1
|
Dembek Z, Hadeed S, Tigabu B, Schwartz-Watjen K, Glass M, Dressner M, Frankel D, Blaney D, Eccles Iii TG, Chekol T, Owens A, Wu A. Ebola Virus Disease Outbreaks: Lessons Learned From Past and Facing Future Challenges. Mil Med 2024; 189:e1470-e1478. [PMID: 38743575 DOI: 10.1093/milmed/usae204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION The purpose of this review is to examine African Ebola outbreaks from their first discovery to the present, to determine how the medical and public health response has changed and identify the causes for those changes. We sought to describe what is now known about the epidemiology and spread of Ebola virus disease (EVD) from the significant outbreaks that have occurred and outbreak control methods applied under often challenging circumstances. Given the substantial role that the U.S. Government and the U.S. DoD have played in the 2014 to 2016 West African Ebola outbreak, the role of the DoD and the U.S. Africa Command in controlling EVD is described. MATERIALS AND METHODS A descriptive method design was used to collect and analyze all available Ebola outbreak literature using the PubMed database. An initial literature search was conducted by searching for, obtaining, and reading original source articles on all major global Ebola outbreaks. To conduct a focused search, we used initial search terms "Ebola outbreak," "Ebola virus disease," "Ebola response," "Ebola countermeasures," and also included each country's name where Ebola cases are known to have occurred. From the 4,673 unique articles obtained from this search and subsequent article title review, 307 articles were identified for potential inclusion. Following abstract and article review, 45 original source articles were used to compile the history of significant Ebola outbreaks. From this compilation, articles focused on each respective subsection of this review to delineate and describe the history of EVD and response, identifying fundamental changes, were obtained and incorporated. RESULTS We present known Ebola virus and disease attributes, including a general description, seasonality and location, transmission capacity, clinical symptoms, surveillance, virology, historical EVD outbreaks and response, international support for Ebola outbreak response, U.S. DoD support, medical countermeasures supporting outbreak response, remaining gaps to include policy limitations, regional instability, climate change, migration, and urbanization, public health education and infrastructure, and virus persistence and public awareness. CONCLUSIONS The health and societal impacts of EVD on Africa has been far-reaching, with about 35,000 cases and over 15,000 deaths, with small numbers of cases spreading globally. However, the history of combatting EVD reveals that there is considerable hope for African nations to quickly and successfully respond to Ebola outbreaks, through use of endemic resources including Africa CDC and African Partner Outbreak Response Alliance and the U.S. Africa Command with greater DoD reachback. Although there remains much to be learned about the Ebola virus and EVD including whether the potential for novel strains to become deadly emerging infections, invaluable vaccines, antivirals, and public health measures are now part of the resources that can be used to combat this disease.
Collapse
Affiliation(s)
- Zygmunt Dembek
- Support to DTRA Technical Reachback, Battelle Memorial Institute, Columbus, OH 43201, USA
| | - Steven Hadeed
- Support to DTRA Technical Reachback, Battelle Memorial Institute, Columbus, OH 43201, USA
| | - Bersabeh Tigabu
- Support to DTRA Technical Reachback, Global Systems Engineering (GSE), Alexandria, VA 22312, USA
| | - Kierstyn Schwartz-Watjen
- Support to DTRA Technical Reachback, Applied Research Associates (ARA), Albuquerque, NM 87110, USA
| | - Michael Glass
- SME Support to DTRA Technical Reachback, Manta Solutions, Charlottesville, VA 22901, USA
| | - Michelle Dressner
- Office of the Command Surgeon, U.S. Africa Command, APO, AE 09751, USA
| | - Dianne Frankel
- Office of the Command Surgeon, U.S. Africa Command, APO, AE 09751, USA
| | - David Blaney
- Office of the Command Surgeon, U.S. Africa Command, APO, AE 09751, USA
- Office of Readiness and Response, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Tesema Chekol
- Support to DTRA Technical Reachback, Battelle Memorial Institute, Columbus, OH 43201, USA
| | - Akeisha Owens
- Technical Reachback, Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA
| | - Aiguo Wu
- Technical Reachback, Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA
| |
Collapse
|
2
|
Zeng W, Samaha H, Yao M, Ahuka-Mundeke S, Wilkinson T, Jombart T, Baabo D, Lokonga JP, Yuma S, Mobula-Shufelt L. The cost of public health interventions to respond to the 10th Ebola outbreak in the Democratic Republic of the Congo. BMJ Glob Health 2023; 8:e012660. [PMID: 37848269 PMCID: PMC10583089 DOI: 10.1136/bmjgh-2023-012660] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/11/2023] [Indexed: 10/19/2023] Open
Abstract
The 10th Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) drew substantial attention from the international community, which in turn invested more than US$1 billion in EVD control over two years (2018-2020). This is the first EVD outbreak to take place in a conflict area, which led to a shift in strategy from a pure public health response (PHR) to a multisectoral humanitarian response. A wide range of disease control and mitigation activities were implemented and were outlined in the five budgeted Strategic Response Plans used throughout the 26 months. This study used the budget/expenditure and output indicators for disease control and mitigation interventions compiled by the government of DRC and development and humanitarian partners to estimate unit costs of key Ebola control interventions. Of all the investment in EVD control, 68% was spent on PHR. The remaining 32% covered security, community support interventions for the PHR. The disbursement for the public health pillar was distributed as follows: (1) coordination (18.8%), (2), clinical management of EVD cases (18.4%), (3) surveillance and vaccination (15.9%), (4) infection prevention and control/WASH (13.8%) and (5) risk communication (13.7%). The unit costs of key EVD control interventions were as follows: US$66 182 for maintaining a rapid response team per month, US$4435 for contact tracing and surveillance per identified EVD case, US$1464 for EVD treatment per case, US$59.4 per EVD laboratory test, US$120.7 per vaccinated individual against EVD and US$175.0 for mental health and psychosocial support per beneficiary. The estimated unit costs of key EVD disease control interventions provide crucial information for future infectious disease control planning and budgeting, as well as prioritisation of disease control interventions.
Collapse
Affiliation(s)
- Wu Zeng
- Department of Global Health, Georgetown University, Washington, District of Columbia, USA
| | - Hadia Samaha
- World Bank Group, Washington, District of Columbia, USA
| | - Michel Yao
- World Health Organization, Geneva, Switzerland
| | - Steve Ahuka-Mundeke
- National Institute for Biomedical Research, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Thibaut Jombart
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK
| | - Dominique Baabo
- Project Implementation Unit of World Bank Health Projects, Ministry of Public Health, Hygiene and Prevention, Kinshasa, Congo (the Democratic Republic of the)
| | - Jean-Pierre Lokonga
- Project Implementation Unit of World Bank Health Projects, Ministry of Public Health, Hygiene and Prevention, Kinshasa, Congo (the Democratic Republic of the)
| | - Sylvain Yuma
- Ministry of Public Health, Hygiene and Prevention, Kinshasa, Congo (the Democratic Republic of the)
| | | |
Collapse
|
3
|
Gayedyu-Dennis D, Fallah MP, Drew C, Badio M, Moses JS, Fayiah T, Johnson K, Richardson ET, Weiser SD, Porco TC, Martin JN, Sneller MC, Rutherford GW, Reilly C, Lindan CP, Kelly JD. Identifying Paucisymptomatic or Asymptomatic and Unrecognized Ebola Virus Disease Among Close Contacts Based on Exposure Risk Assessments and Screening Algorithms. J Infect Dis 2023; 227:878-887. [PMID: 36047331 PMCID: PMC10319948 DOI: 10.1093/infdis/jiac359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is limited evidence to evaluate screening algorithms with rapid antigen testing and exposure assessments as identification strategies for paucisymptomatic or asymptomatic Ebola virus (EBOV) infection and unrecognized EBOV disease (EVD). METHODS We used serostatus and self-reported postexposure symptoms from a cohort study to classify contact-participants as having no infection, paucisymptomatic or asymptomatic infection, or unrecognized EVD. Exposure risk was categorized as low, intermediate, or high. We created hypothetical scenarios to evaluate the World Health Organization (WHO) case definition with or without rapid diagnostic testing (RDT) or exposure assessments. RESULTS This analysis included 990 EVD survivors and 1909 contacts, of whom 115 (6%) had paucisymptomatic or asymptomatic EBOV infection, 107 (6%) had unrecognized EVD, and 1687 (88%) were uninfected. High-risk exposures were drivers of unrecognized EVD (adjusted odds ratio, 3.5 [95% confidence interval, 2.4-4.9]). To identify contacts with unrecognized EVD who test negative by the WHO case definition, the sensitivity was 96% with RDT (95% confidence interval, 91%-99%), 87% with high-risk exposure (82%-92%), and 97% with intermediate- to high-risk exposures (93%-99%). The proportion of false-positives was 2% with RDT and 53%-93% with intermediate- and/or high-risk exposures. CONCLUSION We demonstrated the utility and trade-offs of sequential screening algorithms with RDT or exposure risk assessments as identification strategies for contacts with unrecognized EVD.
Collapse
Affiliation(s)
- Dehkontee Gayedyu-Dennis
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Mosoka P Fallah
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Clara Drew
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Moses Badio
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - J S Moses
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Tamba Fayiah
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Kumblytee Johnson
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Eugene T Richardson
- Department of Medicine, Brigham and Women’s Hospital, Boston, Minnesota, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Minnesota, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Michael C Sneller
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - George W Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Cavan Reilly
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christina P Lindan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - J D Kelly
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| |
Collapse
|
4
|
Park SJ, Brown H, Wema KM, Gobat N, Borchert M, Kalubi J, Komanda G, Morisho N. ‘Ebola is a business’: an analysis of the atmosphere of mistrust in the tenth Ebola epidemic in the DRC. CRITICAL PUBLIC HEALTH 2022. [DOI: 10.1080/09581596.2022.2128990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Sung-Joon Park
- Bernhard Nocht Institute for Tropical Medicine, Medical Anthropology Group, Hamburg, Germany
| | - Hannah Brown
- Department of Anthropology, Durham University, Durham, UK
| | - Kennedy Muhindo Wema
- Bernhard Nocht Institute for Tropical Medicine, Medical Anthropology Group, Hamburg, Germany
- Pole Institute, Goma, Democratic Republic of Congo
| | - Nina Gobat
- Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - Matthias Borchert
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | | | - Gaston Komanda
- Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Nene Morisho
- Pole Institute, Goma, Democratic Republic of Congo
| |
Collapse
|
5
|
Vivalya BM, Ayodeji OA, Bafwa YT, Muyisa LK, Piripiri AL, Mbeva JBK. Analysis of the management of the tenth Ebola virus disease outbreak in the Democratic Republic of Congo: developing a multidisciplinary response model to strengthen the healthcare system during disease outbreaks. Global Health 2021; 17:121. [PMID: 34663370 PMCID: PMC8521269 DOI: 10.1186/s12992-021-00775-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022] Open
Abstract
The declaration of any public health emergency in the Democratic Republic of Congo (DRC) is usually followed by the provision of technical and organizational support from international organizations, which build a parallel and short-time healthcare emergency response centered on preventing the extension of health emergencies across the countries and over the world. Previous Ebola virus disease (EVD) outbreaks have highlighted the need to reinforce the healthcare sector in different countries.Based on the difficulty to implement the International Health Regulations (2005) to the local level of affected countries including the DRC, this paper proposes a multidisciplinary model based on the health zones through the strengthening of preparedness and response structures to public health emergencies vis-à-vis the existing weak health systems existing in DRC. A commitment to integrating the emergency response in the existing health system should work to reduce the tension that exists between local recruitment and its impact on the quality of daily healthcare in the region affected by EVD outbreak on one hand, and the involvement of international recruitment and its impact on the trust of the population on the emergency response on the other. This paper highlights the provision of a local healthcare workforce skilled to treat infectious diseases, the compulsory implementation of training programs focused on the emergency response in countries commonly affected by EVD outbreaks including the DRC. These innovations should reduce the burden of health problems prior to and in the aftermath of any public health emergency in DRC hence increasing the wellbeing of the community, especially the vulnerable people as well as the availability of trained healthcare providers able to early recognize and treat EVD.
Collapse
Affiliation(s)
- Bives Mutume Vivalya
- Department of Psychiatry, Kampala International University Western campus, Bushenyi, Uganda.
- Department of Internal Medicine, Masereka Referral General Hospital, North- Kivu, Democratic Republic of the Congo.
| | - Okesina Akeem Ayodeji
- Department of Human Anatomy, Kampala International University Western Campus, Kampala, Uganda
| | - Yves Tibamwenda Bafwa
- Department of Internal Medicine, University of Bunia, Ituri, Bunia, Democratic Republic of the Congo
| | - Louis Kasereka Muyisa
- Department of Pediatrics, Musienene Referral General Hospital, North-Kivu, Democratic Republic of the Congo
| | - Astride Lina Piripiri
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jean-Bosco Kahindo Mbeva
- Department of Public Health, Official University of Ruwenzori, North-Kivu, Democratic Republic of the Congo
| |
Collapse
|
6
|
Mayhew SH, Kyamusugulwa PM, Kihangi Bindu K, Richards P, Kiyungu C, Balabanova D. Responding to the 2018-2020 Ebola Virus Outbreak in the Democratic Republic of the Congo: Rethinking Humanitarian Approaches. Risk Manag Healthc Policy 2021; 14:1731-1747. [PMID: 33953623 PMCID: PMC8092619 DOI: 10.2147/rmhp.s219295] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/20/2021] [Indexed: 11/23/2022] Open
Abstract
The Democratic Republic of Congo (DRC) presents a challenging context in which to respond to public health crises. Its 2018-2020 Ebola outbreak was the second largest in history. Lessons were known from the previous West African outbreak. Chief among these was the recognition that local action and involvement are key to establishing effective epidemic-response. It remains unclear whether and how this was achieved in DRC's Ebola response. Additionally, there is a lack of scholarship on how to build resilience (the ability to adapt or transform under pressure) in crisis-response. In this article, we critically review literature to examine evidence on whether and how communities were involved, trust built, and resilience strengthened through adaptation or transformation of DRC's 2018-2020 Ebola response measures. Overall, we found limited evidence that the response adapted to engage and involve local actors and institutions or respond to locally expressed concerns. When adaptations occurred, they were shaped by national and international actors rather than enabling local actors to develop locally trusted initiatives. Communities were "engaged" to understand their perceptions but were not involved in decision-making or shaping responses. Few studies documented how trust was built or analyzed power dynamics between different groups in DRC. Yet, both these elements appear to be critical in building effective, resilient responses. These failures occurred because there was no willingness by the national government or international agencies to concede decision-making power to local people. Emergency humanitarian response is entrenched in highly medicalized, military style command and control approaches which have no space for decentralizing decision-making to "non-experts". To transform humanitarian responses, international responders can no longer be regarded as "experts" who own the knowledge and control the response. To successfully tackle future humanitarian crises requires a transformation of international humanitarian and emergency response systems such that they are led, or shaped, through inclusive, equitable collaboration with local actors.
Collapse
Affiliation(s)
- Susannah H Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Patrick Milabyo Kyamusugulwa
- Bukavu Medical University College/Institut Supérieur des Techniques Médicales de Bukavu (ISTM-Bukavu), Bukavu, Eastern Democratic Republic of Congo
| | - Kennedy Kihangi Bindu
- Centre de Recherche sur la Démocratie et le Développement en Afrique (CREDDA), Université Libre des Pays des Grands Lacs, Goma, Democratic Republic of Congo
| | - Paul Richards
- School of Environmental Sciences, Njala University, Freetown, Sierra Leone
| | - Cyrille Kiyungu
- Hygiene, State Administration, Kikwit, Democratic Republic of Congo
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
7
|
Adegboye O, Gayawan E, James A, Adegboye A, Elfaki F. Bayesian spatial modelling of Ebola outbreaks in Democratic Republic of Congo through the INLA-SPDE approach. Zoonoses Public Health 2021; 68:443-451. [PMID: 33780159 DOI: 10.1111/zph.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 02/09/2021] [Accepted: 03/13/2021] [Indexed: 12/01/2022]
Abstract
Ebola virus (EBV) disease is a globally acknowledged public health emergency, endemic in the west and equatorial Africa. To understand the epidemiology especially the dynamic pattern of EBV disease, we analyse the EBV case notification data for confirmed cases and reported deaths of the ongoing outbreak in the Democratic Republic of Congo (DRC) between 2018 and 2019, and examined the impact of reported violence on the spread of the virus. Using fully Bayesian geo-statistical analysis through stochastic partial differential equations (SPDE) allows us to quantify the spatial patterns at every point of the spatial domain. Parameter estimation was based on the integrated nested Laplace approximation (INLA). Our findings revealed a positive association between violent events in the affected areas and the reported EBV cases (posterior mean = 0.024, 95% CI: 0.005, 0.045) and deaths (posterior mean = 0.022, 95% CI: 0.005, 0.041). Translating to an increase of 2.4% and 2.2% in the relative risks of EBV cases and deaths associated with a unit increase in violent events (one additional Ebola case is associated with an average of 45 violent events). We also observed clusters of EBV cases and deaths spread to neighbouring locations in similar manners. Findings from the study are therefore useful for hot spot identification, location-specific disease surveillance and intervention.
Collapse
Affiliation(s)
- Oyelola Adegboye
- Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, QLD, Australia.,Australian Institute of Tropical Health and Medicine, James Cook University, QLD, Australia
| | - Ezra Gayawan
- Biostatistics and Spatial Statistics Laboratory, Department of Statistics, Federal University of Technology, Akure, Nigeria
| | - Adewale James
- Division of Mathematics, American University of Nigeria, Yola
| | | | - Faiz Elfaki
- Department of Mathematics, Physics and Statistics, Qatar University, Doha, Qatar
| |
Collapse
|
8
|
Pollett S, Johansson M, Biggerstaff M, Morton LC, Bazaco SL, Brett Major DM, Stewart-Ibarra AM, Pavlin JA, Mate S, Sippy R, Hartman LJ, Reich NG, Maljkovic Berry I, Chretien JP, Althouse BM, Myer D, Viboud C, Rivers C. Identification and evaluation of epidemic prediction and forecasting reporting guidelines: A systematic review and a call for action. Epidemics 2020; 33:100400. [PMID: 33130412 PMCID: PMC8667087 DOI: 10.1016/j.epidem.2020.100400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/24/2020] [Accepted: 06/25/2020] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION High quality epidemic forecasting and prediction are critical to support response to local, regional and global infectious disease threats. Other fields of biomedical research use consensus reporting guidelines to ensure standardization and quality of research practice among researchers, and to provide a framework for end-users to interpret the validity of study results. The purpose of this study was to determine whether guidelines exist specifically for epidemic forecast and prediction publications. METHODS We undertook a formal systematic review to identify and evaluate any published infectious disease epidemic forecasting and prediction reporting guidelines. This review leveraged a team of 18 investigators from US Government and academic sectors. RESULTS A literature database search through May 26, 2019, identified 1467 publications (MEDLINE n = 584, EMBASE n = 883), and a grey-literature review identified a further 407 publications, yielding a total 1777 unique publications. A paired-reviewer system screened in 25 potentially eligible publications, of which two were ultimately deemed eligible. A qualitative review of these two published reporting guidelines indicated that neither were specific for epidemic forecasting and prediction, although they described reporting items which may be relevant to epidemic forecasting and prediction studies. CONCLUSIONS This systematic review confirms that no specific guidelines have been published to standardize the reporting of epidemic forecasting and prediction studies. These findings underscore the need to develop such reporting guidelines in order to improve the transparency, quality and implementation of epidemic forecasting and prediction research in operational public health.
Collapse
Affiliation(s)
- Simon Pollett
- Viral Diseases Branch, Walter Reed Army Institute of Research, MD, USA.
| | - Michael Johansson
- Division of Vector-Borne Diseases, Centers for Disease Control & Prevention, San Juan, Puerto Rico, USA
| | | | - Lindsay C Morton
- Global Emerging Infections Surveillance, Armed Forces Health Surveillance Division, Silver Spring, MD, USA; Cherokee Nation Strategic Programs, Tulsa, OK, USA; Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Sara L Bazaco
- Global Emerging Infections Surveillance, Armed Forces Health Surveillance Division, Silver Spring, MD, USA; General Dynamics Information Technology, Falls Church, VA, USA
| | | | - Anna M Stewart-Ibarra
- Institute for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, NY, USA; InterAmerican Institute for Global Change Research (IAI), Montevideo, Department of Montevideo, Uruguay
| | - Julie A Pavlin
- National Academies of Sciences, Engineering, and Medicine, DC, USA
| | - Suzanne Mate
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, MD, USA
| | - Rachel Sippy
- Institute for Global Health and Translational Science, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Laurie J Hartman
- Global Emerging Infections Surveillance, Armed Forces Health Surveillance Division, Silver Spring, MD, USA; Cherokee Nation Strategic Programs, Tulsa, OK, USA
| | | | | | | | - Benjamin M Althouse
- University of Washington, WA, USA; Institute for Disease Modeling, Bellevue, WA, USA; New Mexico State University, Las Cruces, NM, USA
| | - Diane Myer
- Johns Hopkins Center for Health Security, MD, USA
| | - Cecile Viboud
- Fogarty International Center, National Institutes of Health, MD, USA
| | | |
Collapse
|
9
|
Kelly JD, Wannier SR, Sinai C, Moe CA, Hoff NA, Blumberg S, Selo B, Mossoko M, Chowell-Puente G, Jones JH, Okitolonda-Wemakoy E, Rutherford GW, Lietman TM, Muyembe-Tamfum JJ, Rimoin AW, Porco TC, Richardson ET. The Impact of Different Types of Violence on Ebola Virus Transmission During the 2018-2020 Outbreak in the Democratic Republic of the Congo. J Infect Dis 2020; 222:2021-2029. [PMID: 32255180 PMCID: PMC7661768 DOI: 10.1093/infdis/jiaa163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/05/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Our understanding of the different effects of targeted versus nontargeted violence on Ebola virus (EBOV) transmission in Democratic Republic of the Congo (DRC) is limited. METHODS We used time-series data of case counts to compare individuals in Ebola-affected health zones in DRC, April 2018-August 2019. Exposure was number of violent events per health zone, categorized into Ebola-targeted or Ebola-untargeted, and into civilian-induced, (para)military/political, or protests. Outcome was estimated daily reproduction number (Rt) by health zone. We fit linear time-series regression to model the relationship. RESULTS Average Rt was 1.06 (95% confidence interval [CI], 1.02-1.11). A mean of 2.92 violent events resulted in cumulative absolute increase in Rt of 0.10 (95% CI, .05-.15). More violent events increased EBOV transmission (P = .03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on Rt, Ebola-targeted events corresponded to Rt of 1.52 (95% CI, 1.30-1.74), while civilian-induced events corresponded to Rt of 1.43 (95% CI, 1.21-1.35). Untargeted events corresponded to Rt of 1.18 (95% CI, 1.02-1.35); among these, militia/political or ville morte events increased transmission. CONCLUSIONS Ebola-targeted violence, primarily driven by civilian-induced events, had the largest impact on EBOV transmission.
Collapse
Affiliation(s)
- John Daniel Kelly
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
- F. I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Rae Wannier
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
- F. I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA
| | - Cyrus Sinai
- Department of Geography, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Caitlin A Moe
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Firearm Injury Policy and Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Nicole A Hoff
- School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Seth Blumberg
- F. I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA
| | - Bernice Selo
- Ministry of Health, Kinshasa, Democratic Republic of Congo
| | | | - Gerardo Chowell-Puente
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - James Holland Jones
- Department of Earth Systems Science, Stanford University, Stanford, California, USA
| | | | - George W Rutherford
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas M Lietman
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Anne W Rimoin
- School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
- F. I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA
| | - Eugene T Richardson
- Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| |
Collapse
|
10
|
Jombart T, Jarvis CI, Mesfin S, Tabal N, Mossoko M, Mpia LM, Abedi AA, Chene S, Forbin EE, Belizaire MRD, de Radiguès X, Ngombo R, Tutu Y, Finger F, Crowe M, Edmunds WJ, Nsio J, Yam A, Diallo B, Gueye AS, Ahuka-Mundeke S, Yao M, Fall IS. The cost of insecurity: from flare-up to control of a major Ebola virus disease hotspot during the outbreak in the Democratic Republic of the Congo, 2019. ACTA ACUST UNITED AC 2020; 25. [PMID: 31964460 PMCID: PMC6976886 DOI: 10.2807/1560-7917.es.2020.25.2.1900735] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The ongoing Ebola outbreak in the eastern Democratic Republic of the Congo is facing unprecedented levels of insecurity and violence. We evaluate the likely impact in terms of added transmissibility and cases of major security incidents in the Butembo coordination hub. We also show that despite this additional burden, an adapted response strategy involving enlarged ring vaccination around clusters of cases and enhanced community engagement managed to bring this main hotspot under control.
Collapse
Affiliation(s)
- Thibaut Jombart
- Global Outbreak Alert and Response Network, Geneva, Switzerland.,MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom.,UK Public Health Rapid Support Team, London, United Kingdom.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Christopher I Jarvis
- Global Outbreak Alert and Response Network, Geneva, Switzerland.,UK Public Health Rapid Support Team, London, United Kingdom.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Nabil Tabal
- World Health Organization, Geneva, Switzerland
| | - Mathias Mossoko
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | | | - Aaron Aruna Abedi
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Sonia Chene
- World Health Organization, Geneva, Switzerland
| | | | | | | | | | - Yannick Tutu
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | - Flavio Finger
- Global Outbreak Alert and Response Network, Geneva, Switzerland.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - W John Edmunds
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Justus Nsio
- Ministère de la Santé Publique, Kinshasa, Democratic Republic of the Congo
| | | | | | | | - Steve Ahuka-Mundeke
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Michel Yao
- World Health Organization, Geneva, Switzerland
| | | |
Collapse
|
11
|
Iversen PL, Kane CD, Zeng X, Panchal RG, Warren TK, Radoshitzky SR, Kuhn JH, Mudhasani RR, Cooper CL, Shurtleff AC, Nasar F, Sunay MM, Duplantier AJ, Eaton BP, Zumbrun EE, Bixler SL, Martin S, Meinig JM, Chiang CY, Sanchez-Lockhart M, Palacios GF, Kugelman JR, Martins KA, Pitt ML, Crozier I, Saunders DL. Recent successes in therapeutics for Ebola virus disease: no time for complacency. THE LANCET. INFECTIOUS DISEASES 2020; 20:e231-e237. [PMID: 32563280 PMCID: PMC7302789 DOI: 10.1016/s1473-3099(20)30282-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022]
Abstract
The PALM trial in the Democratic Republic of the Congo identified a statistically significant survival benefit for two monoclonal antibody-based therapeutics in the treatment of acute Ebola virus disease; however, substantial gaps remain in improving the outcomes of acute Ebola virus disease and for the survivors. Ongoing efforts are needed to develop more effective strategies, particularly for individuals with severe disease, for prevention and treatment of viral persistence in immune-privileged sites, for optimisation of post-exposure prophylaxis, and to increase therapeutic breadth. As antibody-based approaches are identified and advanced, promising small-molecule antivirals currently in clinical stage development should continue to be evaluated for filovirus diseases, with consideration of their added value in combination approaches with bundled supportive care, their penetration in tissues of interest, the absence of interaction with glycoprotein-based vaccines, and filoviral breadth.
Collapse
Affiliation(s)
- Patrick L Iversen
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Christopher D Kane
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Xiankun Zeng
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Rekha G Panchal
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Travis K Warren
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Sheli R Radoshitzky
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA
| | - Rajini R Mudhasani
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Christopher L Cooper
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Amy C Shurtleff
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Farooq Nasar
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Melek Me Sunay
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Allen J Duplantier
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Brett P Eaton
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Elizabeth E Zumbrun
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Sandra L Bixler
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Shannon Martin
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - J Matthew Meinig
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Chih-Yuan Chiang
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Mariano Sanchez-Lockhart
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Gustavo F Palacios
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Jeffrey R Kugelman
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Karen A Martins
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Margaret L Pitt
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA
| | - Ian Crozier
- Integrated Research Facility at Fort Detrick, Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - David L Saunders
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD, USA.
| |
Collapse
|
12
|
Roosa K, Tariq A, Yan P, Hyman JM, Chowell G. Multi-model forecasts of the ongoing Ebola epidemic in the Democratic Republic of Congo, March-October 2019. J R Soc Interface 2020; 17:20200447. [PMID: 32842888 PMCID: PMC7482568 DOI: 10.1098/rsif.2020.0447] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The 2018–2020 Ebola outbreak in the Democratic Republic of the Congo is the first to occur in an armed conflict zone. The resulting impact on population movement, treatment centres and surveillance has created an unprecedented challenge for real-time epidemic forecasting. Most standard mathematical models cannot capture the observed incidence trajectory when it deviates from a traditional epidemic logistic curve. We fit seven dynamic models of increasing complexity to the incidence data published in the World Health Organization Situation Reports, after adjusting for reporting delays. These models include a simple logistic model, a Richards model, an endemic Richards model, a double logistic growth model, a multi-model approach and two sub-epidemic models. We analyse model fit to the data and compare real-time forecasts throughout the ongoing epidemic across 29 weeks from 11 March to 23 September 2019. We observe that the modest extensions presented allow for capturing a wide range of epidemic behaviour. The multi-model approach yields the most reliable forecasts on average for this application, and the presented extensions improve model flexibility and forecasting accuracy, even in the context of limited epidemiological data.
Collapse
Affiliation(s)
- Kimberlyn Roosa
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Amna Tariq
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Ping Yan
- Infectious Disease Prevention and Control Branch, Public Health Agency of Canada, Ottawa, Canada
| | - James M Hyman
- Department of Mathematics, Center for Computational Science, Tulane University, New Orleans, LA, USA
| | - Gerardo Chowell
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA.,Division of International Epidemiology and Population Studies, Fogarty International Center, National Institute of Health, Bethesda, MD, USA
| |
Collapse
|
13
|
Rivers C, Pollett S, Viboud C. The opportunities and challenges of an Ebola modeling research coordination group. PLoS Negl Trop Dis 2020; 14:e0008158. [PMID: 32673319 PMCID: PMC7365411 DOI: 10.1371/journal.pntd.0008158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Caitlin Rivers
- Johns Hopkins Center for Health Security, Maryland, United States of America
| | - Simon Pollett
- Viral Diseases Branch, Walter Reed Army Institute of Research, Marlyand, United States of America
- Uniformed Services University of the Health Sciences, Maryland, United States of America
- Marie Bashir Institute, University of Sydney, New South Wales, Australia
| | - Cecile Viboud
- National Institutes of Health, Maryland, United States of America
| |
Collapse
|
14
|
The Ebola outbreak in the Democratic Republic of the Congo: why there is no ‘silver bullet’. Nat Immunol 2020; 21:591-594. [DOI: 10.1038/s41590-020-0675-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
15
|
Olu OO, Lako R, Wamala JF, Ramadan PO, Ryan C, Udenweze I, Berta K, Guyo AG, Sokemawu A, Tukuru M, Gray HJ, Chimbaru A. What did we learn from preparing for cross-border transmission of Ebola virus disease into a complex humanitarian setting - The Republic of South Sudan? Infect Dis Poverty 2020; 9:40. [PMID: 32312320 PMCID: PMC7170723 DOI: 10.1186/s40249-020-00657-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/06/2020] [Indexed: 11/29/2022] Open
Abstract
Background Following the West Africa Ebola virus disease (EVD) outbreak (2013–2016), WHO developed a preparedness checklist for its member states. This checklist is currently being applied for the first time on a large and systematic scale to prepare for the cross border importation of the ongoing EVD outbreak in the Democratic Republic of Congo hence the need to document the lessons learnt from this experience. This is more pertinent considering the complex humanitarian context and weak health system under which some of the countries such as the Republic of South Sudan are implementing their EVD preparedness interventions. Main text We identified four main lessons from the ongoing EVD preparedness efforts in the Republic South Sudan. First, EVD preparedness is possible in complex humanitarian settings such as the Republic of South Sudan by using a longer-term health system strengthening approach. Second, the Republic of South Sudan is at risk of both domestic and cross border transmission of EVD and several other infectious disease outbreaks hence the need for an integrated and sustainable approach to outbreak preparedness in the country. Third, a phased and well-prioritized approach is required for EVD preparedness in complex humanitarian settings given the costs associated with preparedness and the difficulties in the accurate prediction of outbreaks in such settings. Fourth, EVD preparedness in complex humanitarian settings is a massive undertaking that requires effective and decentralized coordination. Conclusion Despite a very challenging context, the Republic of South Sudan made significant progress in its EVD preparedness drive demonstrating that it is possible to rapidly scale up preparedness efforts in complex humanitarian contexts if appropriate and context-specific approaches are used. Further research, systematic reviews and evaluation of the ongoing preparedness efforts are required to ensure comprehensive documentation and application of the lessons learnt for future EVD outbreak preparedness and response efforts.
Collapse
Affiliation(s)
- Olushayo Oluseun Olu
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan.
| | - Richard Lako
- National Ebola virus disease preparedness Incident Manager, Ministry of Health, Juba, Republic of South Sudan
| | - Joseph Francis Wamala
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Patrick Otim Ramadan
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Caroline Ryan
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Ifeanyi Udenweze
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Kibebu Berta
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Argata Guracha Guyo
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Alex Sokemawu
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Michael Tukuru
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Henry John Gray
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| | - Alex Chimbaru
- World Health Organization Ebola Virus Disease preparedness team, Juba, Republic of South Sudan
| |
Collapse
|
16
|
Jacob ST, Crozier I, Fischer WA, Hewlett A, Kraft CS, Vega MADL, Soka MJ, Wahl V, Griffiths A, Bollinger L, Kuhn JH. Ebola virus disease. Nat Rev Dis Primers 2020; 6:13. [PMID: 32080199 PMCID: PMC7223853 DOI: 10.1038/s41572-020-0147-3] [Citation(s) in RCA: 296] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 12/16/2022]
Abstract
Ebola virus disease (EVD) is a severe and frequently lethal disease caused by Ebola virus (EBOV). EVD outbreaks typically start from a single case of probable zoonotic transmission, followed by human-to-human transmission via direct contact or contact with infected bodily fluids or contaminated fomites. EVD has a high case-fatality rate; it is characterized by fever, gastrointestinal signs and multiple organ dysfunction syndrome. Diagnosis requires a combination of case definition and laboratory tests, typically real-time reverse transcription PCR to detect viral RNA or rapid diagnostic tests based on immunoassays to detect EBOV antigens. Recent advances in medical countermeasure research resulted in the recent approval of an EBOV-targeted vaccine by European and US regulatory agencies. The results of a randomized clinical trial of investigational therapeutics for EVD demonstrated survival benefits from two monoclonal antibody products targeting the EBOV membrane glycoprotein. New observations emerging from the unprecedented 2013-2016 Western African EVD outbreak (the largest in history) and the ongoing EVD outbreak in the Democratic Republic of the Congo have substantially improved the understanding of EVD and viral persistence in survivors of EVD, resulting in new strategies toward prevention of infection and optimization of clinical management, acute illness outcomes and attendance to the clinical care needs of patients.
Collapse
Affiliation(s)
- Shevin T Jacob
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Global Health Security Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Ian Crozier
- Integrated Research Facility at Fort Detrick, Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research supported by the National Cancer Institute, Frederick, MD, USA
| | - William A Fischer
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Chapel Hill, NC, USA
| | - Angela Hewlett
- Nebraska Biocontainment Unit, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Colleen S Kraft
- Microbiology Section, Emory Medical Laboratory, Emory University School of Medicine, Atlanta, GA, USA
| | - Marc-Antoine de La Vega
- Department of Microbiology, Immunology & Infectious Diseases, Université Laval, Quebec City, QC, Canada
| | - Moses J Soka
- Partnership for Ebola Virus Disease Research in Liberia, Monrovia Medical Units ELWA-2 Hospital, Monrovia, Liberia
| | - Victoria Wahl
- National Biodefense Analysis and Countermeasures Center, Fort Detrick, Frederick, MD, USA
| | - Anthony Griffiths
- Department of Microbiology and National Emerging Infectious Diseases Laboratories, Boston University School of Medicine, Boston, MA, USA
| | - Laura Bollinger
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA
| | - Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD, USA.
| |
Collapse
|
17
|
Shears P, Garavan C. The 2018/19 Ebola epidemic the Democratic Republic of the Congo (DRC): epidemiology, outbreak control, and conflict. Infect Prev Pract 2020; 2:100038. [PMID: 34368690 PMCID: PMC8336035 DOI: 10.1016/j.infpip.2020.100038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 11/28/2022] Open
Abstract
The Democratic Republic of Congo (DRC) (formerly Zaire) was the location of the first Ebola outbreak, in 1976, and since then there have been a total of ten outbreaks in different parts of the country. The current outbreak, the first in eastern DRC (North Kivu and Ituri provinces), began in July 2018, and by December 2019, there had been 3262 cases and 2232 deaths. Within weeks of the first reported cases, the World Health Organisation (WHO) and the DRC Ministry of Health (MOH) initiated a major response programme, with laboratory support, international agencies providing personnel, and material resources. Unlike previous Ebola outbreaks, including the west Africa epidemic, a proven vaccine, and trial therapeutic agents have been available as part of the outbreak response. Two therapeutic agents, mAb114 and REGN-EB3, both monoclonal antibody derived, have shown case fatality rates (CFR) of around 30%, compared to the overall of 66%. Despite these positive interventions, the outbreak has continued for eighteen months. Underlying the outbreak response has been a high number of violent incidents by local militias, and community mistrust and lack of involvement that has hampered many aspects of the response programme. As a result, many cases are not reported early and not transferred to treatment centres, deaths and increased transmission occur in the community, and the response programme is reaching only a proportion of the cases. New strategies to improve community participation, and integrate the Ebola response into the existing health structure are planned to improve the programme effectiveness.
Collapse
Affiliation(s)
- Paul Shears
- Wirral University Teaching Hospital, Wirral, Merseyside UK
| | - Carrie Garavan
- WHO Ebola Case Management Team, Butembo DRC & Medicines Sans Frontiers' Ebola Emergency Response Team DRC, Ireland
| |
Collapse
|
18
|
Affiliation(s)
- Myron M Levine
- From the University of Maryland School of Medicine, Baltimore
| |
Collapse
|
19
|
Inungu J, Iheduru-Anderson K, Odio OJ. Recurrent Ebolavirus disease in the Democratic Republic of Congo: update and challenges. AIMS Public Health 2019; 6:502-513. [PMID: 31909070 PMCID: PMC6940573 DOI: 10.3934/publichealth.2019.4.502] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/18/2019] [Indexed: 12/31/2022] Open
Abstract
The current Ebolavirus disease (EVD) outbreak in the provinces of North Kivu and Ituri is the tenth outbreak affecting the Democratic Republic of Congo (DRC); the first outbreak occurring in a war context, and the second most deadly Ebolavirus outbreak on record following the 2014 outbreak in West Africa. The DRC government's response consisted of applying a package of interventions including detection and rapid isolation of cases, contact tracing, population mapping, and identification of high-risk areas to inform a coordinated effort. The coordinated effort was to screen, ring vaccinate, and conduct laboratory diagnoses using GeneXpert (Cepheid) polymerase chain reaction. The effort also included ensuring safe and dignified burials and promoting risk communication, community engagement, and social mobilization. Following the adoption of the “Monitored Emergency Use of Unregistered Products Protocol,” a randomized controlled trial of four investigational treatments (mAb114, ZMapp, and REGN-EB3 and Remdesivir) was carried out with all consenting patients with laboratory-confirmed EVD. REGN-EB3 and mAb114 showed promise as treatments for EVD. In addition, one investigational vaccine (rVSV-ZEBOV-GP) was used first, followed by a second prophylactic vaccine (Ad26.ZEBOV/MVA-BN-Filo) to reinforce the prevention. Although the provision of clinical supportive care remains the cornerstone of EVD outbreak management, the DRC response faced daunting challenges including general insecurity, violence and community resistance, appalling poverty, and entrenched distrust of authority. Ebolavirus remains a public health threat. A fully curative treatment is unlikely to be a game-changer given the settings of transmission, zoonotic nature, limits of effectiveness of any therapeutic intervention, and timing of presentation.
Collapse
Affiliation(s)
- Joseph Inungu
- Master of Public Health Program, College of Health Professions, Central Michigan University, Michigan, United States
| | | | - Ossam J Odio
- Department of Internal Medicine, Medical School Hospital, University of Kinshasa, Kinshasa, Congo
| |
Collapse
|
20
|
Mizumoto K, Tariq A, Roosa K, Kong J, Yan P, Chowell G. Spatial variability in the reproduction number of Ebola virus disease, Democratic Republic of the Congo, January-September 2019. Euro Surveill 2019; 24:1900588. [PMID: 31640841 PMCID: PMC6807257 DOI: 10.2807/1560-7917.es.2019.24.42.1900588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The ongoing Ebola virus disease epidemic (August 2018─October 2019) in the Democratic Republic of the Congo, has been exacerbated by deliberate attacks on healthcare workers despite vaccination efforts. Using a mathematical/statistical modelling framework, we present the quantified effective reproduction number (Rt) at national and regional levels as at 29 September. The weekly trend in Rt displays fluctuations while our recent national-level Rt falls slightly above 1.0 with substantial uncertainty, which suggests improvements in epidemic control.
Collapse
Affiliation(s)
- Kenji Mizumoto
- Graduate School of Advanced Integrated Studies in Human Survivability, Kyoto University Yoshida-Nakaadachi-cho, Sakyo-ku, Kyoto, Japan,Hakubi Center for Advanced Research, Kyoto University, Yoshidahonmachi, Sakyo-ku, Kyoto, Japan,Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Amna Tariq
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Kimberlyn Roosa
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Jun Kong
- Department of Mathematics and Statistics, Georgia State University, Atlanta, Georgia, United States of America,Department of Computer Science, Georgia State University, Atlanta, Georgia, United States of America,Department of Computer Science, Emory University, Atlanta, Georgia, United States of America
| | - Ping Yan
- Public Health Agency of Canada, Ottawa, Canada
| | - Gerardo Chowell
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, United States of America,Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
| |
Collapse
|