, and Liberia. For comparison, SEIR models that fit previously to the same data are evaluated using identical metrics. To test the predictive power of each of the models, we simulate the ability to make near real-time predictions during an actual outbreak by using the first 75% of the data for estimation and the subsequent 25% of the data for evaluation. Forecasts generated from Hawkes models more accurately describe the spread of Ebola in each of the three countries investigated and result in a 38% reduction in RMSE for weekly case estimation across all countries when compared to SEIR models (total RMSE of 59.8 cases/week using SEIR compared to 37.1 for Hawkes). We demonstrate that the improved fit from Hawkes modeling cannot be attributed to overfitting and evaluate the advantages and disadvantages of Hawkes models in general for forecasting the spread of epidemic diseases.

Convalescent Plasma for the Treatment of COVID-19: Perspectives of the National Institutes of Health COVID-19 Treatment Guidelines Panel.

In the United States, the efficacy and safety of convalescent plasma for treating coronavirus disease 2019 (COVID-19) is currently being tested in randomized placebo-controlled clinical trials. Treatment of individual patients with COVID-19 with convalescent plasma outside such trials is also now permitted through U.S. Food and Drug Administration Emergency Use Authorization. Here, members of the National Institutes of Health COVID-19 Treatment Guidelines Panel provide their views regarding use of convalescent plasma for treating COVID-19.

Occupational Heat Stress and Practical Cooling Solutions for Healthcare and Industry Workers During the COVID-19 Pandemic

Treatment and management of severe acute respiratory syndrome coronavirus-2, which causes coronavirus disease (COVID-19), requires increased adoption of personal protective equipment (PPE) to be worn by workers in healthcare and industry. In warm occupational settings, the added burden of PPE threatens worker health and productivity, a major lesson learned during the West-African Ebola outbreak which ultimately constrained disease control. In this paper, we comment on the link between COVID-19 PPE and occupational heat strain, cooling solutions available to mitigate occupational heat stress, and practical considerations surrounding their effectiveness and feasibility. While the choice of cooling solution depends on the context of the work and what is practical, mitigating occupational heat stress benefits workers in the healthcare and industrial sectors during the COVID-19 disease outbreak.

Challenges Associated With the Response to the Coronavirus Disease (COVID-19) Pandemic in Africa-An African Diaspora Perspective.

The 2014–2016 Ebola outbreak in West Africa extracted huge health, social, and economic costs. How can lessons learnt during the 2014–2016 Ebola outbreak in West Africa help to mitigate the likelihood of a long‐term devastating effect of the coronavirus disease (COVID‐19) outbreak on the African continent? Despite COVID‐19 spreading quickly across the globe after being first reported in Wuhan, China on December 31, 2019, African countries remained relatively unaffected until the second week of March 2020. The majority of Africa countries have been at low to moderate risk. However, they have experienced many sociocultural, economic, political, and structural challenges. These have included laboratory capacity and logistical challenges; ill‐equipped public health systems; land border permeability, and delayed preparedness to transnational threats; and abject economic deprivation, lack of basic infrastructure, and associated sociocultural implications. There needs to be a strong country‐level leadership to coordinate and own all aspects of the responses to the COVID‐19 pandemic in a collaborative, transparent, and accountable way. Strategic and sustained response plans to fight the pandemic should incorporate culturally competent strategies that harness different cultural practices and strengthen cultural security. They should also promote and strengthen the implementation of the International Health Regulations.

Comparative performance study of three Ebola rapid diagnostic tests in Guinea

BackgroundThe 2014/15 Ebola outbreak in West Africa resulted in 11,000 deaths and massive strain on local health systems, and the ongoing outbreak in Democratic Republic of Congo has afflicted more than 3000 people. Accurate, rapid Ebola diagnostics suitable for field deployment would enable prompt identification and effective response to future outbreaks, yet remain largely unavailable. The purpose of this study was to assess the accuracy of three novel rapid diagnostic tests (RDTs): an Ebola, an Ebola-Malaria, and a Fever Panel test that includes Ebola, all from a single manufacturer.MethodsWe evaluated the three RDTs in 109 Ebola-positive and 96 Ebola-negative stored serum samples collected during the outbreak in Guinea in 2014/15, and tested by real-time polymerase chain reaction (RT-PCR). Sensitivity, specificity, and overall percent agreement were calculated for each RDT using RT-PCR as a reference standard, stratified by Ct value ranges.ResultsAll tests performed with high accuracy on samples with low Ct value (high viral load). The Fever Panel test performed with the highest accuracy, with a sensitivity of 89.9% and specificity of 90.6%. The Ebola and Ebola-Malaria tests performed comparably to each other: sensitivity was 77.1 and 78% respectively, and specificity was 91.7% for the Ebola test and 95.8% for the Ebola-Malaria test.ConclusionsThis study evaluated the accuracy of three novel rapid diagnostic tests for Ebola. The tests may have significant public health relevance, particularly the Fever Panel test, which detects seven pathogens including Ebola. Given limitations to the study resulting from uncertain sample quality, further evaluation is warranted. All tests performed with highest accuracy on samples with low Ct value (high viral load), and the data presented here suggests that these RDTs may be useful for point-of-care diagnosis of cases in the context of an outbreak. Restrictions to their use in non-severe Ebola cases or for longitudinal monitoring, when viral loads are lower, may be appropriate. Highlighting the challenge in developing and evaluating Ebola RDTs, there were concerns regarding sample integrity and reference testing, and there is a need for additional research to validate these assays.

On Pandemic Preparedness: How Well is the Modeling Community Prepared for COVID-19?

On Pandemic Preparedness: How Well is the Modeling Community Prepared for COVID-19?

"We Live on Hope...": Ethical Considerations of Humanitarian Use of Drones in Post-Disaster Nepal

As international humanitarian assistance from governments and private donors continued to increase in recent years, the pace of growth, however, has slowed down [1]. For instance, in 2018, while USd17.0 billion out of USd28.1 billion funding was committed to UN-coordinated appeals, there was still a funding shortfall of USd11.1 billion, with only 61% of requirements met [1]. Against this backdrop, international organizations are in - creasingly implementing innovative solutions to respond the needs of affected communities [2], [3]. Many of these solutions involve the use of digital technologies, such as geographic information systems (GIS), robotics, spatial decision support systems, and unmanned aerial vehicles, also known as drones [4]. Although drones are not the first use of robotics in commercial and industrial settings, the humanitarian use of drones represents the first wave of robotics applied in the aid sector, and is representative of emerging technologies being used for humanitarian purposes [5]. Examples of successful drone use in this setting include the 2010 Haiti earthquake (damage inspection), 2012 Hurricane Sandy in the U.S.A. (epidemic prevention), 2013 Typhoon Haiyan in the Philippines (rescue logistics), the 2014 Ebola outbreak in West Africa (medical equipment delivery), and the 2015 Nepal earthquake - the site of this case study - when Nepal was stricken by one of the most devastating natural disasters in history, leaving the country with heavy burdens of immediate emergency relief and long-term postdisaster reconstruction [6]-[8].

When Is It Democratic to Postpone an Election? Elections During Natural Disasters, COVID-19, and Emergency Situations

Holding regular elections is an essential feature of democratic practices. The case for postponing elections is often made during emergency situations, however. Despite the critical nature of the i...

Understanding the Anemic Global Response to COVID-19.

The COVID-19 outbreak is the most serious test of the international system since the 2008 global financial crisis. Rather than cooperate to contain and respond to a common threat, the world's leading powers-the United States and China-have increasingly blamed each other through wildly speculative theories about the origins of the virus. The World Health Organization sought to coordinate a global response, but it has been hamstrung and has come under attack. Given past cooperation between major powers to mobilize and eradicate smallpox and previous US leadership to fight HIV/AIDS and the 2014 West African Ebola crisis, the limited cooperation and lack of leadership are puzzling. What explains the anemic global response to date? This article draws from structural international relations theory to suggest a partial but somewhat dissatisfying answer. International organizations are inherently weak and now face opposition by major powers. The international system simultaneously incentivizes states to cooperate and address common threats, but it also encourages countries to take care of themselves, potentially at the expense of others. Which of these motives dominates cannot be explained by structural theory, thus requiring us to look to other factors such as the attributes of states and leaders themselves.

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.

Community engagement in Australia’s COVID-19 communications response: learning lessons from the humanitarian sector

This essay analyses the official communications response to COVID-19 in Australia in relation to its effectiveness in engaging communities to encourage the behaviour changes required to address the outbreak. In particular, it outlines three key considerations regarding the way in which the use of community engagement in the humanitarian sector during the Ebola outbreak in West Africa and the Democratic Republic of Congo can inform current and future information preparedness of Governments in Australia in response to health and social crises.

Severity score for predicting in-facility Ebola treatment outcome

PurposeSierra Leone recorded the highest incidence rate for the 2013–2016 West African Ebola outbreak. In this investigation, we used the medical records of Ebola patients with different sociodemographic and clinical features to determine the factors that are associated with Ebola treatment outcome during the 2013–2016 West African Ebola outbreak in Sierra Leone and constructed a predictive in-facility mortality score. MethodsWe used the anonymized medical records of 1077 laboratory-confirmed pediatric and adult patients with EVD who received treatment at the 34 Military Hospital and the Police Training School Ebola Treatment Centers in Sierra Leone between the period of June 2014 and April 2015. We later determined the in-facility case fatality rates for Ebola, the odds of dying during Ebola treatment, and later constructed a predictive in-facility mortality score for these patients based on their clinical and sociodemographic characteristics. ResultsWe constructed a model that partitioned the study population into three mortality risk groups of equal patient numbers, based on risk scoring: low (score ≤ –5), medium (score –4 to 1), and high-risk group (score ≥ 2). The CFR of patients with EVD belonging to the low- (≤–5), medium (–4 to 1), and high- (≥2) risk groups were 0.56%, 9.75%, and 67.41%, respectively. ConclusionsWe succeeded in designing an in-facility mortality risk score that reflects EVD clinical severity and can assist in the clinical prioritization of patients with EVD.