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Frankfurter RG, Willet V, Richardson ET, Rutherford GW, Baller A, Kelly JD. Infection prevention and control studies for care of patients with suspected or confirmed filovirus disease in healthcare settings, with focus on Ebola and Marburg: an integrative review. BMJ PUBLIC HEALTH 2024; 2:e000556. [PMID: 39015119 PMCID: PMC11251729 DOI: 10.1136/bmjph-2023-000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Objective To review evidence pertaining to methods for preventing healthcare-associated filovirus infections (including the survivability of filoviruses in clinical environments and the chlorine concentration required for effective disinfection), and to assess protocols for determining the risk of health worker (HW) exposures to filoviruses. Design Integrative review. Data sources PubMed, Embase, Google Scholar, internet-based sources of international health organisations (eg, WHO, CDC), references of the included literature and grey literature. Study selection Laboratory science, clinical research and real-world observational studies identified through comprehensive search strings that pertained to Ebola disease and Marburg disease and the three research objectives. Methods Using the framework of population, intervention or exposure, outcomes, study types and report characteristics, reviewers extracted data and critically appraised the evidence using predefined data extraction forms and summary tables. The extraction forms, summary tables and critical appraisals varied based on the included literature; we used both the QUIPS Risk-of-Bias tool when possible and an internally developed instrument to systematically extract and review the evidence from observational and experimental studies. Evidence was then synthesised and summarised to create summary recommendations. Results Thirty-six studies (including duplicates across research questions) were included in our reviews. All studies that related to the review questions were either (1) descriptive, real-world studies (ie, environmental audits of various surfaces in operational Ebola Treatment Units) or (2) controlled, laboratory studies (ie, experimental studies on the survivability of ebolaviruses in controlled conditions), presenting a range of concerns pertaining to bias and external validity. Our reviews of viral survivability evidence revealed significant disconnections between laboratory-based and real-world findings. However, there is greater viral persistence in liquid than dried body fluids, with the possible exception of blood, and ebolaviruses can survive for significant periods of time in dried substrate. Evidence suggests that 0.5% hypochlorite solution should be used for disinfection activity. Spills should be cleaned with covering and soaking for 15 min. Existing literature suggests that within a well-resourced clinical environment with trained, foreign HWs and established protocols, transmission of ebolaviruses as an occupational risk is a rare event. Despite the high rates of HW infections within public African healthcare settings, no evidence with low risk of bias exists to assess the risk of various occupational exposures given that all high-quality studies were conducted on foreign Ebola clinicians who had low overall rates of infection. This review underscores the critical need for better-quality evidence to inform best practices to ensure HW safety during filovirus disease epidemics.
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Affiliation(s)
- Raphael G Frankfurter
- University of California San Francisco School of Medicine,
San Francisco, California, USA
| | | | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard
Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
| | - George W Rutherford
- Department of Epidemiology and Biostatistics, University of
California San Francisco, San Francisco, California, USA
| | - April Baller
- WHO Health Emergencies (WHE) Programme, Geneva,
Switzerland
| | - J Daniel Kelly
- University of California San Francisco School of Medicine,
San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of
California San Francisco, San Francisco, California, USA
- Department of Medicine, University of California San
Francisco, San Francisco, California, USA
- Francis I. Proctor Foundation, San Francisco, CA, USA
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2
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Frankfurter R, Malik M, Kpakiwa SD, McGinnis T, Malik MM, Chitre S, Barrie MB, Dibba Y, Mulalu L, Baldwinson R, Fallah M, Rashid I, Kelly JD, Richardson ET. Representations of an Ebola 'outbreak' through Story Technologies. BMJ Glob Health 2024; 9:e013210. [PMID: 38341190 PMCID: PMC10862337 DOI: 10.1136/bmjgh-2023-013210] [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: 06/26/2023] [Accepted: 01/14/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Attempts to understand biosocial phenomena using scientific methods are often presented as value-neutral and objective; however, when used to reduce the complexity of open systems such as epidemics, these forms of inquiry necessarily entail normative considerations and are therefore fashioned by political worldviews (ideologies). From the standpoint of poststructural theory, the character of these representations is at most limited and partial. In addition, these modes of representation (as stories) do work (as technologies) in the service of, or in resistance to, power. METHODS We focus on a single Ebola case cluster from the 2013-2016 outbreak in West Africa and examine how different disciplinary forms of knowledge production (including outbreak forecasting, active epidemiological surveillance, post-outbreak serosurveys, political economic analyses, and ethnography) function as Story Technologies. We then explore how these technologies are used to curate 'data,' analysing the erasures, values, and imperatives evoked by each. RESULTS We call attention to the instrumental-in addition to the descriptive-role Story Technologies play in ordering contingencies and establishing relationships in the wake of health crises. DISCUSSION By connecting each type of knowledge production with the systems of power it reinforces or disrupts, we illustrate how Story Technologies do ideological work. These findings encourage research from pluriversal perspectives and advocacy for measures that promote more inclusive modes of knowledge production.
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Affiliation(s)
| | - Maya Malik
- School of Social Work, McGill University, Montreal, Québec, Canada
| | | | - Timothy McGinnis
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Momin M Malik
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Smit Chitre
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Lulwama Mulalu
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Raquel Baldwinson
- Department of English Language and Literatures, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mosoka Fallah
- Africa Centres for Disease Control and Prevention, African Union, Addis Ababa, Ethiopia
| | - Ismail Rashid
- Department of History, Vassar College, Poughkeepsie, New York, USA
| | - J Daniel Kelly
- Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Eugene T Richardson
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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3
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Yanful B, Kumar MB, García-Elorrio E, Atim C, Roder-DeWan S. Decolonisation and quality of care. BMJ 2023; 380:e071585. [PMID: 36914173 DOI: 10.1136/bmj-2022-071585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Affiliation(s)
- Bernice Yanful
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Meghan Bruce Kumar
- London School of Hygiene and Tropical Medicine, London, UK
- KEMRI-Wellcome Trust Programme, Nairobi, Kenya
| | | | - Chris Atim
- Results for Development (R4D), Accra, Ghana
| | - Sanam Roder-DeWan
- World Bank Group, Washington, DC, USA
- Dartmouth Medical School, Hanover, NH, USA
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4
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Hazel A, Davidson MC, Rogers A, Barrie MB, Freeman A, Mbayoh M, Kamara M, Blumberg S, Lietman TM, Rutherford GW, Jones JH, Porco TC, Richardson ET, Kelly JD. Social Network Analysis of Ebola Virus Disease During the 2014 Outbreak in Sukudu, Sierra Leone. Open Forum Infect Dis 2022; 9:ofac593. [PMID: 36467298 PMCID: PMC9709704 DOI: 10.1093/ofid/ofac593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/01/2022] [Indexed: 08/02/2023] Open
Abstract
Background Transmission by unreported cases has been proposed as a reason for the 2013-2016 Ebola virus (EBOV) epidemic decline in West Africa, but studies that test this hypothesis are lacking. We examined a transmission chain within social networks in Sukudu village to assess spread and transmission burnout. Methods Network data were collected in 2 phases: (1) serological and contact information from Ebola cases (n = 48, including unreported); and (2) interviews (n = 148), including Ebola survivors (n = 13), to identify key social interactions. Social links to the transmission chain were used to calculate cumulative incidence proportion as the number of EBOV-infected people in the network divided by total network size. Results The sample included 148 participants and 1522 contacts, comprising 10 social networks: 3 had strong links (>50% of cases) to the transmission chain: household sharing (largely kinship), leisure time, and talking about important things (both largely non-kin). Overall cumulative incidence for these networks was 37 of 311 (12%). Unreported cases did not have higher network centrality than reported cases. Conclusions Although this study did not find evidence that explained epidemic decline in Sukudu, it excluded potential reasons (eg, unreported cases, herd immunity) and identified 3 social interactions in EBOV transmission.
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Affiliation(s)
- Ashley Hazel
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Michelle C Davidson
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Abu Rogers
- School of Medicine, Stanford University, Stanford, California, USA
| | - M Bailor Barrie
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Partners in Health, Freetown, Sierra Leone
| | | | | | | | - Seth Blumberg
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - George W Rutherford
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - James Holland Jones
- Division of Social Sciences, Doerr School of Sustainability and the Environment, Stanford University, Stanford, California, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Eugene T Richardson
- Partners in Health, Freetown, Sierra Leone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Daniel Kelly
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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5
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Djomaleu ML, Rogers AB, Barrie MB, Rutherford GW, Weiser SD, Kelly JD. Long-term consequences of food insecurity among Ebola virus disease-affected households after the 2013-2016 epidemic in rural communities of Kono District, Sierra Leone: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000770. [PMID: 36382340 PMCID: PMC9648537 DOI: 10.1371/journal.pgph.0000770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/14/2022] [Indexed: 12/03/2022]
Abstract
The 2013-2016 Ebola virus disease (EVD) epidemic caused food insecurity during and immediately following local outbreaks in Sierra Leone, but longer-term effects are less well described, particularly among households with no EVD survivors. We conducted a qualitative sub-study in July 2018 in Kono District, Sierra Leone to understand the impact of food insecurity on EVD-affected households. Using data from a community-based cohort, we compiled a list of all households, within the sampled communities in Kono District, that had at least one EVD case during the epidemic. We used purposive sampling to recruit 30 households, inclusive of 10 households with no EVD survivors, to participate in the study. The research team conducted open-ended, semi-structured interviews with the head of each household. All 30 interviews were transcribed, translated, and analyzed using comparative content analysis consistent with a grounded theory approach. Most household members were facing persistent food insecurity as direct or indirect consequences of the EVD epidemic, regardless of whether they did or did not live with EVD survivors. Three major themes emerged as drivers and/or mitigators of EVD-related food insecurity. Financial instability and physical health complications were drivers of food insecurity in the population, whereas support provided by NGOs or governmental agencies was observed as a mitigator and driver of food insecurity after its removal. Among the EVD-households reporting long-term support through jobs and educational opportunities, there was sustained mitigation of food insecurity. EVD-affected households with and without survivors continue to face food insecurity three years after the EVD epidemic. Provision of support was a mitigator of food insecurity in the short term, but its removal was a driver of food insecurity in the longer term, suggesting the need for longer-term transitional support in affected households.
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Affiliation(s)
- Manuella L. Djomaleu
- School of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Abu B. Rogers
- School of Medicine, Stanford University, Stanford, California, United States of America
| | - M. Bailor Barrie
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Partners In Health, Freetown, Sierra Leone
| | - George W. Rutherford
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Sheri D. Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - J. Daniel Kelly
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
- Partners In Health, Freetown, Sierra Leone
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
- F.I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
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6
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Mayhew SH, Balabanova D, Vandi A, Mokuwa GA, Hanson T, Parker M, Richards P. (Re)arranging "systems of care" in the early Ebola response in Sierra Leone: An interdisciplinary analysis. Soc Sci Med 2022; 300:114209. [PMID: 34247897 PMCID: PMC9077326 DOI: 10.1016/j.socscimed.2021.114209] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/15/2021] [Accepted: 07/02/2021] [Indexed: 11/21/2022]
Abstract
Despite an expanding literature on Ebola-response, few studies detail or reflect on the responses of diverse systems of care. Little is known about how, why or in what ways, strategies of ill-health management were enacted locally, how health-systems power, authority and hierarchy were perceived and contested, or how other social systems, institutions and relationships shaped the response. This paper presents an interdisciplinary analysis of local responses in two early affected districts in Sierra Leone. Drawing on anthropological theories of social ordering and assemblage, we present an analysis of contrasting infection chains in three extended case studies from Bo and Moyamba districts. In contrast to previous scholarship which has understood local actions as being reactive (supporting or obstructing) to a national Ebola response, we show that local arrangements lead and shape responses. Our cases show how multiple, entangled, dynamic and co-existing systems of care influence these responses. Some individuals and communities collaborated with health authorities on measures like reporting and quarantine, others actively opposed them, or played an intermediary role. Collectively, formal health systems actors, local authorities and ordinary citizens negotiated and enacted new arrangements. These arrangements involved compromise and sometimes power was reconfigured. They were also shaped by wider political and historical contexts and by availability or absence of formal healthcare resources. Our research shows the critical importance of understanding how institutions and people involved in healthcare enact diverse "systems of care" and thereby shape Ebola response. Most importantly, our work underlines the need for alignment between formal health-systems and wider social, cultural, political and economic forms of organisation at family and community levels to improve crisis-response and promote sustainable care. In particular, health systems responders need to identify and engage with key brokers - or arrangers - in frontline care systems, with whom mutually acceptable, and effective, reconfigurations of care can be achieved.
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Affiliation(s)
- Susannah H Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Ahmed Vandi
- School of Community Health Sciences, Njala University, Kowama, Bo, Sierra Leone
| | | | - Tommy Hanson
- School of Community Health Sciences, Njala University, Kowama, Bo, Sierra Leone
| | - Melissa Parker
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Richards
- School of Environmental Sciences, Njala University, Mokonde, Sierra Leone
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7
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Barrie MB, Lakoh S, Kelly JD, Kanu JS, Squire JS, Koroma Z, Bah S, Sankoh O, Brima A, Ansumana R, Goldberg SA, Chitre S, Osuagwu C, Frankfurter R, Maeda J, Barekye B, Numbere TW, Abdulaziz M, Mounts A, Blanton C, Singh T, Samai M, Vandi M, Richardson ET. SARS-CoV-2 antibody prevalence in Sierra Leone, March 2021: a cross-sectional, nationally representative, age-stratified serosurvey. BMJ Glob Health 2021; 6:e007271. [PMID: 34764148 PMCID: PMC8587532 DOI: 10.1136/bmjgh-2021-007271] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/20/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION As of 26 March 2021, the Africa Centres for Disease Control and Prevention had reported 4 159 055 cases of COVID-19 and 111 357 deaths among the 55 African Union member states; however, no country has published a nationally representative serosurvey as of October 2021. Such data are vital for understanding the pandemic's progression on the continent, evaluating containment measures, and policy planning. METHODS We conducted a cross-sectional, nationally representative, age-stratified serosurvey in Sierra Leone in March 2021 by randomly selecting 120 Enumeration Areas throughout the country and 10 randomly selected households in each of these. One to two persons per selected household were interviewed to collect information on sociodemographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. Capillary blood was collected by fingerstick, and blood samples were tested using the Hangzhou Biotest Biotech RightSign COVID-19 IgG/IgM Rapid Test Cassette. Total seroprevalence was estimated after applying sampling weights. RESULTS The overall weighted seroprevalence was 2.6% (95% CI 1.9% to 3.4%). This was 43 times higher than the reported number of cases. Rural seropositivity was 1.8% (95% CI 1.0% to 2.5%), and urban seropositivity was 4.2% (95% CI 2.6% to 5.7%). DISCUSSION Overall seroprevalence was low compared with countries in Europe and the Americas (suggesting relatively successful containment in Sierra Leone). This has ramifications for the country's third wave (which started in June 2021), during which the average number of daily reported cases was 87 by the end of the month:this could potentially be on the order of 3700 actual infections per day, calling for stronger containment measures in a country with only 0.2% of people fully vaccinated. It may also reflect significant under-reporting of incidence and mortality across the continent.
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Affiliation(s)
- Mohamed Bailor Barrie
- Institute for Global Health Sciences, UCSF, San Francisco, California, USA
- Partners In Health, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - J Daniel Kelly
- Institute for Global Health Sciences, UCSF, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | - Joseph Sam Kanu
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - James Sylvester Squire
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - Zikan Koroma
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - Silleh Bah
- Statistics Sierra Leone, Freetown, Sierra Leone
| | - Osman Sankoh
- Statistics Sierra Leone, Freetown, Sierra Leone
- Njala University, Bo, Sierra Leone
- HIGH, University of Heidelberg, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Sarah A Goldberg
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | - Smit Chitre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Chidinma Osuagwu
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Raphael Frankfurter
- Department of Humanities and Social Sciences, UCSF, San Francisco, California, USA
| | - Justin Maeda
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Bernard Barekye
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Mohammed Abdulaziz
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Anthony Mounts
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Curtis Blanton
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tushar Singh
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Mohamed Vandi
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
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8
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Barrie MB, Lakoh S, Kelly JD, Kanu JS, Squire J, Koroma Z, Bah S, Sankoh O, Brima A, Ansumana R, Goldberg SA, Chitre S, Osuagwu C, Maeda J, Barekye B, Numbere TW, Abdulaziz M, Mounts A, Blanton C, Singh T, Samai M, Vandi MA, Richardson ET. SARS-CoV-2 antibody prevalence in Sierra Leone, March 2021: a cross-sectional, nationally representative, age-stratified serosurvey. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.06.27.21259271. [PMID: 34230939 PMCID: PMC8259916 DOI: 10.1101/2021.06.27.21259271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background As of 26 March 2021, the Africa CDC had reported 4,159,055 cases of COVID-19 and 111,357 deaths among the 55 African Union Member States; however, no country has published a nationally representative serosurvey as of May 2021. Such data are vital for understanding the pandemic's progression on the continent, evaluating containment measures, and policy planning. Methods We conducted a cross-sectional, nationally representative, age-stratified serosurvey in Sierra Leone in March 2021 by randomly selecting 120 Enumeration Areas throughout the country and 10 randomly selected households in each of these. One to two persons per selected household were interviewed to collect information on socio-demographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. Capillary blood was collected by fingerstick, and blood samples were tested using the Hangzhou Biotest Biotech RightSign COVID-19 IgG/IgM Rapid Test Cassette. Total seroprevalence was was estimated after applying sampling weights. Findings The overall weighted seroprevalence was 2.6% (95% CI 1.9-3.4). This is 43 times higher than the reported number of cases. Rural seropositivity was 1.8% (95% CI 1.0-2.5), and urban seropositivity was 4.2% (95% CI 2.6-5.7). Interpretation Although overall seroprevalence was low compared to countries in Europe and the Americas (suggesting relatively successful containment in Sierra Leone), our findings indicate enormous underreporting of active cases. This has ramifications for the country's third wave (which started in June 2021), where the average number of daily reported cases was 87 by the end of the month: this could potentially be on the order of 3,700 actual infections, calling for stronger containment measures in a country with only 0.2% of people fully vaccinated. It may also reflect significant underreporting of incidence and mortality across the continent.
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Affiliation(s)
- Mohamed Bailor Barrie
- Institute for Global Health Sciences, University of California, San Francisco, USA
- Partners In Health, Sierra Leone
| | - Sulaiman Lakoh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | | | - Joseph Sam Kanu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - James Squire
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Zikan Koroma
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | | | - Osman Sankoh
- Statistics Sierra Leone
- Njala University, Sierra Leone
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Heath, University of Heidelberg Medical School, Germany
| | | | | | - Sarah A. Goldberg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Smit Chitre
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Chidinma Osuagwu
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Justin Maeda
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Bernard Barekye
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Mohammed Abdulaziz
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Anthony Mounts
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Curtis Blanton
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tushar Singh
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Mohamed A. Vandi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Eugene T. Richardson
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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Park S. Deadly secret: situating the unknowing and knowing of the source of the Ebola epidemic in Northern Uganda. JOURNAL OF THE ROYAL ANTHROPOLOGICAL INSTITUTE 2021. [DOI: 10.1111/1467-9655.13488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Sung‐Joon Park
- Department of Anthropology Martin‐Luther‐University Halle‐Wittenberg Reichardtstraße 11, 06114 Halle (Saale) Germany
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10
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Richardson ET. Pandemicity, COVID-19 and the limits of public health 'science'. BMJ Glob Health 2020; 5:e002571. [PMID: 32469327 PMCID: PMC7222576 DOI: 10.1136/bmjgh-2020-002571] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Eugene T Richardson
- Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
- Medicine, Brigham and Women's Hospital, Boston, MA, United States
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11
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Richardson ET, McGinnis T, Frankfurter R. Ebola and the narrative of mistrust. BMJ Glob Health 2019; 4:e001932. [PMID: 31908869 PMCID: PMC6936462 DOI: 10.1136/bmjgh-2019-001932] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Eugene T Richardson
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy McGinnis
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Raphael Frankfurter
- Department of Anthropology, History And Social Medicine, University of California San Francisco, San Francisco, California, USA
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Wannier SR, Worden L, Hoff NA, Amezcua E, Selo B, Sinai C, Mossoko M, Njoloko B, Okitolonda-Wemakoy E, Mbala-Kingebeni P, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Richardson ET, Rutherford GW, Jones JH, Lietman TM, Rimoin AW, Porco TC, Kelly JD. Estimating the impact of violent events on transmission in Ebola virus disease outbreak, Democratic Republic of the Congo, 2018-2019. Epidemics 2019; 28:100353. [PMID: 31378584 PMCID: PMC7363034 DOI: 10.1016/j.epidem.2019.100353] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/22/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION As of April 2019, the current Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) is occurring in a longstanding conflict zone and has become the second largest EVD outbreak in history. It is suspected that after violent events occur, EVD transmission will increase; however, empirical studies to understand the impact of violence on transmission are lacking. Here, we use spatial and temporal trends of EVD case counts to compare transmission rates between health zones that have versus have not experienced recent violent events during the outbreak. METHODS We collected daily EVD case counts from DRC Ministry of Health. A time-varying indicator of recent violence in each health zone was derived from events documented in the WHO situation reports. We used the Wallinga-Teunis technique to estimate the reproduction number R for each case by day per zone in the 2018-2019 outbreak. We fit an exponentially decaying curve to estimates of R overall and by health zone, for comparison to past outbreaks. RESULTS As of 16 April 2019, the mean overall R for the entire outbreak was 1.11. We found evidence of an increase in the estimated transmission rates in health zones with recently reported violent events versus those without (p = 0.008). The average R was estimated as between 0.61 and 0.86 in regions not affected by recent violent events, and between 1.01 and 1.07 in zones affected by violent events within the last 21 days, leading to an increase in R between 0.17 and 0.53. Within zones with recent violent events, the mean estimated quenching rate was lower than for all past outbreaks except the 2013-2016 West African outbreak. CONCLUSION The difference in the estimated transmission rates between zones affected by recent violent events suggests that violent events are contributing to increased transmission and the ongoing nature of this outbreak.
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Affiliation(s)
- S Rae Wannier
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lee Worden
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA
| | - Nicole A Hoff
- Department of Epidemiology, School of Public Health University of California, Los Angeles, CA, USA
| | - Eduardo Amezcua
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Bernice Selo
- Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Cyrus Sinai
- Department of Geography at University of North Carolina, Chapel Hill, NC, USA
| | | | - Bathe Njoloko
- Ministry of Health, Kinshasa, Democratic Republic of Congo
| | | | | | - Steve Ahuka-Mundeke
- Insitut National de Recherche Biomedicale, Kinshasa, Democratic Republic of Congo
| | | | | | - George W Rutherford
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA
| | - James H Jones
- Department of Earth System Science, Stanford University, Stanford, CA, USA; Woods Institute for the Environment, Stanford University, Stanford, CA, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anne W Rimoin
- Department of Epidemiology, School of Public Health University of California, Los Angeles, CA, USA
| | - Travis C Porco
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - J Daniel Kelly
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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