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Migamba SM, Ardiet DL, Migisha R, Nansikombi HT, Agaba B, Naiga HN, Wanyana M, Zalwango JF, Atuhaire I, Kawungezi PC, Zalwango MG, Simbwa B, Kadobera D, Ario AR, Harris JR. Individual and household risk factors for Ebola disease among household contacts in Mubende and Kassanda districts, Uganda, 2022. BMC Infect Dis 2024; 24:543. [PMID: 38816800 PMCID: PMC11138048 DOI: 10.1186/s12879-024-09439-1] [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: 02/23/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND In 2022, an Ebola disease outbreak caused by Sudan virus (SUDV) occurred in Uganda, primarily affecting Mubende and Kassanda districts. We determined risk factors for SUDV infection among household members (HHM) of cases. METHODS We conducted a case-control and retrospective cohort study in January 2023. Cases were RT-PCR-confirmed SUDV infection in residents of Mubende or Kassanda districts during the outbreak. Case-households housed a symptomatic, primary case-patient for ≥ 24 h and had ≥ 1 secondary case-patient with onset < 2 weeks after their last exposure to the primary case-patient. Control households housed a case-patient and other HHM but no secondary cases. A risk factor questionnaire was administered to the primary case-patient or another adult who lived at home while the primary case-patient was ill. We conducted a retrospective cohort study among case-household members and categorized their interactions with primary case-patients during their illnesses as none, minimal, indirect, and direct contact. We conducted logistic regression to explore associations between exposures and case-household status, and Poisson regression to identify risk factors for SUDV infection among HHM. RESULTS Case- and control-households had similar median sizes. Among 19 case-households and 51 control households, primary case-patient death (adjusted odds ratio [ORadj] = 7.6, 95% CI 1.4-41) and ≥ 2 household bedrooms (ORadj=0.19, 95% CI 0.056-0.71) were associated with case-household status. In the cohort of 76 case-HHM, 44 (58%) were tested for SUDV < 2 weeks from their last contact with the primary case-patient; 29 (38%) were positive. Being aged ≥ 18 years (adjusted risk ratio [aRRadj] = 1.9, 95%CI: 1.01-3.7) and having direct or indirect contact with the primary case-patient (aRRadj=3.2, 95%CI: 1.1-9.7) compared to minimal or no contact increased risk of Sudan virus disease (SVD). Access to a handwashing facility decreased risk (aRRadj=0.52, 95%CI: 0.31-0.88). CONCLUSION Direct contact, particularly providing nursing care for and sharing sleeping space with SVD patients, increased infection risk among HHM. Risk assessments during contact tracing may provide evidence to justify closer monitoring of some HHM. Health messaging should highlight the risk of sharing sleeping spaces and providing nursing care for persons with Ebola disease symptoms and emphasize hand hygiene to aid early case identification and reduce transmission.
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Affiliation(s)
- Stella M Migamba
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda.
| | - Denis-Luc Ardiet
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Richard Migisha
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Hildah T Nansikombi
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Brian Agaba
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Helen Nelly Naiga
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Mercy Wanyana
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Jane Frances Zalwango
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Immaculate Atuhaire
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Peter Chris Kawungezi
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Marie Goretti Zalwango
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Brenda Simbwa
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Alex R Ario
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Julie R Harris
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
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Komakech A, Whitmer S, Izudi J, Kizito C, Ninsiima M, Ahirirwe SR, Kabami Z, Ario AR, Kadobera D, Kwesiga B, Gidudu S, Migisha R, Makumbi I, Eurien D, Kayiwa J, Bulage L, Gonahasa DN, Kyamwine I, Okello PE, Nansikombi HT, Atuhaire I, Asio A, Elayeete S, Nsubuga EJ, Masanja V, Migamba SM, Mwine P, Nakamya P, Nampeera R, Kwiringira A, Akunzirwe R, Naiga HN, Namubiru SK, Agaba B, Zalwango JF, Zalwango MG, King P, Simbwa BN, Zavuga R, Wanyana MW, Kiggundu T, Oonyu L, Ndyabakira A, Komugisha M, Kibwika B, Ssemanda I, Nuwamanya Y, Kamukama A, Aanyu D, Kizza D, Ayen DO, Mulei S, Balinandi S, Nyakarahuka L, Baluku J, Kyondo J, Tumusiime A, Aliddeki D, Masiira B, Muwanguzi E, Kimuli I, Bulwadda D, Isabirye H, Aujo D, Kasambula A, Okware S, Ochien E, Komakech I, Okot C, Choi M, Cossaboom CM, Eggers C, Klena JD, Osinubi MO, Sadigh KS, Worrell MC, Boore AL, Shoemaker T, Montgomery JM, Nabadda SN, Mwanga M, Muruta AN, Harris JR. Sudan virus disease super-spreading, Uganda, 2022. BMC Infect Dis 2024; 24:520. [PMID: 38783244 PMCID: PMC11112911 DOI: 10.1186/s12879-024-09391-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND On 20 September 2022, Uganda declared its fifth Sudan virus disease (SVD) outbreak, culminating in 142 confirmed and 22 probable cases. The reproductive rate (R) of this outbreak was 1.25. We described persons who were exposed to the virus, became infected, and they led to the infection of an unusually high number of cases during the outbreak. METHODS In this descriptive cross-sectional study, we defined a super-spreader person (SSP) as any person with real-time polymerase chain reaction (RT-PCR) confirmed SVD linked to the infection of ≥ 13 other persons (10-fold the outbreak R). We reviewed illness narratives for SSPs collected through interviews. Whole-genome sequencing was used to support epidemiologic linkages between cases. RESULTS Two SSPs (Patient A, a 33-year-old male, and Patient B, a 26-year-old male) were identified, and linked to the infection of one probable and 50 confirmed secondary cases. Both SSPs lived in the same parish and were likely infected by a single ill healthcare worker in early October while receiving healthcare. Both sought treatment at multiple health facilities, but neither was ever isolated at an Ebola Treatment Unit (ETU). In total, 18 secondary cases (17 confirmed, one probable), including three deaths (17%), were linked to Patient A; 33 secondary cases (all confirmed), including 14 (42%) deaths, were linked to Patient B. Secondary cases linked to Patient A included family members, neighbours, and contacts at health facilities, including healthcare workers. Those linked to Patient B included healthcare workers, friends, and family members who interacted with him throughout his illness, prayed over him while he was nearing death, or exhumed his body. Intensive community engagement and awareness-building were initiated based on narratives collected about patients A and B; 49 (96%) of the secondary cases were isolated in an ETU, a median of three days after onset. Only nine tertiary cases were linked to the 51 secondary cases. Sequencing suggested plausible direct transmission from the SSPs to 37 of 39 secondary cases with sequence data. CONCLUSION Extended time in the community while ill, social interactions, cross-district travel for treatment, and religious practices contributed to SVD super-spreading. Intensive community engagement and awareness may have reduced the number of tertiary infections. Intensive follow-up of contacts of case-patients may help reduce the impact of super-spreading events.
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Affiliation(s)
- Allan Komakech
- Uganda National Institute of Public Health, Kampala, Uganda.
- Clarke International University, Kampala, Uganda.
| | - Shannon Whitmer
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jonathan Izudi
- Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
- Data Science and Evaluations Unit, African Population and Health Research Center, Nairobi, Kenya
| | | | | | | | - Zainah Kabami
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Alex R Ario
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Benon Kwesiga
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Samuel Gidudu
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Issa Makumbi
- National Public Health Emergency Operations Center, Kampala, Uganda
| | | | - Joshua Kayiwa
- National Public Health Emergency Operations Center, Kampala, Uganda
| | - Lilian Bulage
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Irene Kyamwine
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Paul E Okello
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | - Alice Asio
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Sarah Elayeete
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | | | - Patience Mwine
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Rose Nampeera
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | | | | | - Brian Agaba
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | - Patrick King
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Robert Zavuga
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | - Lawrence Oonyu
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | - Brian Kibwika
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | | | - Adams Kamukama
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Dorothy Aanyu
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Dominic Kizza
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Sophia Mulei
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Luke Nyakarahuka
- Uganda Virus Research Institute, Entebbe, Uganda
- Department of Biosecurity, Ecosystems, and Veterinary Public Health, Makerere University, Kampala, Uganda
| | - Jimmy Baluku
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Dativa Aliddeki
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Ben Masiira
- , African Field Epidemiology Network, Kampala, Uganda
| | | | - Ivan Kimuli
- World Health Organization, Geneva, Switzerland
| | | | | | | | | | | | | | | | | | - Mary Choi
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Carrie Eggers
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John D Klena
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Modupe O Osinubi
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Katrin S Sadigh
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary C Worrell
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy L Boore
- United States Centers for Disease Control and Prevention, Kampala, Uganda
| | - Trevor Shoemaker
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joel M Montgomery
- United States Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Susan N Nabadda
- National Health Laboratory and Diagnostic Services, Kampala, Uganda
| | | | | | - Julie R Harris
- United States Centers for Disease Control and Prevention, Kampala, Uganda
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Prasad AN, Agans KN, Geisbert JB, Borisevich V, Deer DJ, Dobias NS, Comer JE, Woolsey C, Fenton KA, Geisbert TW, Cross RW. Natural History of Nonhuman Primates After Oral Exposure to Ebola Virus Variant Makona. J Infect Dis 2023; 228:S571-S581. [PMID: 37348509 PMCID: PMC10651204 DOI: 10.1093/infdis/jiad225] [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: 04/14/2023] [Revised: 06/03/2023] [Accepted: 06/21/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND The primary route of infection by Ebola virus (EBOV) is through contact of mucosal surfaces. Few studies have explored infection of nonhuman primates (NHPs) via the oral mucosa, which is a probable portal of natural infection in humans. METHODS To further characterize the pathogenesis of EBOV infection via the oral exposure route, we challenged cohorts of cynomolgus monkeys with low doses of EBOV variant Makona. RESULTS Infection with 100 or 50 PFU of EBOV Makona via the oral route resulted in 50% and 83% lethality, respectively. Animals that progressed to fatal disease exhibited lymphopenia, marked coagulopathy, high viral loads, and increased levels of serum markers of inflammation and hepatic/renal injury. Survival in these cohorts was associated with milder fluctuations in leukocyte populations, lack of coagulopathy, and reduced or absent serum markers of inflammation and/or hepatic/renal function. Surprisingly, 2 surviving animals from the 100- and 50-PFU cohorts developed transient low-level viremia in the absence of other clinical signs of disease. Conversely, all animals in the 10 PFU cohort remained disease free and survived to the study end point. CONCLUSIONS Our observations highlight the susceptibility of NHPs, and by extension, likely humans, to relatively low doses of EBOV via the oral route.
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Affiliation(s)
- Abhishek N Prasad
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Krystle N Agans
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Joan B Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Viktoriya Borisevich
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Daniel J Deer
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Natalie S Dobias
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jason E Comer
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Courtney Woolsey
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Karla A Fenton
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Thomas W Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Robert W Cross
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
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Prasad AN, Fenton KA, Agans KN, Borisevich V, Woolsey C, Comer JE, Dobias NS, Peel JE, Deer DJ, Geisbert JB, Lawrence WS, Cross RW, Geisbert TW. Pathogenesis of Aerosolized Ebola Virus Variant Makona in Nonhuman Primates. J Infect Dis 2023; 228:S604-S616. [PMID: 37145930 PMCID: PMC10651212 DOI: 10.1093/infdis/jiad137] [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: 03/03/2023] [Revised: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Highly pathogenic filoviruses such as Ebola virus (EBOV) hold capacity for delivery by artificial aerosols, and thus potential for intentional misuse. Previous studies have shown that high doses of EBOV delivered by small-particle aerosol cause uniform lethality in nonhuman primates (NHPs), whereas only a few small studies have assessed lower doses in NHPs. METHODS To further characterize the pathogenesis of EBOV infection via small-particle aerosol, we challenged cohorts of cynomolgus monkeys with low doses of EBOV variant Makona, which may help define risks associated with small particle aerosol exposures. RESULTS Despite using challenge doses orders of magnitude lower than previous studies, infection via this route was uniformly lethal across all cohorts. Time to death was delayed in a dose-dependent manner between aerosol-challenged cohorts, as well as in comparison to animals challenged via the intramuscular route. Here, we describe the observed clinical and pathological details including serum biomarkers, viral burden, and histopathological changes leading to death. CONCLUSIONS Our observations in this model highlight the striking susceptibility of NHPs, and likely humans, via small-particle aerosol exposure to EBOV and emphasize the need for further development of diagnostics and postexposure prophylactics in the event of intentional release via deployment of an aerosol-producing device.
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Affiliation(s)
- Abhishek N Prasad
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Karla A Fenton
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Krystle N Agans
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Viktoriya Borisevich
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Courtney Woolsey
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jason E Comer
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Natalie S Dobias
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jennifer E Peel
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Daniel J Deer
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Joan B Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - William S Lawrence
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Robert W Cross
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
| | - Thomas W Geisbert
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, Texas, USA
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Marziano V, Guzzetta G, Longini I, Merler S. Estimates of Serial Interval and Reproduction Number of Sudan Virus, Uganda, August-November 2022. Emerg Infect Dis 2023; 29:1429-1432. [PMID: 37347815 PMCID: PMC10310358 DOI: 10.3201/eid2907.221718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
We estimated the mean serial interval for Sudan virus in Uganda to be 11.7 days (95 CI% 8.2-15.8 days). Estimates for the 2022 outbreak indicate a mean basic reproduction number of 2.4-2.7 (95% CI 1.7-3.5). Estimated net reproduction numbers across districts suggest a marked spatial heterogeneity.
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Schaber KL, Kumar S, Lubwama B, Desai A, Majumder MS. An Epidemic Model for Multi-Intervention Outbreaks. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.27.23291973. [PMID: 37425878 PMCID: PMC10327283 DOI: 10.1101/2023.06.27.23291973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Modeling is an important tool to utilize at the beginning of an infectious disease outbreak, as it allows estimation of parameters - such as the basic reproduction number, R 0 -that can be used to postulate how the outbreak may continue to spread. However, there exist many challenges that need to be accounted for, such as an unknown first case date, retrospective reporting of 'probable' cases, changing dynamics between case count and death count trends, and the implementation of multiple control efforts and their delayed or diminished effects. Using the near-daily data provided from the recent outbreak of Sudan ebolavirus in Uganda as a case study, we create a model and present a framework aimed at overcoming these aforementioned challenges. The impact of each challenge is examined by comparing model estimates and fits throughout our framework. Indeed, we found that allowing for multiple fatality rates over the course of an outbreak generally resulted in better fitting models. On the other hand, not knowing the start date of an outbreak appeared to have large and non-uniform effects on parameter estimates, particularly at the beginning stages of an outbreak. While models that did not account for the decaying effect of interventions on transmission underestimated R 0 , all decay models run on the full dataset yielded precise R 0 estimates, demonstrating the robustness of R 0 as a measure of disease spread when examining data from the entire outbreak.
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Affiliation(s)
- Kathryn L. Schaber
- Boston Children’s Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | | | - Baker Lubwama
- School of Clinical Medicine, University of Cambridge, Cambridge, GB
| | - Angel Desai
- Department of Internal Medicine, Division of Infectious Diseases, University of California-Davis Health Medical Center, Sacramento, CA, US
| | - Maimuna S. Majumder
- Boston Children’s Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
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Stephens PR, Sundaram M, Ferreira S, Gottdenker N, Nipa KF, Schatz AM, Schmidt JP, Drake JM. Drivers of African Filovirus (Ebola and Marburg) Outbreaks. Vector Borne Zoonotic Dis 2022; 22:478-490. [PMID: 36084314 PMCID: PMC9508452 DOI: 10.1089/vbz.2022.0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Outbreaks of African filoviruses often have high mortality, including more than 11,000 deaths among 28,562 cases during the West Africa Ebola outbreak of 2014-2016. Numerous studies have investigated the factors that contributed to individual filovirus outbreaks, but there has been little quantitative synthesis of this work. In addition, the ways in which the typical causes of filovirus outbreaks differ from other zoonoses remain poorly described. In this study, we quantify factors associated with 45 outbreaks of African filoviruses (ebolaviruses and Marburg virus) using a rubric of 48 candidate causal drivers. For filovirus outbreaks, we reviewed >700 peer-reviewed and gray literature sources and developed a list of the factors reported to contribute to each outbreak (i.e., a "driver profile" for each outbreak). We compare and contrast the profiles of filovirus outbreaks to 200 background outbreaks, randomly selected from a global database of 4463 outbreaks of bacterial and viral zoonotic diseases. We also test whether the quantitative patterns that we observed were robust to the influences of six covariates, country-level factors such as gross domestic product, population density, and latitude that have been shown to bias global outbreak data. We find that, regardless of whether covariates are included or excluded from models, the driver profile of filovirus outbreaks differs from that of background outbreaks. Socioeconomic factors such as trade and travel, wild game consumption, failures of medical procedures, and deficiencies in human health infrastructure were more frequently reported in filovirus outbreaks than in the comparison group. Based on our results, we also present a review of drivers reported in at least 10% of filovirus outbreaks, with examples of each provided.
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Affiliation(s)
- Patrick R. Stephens
- Department of Integrative Biology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Mekala Sundaram
- Department of Integrative Biology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Susana Ferreira
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Department of Agricultural and Applied Economics, University of Georgia, Athens, Georgia, USA
| | - Nicole Gottdenker
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Department of Agricultural and Applied Economics, University of Georgia, Athens, Georgia, USA
- Department of Pathology, College of Veterinary Medicine, University of Georgia, Athens, Georgia, USA
- Odum School of Ecology, University of Georgia, Athens, Georgia, USA
| | - Kaniz Fatema Nipa
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Odum School of Ecology, University of Georgia, Athens, Georgia, USA
| | - Annakate M. Schatz
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Odum School of Ecology, University of Georgia, Athens, Georgia, USA
| | - John Paul Schmidt
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Odum School of Ecology, University of Georgia, Athens, Georgia, USA
| | - John M. Drake
- Center for the Ecology of Infectious Diseases, University of Georgia, Athens, Georgia, USA
- Odum School of Ecology, University of Georgia, Athens, Georgia, USA
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RNA Viruses, Pregnancy and Vaccination: Emerging Lessons from COVID-19 and Ebola Virus Disease. Pathogens 2022; 11:pathogens11070800. [PMID: 35890044 PMCID: PMC9322689 DOI: 10.3390/pathogens11070800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/10/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023] Open
Abstract
Pathogenic viruses with an RNA genome represent a challenge for global human health since they have the tremendous potential to develop into devastating pandemics/epidemics. The management of the recent COVID-19 pandemic was possible to a certain extent only because of the strong foundations laid by the research on previous viral outbreaks, especially Ebola Virus Disease (EVD). A clear understanding of the mechanisms of the host immune response generated upon viral infections is a prime requisite for the development of new therapeutic strategies. Hence, we present here a comparative study of alterations in immune response upon SARS-CoV-2 and Ebola virus infections that illustrate many common features. Vaccination and pregnancy are two important aspects that need to be studied from an immunological perspective. So, we summarize the outcomes and immune responses in vaccinated and pregnant individuals in the context of COVID-19 and EVD. Considering the significance of immunomodulatory approaches in combating both these diseases, we have also presented the state of the art of such therapeutics and prophylactics. Currently, several vaccines against these viruses have been approved or are under clinical trials in various parts of the world. Therefore, we also recapitulate the latest developments in these which would inspire researchers to look for possibilities of developing vaccines against many other RNA viruses. We hope that the similar aspects in COVID-19 and EVD open up new avenues for the development of pan-viral therapies.
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Khan SA, Imtiaz MA, Islam MM, Tanzin AZ, Islam A, Hassan MM. Major bat-borne zoonotic viral epidemics in Asia and Africa: A systematic review and meta-analysis. Vet Med Sci 2022; 8:1787-1801. [PMID: 35537080 PMCID: PMC9297750 DOI: 10.1002/vms3.835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Bats are the natural reservoir host for many pathogenic and non‐pathogenic viruses, potentially spilling over to humans and domestic animals directly or via an intermediate host. The ongoing COVID‐19 pandemic is the continuation of virus spillover events that have taken place over the last few decades, particularly in Asia and Africa. Therefore, these bat‐associated epidemics provide a significant number of hints, including respiratory cellular tropism, more intense susceptibility to these cell types, and overall likely to become a pandemic for the next spillover. In this systematic review, we analysed data to insight, through bat‐originated spillover in Asia and Africa. We used STATA/IC‐13 software for descriptive statistics and meta‐analysis. The random effect of meta‐analysis showed that the pooled estimates of case fatality rates of bat‐originated viral zoonotic diseases were higher in Africa (61.06%, 95%CI: 50.26 to 71.85, l2% = 97.3, p < 0.001). Moreover, estimates of case fatality rates were higher in Ebola (61.06%; 95%CI: 50.26 to 71.85, l2% = 97.3, p < 0.001) followed by Nipah (55.19%; 95%CI: 39.29 to 71.09, l2% = 94.2, p < 0.001), MERS (18.49%; 95%CI: 8.19 to 28.76, l2% = 95.4, p < 0.001) and SARS (10.86%; 95%CI: 6.02 to 15.71, l2% = 85.7, p < 0.001) with the overall case fatality rates of 29.86 (95%CI: 29.97 to 48.58, l2% = 99.0, p < 0.001). Bat‐originated viruses have caused several outbreaks of deadly diseases, including Nipah, Ebola, SARS and MERS in Asia and Africa in a sequential fashion. Nipah virus emerged first in Malaysia, but later, periodic outbreaks were noticed in Bangladesh and India. Similarly, the Ebola virus was detected in the African continent with neurological disorders in humans, like Nipah, seen in the Asian region. Two important coronaviruses, MERS and SARS, were introduced, both with the potential to infect respiratory passages. This paper explores the dimension of spillover events within and/or between bat–human and the epidemiological risk factors, which may lead to another pandemic occurring. Further, these processes enhance the bat‐originated virus, which utilises an intermediate host to jump into human species.
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Affiliation(s)
- Shahneaz Ali Khan
- Department of Physiology, Biochemistry and Pharmacology, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram, Bangladesh
| | - Mohammed Ashif Imtiaz
- Department of Physiology, Biochemistry and Pharmacology, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram, Bangladesh
| | - Md Mazharul Islam
- Department of Animal Resources, Ministry of Municipality, Doha, Qatar
| | - Abu Zubayer Tanzin
- Department of Physiology, Biochemistry and Pharmacology, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram, Bangladesh
| | - Ariful Islam
- EcoHealth Alliance, New York, New York.,Centre for Integrative Ecology, Deakin University, Geelong Campus, Victoria, Australia
| | - Mohammad Mahmudul Hassan
- Department of Physiology, Biochemistry and Pharmacology, Faculty of Veterinary Medicine, Chattogram Veterinary and Animal Sciences University, Khulshi, Chattogram, Bangladesh.,Queensland Alliance for One Health Sciences, School of Veterinary Science, The University of Queensland, Queensland, Australia
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10
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Duffy N, Bruden D, Thomas H, Nichols E, Knust B, Hennessy T, Reichler MR. Risk factors for Ebola virus disease among household care providers, Sierra Leone, 2015. Int J Epidemiol 2022; 51:1457-1468. [PMID: 35441222 DOI: 10.1093/ije/dyac081] [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: 02/28/2021] [Accepted: 04/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Household contacts who provide care to an Ebola virus disease (EVD) case have a 3-fold higher risk of EVD compared with contacts who do not provide care. METHODS We enrolled persons with confirmed EVD from December 2014 to April 2015 in Freetown, Sierra Leone, and their household contacts. Index cases and contacts were interviewed, and contacts were followed for 21 days to identify secondary cases. Epidemiological data were analysed to describe household care and to identify risk factors for developing EVD. RESULTS Of 838 contacts in 147 households, 156 (17%) self-reported providing care to the index case; 56 households had no care provider, 52 a single care provider and 39 multiple care providers. The median care provider age was 29 years, 68% were female and 32% were the index case's spouse. Care providers were more likely to report physical contact, contact with body fluids or sharing clothing, bed linens or utensils with an index case, compared with non-care providers (P <0.01). EVD risk among non-care providers was greater when the number of care providers in the household increased (odds ratio: 1.61; 95% confidence interval: 1.1, 2.4). In multivariable analysis, factors associated with care provider EVD risk included no piped water access and absence of index case fever, and protective factors included age <20 years and avoiding the index case. CONCLUSIONS Limiting the number of care providers in a household could reduce the risk of EVD transmission to both care providers and non-care providers. Strategies to protect care providers from EVD exposure are needed.
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Affiliation(s)
- Nadezhda Duffy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dana Bruden
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Harold Thomas
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Erin Nichols
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - Barbara Knust
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Hennessy
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Mary R Reichler
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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11
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DAUTEL KIMBERLYA, AGYINGI EPHRAIMO. MODELING THE IMPACT OF EDUCATIONAL CAMPAIGN ON THE TRANSMISSION DYNAMICS OF EBOLA. J BIOL SYST 2021. [DOI: 10.1142/s0218339021500248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Disease awareness that informs the public about the severity and transmission pathways of infectious diseases such as Ebola is key to curtailing an outbreak. Public health education when available can limit the intensity and duration of an Ebola outbreak in any community if there is compliance. It is important that all population groups be informed about the methods in which Ebola is transmitted to control the disease when there is an outbreak. In this paper, we study the impact of public health education that leads to behavioral changes on the dynamics of Ebola spread. The model is formulated as a system of ordinary differential equations and incorporates direct transmission from infectious, hospitalized, and deceased individuals with Ebola. We establish the existence of a disease free equilibrium and an endemic equilibrium, and investigate them for local and global stability. Model predictions show that a more informed community results in fewer cases, and thus limits the impact of an Ebola outbreak. Further, the model also predicts subsequent outbreak waves within a community in the absence of complete eradication. Lastly, the model successfully captures the dynamics of the 2014–2016 West Africa Ebola outbreak and the 2018–2020 Democratic Republic of Congo Ebola outbreak.
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Affiliation(s)
- KIMBERLY A. DAUTEL
- School of Mathematical Sciences, Rochester Institute of Technology, 85 Lomb Memorial Drive, Rochester, New York 14623, USA
| | - EPHRAIM O. AGYINGI
- School of Mathematical Sciences, Rochester Institute of Technology, 85 Lomb Memorial Drive, Rochester, New York 14623, USA
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12
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Kayem ND, Benson C, Aye CYL, Barker S, Tome M, Kennedy S, Ariana P, Horby P. Ebola virus disease in pregnancy: a systematic review and meta-analysis. Trans R Soc Trop Med Hyg 2021; 116:509-522. [PMID: 34865173 PMCID: PMC9157681 DOI: 10.1093/trstmh/trab180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/25/2021] [Accepted: 11/09/2021] [Indexed: 11/24/2022] Open
Abstract
This review synthesises and appraises evidence on the effects of Ebola virus disease (EVD) in pregnancy. We searched bibliographic databases from dates of inception to November 2020, yielding 28 included studies. The absolute risk of maternal death associated with EVD was estimated at 67.8% (95% confidence interval [CI] 49.8 to 83.7, I2=85%, p<0.01) and the relative risk of death in pregnant women compared with non-pregnant women was estimated at 1.18 (95% CI 0.59 to 2.35, I2=31.0%, p=0.230). The absolute risk for foetal losses was estimated at 76.9% (95% CI 45.0 to 98.3, I2=96%, p<0.01) and neonatal death was 98.5% (95% CI 84.9 to 100, I2=0.0%, p=0.40). The gap analysis suggests limited or no data on the clinical course, non-fatal perinatal outcomes and EVD management in pregnant women. The review suggests that EVD has a high maternal and perinatal mortality, underscoring the urgent need for preventative and therapeutic solutions and improved screening and follow-up of pregnant women and newborns during outbreaks. There is not enough evidence to conclusively rule out pregnancy as a risk factor for mortality and there is limited evidence on the disease course, outcomes and management of EVD in pregnancy, and this supports the need for robust clinical trials and prospective studies that include pregnant women.
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Affiliation(s)
- Nzelle D Kayem
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Charlotte Benson
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Christina Y L Aye
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK.,Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Sarah Barker
- Women's Centre, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, UK
| | - Mariana Tome
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Stephen Kennedy
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford OX3 9DU, UK
| | - Proochista Ariana
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Peter Horby
- Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
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13
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Pomara C, Sessa F, Galante D, Pace L, Fasanella A, Di Nunno N, Esposito M, Salerno M. Do We Really Need Hazard Prevention at the Expense of Safeguarding Death Dignity in COVID-19? Diagnostics (Basel) 2021; 11:1913. [PMID: 34679611 PMCID: PMC8534407 DOI: 10.3390/diagnostics11101913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/23/2022] Open
Abstract
To date, little is known regarding the transmission risks of SARS-CoV-2 infection for subjects involved in handling, transporting, and examining deceased persons with known or suspected COVID-19 positivity at the time of death. This experimental study aims to define if and/or how long SARS-CoV-2 persists with replication capacity in the tissues of individuals who died with/from COVID-19, thereby generating infectious hazards. Sixteen patients who died with/from COVID-19 who underwent autopsy between April 2020 and April 2021 were included in this study. Based on PMI, all samples were subdivided into two groups: 'short PMI' group (eight subjects who were autopsied between 12 to 72 h after death); 'long PMI' (eight subjects who were autopsied between 24 to 78 days after death). All patients tested positive for RT-PCR at nasopharyngeal swab both before death and on samples collected during post-mortem investigation. Moreover, a lung specimen was collected and frozen at -80 °C in order to perform viral culture. The result was defined based on the cytopathic effect (subjective reading) combined with the positivity of the RT-PCR test (objective reading) in the supernatant. Only in one sample (PMI 12 h), virus vitality was demonstrated. This study, supported by a literature review, suggests that the risk of cadaveric infection in cases of a person who died from/with COVID-19 is extremely low in the first hours after death, becoming null after 12 h after death, confirming the World Health Organization (WHO) assumed in March 2020 and suggesting that the corpse of a subject who died from/with COVID-19 should be generally considered not infectious.
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Affiliation(s)
- Cristoforo Pomara
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Domenico Galante
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, 71121 Foggia, Italy; (D.G.); (L.P.); (A.F.)
| | - Lorenzo Pace
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, 71121 Foggia, Italy; (D.G.); (L.P.); (A.F.)
| | - Antonio Fasanella
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, 71121 Foggia, Italy; (D.G.); (L.P.); (A.F.)
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
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14
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de St Maurice A, Ervin E, Chu A. Ebola, Dengue, Chikungunya, and Zika Infections in Neonates and Infants. Clin Perinatol 2021; 48:311-329. [PMID: 34030816 DOI: 10.1016/j.clp.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Emerging infectious diseases, including Ebola, chikungunya, Zika, and dengue, may have significant impacts on maternal-fetal dyads and neonatal outcomes. Pregnant women infected with Ebola demonstrate high mortality and very low evidence of neonatal survival. Maternal chikungunya infection can result in high rates of perinatal transmission, and infected neonates demonstrate variable disease severity. Dengue can be transmitted to neonates via vertical transmission or perinatal transmission. Zika is characterized by mild disease in pregnant women, but congenital infection can be severe. Treatment largely is supportive for these diseases, and vaccine development remains under way, with promising recent advances, notably for Ebola.
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Affiliation(s)
- Annabelle de St Maurice
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Los Angeles, 924 Westwood Boulevard, Suite 900, CA 90095, USA.
| | - Elizabeth Ervin
- Post-baccalaureate Premedical Program, University of Michigan, Office of Graduate and Postdoctoral Studies, 2960 Taubman Health Science Library, 1135 Catherine Street, Ann Arbor, MI 48109, USA
| | - Alison Chu
- Division of Neonatology and Developmental Biology, Department of Pediatrics, 10833 Le Conte Avenue, MDCC B2-411, Los Angeles, CA 90095, USA
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15
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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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16
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Medina‐Rivera M, Centeno‐Tablante E, Finkelstein JL, Rayco‐Solon P, Peña‐Rosas JP, Garcia‐Casal MN, Rogers L, Ridwan P, Martinez SS, Andrade J, Layden AJ, Chang J, Zambrano MP, Ghezzi‐Kopel K, Mehta S. Presence of Ebola virus in breast milk and risk of mother-to-child transmission: synthesis of evidence. Ann N Y Acad Sci 2021; 1488:33-43. [PMID: 33113592 PMCID: PMC8048832 DOI: 10.1111/nyas.14519] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/16/2020] [Accepted: 10/08/2020] [Indexed: 12/28/2022]
Abstract
To help inform global guidelines on infant feeding, this systematic review synthesizes evidence related to the presence of the Ebola virus (EBOV) in breast milk and its potential risk of viral transmission to the infant when breastfeeding. We relied on a comprehensive search strategy to identify studies including women with suspected, probable, or confirmed EBOV infection, intending to breastfeed or give breast milk to an infant. Our search identified 10,454 records, and after deduplication and screening, we assessed 148 full texts. We included eight studies reporting on 10 breastfeeding mothers and their children (one mother with twins), who provided breast milk samples for assessment. EBOV was detected via RT-PCR or viral culture in seven out of ten breast milk samples. Four out of the five-breastfed infants with EBOV-positive breast milk were found positive for EBOV infection, and all of these EBOV-positive infants died. Since previous reports have detected EBOV in tears, saliva, sweat, and contaminated surfaces, with the current evidence, it is not possible to conclude with certainty that breast milk was the main route of EBOV transmission.
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Affiliation(s)
| | | | | | - Pura Rayco‐Solon
- Department of Maternal, Newborn, Child and Adolescent Health and AgeingWorld Health OrganizationGenevaSwitzerland
| | | | | | - Lisa Rogers
- Department of Nutrition and Food SafetyWorld Health OrganizationGenevaSwitzerland
| | - Pratiwi Ridwan
- Division of Nutritional SciencesCornell UniversityIthacaNew York
| | - Sabrina Sales Martinez
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health and Social WorkFlorida International UniversityMiamiFlorida
| | - Joyce Andrade
- Hospital de Niños Roberto Gilbert ElizaldeGuayaquilEcuador
| | | | - Juan Chang
- Hospital de Niños Roberto Gilbert ElizaldeGuayaquilEcuador
| | | | | | - Saurabh Mehta
- Division of Nutritional SciencesCornell UniversityIthacaNew York
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17
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Jalloh MF, Nur AA, Nur SA, Winters M, Bedson J, Pedi D, Prybylski D, Namageyo-Funa A, Hageman KM, Baker BJ, Jalloh MB, Eng E, Nordenstedt H, Hakim AJ. Behaviour adoption approaches during public health emergencies: implications for the COVID-19 pandemic and beyond. BMJ Glob Health 2021; 6:e004450. [PMID: 33514594 PMCID: PMC7849902 DOI: 10.1136/bmjgh-2020-004450] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/29/2022] Open
Abstract
Human behaviour will continue to play an important role as the world grapples with public health threats. In this paper, we draw from the emerging evidence on behaviour adoption during diverse public health emergencies to develop a framework that contextualises behaviour adoption vis-à-vis a combination of top-down, intermediary and bottom-up approaches. Using the COVID-19 pandemic as a case study, we operationalise the contextual framework to demonstrate how these three approaches differ in terms of their implementation, underlying drivers of action, enforcement, reach and uptake. We illustrate how blended strategies that include all three approaches can help accelerate and sustain protective behaviours that will remain important even when safe and effective vaccines become more widely available. As the world grapples with the COVID-19 pandemic and prepares to respond to (re)emerging public health threats, our contextual framework can inform the design, implementation, tracking and evaluation of comprehensive public health and social measures during health emergencies.
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Affiliation(s)
- Mohamed F Jalloh
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aasli A Nur
- Department of Sociology, University of Washington, Seattle, Washington, USA
| | - Sophia A Nur
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maike Winters
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jamie Bedson
- Independent Consultant, Seattle, Washington, USA
| | - Danielle Pedi
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Dimitri Prybylski
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Apophia Namageyo-Funa
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathy M Hageman
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brian J Baker
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Eugenia Eng
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Avi J Hakim
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
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18
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Reichler MR, Bruden D, Thomas H, Erickson BR, Knust B, Duffy N, Klena J, Hennessy T. Ebola Patient Virus Cycle Threshold and Risk of Household Transmission of Ebola Virus. J Infect Dis 2020; 221:707-714. [PMID: 31858125 DOI: 10.1093/infdis/jiz511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 10/23/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Identifying risk factors for household transmission of Ebola virus (EBOV) is important to guide preventive measures during Ebola outbreaks. METHODS We enrolled all confirmed persons with EBOV disease who were the first case patient in a household from December 2014 to April 2015 in Freetown, Sierra Leone, and their household contacts. Index patients and contacts were interviewed, and contacts were followed up for 21 days to identify secondary cases. Epidemiologic data were linked to EBOV real-time reverse-transcription polymerase chain reaction cycle threshold (Ct) data from initial diagnostic specimens obtained from enrolled index case patients. RESULTS Ct data were available for 106 (71%) of 150 enrolled index patients. Of the Ct results, 85 (80%) were from blood specimens from live patients and 21 (20%) from oral swab specimens from deceased patients. The median Ct values for blood and swab specimens were 21.0 and 24.0, respectively (P = .007). In multivariable analysis, a Ct value from blood specimens in the lowest quintile was an independent predictor of both increased risk of household transmission (P = .009) and higher secondary attack rate among household contacts (P = .03), after adjustment for epidemiologic factors. CONCLUSIONS Our findings suggest the potential to use Ct values from acute EBOV diagnostic specimens for index patients as an early predictor of high-risk households and high-risk groups of contacts to help prioritize EBOV disease investigation and control efforts.
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Affiliation(s)
- Mary R Reichler
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dana Bruden
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
| | - Harold Thomas
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Bobbie Rae Erickson
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases , Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Barbara Knust
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases , Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Nadia Duffy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John Klena
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases , Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Thomas Hennessy
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic diseases, Centers for Disease Control and Prevention, Anchorage, Alaska, USA
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19
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Foeller ME, Carvalho Ribeiro do Valle C, Foeller TM, Oladapo OT, Roos E, Thorson AE. Pregnancy and breastfeeding in the context of Ebola: a systematic review. THE LANCET. INFECTIOUS DISEASES 2020; 20:e149-e158. [PMID: 32595045 DOI: 10.1016/s1473-3099(20)30194-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/06/2020] [Accepted: 03/06/2020] [Indexed: 12/31/2022]
Abstract
The outbreaks of Ebola virus between 2014 and 2020 have drawn attention to knowledge gaps related to Ebola virus disease in pregnant women. The aim of this study was to systematically evaluate available data on pregnant and lactating women with acute Ebola virus disease or following recovery. We searched MEDLINE, Embase, Cochrane Library (CENTRAL), Web of Science Core Collection, CINAHL, POPLINE, Global Health, and WHO Global Index Medicus, in addition to grey literature, for relevant articles. Studies of all types and published between database inception and Aug 19, 2019, were eligible (PROSPERO 129335). We identified 1060 records, of which 52 studies met our inclusion criteria. Overall, mortality in 274 pregnant women with Ebola virus disease was 72% (197 women died); mortality for pregnant women with Ebola virus disease were not higher than those in the general population of patients with Ebola virus disease. Nearly all women with Ebola virus disease had adverse pregnancy outcomes. Among survivors, Ebola virus RNA was detected by RT-PCR in amniotic fluid up to 32 days after maternal clearance of Ebola virus from the blood and in breastmilk 26 days after symptom onset. A risk of transmission of Ebola virus from pregnancy-related fluids and breastmilk probably exists, and precautions should be taken.
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Affiliation(s)
- Megan E Foeller
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Obstetrics and Gynecology, Stanford University, Stanford, CA, USA; Obstetrics and Gynecology, Washington University in St Louis, St Louis, MO, USA
| | | | - Timothy M Foeller
- Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - Olufemi T Oladapo
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Elin Roos
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna E Thorson
- UNDP/UN Population Fund/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HPR), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
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20
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Ko Y, Lee SM, Kim S, Ki M, Jung E. Ebola virus disease outbreak in Korea: use of a mathematical model and stochastic simulation to estimate risk. Epidemiol Health 2019; 41:e2019048. [PMID: 31801320 PMCID: PMC7005456 DOI: 10.4178/epih.e2019048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 11/20/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES According to the World Health Organization, there have been frequent reports of Ebola virus disease (EVD) since the 2014 EVD pandemic in West Africa. We aim to estimate the outbreak scale when an EVD infected person arrives in Korea. METHODS Western Africa EVD epidemic mathematical model SEIJR or SEIJQR was modified to create a Korean EVD outbreak model. The expected number of EVD patients and outbreak duration were calculated by stochastic simulation under the scenarios of Best case, Diagnosis delay, and Case missing. RESULTS The 2,000 trials of stochastic simulation for each scenario demonstrated the following results: The possible median number of patients is 2 and the estimated maximum number is 11 when the government intervention is proceeded immediately right after the first EVD case is confirmed. With a 6-day delay in diagnosis of the first case, the median number of patients becomes 7, and the maximum, 20. If the first case is missed and the government intervention is not activated until 2 cases of secondary infection occur, the median number of patients is estimated at 15, and the maximum, at 35. CONCLUSIONS Timely and rigorous diagnosis is important to reduce the spreading scale of infection when a new communicable disease is inflowed into Korea. Moreover, it is imperative to strengthen the local surveillance system and diagnostic protocols to avoid missing cases of secondary infection.
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Affiliation(s)
- Youngsuk Ko
- Department of Mathematics, Konkuk University, Seoul, Korea
| | - Seok-Min Lee
- Department of Liberal Arts, Hongik University College of Engineering, Seoul, Korea
| | - Soyoung Kim
- Department of Mathematics, Konkuk University, Seoul, Korea
| | - Moran Ki
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Eunok Jung
- Department of Mathematics, Konkuk University, Seoul, Korea
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21
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Thompson RN, Stockwin JE, van Gaalen RD, Polonsky JA, Kamvar ZN, Demarsh PA, Dahlqwist E, Li S, Miguel E, Jombart T, Lessler J, Cauchemez S, Cori A. Improved inference of time-varying reproduction numbers during infectious disease outbreaks. Epidemics 2019; 29:100356. [PMID: 31624039 PMCID: PMC7105007 DOI: 10.1016/j.epidem.2019.100356] [Citation(s) in RCA: 244] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 02/07/2023] Open
Abstract
Accurate estimation of the parameters characterising infectious disease transmission is vital for optimising control interventions during epidemics. A valuable metric for assessing the current threat posed by an outbreak is the time-dependent reproduction number, i.e. the expected number of secondary cases caused by each infected individual. This quantity can be estimated using data on the numbers of observed new cases at successive times during an epidemic and the distribution of the serial interval (the time between symptomatic cases in a transmission chain). Some methods for estimating the reproduction number rely on pre-existing estimates of the serial interval distribution and assume that the entire outbreak is driven by local transmission. Here we show that accurate inference of current transmissibility, and the uncertainty associated with this estimate, requires: (i) up-to-date observations of the serial interval to be included, and; (ii) cases arising from local transmission to be distinguished from those imported from elsewhere. We demonstrate how pathogen transmissibility can be inferred appropriately using datasets from outbreaks of H1N1 influenza, Ebola virus disease and Middle-East Respiratory Syndrome. We present a tool for estimating the reproduction number in real-time during infectious disease outbreaks accurately, which is available as an R software package (EpiEstim 2.2). It is also accessible as an interactive, user-friendly online interface (EpiEstim App), permitting its use by non-specialists. Our tool is easy to apply for assessing the transmission potential, and hence informing control, during future outbreaks of a wide range of invading pathogens.
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Affiliation(s)
- R N Thompson
- Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, UK; Mathematical Institute, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; Christ Church, University of Oxford, St Aldates, Oxford OX1 1DP, UK.
| | - J E Stockwin
- Lady Margaret Hall, University of Oxford, Norham Gardens, Oxford OX2 6QA, UK
| | - R D van Gaalen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, the Netherlands
| | - J A Polonsky
- World Health Organization, Avenue Appia, Geneva 1202, Switzerland; Faculty of Medicine, University of Geneva, 1 Rue Michel-Servet, Geneva 1211, Switzerland
| | - Z N Kamvar
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, Faculty of Medicine, London W2 1PG, UK
| | - P A Demarsh
- The Surveillance Lab, McGill University, 1140 Pine Avenue West, Montreal H3A 1A3, Canada; Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, 130 Colonnade Road, Ottawa, Ontario, K1A 0K9, Canada
| | - E Dahlqwist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - S Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - E Miguel
- MIVEGEC, IRD, University of Montpellier, CNRS, Montpellier, France
| | - T Jombart
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, Faculty of Medicine, London W2 1PG, UK; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - J Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - S Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, Paris 75015, France
| | - A Cori
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, Faculty of Medicine, London W2 1PG, UK
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22
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Thompson RN, Stockwin JE, van Gaalen RD, Polonsky JA, Kamvar ZN, Demarsh PA, Dahlqwist E, Li S, Miguel E, Jombart T, Lessler J, Cauchemez S, Cori A. Improved inference of time-varying reproduction numbers during infectious disease outbreaks. Epidemics 2019. [PMID: 31624039 DOI: 10.5281/zenodo.3685977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
Accurate estimation of the parameters characterising infectious disease transmission is vital for optimising control interventions during epidemics. A valuable metric for assessing the current threat posed by an outbreak is the time-dependent reproduction number, i.e. the expected number of secondary cases caused by each infected individual. This quantity can be estimated using data on the numbers of observed new cases at successive times during an epidemic and the distribution of the serial interval (the time between symptomatic cases in a transmission chain). Some methods for estimating the reproduction number rely on pre-existing estimates of the serial interval distribution and assume that the entire outbreak is driven by local transmission. Here we show that accurate inference of current transmissibility, and the uncertainty associated with this estimate, requires: (i) up-to-date observations of the serial interval to be included, and; (ii) cases arising from local transmission to be distinguished from those imported from elsewhere. We demonstrate how pathogen transmissibility can be inferred appropriately using datasets from outbreaks of H1N1 influenza, Ebola virus disease and Middle-East Respiratory Syndrome. We present a tool for estimating the reproduction number in real-time during infectious disease outbreaks accurately, which is available as an R software package (EpiEstim 2.2). It is also accessible as an interactive, user-friendly online interface (EpiEstim App), permitting its use by non-specialists. Our tool is easy to apply for assessing the transmission potential, and hence informing control, during future outbreaks of a wide range of invading pathogens.
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Affiliation(s)
- R N Thompson
- Department of Zoology, University of Oxford, South Parks Road, Oxford OX1 3PS, UK; Mathematical Institute, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK; Christ Church, University of Oxford, St Aldates, Oxford OX1 1DP, UK.
| | - J E Stockwin
- Lady Margaret Hall, University of Oxford, Norham Gardens, Oxford OX2 6QA, UK
| | - R D van Gaalen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, the Netherlands
| | - J A Polonsky
- World Health Organization, Avenue Appia, Geneva 1202, Switzerland; Faculty of Medicine, University of Geneva, 1 Rue Michel-Servet, Geneva 1211, Switzerland
| | - Z N Kamvar
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, Faculty of Medicine, London W2 1PG, UK
| | - P A Demarsh
- The Surveillance Lab, McGill University, 1140 Pine Avenue West, Montreal H3A 1A3, Canada; Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, 130 Colonnade Road, Ottawa, Ontario, K1A 0K9, Canada
| | - E Dahlqwist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - S Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - E Miguel
- MIVEGEC, IRD, University of Montpellier, CNRS, Montpellier, France
| | - T Jombart
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, Faculty of Medicine, London W2 1PG, UK; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - J Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - S Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, UMR2000, CNRS, Paris 75015, France
| | - A Cori
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, Faculty of Medicine, London W2 1PG, UK
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23
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Choi B, Busch S, Kazadi D, Ilunga B, Okitolonda E, Dai Y, Lumpkin R, Saucedo O, KhudaBukhsh WR, Tien J, Yotebieng M, Kenah E, Rempala GA. Modeling outbreak data: Analysis of a 2012 Ebola virus disease epidemic in DRC. BIOMATH (SOFIA, BULGARIA) 2019; 8:1910037. [PMID: 33192155 PMCID: PMC7665115 DOI: 10.11145/j.biomath.2019.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
We describe two approaches to modeling data from a small to moderate-sized epidemic outbreak. The first approach is based on a branching process approximation and direct analysis of the transmission network, whereas the second one is based on a survival model derived from the classical SIR equations with no explicit transmission information. We compare these approaches using data from a 2012 outbreak of Ebola virus disease caused by Bundibugyo ebolavirus in city of Isiro, Democratic Republic of the Congo. The branching process model allows for a direct comparison of disease transmission across different environments, such as the general community or the Ebola treatment unit. However, the survival model appears to yield parameter estimates with more accuracy and better precision in some circumstances.
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Affiliation(s)
- Boseung Choi
- Department of National Statistics, Korea University Sejoung Campus Sejoung, Republic of Korea
| | - Sydney Busch
- Department of Mathematics, Augsburg College Minneapolis, MN, USA
| | - Dieudonné Kazadi
- Ministry of Health, Democratic Republic of the Congo
- School of Public Health, University of Kinshasa Kinshasa, Democratic Republic of the Congo
| | - Benoit Ilunga
- School of Public Health, University of Kinshasa Kinshasa, Democratic Republic of the Congo
| | | | - Yi Dai
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Robert Lumpkin
- Department of Mathematics, The Ohio State University, Columbus, OH, USA
| | - Omar Saucedo
- Mathematical Biosciences Institute, The Ohio State University, Columbus, OH, USA
| | - Wasiur R. KhudaBukhsh
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
- Mathematical Biosciences Institute, The Ohio State University, Columbus, OH, USA
| | - Joseph Tien
- Department of Mathematics, The Ohio State University, Columbus, OH, USA
| | - Marcel Yotebieng
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Eben Kenah
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Grzegorz A. Rempala
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
- Department of Mathematics, The Ohio State University, Columbus, OH, USA
- Mathematical Biosciences Institute, The Ohio State University, Columbus, OH, USA
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24
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Reichler MR, Bangura J, Bruden D, Keimbe C, Duffy N, Thomas H, Knust B, Farmar I, Nichols E, Jambai A, Morgan O, Hennessy T. Household Transmission of Ebola Virus: Risks and Preventive Factors, Freetown, Sierra Leone, 2015. J Infect Dis 2019; 218:757-767. [PMID: 29659910 DOI: 10.1093/infdis/jiy204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/05/2018] [Indexed: 11/15/2022] Open
Abstract
Background Knowing risk factors for household transmission of Ebola virus is important to guide preventive measures during Ebola outbreaks. Methods We enrolled all confirmed persons with Ebola who were the first case in a household, December 2014-April 2015, in Freetown, Sierra Leone, and their household contacts. Cases and contacts were interviewed, contacts followed prospectively through the 21-day incubation period, and secondary cases confirmed by laboratory testing. Results We enrolled 150 index Ebola cases and 838 contacts; 83 (9.9%) contacts developed Ebola during 21-day follow-up. In multivariable analysis, risk factors for transmission included index case death in the household, Ebola symptoms but no reported fever, age <20 years, more days with wet symptoms; and providing care to the index case (P < .01 for each). Protective factors included avoiding the index case after illness onset and a piped household drinking water source (P < .01 for each). Conclusions To reduce Ebola transmission, communities should rapidly identify and follow-up all household contacts; isolate those with Ebola symptoms, including those without reported fever; and consider closer monitoring of contacts who provided care to cases. Households could consider efforts to minimize risk by designating one care provider for ill persons with all others avoiding the suspected case.
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Affiliation(s)
- Mary R Reichler
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Bangura
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Dana Bruden
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Charles Keimbe
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Harold Thomas
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Barbara Knust
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ishmail Farmar
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Erin Nichols
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Amara Jambai
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Oliver Morgan
- Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - Thomas Hennessy
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
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25
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Robert A, Edmunds WJ, Watson CH, Henao-Restrepo AM, Gsell PS, Williamson E, Longini IM, Sakoba K, Kucharski AJ, Touré A, Nadlaou SD, Diallo B, Barry MS, Fofana TO, Camara L, Kaba IL, Sylla L, Diaby ML, Soumah O, Diallo A, Niare A, Diallo A, Eggo RM. Determinants of Transmission Risk During the Late Stage of the West African Ebola Epidemic. Am J Epidemiol 2019; 188:1319-1327. [PMID: 30941398 PMCID: PMC6601535 DOI: 10.1093/aje/kwz090] [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] [Received: 09/05/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 11/14/2022] Open
Abstract
Understanding risk factors for Ebola transmission is key for effective prediction and design of interventions. We used data on 860 cases in 129 chains of transmission from the latter half of the 2013-2016 Ebola epidemic in Guinea. Using negative binomial regression, we determined characteristics associated with the number of secondary cases resulting from each infected individual. We found that attending an Ebola treatment unit was associated with a 38% decrease in secondary cases (incidence rate ratio (IRR) = 0.62, 95% confidence interval (CI): 0.38, 0.99) among individuals that did not survive. Unsafe burial was associated with a higher number of secondary cases (IRR = 1.82, 95% CI: 1.10, 3.02). The average number of secondary cases was higher for the first generation of a transmission chain (mean = 1.77) compared with subsequent generations (mean = 0.70). Children were least likely to transmit (IRR = 0.35, 95% CI: 0.21, 0.57) compared with adults, whereas older adults were associated with higher numbers of secondary cases. Men were less likely to transmit than women (IRR = 0.71, 95% CI: 0.55, 0.93). This detailed surveillance data set provided an invaluable insight into transmission routes and risks. Our analysis highlights the key role that age, receiving treatment, and safe burial played in the spread of EVD.
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Affiliation(s)
- Alexis Robert
- 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
| | - Conall H Watson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Elizabeth Williamson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ira M Longini
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Keïta Sakoba
- World Health Organization Ebola Vaccination Team, Conakry, Guinea
| | - Adam J Kucharski
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alhassane Touré
- World Health Organization Ebola Vaccination Team, Conakry, Guinea
| | | | | | | | | | - Louceny Camara
- World Health Organization Ebola Vaccination Team, Conakry, Guinea
| | | | - Lansana Sylla
- World Health Organization Ebola Vaccination Team, Conakry, Guinea
| | | | - Ousmane Soumah
- World Health Organization Ebola Vaccination Team, Conakry, Guinea
| | | | - Amadou Niare
- World Health Organization Ebola Vaccination Team, Conakry, Guinea
| | | | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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26
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Baraka NK, Mumbere M, Ndombe E. One month follow up of a neonate born to a mother who survived Ebola virus disease during pregnancy: a case report in the Democratic Republic of Congo. BMC Pediatr 2019; 19:202. [PMID: 31215482 PMCID: PMC6580501 DOI: 10.1186/s12887-019-1584-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background The authors report a 1 month follow up of a neonate described as “miracle baby” because she was born Ebola virus disease-free and survived after her mother was infected with Ebola virus during the third trimester of pregnancy. Case presentation This female newborn baby was registered at the Maternity of Beni Reference General Hospital and the Ebola Treatment Centre in eastern Democratic Republic of Congo. She was delivered normally and showed no signs of Ebola infection. All tests were negative for Ebola. At 1 month follow up, the baby is growing normally. Conclusions This very rare happy outcome for neonates of mothers infected with Ebola virus motivated the authors to report the case.
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Affiliation(s)
- N Kasereka Baraka
- Department of Paediatrics, Faculty of Medicine, University of Kalemie, Kalemie, Democratic Republic of the Congo
| | - Mupenzi Mumbere
- Department of Paediatrics, Faculty of Medicine, Catholic University of Graben, Butembo, Democratic Republic of the Congo.
| | - Evie Ndombe
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Kalemie, Kalemie, Democratic Republic of the Congo
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27
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Muñoz-Fontela C, McElroy AK. Ebola Virus Disease in Humans: Pathophysiology and Immunity. Curr Top Microbiol Immunol 2019; 411:141-169. [PMID: 28653186 PMCID: PMC7122202 DOI: 10.1007/82_2017_11] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Viruses of the Ebolavirus genus cause sporadic epidemics of severe and systemic febrile disease that are fueled by human-to-human transmission. Despite the notoriety of ebolaviruses, particularly Ebola virus (EBOV), as prominent viral hemorrhagic fever agents, and the international concern regarding Ebola virus disease (EVD) outbreaks, very little is known about the pathophysiology of EVD in humans and, in particular, about the human immune correlates of survival and immune memory. This lack of basic knowledge about physiological characteristics of EVD is probably attributable to the dearth of clinical and laboratory data gathered from past outbreaks. The unprecedented magnitude of the EVD epidemic that occurred in West Africa from 2013 to 2016 has allowed, for the first time, evaluation of clinical, epidemiological, and immunological parameters in a significant number of patients using state-of-the-art laboratory equipment. This review will summarize the data from the literature regarding human pathophysiologic and immunologic responses to filoviral infection.
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Affiliation(s)
- César Muñoz-Fontela
- Laboratory of Emerging Viruses, Heinrich Pette Institute, Leibniz Institute for Experimental Virology, Martinistraße 52, 20251, Hamburg, Germany.
| | - Anita K McElroy
- Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive NE, Atlanta, GA, 30322, USA.
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28
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Schneider-Futschik EK, Hoyer D, Khromykh AA, Baell JB, Marsh GA, Baker MA, Li J, Velkov T. Contemporary Anti-Ebola Drug Discovery Approaches and Platforms. ACS Infect Dis 2019; 5:35-48. [PMID: 30516045 DOI: 10.1021/acsinfecdis.8b00285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Ebola virus has a grave potential to destabilize civil society as we know it. The past few deadly Ebola outbreaks were unprecedented in size: The 2014-15 Ebola West Africa outbreak saw the virus spread from the epicenter through to Guinea, Sierra Leone, Nigeria, Congo, and Liberia. The 2014-15 Ebola West Africa outbreak was associated with almost 30,000 suspected or confirmed cases and over 11,000 documented deaths. The more recent 2018 outbreak in the Democratic Republic of Congo has so far resulted in 216 suspected or confirmed cases and 139 deaths. There is a general acceptance within the World Health Organization (WHO) and the Ebola outbreak response community that future outbreaks will become increasingly more frequent and more likely to involve intercontinental transmission. The magnitude of the recent outbreaks demonstrated in dramatic fashion the shortcomings of our mass casualty disease response capabilities and lack of therapeutic modalities for supporting Ebola outbreak prevention and control. Currently, there are no approved drugs although vaccines for human Ebola virus infection are in the trial phases and some potential treatments have been field tested most recently in the Congo Ebola outbreak. Treatment is limited to pain management and supportive care to counter dehydration and lack of oxygen. This underscores the critical need for effective antiviral drugs that specifically target this deadly disease. This review examines the current approaches for the discovery of anti-Ebola small molecule or biological therapeutics, their viral targets, mode of action, and contemporary platforms, which collectively form the backbone of the anti-Ebola drug discovery pipeline.
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Affiliation(s)
- Elena K. Schneider-Futschik
- Department of Pharmacology and Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Daniel Hoyer
- Department of Pharmacology and Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, 30 Royal Parade, Parkville, Victoria 3052, Australia
- Department of Molecular Medicine, The Scripps Research Institute, 10550 N. Torrey Pines Road, La Jolla, California 92037, United States
| | - Alexander A. Khromykh
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, Queensland 4072, Australia
| | - Jonathan B. Baell
- School of Pharmaceutical Sciences, Nanjing Tech University, No. 30 South Puzhu Road, Nanjing, Jiangsu 211816, People’s Republic of China
- Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria 3052, Australia
| | - Glenn A. Marsh
- CSIRO Livestock Industries, Australian Animal Health Laboratory, Geelong, Victoria 3220, Australia
| | - Mark A. Baker
- Priority Research Centre in Reproductive Science, School of Environmental and Life Sciences, University of Newcastle, Callaghan, New South Wales 2308, Australia
| | - Jian Li
- Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
| | - Tony Velkov
- Department of Pharmacology and Therapeutics, School of Biomedical Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria 3010, Australia
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29
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Yamazaki K. Threshold dynamics of reaction–diffusion partial differential equations model of Ebola virus disease. INT J BIOMATH 2019. [DOI: 10.1142/s1793524518501085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We study the reaction–diffusion Ebola PDE model that consists of equations that govern the evolution of susceptible, infected, recovered and deceased human individuals, as well as Ebola virus pathogens in the environment, with diffusive terms in all except the equation of the deceased human individuals. Under the setting of a spatial domain that is bounded, we prove the global well-posedness of the system; in contrast to the previous work on similar models such as cholera, avian influenza, malaria and dengue fever, diffusion coefficients may be different. Moreover, we derive its basic reproduction number, and under the condition that the diffusion coefficients of the susceptible and infected hosts are same, we prove the global stability of the disease-free-equilibrium, and uniform persistence in cases when the basic reproduction number lies beneath and above one, respectively. Again, we do not require that the diffusion coefficients of the recovered hosts be the same as the diffusion coefficients of the susceptible and infected hosts, in contrast to previous work on other models of infectious diseases. Another technical difficulty in our model is that the solution semiflow is not compact due to the lack of diffusion in the equation of the deceased human individuals; we overcome this difficulty using functional analysis techniques concerning Kuratowski measure of non-compactness.
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Affiliation(s)
- Kazuo Yamazaki
- University of Rochester, Department of Mathematics, Rochester, NY 14627, USA
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30
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Levy B, Odoi A. Exploratory investigation of region level risk factors of Ebola Virus Disease in West Africa. PeerJ 2018; 6:e5888. [PMID: 30488016 PMCID: PMC6250096 DOI: 10.7717/peerj.5888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 10/08/2018] [Indexed: 11/29/2022] Open
Abstract
Background Ebola Virus Disease (EVD) is a highly infectious disease that has produced over 25,000 cases in the past 50 years. While many past outbreaks resulted in relatively few cases, the 2014 outbreak in West Africa was the most deadly occurrence of EVD to date, producing over 15,000 confirmed cases. Objective In this study, we investigated population level predictors of EVD risk at the regional level in Sierra Leone, Liberia, and Guinea. Methods Spatial and descriptive analyses were conducted to assess distribution of EVD cases. Choropleth maps showing the spatial distribution of EVD risk across the study area were generated in ArcGIS. Poisson and negative binomial models were then used to investigate population and regional predictors of EVD risk. Results Results indicated that the risk of EVD was significantly lower in areas with higher proportions of: (a) the population living in urban areas, (b) households with a low quality or no toilets, and (c) married men working in blue collar jobs. However, risk of EVD was significantly higher in areas with high mean years of education. Conclusions The identified significant predictors of high risk were associated with areas with higher levels of urbanization. This may be due to higher population densities in the more urban centers and hence higher potential of infectious contact. However, there is need to better understand the role of urbanization and individual contact structure in an Ebola outbreak. We discuss shortcomings in available data and emphasize the need to consider spatial scale in future data collection and epidemiological studies.
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Affiliation(s)
- Benjamin Levy
- Department of Mathematics, Fitchburg State University, Fitchburg, MA, United States of America
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, University of Tennessee-Knoxville, Knoxville, TN, United States of America
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Hsu CH, Champaloux SW, Keïta S, Martel L, Bilivogui P, Knust B, McCollum AM. Sensitivity and Specificity of Suspected Case Definition Used during West Africa Ebola Epidemic. Emerg Infect Dis 2018; 24:9-14. [PMID: 29260687 PMCID: PMC5749454 DOI: 10.3201/eid2401.161678] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Rapid early detection and control of Ebola virus disease (EVD) is contingent on accurate case definitions. Using an epidemic surveillance dataset from Guinea, we analyzed an EVD case definition developed by the World Health Organization (WHO) and used in Guinea. We used the surveillance dataset (March-October 2014; n = 2,847 persons) to identify patients who satisfied or did not satisfy case definition criteria. Laboratory confirmation determined cases from noncases, and we calculated sensitivity, specificity and predictive values. The sensitivity of the defintion was 68.9%, and the specificity of the definition was 49.6%. The presence of epidemiologic risk factors (i.e., recent contact with a known or suspected EVD case-patient) had the highest sensitivity (74.7%), and unexplained deaths had the highest specificity (92.8%). Results for case definition analyses were statistically significant (p<0.05 by χ2 test). Multiple components of the EVD case definition used in Guinea contributed to improved overall sensitivity and specificity.
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Filovirus – Auslöser von hämorrhagischem Fieber. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:894-907. [DOI: 10.1007/s00103-018-2757-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gomes MF, de la Fuente-Núñez V, Saxena A, Kuesel AC. Protected to death: systematic exclusion of pregnant women from Ebola virus disease trials. Reprod Health 2017; 14:172. [PMID: 29297366 PMCID: PMC5751665 DOI: 10.1186/s12978-017-0430-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For 30 years, women have sought equal opportunity to be included in trials so that drugs are equitably studied in women as well as men; regulatory guidelines have changed accordingly. Pregnant women, however, continue to be excluded from trials for non-obstetric conditions, though they have been included for trials of life-threatening diseases because prospects for maternal survival outweighed potential fetal risks. Ebola virus disease is a life-threatening infection without approved treatments or vaccines. Previous Ebola virus (EBOV) outbreak data showed 89-93% maternal and 100% fetal/neonatal mortality. Early in the 2013-2016 EBOV epidemic, an expert panel pointed to these high mortality rates and the need to prioritize and preferentially allocate unregistered interventions in favor of pregnant women (and children). Despite these recommendations and multiple ethics committee requests for their inclusion on grounds of justice, equity, and medical need, pregnant women were excluded from all drug and vaccine trials in the affected countries, either without justification or on grounds of potential fetal harm. An opportunity to offer pregnant women the same access to potentially life-saving interventions as others, and to obtain data to inform their future use, was lost. Once again, pregnant women were denied autonomy and their right to decide. CONCLUSION We recommend that, without clear justification for exclusion, pregnant women are included in clinical trials for EBOV and other life-threatening conditions, with lay language on risks and benefits in information documents, so that pregnant women can make their own decision to participate. Their automatic exclusion from trials for other conditions should be questioned.
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Affiliation(s)
| | | | - Abha Saxena
- Department for Information Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Annette C. Kuesel
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
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Berge T, Lubuma JMS, Moremedi GM, Morris N, Kondera-Shava R. A simple mathematical model for Ebola in Africa. JOURNAL OF BIOLOGICAL DYNAMICS 2017; 11:42-74. [PMID: 29067875 DOI: 10.1080/17513758.2016.1229817] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We deal with the following question: Can the consumption of contaminated bush meat, the funeral practices and the environmental contamination explain the recurrence and persistence of Ebola virus disease outbreaks in Africa? We develop an SIR-type model which, incorporates both the direct and indirect transmissions in such a manner that there is a provision of Ebola viruses. We prove that the full model has one (endemic) equilibrium which is locally asymptotically stable whereas, it is globally asymptotically stable in the absence of the Ebola virus shedding in the environment. For the sub-model without the provision of Ebola viruses, the disease dies out or stabilizes globally at an endemic equilibrium. At the endemic level, the number of infectious is larger for the full model than for the sub-model without provision of Ebola viruses. We design a nonstandard finite difference scheme, which preserves the dynamics of the model. Numerical simulations are provided.
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Affiliation(s)
- T Berge
- a Department of Mathematics and Applied Mathematics , University of Pretoria , Pretoria , South Africa
- b Department of Mathematics and Computer Sciences , University of Dschang , Dschang , Cameroon
| | - J M-S Lubuma
- a Department of Mathematics and Applied Mathematics , University of Pretoria , Pretoria , South Africa
| | - G M Moremedi
- c Department of Mathematical Sciences , University of South Africa , Pretoria , South Africa
| | - N Morris
- d Department of Forensic Medicine , University of Pretoria , Pretoria , South Africa
| | - R Kondera-Shava
- e Department of Mathematical Sciences , University of Botswana , Gaborone , Botswana
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Horigan V, Gale P, Kosmider RD, Minnis C, Snary EL, Breed AC, Simons RR. Application of a quantitative entry assessment model to compare the relative risk of incursion of zoonotic bat-borne viruses into European Union Member States. MICROBIAL RISK ANALYSIS 2017; 7:8-28. [PMID: 32289058 PMCID: PMC7103962 DOI: 10.1016/j.mran.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 06/11/2023]
Abstract
This paper presents a quantitative assessment model for the risk of entry of zoonotic bat-borne viruses into the European Union (EU). The model considers four routes of introduction: human travel, legal trade of products, live animal imports and illegal import of bushmeat and was applied to five virus outbreak scenarios. Two scenarios were considered for Zaire ebolavirus (wEBOV, cEBOV) and other scenarios for Hendra virus, Marburg virus (MARV) and Middle East Respiratory Syndrome Coronavirus (MERS-CoV). The use of the same framework and generic data sources for all EU Member States (MS) allows for a relative comparison of the probability of virus introduction and of the importance of the routes of introduction among MSs. According to the model wEBOV posed the highest risk of an introduction event within the EU, followed by MARV and MERS-CoV. However, the main route of introduction differed, with wEBOV and MERS-CoV most likely through human travel and MARV through legal trade of foodstuffs. The relative risks to EU MSs as entry points also varied between outbreak scenarios, highlighting the heterogeneity in global trade and travel to the EU MSs. The model has the capability to allow for a continual updating of the risk estimate using new data as, and when, it becomes available. The model provides an horizon scanning tool for use when available data are limited and, therefore, the absolute risk estimates often have high uncertainty. Sensitivity analysis suggested virus prevalence in bats has a large influence on the results; a 90% reduction in prevalence reduced the risk of introduction considerably and resulted in the relative ranking of MARV falling below that for MERS-CoV, due to this parameter disproportionately affecting the risk of introduction from the trade route over human travel.
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Affiliation(s)
- Verity Horigan
- Animal and Plant Health Agency (APHA), Department of Epidemiological Sciences, New Haw, Addlestone, Surrey KT15 3NB, United Kingdom
| | - Paul Gale
- Animal and Plant Health Agency (APHA), Department of Epidemiological Sciences, New Haw, Addlestone, Surrey KT15 3NB, United Kingdom
| | - Rowena D. Kosmider
- Animal and Plant Health Agency (APHA), Department of Epidemiological Sciences, New Haw, Addlestone, Surrey KT15 3NB, United Kingdom
| | - Christopher Minnis
- The Royal Veterinary College, Royal College Street, London, England NW1 0TU, United Kingdom
| | - Emma L. Snary
- Animal and Plant Health Agency (APHA), Department of Epidemiological Sciences, New Haw, Addlestone, Surrey KT15 3NB, United Kingdom
| | - Andrew C. Breed
- Animal and Plant Health Agency (APHA), Department of Epidemiological Sciences, New Haw, Addlestone, Surrey KT15 3NB, United Kingdom
| | - Robin R.L. Simons
- Animal and Plant Health Agency (APHA), Department of Epidemiological Sciences, New Haw, Addlestone, Surrey KT15 3NB, United Kingdom
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Singh RK, Dhama K, Malik YS, Ramakrishnan MA, Karthik K, Khandia R, Tiwari R, Munjal A, Saminathan M, Sachan S, Desingu PA, Kattoor JJ, Iqbal HMN, Joshi SK. Ebola virus - epidemiology, diagnosis, and control: threat to humans, lessons learnt, and preparedness plans - an update on its 40 year's journey. Vet Q 2017; 37:98-135. [PMID: 28317453 DOI: 10.1080/01652176.2017.1309474] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Ebola virus (EBOV) is an extremely contagious pathogen and causes lethal hemorrhagic fever disease in man and animals. The recently occurred Ebola virus disease (EVD) outbreaks in the West African countries have categorized it as an international health concern. For the virus maintenance and transmission, the non-human primates and reservoir hosts like fruit bats have played a vital role. For curbing the disease timely, we need effective therapeutics/prophylactics, however, in the absence of any approved vaccine, timely diagnosis and monitoring of EBOV remains of utmost importance. The technologically advanced vaccines like a viral-vectored vaccine, DNA vaccine and virus-like particles are underway for testing against EBOV. In the absence of any effective control measure, the adaptation of high standards of biosecurity measures, strict sanitary and hygienic practices, strengthening of surveillance and monitoring systems, imposing appropriate quarantine checks and vigilance on trade, transport, and movement of visitors from EVD endemic countries remains the answer of choice for tackling the EBOV spread. Herein, we converse with the current scenario of EBOV giving due emphasis on animal and veterinary perspectives along with advances in diagnosis and control strategies to be adopted, lessons learned from the recent outbreaks and the global preparedness plans. To retrieve the evolutionary information, we have analyzed a total of 56 genome sequences of various EBOV species submitted between 1976 and 2016 in public databases.
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Affiliation(s)
- Raj Kumar Singh
- a ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Kuldeep Dhama
- b Division of Pathology, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Yashpal Singh Malik
- c Division of Biological Standardization, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | | | - Kumaragurubaran Karthik
- e Divison of Bacteriology and Mycology, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Rekha Khandia
- f Department of Biochemistry and Genetics , Barkatullah University , Bhopal , India
| | - Ruchi Tiwari
- g Department of Veterinary Microbiology and Immunology , College of Veterinary Sciences, Deen Dayal Upadhayay Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU) , Mathura , India
| | - Ashok Munjal
- f Department of Biochemistry and Genetics , Barkatullah University , Bhopal , India
| | - Mani Saminathan
- b Division of Pathology, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Swati Sachan
- h Immunology Section, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | | | - Jobin Jose Kattoor
- c Division of Biological Standardization, ICAR-Indian Veterinary Research Institute , Bareilly , India
| | - Hafiz M N Iqbal
- i School of Engineering and Science, Tecnologico de Monterrey , Monterrey , Mexico
| | - Sunil Kumar Joshi
- j Cellular Immunology Lab , Frank Reidy Research Center for Bioelectrics , School of Medical Diagnostics & Translational Sciences, Old Dominion University , Norfolk , VA , USA
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Kabwama SN, Mafigiri R, Balinandi S, Kagirita A, Riolexus AA, Zhu BP. Risk factors for hematemesis in Hoima and Buliisa Districts, Western Uganda, September-October 2015. Pan Afr Med J 2017; 28:215. [PMID: 29610653 PMCID: PMC5878846 DOI: 10.11604/pamj.2017.28.215.12395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 10/28/2017] [Indexed: 12/12/2022] Open
Abstract
Introduction On 17 September 2015, Buliisa District Health Office reported multiple deaths due to haemorrhage to the Uganda Ministry of Health. We conducted an investigation to verify the existence of an outbreak and to identify the disease nature, mode of transmission and risk factors. Methods We defined a suspected case as onset of hematemesis between 1 June 2015 and 15 October 2015 in a resident of Hoima, Buliisa or neighbouring districts. We identified cases by reviewing medical records and actively searching in the community. We interviewed case-patients and health-care workers and performed descriptive epidemiology to generate hypotheses on possible exposures. In a case-control study we compared exposures between 21 cases and 81 controls, matched by age (± 10 years), sex and village of residence. We collected 22 biological specimens from 19 case-patients to test for Viral Haemorrhagic Fevers (VHF). We analysed the data using the Mantel-Haenszel method to account for the matched study design. Results We identified 56 cases with onset from June to October (attack rate 15/100,000 in Buliisa District and 5.2/100,000 in Hoima District). The age-specific attack rate was highest in persons aged 31-60 years (15/100,000 in Hoima and 47/100,000 in Buliisa); no persons below 15 years of age had the illness. In the case-control study, 42% (5/12) of cases vs. 0.0% (0/77) of controls had liver disease (ORM-H = ∞; 95%CI = 3.7-∞); 71% (10/14) of cases vs. 35% (28/81) of controls had ulcer disease (ORM-H = 13; 95% CI = 1.6-98); 27% (3/11) of cases vs. 14% (11/81) of controls used indomethacin prior to disease onset (ORM-H = 6.0; 95% CI = 1.0-36). None of the blood samples were positive for any of the VHFs. Conclusion This reported cluster of hematemesis illness was due to predisposing conditions and use of Non-Steroidal Anti-inflammatory Drugs (NSAID). Health education should be conducted on the danger of NSAIDs misuse, especially in persons with pre-disposing conditions.
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Affiliation(s)
- Steven Ndugwa Kabwama
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Richardson Mafigiri
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | | | - Atek Kagirita
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Alex Ario Riolexus
- Uganda Public Health Fellowship Program, Field Epidemiology Track, Ministry of Health, Kampala, Uganda
| | - Bao-Ping Zhu
- US Centers for Disease Control and Prevention, Kampala, Uganda
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The perspective of gender on the Ebola virus using a risk management and population health framework: a scoping review. Infect Dis Poverty 2017; 6:135. [PMID: 29017587 PMCID: PMC5635524 DOI: 10.1186/s40249-017-0346-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/07/2017] [Indexed: 11/13/2022] Open
Abstract
Background In the three decades since the first reported case of Ebola virus, most known index cases have been consistently traced to the hunting of “bush meat”, and women have consistently recorded relatively high fatality rates in most catastrophic outbreaks. This paper discusses Ebola-related risk factors, which constantly interact with cultural values, and provides an insight into the link between gender and the risk of contracting infectious diseases, using Ebola virus as an example within Africa. Method A comprehensive search of the literature was conducted using the PubMed, Ovid Medline and Global Health CABI databases as well as CAB Abstracts, including gray literature. We used a descriptive and sex- and gender-based analysis to revisit previous studies on Ebola outbreaks since 1976 to 2014, and disaggregated the cases and fatality rates according to gender and the sources of known index cases based on available data. Results In total, approximately 1530 people died in all previous Ebola outbreaks from 1976 to 2012 compared with over 11,310 deaths from the 2014 outbreak. Women’s increased exposure can be attributed to time spent at home and their responsibility for caring for the sick, while men’s increased vulnerability to the virus can be attributed to their responsibility for caring for livestock and to time spent away from home, as most known sources of the index cases have been infected in the process of hunting. We present a conceptual model of a circle of interacting risk factors for Ebola in the African context. Conclusion There is currently no evidence related to biological differences in female or male sex that increases Ebola virus transmission and vulnerability; rather, there are differences in the level of exposure between men and women. Gender is therefore an important risk factor to consider in the design of health programs. Building the capacity for effective risk communication is a worthwhile investment in public and global health for future emergency responses. Electronic supplementary material The online version of this article (doi:10.1186/s40249-017-0346-7) contains supplementary material, which is available to authorized users.
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Ngatu NR, Kayembe NJM, Phillips EK, Okech-Ojony J, Patou-Musumari M, Gaspard-Kibukusa M, Madone-Mandina N, Godefroid-Mayala M, Mutaawe L, Manzengo C, Roger-Wumba D, Nojima S. Epidemiology of ebolavirus disease (EVD) and occupational EVD in health care workers in Sub-Saharan Africa: Need for strengthened public health preparedness. J Epidemiol 2017; 27:455-461. [PMID: 28416172 PMCID: PMC5602796 DOI: 10.1016/j.je.2016.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/02/2016] [Indexed: 02/01/2023] Open
Abstract
Ebolavirus disease (EVD) is a severe contagious disease in humans, and health care workers (HCW) are at risk of infection when caring for EVD patients. This paper highlights the epidemiologic profile of EVD and its impact on the health care workforce in Africa. A documentary study was conducted which consisted of a review of available literature regarding the epidemiology of EVD, occupational EVD (OEVD), and work safety issues in Sub-Saharan Africa; the literature findings are enriched by field experiences from the authors. EVD outbreaks have already caused 30,500 cases in humans of whom 12,933 died (as of September 9, 2015), and the number of infected HCW has dramatically increased. All eight HCW infected during the 2014 outbreak in Democratic Republic of the Congo died, whereas during the recent West African EVD epidemic more than 890 HCW were infected, with a case fatality rate of 57%. Occupational exposure to blood and other body fluids due to inadequate use of personal protective equipment and needle stick or sharp injuries are among factors that contribute to the occurrence of OEVD. Prevention of OEVD should be one of the top priorities in EVD outbreak preparedness and management, and research should be conducted to elucidate occupational and other factors that expose HCW to EVD. In addition to regularly training HCW to be adequately prepared to care for patients with EVD, it is critical to strengthen the general health care system and improve occupational safety in medical settings of countries at risk.
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Affiliation(s)
- Nlandu Roger Ngatu
- Graduate School of Health Sciences & Nursing, University de Kochi, Kochi, Japan.
| | - Ntumba Jean-Marie Kayembe
- Department of Internal Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Joa Okech-Ojony
- WHO-Ebolavirus Outbreak Response Team, WHO-Liberia, Moronvia, Liberia
| | - Masika Patou-Musumari
- Department of Global Health & Socioepidemiology, Kyoto University School of Public Health, Kyoto, Japan
| | - Mukunda Gaspard-Kibukusa
- Ministry of Social Affairs, Humanitarian Action and National Solidarity, Kinshasa, Democratic Republic of the Congo
| | - Ndona Madone-Mandina
- Department of Internal Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | - Lubogo Mutaawe
- WHO-Ebolavirus Outbreak Response Team, WHO-Liberia, Moronvia, Liberia
| | - Casimir Manzengo
- World Health Organization (WHO), Kinshasa, Democratic Republic of the Congo
| | - Dimosi Roger-Wumba
- Department of Tropical Medicine, Faculty of Medicine, University of Kinshasa, Democratic Republic of the Congo
| | - Sayumi Nojima
- Graduate School of Health Sciences & Nursing, University de Kochi, Kochi, Japan
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Chowell G, Cleaton JM, Viboud C. Elucidating Transmission Patterns From Internet Reports: Ebola and Middle East Respiratory Syndrome as Case Studies. J Infect Dis 2017; 214:S421-S426. [PMID: 28830110 PMCID: PMC5144900 DOI: 10.1093/infdis/jiw356] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The paucity of traditional epidemiological data during epidemic emergencies calls for alternative data streams to characterize the key features of an outbreak, including the nature of risky exposures, the reproduction number, and transmission heterogeneities. We illustrate the potential of Internet data streams to improve preparedness and response in outbreak situations by drawing from recent work on the 2014–2015 Ebola epidemic in West Africa and the 2015 Middle East respiratory syndrome (MERS) outbreak in South Korea. We show that Internet reports providing detailed accounts of epidemiological clusters are particularly useful to characterize time trends in the reproduction number. Moreover, exposure patterns based on Internet reports align with those derived from epidemiological surveillance data on MERS and Ebola, underscoring the importance of disease amplification in hospitals and during funeral rituals (associated with Ebola), prior to the implementation of control interventions. Finally, we discuss future developments needed to generalize Internet-based approaches to study transmission dynamics.
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Affiliation(s)
- Gerardo Chowell
- School of Public Health, Georgia State University, Atlanta.,Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | | | - Cecile Viboud
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland
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Tiffany A, Dalziel BD, Kagume Njenge H, Johnson G, Nugba Ballah R, James D, Wone A, Bedford J, McClelland A. Estimating the number of secondary Ebola cases resulting from an unsafe burial and risk factors for transmission during the West Africa Ebola epidemic. PLoS Negl Trop Dis 2017. [PMID: 28640823 PMCID: PMC5480832 DOI: 10.1371/journal.pntd.0005491] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Safely burying Ebola infected individuals is acknowledged to be important for controlling Ebola epidemics and was a major component of the 2013–2016 West Africa Ebola response. Yet, in order to understand the impact of safe burial programs it is necessary to elucidate the role of unsafe burials in sustaining chains of Ebola transmission and how the risk posed by activities surrounding unsafe burials, including care provided at home prior to death, vary with human behavior and geography. Methodology/Principal findings Interviews with next of kin and community members were carried out for unsafe burials in Sierra Leone, Liberia and Guinea, in six districts where the Red Cross was responsible for safe and dignified burials (SDB). Districts were randomly selected from a district-specific sampling frame comprised of villages and neighborhoods that had experienced cases of Ebola. An average of 2.58 secondary cases were potentially generated per unsafe burial and varied by district (range: 0–20). Contact before and after death was reported for 142 (46%) contacts. Caregivers of a primary case were 2.63 to 5.92 times more likely to become EVD infected compared to those with post-mortem contact only. Using these estimates, the Red Cross SDB program potentially averted between 1,411 and 10,452 secondary EVD cases, reducing the epidemic by 4.9% to 36.5%. Conclusions/Significance SDB is a fundamental control measure that limits community transmission of Ebola; however, for those individuals having contact before and after death, it was impossible to ascertain the exposure that caused their infection. The number of infections prevented through SDB is significant, yet greater impact would be achieved by early hospitalization of the primary case during acute illness. The care of an individual infected with Ebola virus disease (EVD), their death, funeral, and burial in the community rather than in an Ebola Treatment Center (ETC) poses a serious risk for continued disease transmission. Consequently, SDB is an essential component of EVD outbreak response; however, its impact on transmission is not well understood. During the 2013–2016 EVD epidemic the Red Cross carried out over 50% of the official burials in Guinea, Liberia and Sierra Leone. We performed epidemiological investigations in EVD affected communities to better understand disease transmission linked to unsafe burials of (suspect) EVD infected individuals, and risk factors for transmission linked to caring and burial practices. An average of 2.58 secondary cases were potentially generated per unsafe burial investigated and varied by district (range: 0–20). Additionally, the Red Cross SDB program potentially averted between 1,411 and 10,452 secondary EVD cases, reducing the epidemic by 4.9% to 36.5%. Our results quantify for the first time the potential impact this essential EVD response component had on the 2013–2016 epidemic and highlight the importance of SDB as a fundamental control measure, while also underlining the well-known importance of isolating EVD infected individuals as soon as they show symptoms in order to limit transmission.
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Affiliation(s)
| | - Benjamin D. Dalziel
- Department of Integrative Biology, Oregon State University, Corvallis, Oregon, United States of America
- Department of Mathematics, Oregon State University, Corvallis, Oregon, United States of America
| | - Hilary Kagume Njenge
- International Federation of the Red Cross and Red Crescent Societies, Monrovia, Liberia
| | | | | | - Daniel James
- Sierra Leone Red Cross Society, Freetown, Sierra Leone
| | - Abdoulaye Wone
- International Federation of the Red Cross and Red Crescent Societies, Conakry, Guinea
| | | | - Amanda McClelland
- International Federation of the Red Cross and Red Crescent Societies, Geneva, Switzerland
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Skrip LA, Fallah MP, Gaffney SG, Yaari R, Yamin D, Huppert A, Bawo L, Nyenswah T, Galvani AP. Characterizing risk of Ebola transmission based on frequency and type of case-contact exposures. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160301. [PMID: 28396472 PMCID: PMC5394639 DOI: 10.1098/rstb.2016.0301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2017] [Indexed: 11/12/2022] Open
Abstract
During the initial months of the 2013-2016 Ebola epidemic, rapid geographical dissemination and intense transmission challenged response efforts across West Africa. Contextual behaviours associated with increased risk of exposure included travel to high-transmission settings, caring for sick and preparing the deceased for traditional funerals. Although such behaviours are widespread in West Africa, high-transmission pockets were observed. Superspreading and clustering are typical phenomena in infectious disease outbreaks, as a relatively small number of transmission chains are often responsible for the majority of events. Determining the characteristics of contacts at greatest risk of developing disease and of cases with greatest transmission potential could therefore help curb propagation of infection. Our analysis of contact tracing data from Montserrado County, Liberia, suggested that the probability of transmission was 4.5 times higher for individuals who were reported as having contact with multiple cases. The probability of individuals developing disease was not significantly associated with age or sex of their source case but was higher when they were in the same household as the infectious case. Surveillance efforts for rapidly identifying symptomatic individuals and effectively messaged campaigns encouraging household members to bring the sick to designated treatment centres without administration of home care could mitigate transmission.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.
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Affiliation(s)
- Laura A Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
| | - Mosoka P Fallah
- Ministry of Health, Congo Town, Tubman Blvd, Monrovia, Liberia
- A.M. Dogliotti College of Medicine, University of Liberia, Tubman Blvd, Monrovia, Liberia
- National Institute of Allergy and Infectious Diseases, PREVAIL-III Study, JFK Hospital, Tubman Blvd, Monrovia, Liberia
| | - Stephen G Gaffney
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA
| | - Rami Yaari
- Biostatistics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan 52621, Israel
| | - Dan Yamin
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Amit Huppert
- Biostatistics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan 52621, Israel
- Department of Epidemiology and Preventive Medicine, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Luke Bawo
- Ministry of Health, Congo Town, Tubman Blvd, Monrovia, Liberia
| | | | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
- A.M. Dogliotti College of Medicine, University of Liberia, Tubman Blvd, Monrovia, Liberia
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Gallandat K, Lantagne D. Selection of a Biosafety Level 1 (BSL-1) surrogate to evaluate surface disinfection efficacy in Ebola outbreaks: Comparison of four bacteriophages. PLoS One 2017; 12:e0177943. [PMID: 28531182 PMCID: PMC5439676 DOI: 10.1371/journal.pone.0177943] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/05/2017] [Indexed: 11/18/2022] Open
Abstract
The 2014 West African Ebola virus disease outbreak was the largest to date, and conflicting, chlorine-based surface disinfection protocols to interrupt disease transmission were recommended. We identified only one study documenting surface disinfection efficacy against the Ebola virus, showing a >6.6 log reduction after 5-minute exposure to 0.5% sodium hypochlorite (NaOCl) based on small-scale tests (Cook et al. (2015)). In preparation for future extensive, large-scale disinfection efficacy experiments, we replicated the Cook et al. experiment using four potential BSL-1 surrogates selected based on similarities to the Ebola virus: bacteriophages MS2, M13, Phi6, and PR772. Each bacteriophage was exposed to 0.1% and 0.5% NaOCl for 1, 5, and 10 minutes on stainless steel. MS2 and M13 were only reduced by 3.4 log and 3.5 log after a 10-minute exposure to 0.5% NaOCl, and would be overly conservative surrogates. Conversely, PR772 was too easily inactivated for surrogate use, as it was reduced by >4.8 log after only 1-minute exposure to 0.5% NaOCl. Phi6 was slightly more resistant than the Ebola virus, with 4.1 log reduction after a 5-minute exposure and not detected after a 10-minute exposure to 0.5% NaOCl. We therefore recommend Phi6 as a surrogate for evaluating the efficacy of chlorine-based surface disinfectants against the Ebola virus.
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Affiliation(s)
- Karin Gallandat
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
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Zhang Y, Gong Y, Wang C, Liu W, Wang Z, Xia Z, Bu Z, Lu H, Sun Y, Zhang X, Cao Y, Yang F, Su H, Hu Y, Deng Y, Zhou B, Zhao Z, Fu Y, Kargbo D, Dafae F, Kargbo B, Kanu A, Liu L, Qian J, Guo Z. Rapid deployment of a mobile biosafety level-3 laboratory in Sierra Leone during the 2014 Ebola virus epidemic. PLoS Negl Trop Dis 2017; 11:e0005622. [PMID: 28505171 PMCID: PMC5444861 DOI: 10.1371/journal.pntd.0005622] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 05/25/2017] [Accepted: 05/04/2017] [Indexed: 11/23/2022] Open
Abstract
Background Ebola virus emerged in West Africa in December 2013. The high population mobility and poor public health infrastructure in this region led to the development of the largest Ebola virus disease (EVD) outbreak to date. Methodology/Principal findings On September 26, 2014, China dispatched a Mobile Biosafety Level-3 Laboratory (MBSL-3 Lab) and a well-trained diagnostic team to Sierra Leone to assist in EVD diagnosis using quantitative real-time PCR, which allowed the diagnosis of suspected EVD cases in less than 4 hours from the time of sample receiving. This laboratory was composed of three container vehicles equipped with advanced ventilation system, communication system, electricity and gas supply system. We strictly applied multiple safety precautions to reduce exposure risks. Personnel, materials, water and air flow management were the key elements of the biosafety measures in the MBSL-3 Lab. Air samples were regularly collected from the MBSL-3 Lab, but no evidence of Ebola virus infectious aerosols was detected. Potentially contaminated objects were also tested by collecting swabs. On one occasion, a pipette tested positive for EVD. A total of 1,635 suspected EVD cases (824 positive [50.4%]) were tested from September 28 to November 11, 2014, and no member of the diagnostic team was infected with Ebola virus or other pathogens, including Lassa fever. The specimens tested included blood (69.2%) and oral swabs (30.8%) with positivity rates of 54.2% and 41.9%, respectively. The China mobile laboratory was thus instrumental in the EVD outbreak response by providing timely and reliable diagnostics. Conclusions/Significance The MBSL-3 Lab significantly contributed to establishing a suitable laboratory response capacity during the emergence of EVD in Sierra Leone. A Mobile Biosafety Level-3 Laboratory (MBSL-3 Lab) and a well-trained diagnostic team were dispatched to Sierra Leone to assist in Ebola virus disease (EVD) diagnosis when the largest outbreak of EVD to date emerged in West Africa in 2014. This setup allowed for the diagnosis of suspected EVD cases in less than 4 hours from the time of sample receiving. The laboratory was composed of three container vehicles and was equipped with advanced ventilation system, communication system, electricity and gas supply system. Multiple safety precautions were strictly applied to reduce exposure risks. A total of 1,635 suspected EVD cases were evaluated from September 28 to November 11, 2014, and none of the staff members was infected with Ebola virus or other pathogens. The China mobile laboratory was thus instrumental in the EVD outbreak response by providing timely and accurate diagnostics. Therefore, the MBSL-3 Lab played a significant role in establishing a suitable laboratory response capacity during the emergence of EVD in Sierra Leone.
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Affiliation(s)
- Yi Zhang
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Yan Gong
- School of Materials Science & Engineering, Beijing Institute of Fashion Technology, Beijing, China
| | - Chengyu Wang
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Wensen Liu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Zhongyi Wang
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Zhiping Xia
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Zhaoyang Bu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Huijun Lu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Yang Sun
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Xiaoguang Zhang
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuxi Cao
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Yang
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haoxiang Su
- Institute of Pathogen Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yi Hu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Yongqiang Deng
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Bo Zhou
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Zongzheng Zhao
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - Yingying Fu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
| | - David Kargbo
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Foday Dafae
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Brima Kargbo
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Alex Kanu
- Sierra Leone-China Friendship Hospital, Freetown, Sierra Leone
| | - Linna Liu
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
- * E-mail: (ZDG); (JQ); (LNL)
| | - Jun Qian
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
- * E-mail: (ZDG); (JQ); (LNL)
| | - Zhendong Guo
- Key Laboratory of Jilin Province for Zoonosis Prevention and Control, Changchun Veterinary Research Institute, Chinese Academy of Agriculture Sciences, Changchun, Jilin, China
- * E-mail: (ZDG); (JQ); (LNL)
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Palich R, Irenge LM, Barte de Sainte Fare E, Augier A, Malvy D, Gala JL. Ebola virus RNA detection on fomites in close proximity to confirmed Ebola patients; N'Zerekore, Guinea, 2015. PLoS One 2017; 12:e0177350. [PMID: 28493945 PMCID: PMC5426669 DOI: 10.1371/journal.pone.0177350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/26/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Health care workers (HCWs) in contact with patients with Ebola virus disease (EVD) are exposed to a risk of viral contamination. Fomites contaminated with the patient's blood or body fluids represents this risk. Our study aims to detect Ebola virus (EBOV) RNA within the high- and low-risk areas of an Ebola treatment unit (ETU) located in inland Guinea during the 2014-2015 West African Ebola epidemics. For samples from patients' immediate vicinity, we aim to seek an association between viral RNA detectability and level of plasma viral load of patients (intermediate to high, or very high). METHODS Swabbing was performed on immediate vicinity of Ebola patients, on surfaces of an ETU, and on personal protective equipment (PPE) of HCWs after patient care and prior to doffing. All samples were assessed by quantitative reverse-transcribed PCR (RT-qPCR). RESULTS 32% (22/68) of swabs from high-risk areas were tested positive for EBOV RNA, including 42% (18/43) from patients' immediate vicinity, and 16% (4/25) from HCWs PPE. None of specimens from low-risk areas were tested positive (0/19). Swabs were much more often viral RNA positive in the vicinity of patients with a very high plasma viral load (OR 6.7, 95% CI [1.7-23.4]). CONCLUSION Our findings show the persistence of EBOV RNA in the environment of Ebola patients and of HCWs, in a Guinean ETU, despite strict infection prevention and control measures. This detection raises the possibility that patients' environment could be a potential source of contamination with the virus.
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Affiliation(s)
- Romain Palich
- Alliance for International Medical Action, Dakar, Senegal
- * E-mail:
| | - Leonid M. Irenge
- Center for Applied Molecular Technologies, Louvain Catholic University, Brussels, Belgium
| | | | | | - Denis Malvy
- Department of Tropical Medicine and Clinical International Health, Division of Infectious and Tropical Diseases, University Hospital of Bordeaux, Bordeaux, France
- INSERM1219, University of Bordeaux, Bordeaux, France
| | - Jean-Luc Gala
- Center for Applied Molecular Technologies, Louvain Catholic University, Brussels, Belgium
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Gallandat K, Wolfe MK, Lantagne D. Surface Cleaning and Disinfection: Efficacy Assessment of Four Chlorine Types Using Escherichia coli and the Ebola Surrogate Phi6. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:4624-4631. [PMID: 28294602 DOI: 10.1021/acs.est.6b06014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
In the 2014 West African Ebola outbreak, international organizations provided conflicting recommendations for disinfecting surfaces contaminated by uncontrolled patient spills. We compared the efficacy of four chlorine solutions (sodium hypochlorite, sodium dichloroisocyanurate, high-test hypochlorite, and generated hypochlorite) for disinfection of three surface types (stainless steel, heavy-duty tarp, and nitrile) with and without pre-cleaning practices (prewiping, covering, or both) and soil load. The test organisms were Escherichia coli and the Ebola surrogate Phi6. All tests achieved a minimum of 5.9 and 3.1 log removal in E. coli and Phi6, respectively. A 15 min exposure to 0.5% chlorine was sufficient to ensure <8 Phi6 plaque-forming unit (PFU)/cm2 in all tests. While chlorine types were equally efficacious with and without soil load, variation was seen by surface type. Wiping did not increase disinfection efficacy and is not recommended because it generates infectious waste. Covering spills decreased disinfection efficacy against E. coli on heavy-duty tarp but does prevent splashing, which is critical in Ebola contexts. Our results support the recommendation of a 15 min exposure to 0.5% chlorine, independently of chlorine type, surface, pre-cleaning practices, and organic matter, as an efficacious measure to interrupt disease transmission from uncontrolled spills in Ebola outbreaks.
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Affiliation(s)
- Karin Gallandat
- Department of Civil and Environmental Engineering, Tufts University , Medford, Massachusetts 02155, United States
| | - Marlene K Wolfe
- Department of Civil and Environmental Engineering, Tufts University , Medford, Massachusetts 02155, United States
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, Tufts University , Medford, Massachusetts 02155, United States
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Pacheco DADMRA, Rodrigues AAG, Silva CMLD. Ebola virus - from neglected threat to global emergency state. Rev Assoc Med Bras (1992) 2017; 62:458-67. [PMID: 27656857 DOI: 10.1590/1806-9282.62.05.458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 05/11/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This review aims to update knowledge about Ebola virus disease (EVD) and recent advances in its diagnosis, treatment and prevention. METHOD A literature review was performed using the following databases: ISI Web of Knowledge, PubMed, IRIS, Scopus and the websites of the CDC and the WHO. Additionally, we have included articles and reports referenced in the basic literature search, and news that were considered relevant. RESULTS The Ebola virus, endemic in some parts of Africa, is responsible for a severe form of hemorrhagic fever in humans; bats are probably its natural reservoir. It is an extremely virulent virus and easily transmitted by bodily fluids. EVD's complex pathophysiology, characterized by immunosuppression as well as stimulation of an intense inflammatory response, results in a syndrome similar to septic shock. The diagnosis is difficult due to the initial symptoms that mimic other diseases. Despite the high mortality rates that can amount to 90%, a prophylaxis (chemical or vaccine) or effective treatment does not exist. Two vaccines and experimental therapies are being developed for the prevention and treatment of EVD. CONCLUSION Although the virus is known for about 40 years, the lack of knowledge obtained and the disinterest of government authorities in the countries involved justify the state of emergency currently exists regarding this infectious agent. Only the coordination of multiple entities and the effective commitment of the international community will facilitate the control and effective prevention of EVD.
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Affiliation(s)
| | - Acácio Agostinho Gonçalves Rodrigues
- PhD - Director of the Department and Laboratory of Microbiology, Faculdade de Medicina, Universidade do Porto. MD, Department of Anesthesiology and Intensive Care, Burns Unit, Hospital de São João, Porto, Portugal
| | - Carmen Maria Lisboa da Silva
- PhD - Professor of the Department and Laboratory of Microbiology, Faculdade de Medicina, Universidade do Porto. MD, Department of Dermatovenereology, Hospital São João, Porto, Portugal
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Caswell RJ, Manavi K. Emerging sexually transmitted viral infections: 1. Review of Ebola virus disease. Int J STD AIDS 2017; 28:1352-1359. [PMID: 28399710 DOI: 10.1177/0956462417703572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is the first in a series of articles reviewing four viral infections, Ebola virus, Zika virus, human T-cell lymphotropic virus, type 1 and hepatitis C virus, with an emphasis on recent advances in our understanding of their sexual transmission. With current day speed and ease of travel it is important for staff in sexual healthcare services to know and understand these infections when patients present to them and also to be able to advise those travelling to endemic regions. Following the recent resurgence in West Africa, this first article looks at Ebola virus disease (EVD). EVD has a high mortality rate and, of note, has been detected in the semen of those who have cleared the virus from their blood and have clinically recovered from the disease. As the result of emerging data, the WHO now recommends safe sex practices for all male survivors of EVD for 12 months after the onset of the disease or after having had two consecutive negative tests of semen specimens for the virus. This review provides an up-to-date summary of what is currently known about EVD and its implications for sexual health practice.
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Affiliation(s)
- Rachel J Caswell
- Department of HIV and Genitourinary Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Kaveh Manavi
- Department of HIV and Genitourinary Medicine, Queen Elizabeth Hospital, Birmingham, UK
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Wolfe MK, Gallandat K, Daniels K, Desmarais AM, Scheinman P, Lantagne D. Handwashing and Ebola virus disease outbreaks: A randomized comparison of soap, hand sanitizer, and 0.05% chlorine solutions on the inactivation and removal of model organisms Phi6 and E. coli from hands and persistence in rinse water. PLoS One 2017; 12:e0172734. [PMID: 28231311 PMCID: PMC5322913 DOI: 10.1371/journal.pone.0172734] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/07/2017] [Indexed: 11/19/2022] Open
Abstract
To prevent Ebola transmission, frequent handwashing is recommended in Ebola Treatment Units and communities. However, little is known about which handwashing protocol is most efficacious. We evaluated six handwashing protocols (soap and water, alcohol-based hand sanitizer (ABHS), and 0.05% sodium dichloroisocyanurate, high-test hypochlorite, and stabilized and non-stabilized sodium hypochlorite solutions) for 1) efficacy of handwashing on the removal and inactivation of non-pathogenic model organisms and, 2) persistence of organisms in rinse water. Model organisms E. coli and bacteriophage Phi6 were used to evaluate handwashing with and without organic load added to simulate bodily fluids. Hands were inoculated with test organisms, washed, and rinsed using a glove juice method to retrieve remaining organisms. Impact was estimated by comparing the log reduction in organisms after handwashing to the log reduction without handwashing. Rinse water was collected to test for persistence of organisms. Handwashing resulted in a 1.94-3.01 log reduction in E. coli concentration without, and 2.18-3.34 with, soil load; and a 2.44-3.06 log reduction in Phi6 without, and 2.71-3.69 with, soil load. HTH performed most consistently well, with significantly greater log reductions than other handwashing protocols in three models. However, the magnitude of handwashing efficacy differences was small, suggesting protocols are similarly efficacious. Rinse water demonstrated a 0.28-4.77 log reduction in remaining E. coli without, and 0.21-4.49 with, soil load and a 1.26-2.02 log reduction in Phi6 without, and 1.30-2.20 with, soil load. Chlorine resulted in significantly less persistence of E. coli in both conditions and Phi6 without soil load in rinse water (p<0.001). Thus, chlorine-based methods may offer a benefit of reducing persistence in rinse water. We recommend responders use the most practical handwashing method to ensure hand hygiene in Ebola contexts, considering the potential benefit of chlorine-based methods in rinse water persistence.
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Affiliation(s)
- Marlene K. Wolfe
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Karin Gallandat
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Kyle Daniels
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Anne Marie Desmarais
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
| | - Pamela Scheinman
- Department of Dermatology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Daniele Lantagne
- Department of Civil and Environmental Engineering, Tufts University, Medford, Massachusetts, United States of America
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Bibby K, Fischer RJ, Casson LW, de Carvalho NA, Haas CN, Munster VJ. Disinfection of Ebola Virus in Sterilized Municipal Wastewater. PLoS Negl Trop Dis 2017; 11:e0005299. [PMID: 28146555 PMCID: PMC5287448 DOI: 10.1371/journal.pntd.0005299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 01/03/2017] [Indexed: 11/18/2022] Open
Abstract
Concerns have been raised regarding handling of Ebola virus contaminated wastewater, as well as the adequacy of proposed disinfection approaches. In the current study, we investigate the inactivation of Ebola virus in sterilized domestic wastewater utilizing sodium hypochlorite addition and pH adjustment. No viral inactivation was observed in the one-hour tests without sodium hypochlorite addition or pH adjustment. No virus was recovered after 20 seconds (i.e. 4.2 log10 unit inactivation to detection limit) following the addition of 5 and 10 mg L-1 sodium hypochlorite, which resulted in immediate free chlorine residuals of 0.52 and 1.11 mg L-1, respectively. The addition of 1 mg L-1 sodium hypochlorite resulted in an immediate free chlorine residual of 0.16 mg L-1, which inactivated 3.5 log10 units of Ebola virus in 20 seconds. Further inactivation was not evident due to the rapid consumption of the chlorine residual. Elevating the pH to 11.2 was found to significantly increase viral decay over ambient conditions. These results indicate the high susceptibility of the enveloped Ebola virus to disinfection in the presence of free chlorine in municipal wastewater; however, we caution that extension to more complex matrices (e.g. bodily fluids) will require additional verification.
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Affiliation(s)
- Kyle Bibby
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Robert J. Fischer
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States of America
| | - Leonard W. Casson
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Nathalia Aquino de Carvalho
- Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Charles N. Haas
- Department of Civil, Architectural & Environmental Engineering, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Vincent J. Munster
- Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States of America
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