#Determinants of #transmission #risk during the late stage of the West African #Ebola #epidemic (Am J Epidemiol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Epidemiol. 2019 Apr 3. pii: kwz090. doi: 10.1093/aje/kwz090. [Epub ahead of print]

Determinants of transmission risk during the late stage of the West African Ebola epidemic.

Robert A1, Edmunds WJ1, Watson CH1, Henao-Restrepo AM2, Gsell PS2, Williamson E3, Longini IM4, Sakoba K5, Kucharski AJ1, Touré A5, Nadlaou SD5, Diallo B6, Barry MS5, Fofana TO5, Camara L5, Kaba IL5, Sylla L5, Diaby ML5, Soumah O5, Diallo A5, Niare A5, Diallo A5, Eggo RM1.

Author information: 1 Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, UK. 2 World Health Organization, Geneva, Switzerland. 3 Department of Medical Statistics, London School of Hygiene &Tropical Medicine, UK. 4 Department of Biostatistics, University of Florida, USA. 5 WHO Ebola vaccination team, Guinea. 6 WHO Ebola vaccination team, Guinea, Ministry of Health, Guinea.



Understanding risk factors for Ebola transmission is key for effective prediction and design of interventions. We used data on 860 cases in 129 chains of transmission from the latter half of the 2013-16 Ebola outbreak in Guinea. Using negative binomial regression, we determined characteristics associated with the number of secondary cases resulting from each infected individual. We found that attending an Ebola Treatment Unit was associated with a 38% decrease in secondary cases (Incident rate ratio (IRR) 0.62, 95%CI: 0.38, 0.99) in individuals that did not survive. Unsafe burial was associated with a higher number of secondary cases (IRR 1.82, 95%CI: 1.10, 3.02). The average number of secondary cases was higher for the first generation of a transmission chain (mean = 1.77), compared with subsequent generations (mean = 0.70). Children were least likely to transmit (IRR 0.35 (95%CI: 0.21, 0.57) compared with adults, whereas older adults were associated with higher numbers of secondary cases. Men were less likely to transmit than women (IRR 0.71 (95%CI: 0.55, 0.93)). This detailed surveillance dataset provided an invaluable insight into transmission routes and risks. Our analysis highlights the key role that age, receiving treatment, and safe burial played in the spread of EVD.

© The Author(s) 2019. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.

KEYWORDS: Ebola; Guinea; Multiple imputation; Regression analysis; Risk factors

PMID: 30941398 DOI: 10.1093/aje/kwz090

Keywords: Ebola; Ebola-Makona; West Africa.



#Technologies of #trust in #epidemic response: #openness, reflexivity and #accountability during the 2014-2016 #Ebola outbreak in West #Africa (BMJ Glob Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMJ Glob Health. 2019 Feb 13;4(1):e001272. doi: 10.1136/bmjgh-2018-001272. eCollection 2019.

Technologies of trust in epidemic response: openness, reflexivity and accountability during the 2014-2016 Ebola outbreak in West Africa.

Ryan MJ1, Giles-Vernick T2, Graham JE1.

Author information: 1 Pediatrics (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada. 2 Unité d’Epidémiologie des Maladies Emergentes, Institut Pasteur, Paris, France.



Trust is an essential component of successful cooperative endeavours. The global health response to the 2014-2016 West Africa Ebola outbreak confronted historically tenuous regional relationships of trust. Challenging sociopolitical contexts and initially inappropriate communication strategies impeded trustworthy relationships between communities and responders during the epidemic. Social scientists affiliated with the Ebola 100-Institut Pasteur project interviewed approximately 160 local, national and international responders holding a wide variety of roles during the epidemic. Focusing on responder’s experiences of communities’ trust during the epidemic, this qualitative study identifies and explores social techniques for effective emergency response. The response required individuals with diverse knowledges and experiences. Responders’ included on-the-ground social mobilisers, health workers and clinicians, government officials, ambulance drivers, contact tracers and many more. We find that trust was fostered through open, transparent and reflexive communication that was adaptive and accountable to community-led response efforts and to real-time priorities. We expand on these findings to identify ‘technologies of trust’ that can be used to promote actively legitimate trustworthy relationships. Responders engaged the social technologies of openness (a willingness and genuine effort to incorporate multiple perspectives), reflexivity (flexibly responsive to context and ongoing dialogue) and accountability (taking responsibility for local contexts and consequences) to facilitate relations of trust. Technologies of trust contribute to the development of a framework of practical techniques to improve the acceptance and effectiveness of future emergency response strategies.

KEYWORDS: health policy; health services research; prevention strategies; qualitative study; viral haemorrhagic fevers

PMID: 30899567 PMCID: PMC6407545 DOI: 10.1136/bmjgh-2018-001272

Keywords: Ebola; West Africa; Society; Public Health.


#HIV #prevalence in suspected #Ebola cases during the 2014-2016 Ebola #epidemic in #SierraLeone (Infect Dis Poverty, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Infect Dis Poverty. 2019 Mar 4;8(1):15. doi: 10.1186/s40249-019-0525-9.

HIV prevalence in suspected Ebola cases during the 2014-2016 Ebola epidemic in Sierra Leone.

Liu WJ1,2, Hu HY3,4, Su QD5,4, Zhang Z6,4, Liu Y5,4, Sun YL7,4, Yang XD8,4, Sun DP9,4, Cai SJ10,4, Yang XX6,4, Kamara I11,4, Kamara A11, Lebby M11, Kargbo B11, Ongpin P12, Dong XP5, Shu YL5, Xu WB5, Wu GZ5, Gboun M12, Gao GF13,14,15.

Author information: 1 NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention(China CDC), Beijing, 102206, China. liujun@ivdc.chinacdc.cn. 2 Sierra Leone-China Friendship Biological Safety Laboratory, Freetown, Sierra Leone. liujun@ivdc.chinacdc.cn. 3 Jiangsu Provincial Center for Disease control and Prevention, Nanjing, 210009, China. 4 Sierra Leone-China Friendship Biological Safety Laboratory, Freetown, Sierra Leone. 5 NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention(China CDC), Beijing, 102206, China. 6 Beijing Institute of Biotechnology, Beijing, 100071, China. 7 Beijing Center for Disease Prevention and Control, Beijing, 100013, China. 8 Jilin Provincial Center for Disease control and Prevention, Changchun, 130021, China. 9 Shandong Provincial Center for Disease control and Prevention, Jinan, 250014, China. 10 Fujian Provincial Center for Disease control and Prevention, Fuzhou, 350001, China. 11 The Ministry of Health and Sanitation, Freetown, Sierra Leone. 12 UNAIDS, Freetown, Sierra Leone. 13 NHC Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention(China CDC), Beijing, 102206, China. gaofu@chinacdc.cn. 14 Chinese Center for Disease Control and Prevention, Beijing, 102206, China. gaofu@chinacdc.cn. 15 CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences (CAS), Beijing, 100101, China. gaofu@chinacdc.cn.




The 2014-2016 Ebola virus epidemic in West Africa was the largest outbreak of Ebola virus disease (EVD) in history. Clarifying the influence of other prevalent diseases such as human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) will help improve treatment and supportive care of patients with EVD.


We examined HIV and hepatitis C virus (HCV) antibody prevalence among suspected EVD cases from the Sierra Leone-China Friendship Biological Safety Laboratory during the epidemic in Sierra Leone. HIV and HCV antibodies were tested in 678 EVD-negative samples by enzyme-linked immunosorbent assay. A high HIV prevalence (17.6%) and low HCV prevalence (0.22%) were observed among the suspected cases. Notably, we found decreased HIV positive rates among the suspected cases over the course of the epidemic. This suggests a potentially beneficial effect of an improved public health system after assistance from the World Health Organization and other international aid organizations.


This EVD epidemic had a considerable impact on the public health system and influenced the prevalence of HIV found among suspected cases in Sierra Leone, but also provided an opportunity to establish a better surveillance network for infectious diseases.

KEYWORDS: Ebola; HCV; HIV; Prevalence; Sierra Leone

PMID: 30827277 DOI: 10.1186/s40249-019-0525-9

Keywords: Ebola-Makona; West Africa; Sierra Leone; HIV; Hepatitis C.


The West #African #Ebola #emergency and #reconstruction; #lessons from Public Health #England (Br Med Bull., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Br Med Bull. 2019 Feb 26. pii: ldz005. doi: 10.1093/bmb/ldz005. [Epub ahead of print]

The West African Ebola emergency and reconstruction; lessons from Public Health England.

Johnstone PW1, Eder MK1, Newton A1, Bentley N1, Rufus I1.

Author information: 1 Public Health England, North of England. Blenheim House, West One, Leeds, UK.




West African governments, the WHO and wider international community were caught unprepared for the world’s largest Ebola outbreak of 2014-16. This was an unprecedented challenge to local services and international agencies, since the emergency required high-tech molecular diagnostic services operated by specialist staff and a coordinated emergency response in addition to humanitarian support, which was not available at the beginning of the outbreak. Public Health England (PHE), as a new national public health agency was well placed to provide support for these needs. After the outbreak, PHE supported reconstruction to ensure diagnostic and emergency planning capability remained in place in the immediate aftermath of the outbreak and build necessary public health infrastructure for the future. The article describes the role PHE played as a national public health agency supporting reconstruction and long-term development through the UK Government (Department for International Development) programme called ‘Resilient Zero’.


Public Health England (PHE), UK Government’s Department for International Development, WHO, US Centers for Communicable Diseases (CDC), China Centre for Communicable Diseases (China CDC).


The need for reliable, sustainable, in country molecular diagnostics, together with a programme to strengthen in country Emergency Planning, Preparedness and Response (EPRR).


Providing high tech molecular capability in a resource-poor West African country with variable provision of basic diagnostic equipment, intermittent power supply, ineffective supply chains and maintaining training capacity for emergency planning in the long term. Emergency planning models from the West needed to be adapted for the countries’ context. Short term aid projects as a model did not suite this development requirement.


PHE had strong local and international political support to reconstruct three Government regional laboratories and deploy molecular technology. Significant learning by PHE as a national public health agency and sharing this will be of benefit to other national public health agencies. UK staff reported increased levels of satisfaction and experience relevant to public health practice. The Sierra Leonean Government and officials requested long-term levels of commitment. It is important for agencies such as PHE to constantly learn, develop long-term institutional partnerships and play a bigger role with other similar agencies internationally.


How best to support sustainable high-tech molecular technology in West Africa and modules for emergency planning relevant to the context; evidence for long term versus short-term support for highly complex diagnostic capabilities; relevance to maintaining individual country public health infrastructure to ensuring global health security; benefits of overseas work for employee of a national agency.

© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

KEYWORDS: emergency planning; molecular diagnostics; post Ebola reconstruction

PMID: 30806466 DOI: 10.1093/bmb/ldz005

Keywords: West Africa; Ebola-Makona; UK; International Cooperation; Public Health.


The #genesis of the #Ebola virus #outbreak in west #Africa (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Summary, edited.]

The genesis of the Ebola virus outbreak in west Africa

Eugene T Richardson, Mosoka P Fallah

Open Access / PublishedFebruary 21, 2019 / DOI: https://doi.org/10.1016/S1473-3099(19)30055-6



The 2013–16 Ebola virus outbreak in west Africa was purported to have begun in the Guinean village of Meliandou in December, 2013.1 Authorities recorded 11 cases of Ebola virus disease (EVD) at this “index site” (where the virus is believed to have first spilled over into the human population), with 100% case fatality. In The Lancet Infectious Diseases, Joseph WS Timothy and colleagues2  present a brilliant piece of epidemiological sleuthing. By combining classic field investigations with an assay that can measure Ebola virus antibodies in oral fluid, the authors have improved our understanding of the early development of the outbreak in Meliandou. They show that there was almost double the number of individuals infected with Ebola virus (21 cases vs the 11 cases previously reported), and the case fatality was 55·6%.



We declare no competing interests.

Keywords: Ebola; Ebola-Makona; West Africa; Society.


Early #transmission and case #fatality of #Ebola virus at the #index site of the 2013–16 west #African Ebola #outbreak: a cross-sectional #seroprevalence survey (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

Early transmission and case fatality of Ebola virus at the index site of the 2013–16 west African Ebola outbreak: a cross-sectional seroprevalence survey

Joseph W S Timothy, PhD, Yper Hall, PhD, Joseph Akoi-Boré, MSc, Boubacar Diallo, MD, Thomas R W Tipton, PhD, Hilary Bower, MSc, Thomas Strecker, PhD, Judith R Glynn, PhD †, Miles W Carroll, PhD †

Open Access / Published: February 21, 2019 / DOI: https://doi.org/10.1016/S1473-3099(18)30791-6




To date, epidemiological studies at the index site of the 2013–16 west African Ebola outbreak in Meliandou, Guinea, have been restricted in their scope. We aimed to determine the occurrence of previously undocumented Ebola virus disease (EVD) cases and infections, and to reconstruct transmission events.


This cross-sectional seroprevalence survey of the adult population of Meliandou used a highly specific oral fluid test and detailed interviews of all households in the village and key informants. Each household was interviewed, with all members prompted to describe the events of the outbreak, any illness within the household, and possible contact with suspected cases. Information for deceased individuals was provided by relatives living in the same household. Symptoms were based on Ebola virus Makona variant EVD case definitions (focusing on fever, vomiting, and diarrhoea). For antibody testing, we used an Ebola virus glycoprotein IgG capture enzyme immunoassay developed from a previously validated assay. A maximum exposure level was assigned to every participant using a predetermined scale. We used a generalised linear model (logit function) to estimate odds ratios for the association of sociodemographic variables and exposure level with Ebola virus infection. We adjusted estimates for age and maximum exposure, as appropriate.


Between June 22, and July 9, 2017, we enrolled 237 participants from 27 households in Meliandou. Two households refused to participate and one was absent. All adults in participating households who were present for the interview provided an oral fluid swab for testing, of which 224 were suitable for analysis. In addition to the 11 EVD deaths described previously, on the basis of clinical description and oral fluid testing, we found two probable EVD deaths and eight previously unrecognised anti-Ebola virus IgG-positive survivors, including one who had mild symptoms and one who was asymptomatic, resulting in a case fatality of 55·6% (95% CI 30·8–78·5) for adults. Health-care work (adjusted odds ratio 6·64, 1·54–28·56; p=0·001) and level of exposure (odds ratio adjusted for linear trend across five levels 2·79, 1·59–4·883; p<0·0001) were independent risk factors for infection.


Ebola virus infection was more widespread in this spillover population than previously recognised (21 vs 11 cases). We show the first serological evidence of survivors in this population (eight anti-Ebola virus IgG seropositive) and report a case fatality lower than previously reported (55·6% vs 100% in adults). These data show the high community coverage achievable by using a non-invasive test and, by accurately documenting the beginnings of the west African Ebola virus outbreak, reveal important insight into transmission dynamics and risk factors that underpin Ebola virus spillover events.


US Food and Drug Administration, Wellcome Trust, and German Research Council.

Keywords: Ebola; Ebola-Makona; Seroprevalence; West Africa.


Unrecognised #Ebola virus #infection in #contact persons: what can we learn from it? (Lancet Infect Dis., summary)

[Source: The Lancet Infectious Diseases, full page: (LINK). Summary, edited.]

Unrecognised Ebola virus infection in contact persons: what can we learn from it?

Tom E Fletcher, Hilary Bower

Published: February 11, 2019 / DOI: https://doi.org/10.1016/S1473-3099(18)30689-3



The epidemic of Ebola virus disease in west Africa in 2014–16 was the largest and most complex the world has ever seen. The four pillars of Ebola response include: case management, case finding and contact tracing, safe and dignified burial, and social mobilisation and community engagement. These four pillars are being implemented in the current outbreak in the Democratic Republic of the Congo (DRC), which is further complicated by its location in a conflict zone. 1 Increased understanding of disease pathogenesis and the evaluation of novel therapeutics and vaccine candidates has informed current control measures, while access to survivors and their contacts in west Africa has also provided a unique opportunity to research filovirus transmission.

Keywords: Ebola; West Africa; DRC.