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Mercy K, Tibebu B, Fallah M, Faria NR, Ndembi N, Tebeje YK. Mpox continues to spread in Africa and threatens global health security. Nat Med 2024:10.1038/s41591-024-02862-6. [PMID: 38472296 DOI: 10.1038/s41591-024-02862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Affiliation(s)
- Kyeng Mercy
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Bethelhem Tibebu
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Mosoka Fallah
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Nuno R Faria
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Nicaise Ndembi
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia.
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2
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Frankfurter R, Malik M, Kpakiwa SD, McGinnis T, Malik MM, Chitre S, Barrie MB, Dibba Y, Mulalu L, Baldwinson R, Fallah M, Rashid I, Kelly JD, Richardson ET. Representations of an Ebola 'outbreak' through Story Technologies. BMJ Glob Health 2024; 9:e013210. [PMID: 38341190 PMCID: PMC10862337 DOI: 10.1136/bmjgh-2023-013210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/14/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Attempts to understand biosocial phenomena using scientific methods are often presented as value-neutral and objective; however, when used to reduce the complexity of open systems such as epidemics, these forms of inquiry necessarily entail normative considerations and are therefore fashioned by political worldviews (ideologies). From the standpoint of poststructural theory, the character of these representations is at most limited and partial. In addition, these modes of representation (as stories) do work (as technologies) in the service of, or in resistance to, power. METHODS We focus on a single Ebola case cluster from the 2013-2016 outbreak in West Africa and examine how different disciplinary forms of knowledge production (including outbreak forecasting, active epidemiological surveillance, post-outbreak serosurveys, political economic analyses, and ethnography) function as Story Technologies. We then explore how these technologies are used to curate 'data,' analysing the erasures, values, and imperatives evoked by each. RESULTS We call attention to the instrumental-in addition to the descriptive-role Story Technologies play in ordering contingencies and establishing relationships in the wake of health crises. DISCUSSION By connecting each type of knowledge production with the systems of power it reinforces or disrupts, we illustrate how Story Technologies do ideological work. These findings encourage research from pluriversal perspectives and advocacy for measures that promote more inclusive modes of knowledge production.
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Affiliation(s)
| | - Maya Malik
- School of Social Work, McGill University, Montreal, Québec, Canada
| | | | - Timothy McGinnis
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Momin M Malik
- Center for Digital Health, Mayo Clinic, Rochester, Minnesota, USA
| | - Smit Chitre
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Lulwama Mulalu
- McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Raquel Baldwinson
- Department of English Language and Literatures, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mosoka Fallah
- Africa Centres for Disease Control and Prevention, African Union, Addis Ababa, Ethiopia
| | - Ismail Rashid
- Department of History, Vassar College, Poughkeepsie, New York, USA
| | - J Daniel Kelly
- Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Eugene T Richardson
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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3
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Asoudeh F, Fallah M, Aminianfar A, Djafarian K, Shirzad N, Clark CCT, Larijani B, Esmaillzadeh A. Correction to: The effect of Mediterranean diet on inflammatory biomarkers and components of metabolic syndrome in adolescent girls. J Endocrinol Invest 2024; 47:257. [PMID: 37458932 DOI: 10.1007/s40618-023-02149-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- F Asoudeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - M Fallah
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - A Aminianfar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
- Research Center for Biochemistry and Nutrition in Metabolic Disease, Kashan University of Medical Sciences, Kashan, Iran
| | - K Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - N Shirzad
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - C C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - B Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - A Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran.
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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4
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Asoudeh F, Fallah M, Aminianfar A, Djafarian K, Shirzad N, Clark CCT, Larijani B, Esmaillzadeh A. The effect of Mediterranean diet on inflammatory biomarkers and components of metabolic syndrome in adolescent girls. J Endocrinol Invest 2023; 46:1995-2004. [PMID: 36795242 DOI: 10.1007/s40618-023-02027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/28/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND The prevalence of obesity and metabolic syndrome (MetS) during childhood and adolescence is rising significantly worldwide. Previous studies have shown that following a healthy dietary pattern, like the Mediterranean diet (MD), might be an efficacious approach for the prevention and management of MetS during childhood. In the present study, we aimed to examine the effect of MD on inflammatory markers and components of MetS among adolescent girls with MetS. METHODS This randomized controlled clinical trial was conducted on 70 girl adolescents with metabolic syndrome. Patients in the intervention group followed a prescribed MD, while participants in the control group received dietary advice according to the food pyramid. The length of intervention was 12 weeks. Participants' dietary intakes were evaluated using three 1-day food records throughout the study. Anthropometric measures, inflammatory markers, systolic and diastolic blood pressure, and hematological factors were assessed at the baseline and end of the trial. An intention-to-treat approach was taken into account for the statistical analysis. RESULTS After 12 weeks, participants in the intervention group had lower weight (Ptime*group ≤ 0/001), body mass index (BMI) (Ptime*group ≤ 0/001), and waist circumference (WC) (Ptime*group ≤ 0/001) compared with those in the control group. In addition, MD resulted in a significantly reduced systolic blood pressure compared to the those in the control group (Ptime*group ≤ 0/001). In terms of metabolic variables, MD led to a significant decrease in fasting blood glucose (FBS) (Ptime*group ≤ 0/001), triglycerides (TG) (Ptime*group ≤ 0/001), low-density lipoprotein (LDL) (Ptime*group ≤ 0/001), homeostatic model assessment of insulin resistance (HOMA-IR) (Ptime*group = 0/02) and a meaningful increase in serum levels of high-density lipoprotein (HDL) (Ptime*group ≤ 0/001). In addition, adherence to the MD resulted in a significant reduction in serum levels of inflammatory markers including Interleukin 6 (IL-6) (Ptime*group = 0/02) and high-sensitivity C-reactive protein (hs-CRP) (Ptime*group = 0/02). However, no significant effect was seen on serum levels of tumor necrosis factor α (TNF-α) (Ptime*group = 0/43). CONCLUSION Overall, the findings of the present study revealed that consumption of MD for 12 weeks resulted in a favorable effect on anthropometric measures, components of MetS, as well as on some inflammatory biomarkers.
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Affiliation(s)
- F Asoudeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - M Fallah
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
| | - A Aminianfar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran
- Research Center for Biochemistry and Nutrition in Metabolic Disease, Kashan University of Medical Sciences, Kashan, Iran
| | - K Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - N Shirzad
- Endocrinology and Metabolism Research Center, Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - C C T Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, UK
| | - B Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - A Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P.O. Box 14155-6117, Tehran, Iran.
- Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran.
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Drew C, Badio M, Dennis D, Hensley L, Higgs E, Sneller M, Fallah M, Reilly C. Simplifying the estimation of diagnostic testing accuracy over time for high specificity tests in the absence of a gold standard. Biometrics 2022. [PMID: 35531799 DOI: 10.1111/biom.13689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
Many different methods for evaluating diagnostic test results in the absence of a gold standard have been proposed. In this paper, we discuss how one common method, a maximum likelihood estimate for a latent class model found via the Expectation-Maximization (EM) algorithm can be applied to longitudinal data where test sensitivity changes over time. We also propose two simplified and nonparametric methods which use data-based indicator variables for disease status and compare their accuracy to the maximum likelihood estimation (MLE) results. We find that with high specificity tests, the performance of simpler approximations may be just as high as the MLE.
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Affiliation(s)
- Clara Drew
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Moses Badio
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Dehkontee Dennis
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Lisa Hensley
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia.,Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Elizabeth Higgs
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia.,Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Michael Sneller
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Mosoka Fallah
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia.,National Public Health Institute of Liberia, Monrovia, Liberia
| | - Cavan Reilly
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA.,Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
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Fallah M, Lavalah S, Gbelia T, Zondo M, Kromah M, Tantum L, Nallo G, Boakai J, Sheriff K, Skrip L, Ali SH. Contextualizing mobility during the Ebola epidemic in Liberia. PLoS Negl Trop Dis 2022; 16:e0010370. [PMID: 35442980 PMCID: PMC9060338 DOI: 10.1371/journal.pntd.0010370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/02/2022] [Accepted: 03/29/2022] [Indexed: 11/19/2022] Open
Abstract
Based on findings from focus groups and key informant interviews conducted at five sites in Liberia between 2018 and 2019, we explore some of the key factors that influenced people's motivation to travel during the 2014-2016 Ebola Virus Disease (EVD). We discuss how these factors led to certain mobility patterns and the implications these had for EVD response. The reasons for individual mobility during the epidemic were multiple and diverse. Some movements were related to relocation efforts as people attempted to extricate themselves from stigmatizing situations. Others were motivated by fear, convinced that other communities would be safer, particularly if extended family members resided there. Individuals also felt compelled to travel during the epidemic to meet other needs and obligations, such as attending burial rites. Some expressed concerns about obtaining food and earning a livelihood. Notably, these latter concerns served as an impetus to travel surreptitiously to evade quarantine directives aimed specifically at restricting mobility. Improvements in future infectious disease response could be made by incorporating contextually-based mobility factors, for example: the personalization of public health messaging through the recruitment of family members and trusted local leaders, to convey information that would help allay fear and combat stigmatization; activating existing traditional community surveillance systems in which entry into the community must first be approved by the community chief; and increased involvement of local leaders and community members in the provision of food and care to those quarantined so that the need to travel for these reasons is removed.
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Affiliation(s)
- Mosoka Fallah
- Community-Based Initiative for Disease Surveillance and Sustainable Development, Monrovia, Liberia
| | - Stephen Lavalah
- Community-Based Initiative for Disease Surveillance and Sustainable Development, Monrovia, Liberia
- Youth Exploring Solutions in Liberia, Monrovia, Liberia
| | - Tina Gbelia
- Community-Based Initiative for Disease Surveillance and Sustainable Development, Monrovia, Liberia
| | - Myers Zondo
- Community-Based Initiative for Disease Surveillance and Sustainable Development, Monrovia, Liberia
| | - Morris Kromah
- Community-Based Initiative for Disease Surveillance and Sustainable Development, Monrovia, Liberia
| | - Lucy Tantum
- Community-Based Initiative for Disease Surveillance and Sustainable Development, Monrovia, Liberia
| | - Gartee Nallo
- Community-Based Initiative for Disease Surveillance and Sustainable Development, Monrovia, Liberia
| | - Joseph Boakai
- Community-Based Initiative for Disease Surveillance and Sustainable Development, Monrovia, Liberia
| | - Kemoh Sheriff
- Community-Based Initiative for Disease Surveillance and Sustainable Development, Monrovia, Liberia
| | - Laura Skrip
- Community-Based Initiative for Disease Surveillance and Sustainable Development, Monrovia, Liberia
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Talbert-Slagle K, Koomson F, Candy N, Donato S, Whitney J, Plyler C, Allen N, Mourgkos G, Marsh RH, Kerr L, Wong R, Fallah M, Dahn B. Health Management Workforce Capacity-Building in Liberia, Post-Ebola. Ann Glob Health 2021; 87:100. [PMID: 34707980 PMCID: PMC8499719 DOI: 10.5334/aogh.3250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Following the Ebola crisis in Liberia in 2014-15, the Liberian Ministry of Health developed a strategy to build a fit-for-purpose health workforce, focusing on both health care providers and health managers. To help fulfill national capacity-building goals for health management, a team of faculty, staff, and practitioners from the Yale School of Medicine, the University of Liberia, the National Public Health Institute of Liberia, and the Ministry of Health collaboratively developed and launched the health management program in Liberia in July 2017. The team worked to build specific management and leadership competencies for healthcare workers serving in management and leadership roles in Liberia's health sector using two concurrent strategies-1) implementation of a hospital-based partnership-mentorship model in the two largest hospitals in the capital city of Monrovia, and 2) establishment of an executive education-style advanced Certificate in Health Systems Leadership and Management at the University of Liberia. Here we describe the health management program in Liberia, its focus, and its evolution from program launch in 2017 to the present, as well as ongoing efforts to transition program activities to local partner ownership by the end of 2021.
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Affiliation(s)
| | | | - Neima Candy
- National Public Health Institute of Liberia, University of Liberia College of Health Sciences, LR
| | | | | | | | | | | | | | - Lila Kerr
- Brigham and Women’s Hospital, Partners In Health, US
| | - Rex Wong
- Yale University, US
- University of Global Health Equity, RW
| | - Mosoka Fallah
- National Public Health Institute of Liberia, University of Liberia College of Health Sciences, LR
| | - Bernice Dahn
- University of Liberia College of Health Sciences, LR
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8
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Moses SJ, Wachekwa I, Van Ryn C, Grandits G, Pau A, Badio M, Kennedy SB, Sneller MC, Higgs ES, Lane HC, Fallah M, Migueles SA, Reilly C. The impact of the 2014 Ebola epidemic on HIV disease burden and outcomes in Liberia West Africa. PLoS One 2021; 16:e0257049. [PMID: 34506540 PMCID: PMC8432817 DOI: 10.1371/journal.pone.0257049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 08/11/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Detailed longitudinal studies of HIV-positive individuals in West Africa are lacking. Here the HIV prevalence, incidence, all-cause mortality, and the proportion of individuals receiving treatment with cART in two cohorts of participants in Ebola-related studies are described. SETTING Individuals of all ages were enrolled and followed at four sites in the area of Monrovia, Liberia. METHODS Two cohorts identified in response to the Ebola epidemic are described to provide insights into the current state of the HIV epidemic. HIV testing was performed at baseline for participants in both cohorts and during follow-up in one cohort. RESULTS Prevalence and incidence of HIV (prevalence of 3.1% for women and 1.4% for men and incidence of 3.3 per 1,000) were higher in these cohorts compared to 2018 national estimates (prevalence of 1.3% and incidence of 0.39 per 1,000). Most participants testing positive did not know their status prior to testing. Of those who knew they were HIV positive, 7.9% reported being on antiretroviral treatment. The death rate among those with HIV was 12.3% compared to 1.9% in HIV-negative individuals (adjusted odds ratio of 6.87). While higher levels of d-dimer were associated with increased mortality, this was not specific to those with HIV, however lower hemoglobin levels were associated with increased mortality among those with HIV. CONCLUSION These findings point to a need to perform further research studies aimed at fulfilling these knowledge gaps and address current shortcomings in the provision of care for those living with HIV in Liberia.
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Affiliation(s)
- Soka J. Moses
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Ian Wachekwa
- John F Kennedy Medical Center, Monrovia, Liberia
| | - Collin Van Ryn
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Greg Grandits
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Alice Pau
- National Institutes of Health, Bethesda, Maryland, United States of America
| | - Moses Badio
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Stephen B. Kennedy
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Michael C. Sneller
- National Institutes of Health, Bethesda, Maryland, United States of America
| | - Elizabeth S. Higgs
- National Institutes of Health, Bethesda, Maryland, United States of America
| | - H. Clifford Lane
- National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mosoka Fallah
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Cavan Reilly
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
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9
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Engelman D, Marks M, Steer AC, Beshah A, Biswas G, Chosidow O, Coffeng LE, Lardizabal Dofitas B, Enbiale W, Fallah M, Gasimov E, Hopkins A, Jacobson J, Kaldor JM, Ly F, Mackenzie CD, McVernon J, Parnaby M, Rainima-Qaniuci M, Sokana O, Sankara D, Yotsu R, Yajima A, Cantey PT. A framework for scabies control. PLoS Negl Trop Dis 2021; 15:e0009661. [PMID: 34473725 PMCID: PMC8412357 DOI: 10.1371/journal.pntd.0009661] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Scabies is a neglected tropical disease (NTD) that causes a significant health burden, particularly in disadvantaged communities and where there is overcrowding. There is emerging evidence that ivermectin-based mass drug administration (MDA) can reduce the prevalence of scabies in some settings, but evidence remains limited, and there are no formal guidelines to inform control efforts. An informal World Health Organization (WHO) consultation was organized to find agreement on strategies for global control. The consultation resulted in a framework for scabies control and recommendations for mapping of disease burden, delivery of interventions, and establishing monitoring and evaluation. Key operational research priorities were identified. This framework will allow countries to set control targets for scabies as part of national NTD strategic plans and develop control strategies using MDA for high-prevalence regions and outbreak situations. As further evidence and experience are collected and strategies are refined over time, formal guidelines can be developed. The control of scabies and the reduction of the health burden of scabies and associated conditions will be vital to achieving the targets set in WHO Roadmap for NTDs for 2021 to 2030 and the Sustainable Development Goals.
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Affiliation(s)
- Daniel Engelman
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
- Melbourne Children’s Global Health, Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- * E-mail:
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases, London, United Kingdom
| | - Andrew C. Steer
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
- Melbourne Children’s Global Health, Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Abate Beshah
- Communicable Diseases, Neglected Tropical Diseases, WHO Regional Office for Africa, Brazzaville, Congo
| | - Gautam Biswas
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Olivier Chosidow
- Faculté de Santé de Créteil et Service de Dermatologie, APHP, Hôpital Henri-Mondor, Université Paris-Est, Créteil, France
- Research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d’Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - Luc E. Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Belen Lardizabal Dofitas
- College of Medicine, University of the Philippines, Manila, Philippines
- Philippine Leprosy Mission, Inc., Manila, Philippines
| | - Wendemagegn Enbiale
- Department of Dermatovenerology, Bahir Dar University, Medicine and Health Science College, Addis Ababa, Ethiopia
- Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Mosoka Fallah
- University of Liberia, Monrovia, Liberia
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Elkhan Gasimov
- Division of Country Health Programmes, Malaria, Neglected Tropical Diseases and Other Vector-borne Diseases, WHO Regional Office for Europe, Copenhagen, Denmark
| | | | - Julie Jacobson
- Bridges to Development, Seattle, Washington, United States of America
| | - John M. Kaldor
- Public Health Interventions Research Group, Kirby Institute University of New South Wales, Sydney, Australia
| | - Fatimata Ly
- Dermatology Unit, EPS Institut d’Hygiéne Sociale de Dakar, Dakar, Senegal
- University Cheikh Anta Diop of Dakar, Dakar, Senegal
| | | | - Jodie McVernon
- Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Infection Modelling, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Matthew Parnaby
- Tropical Diseases, Murdoch Children’s Research Institute, Melbourne, Australia
- Melbourne Children’s Global Health, Royal Children’s Hospital, Melbourne, Australia
| | | | | | - Dieudonne Sankara
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Rie Yotsu
- Tulane School of Public Health and Tropical Medicine, New Orleans, United States of America
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Department of Dermatology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Aya Yajima
- Division of Communicable Diseases, Medicines, Vaccines and Pharmaceuticals, WHO Regional Office for the Western Pacific, Manila, Philippines
| | - Paul T. Cantey
- Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Former Medical Officer, Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
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10
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Bozman CM, Fallah M, Sneller MC, Freeman C, Fakoli LS, Shobayo BI, Dighero-Kemp B, Reilly CS, Kuhn JH, Bolay F, Higgs E, Hensley LE. Increased Likelihood of Detecting Ebola Virus RNA in Semen by Using Sample Pelleting. Emerg Infect Dis 2021; 27:1239-1241. [PMID: 33755000 PMCID: PMC8007310 DOI: 10.3201/eid2704.204175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Ebola virus RNA can reside for months or years in semen of survivors of Ebola virus disease and is probably associated with increased risk for cryptic sexual transmission of the virus. A modified protocol resulted in increased detection of Ebola virus RNA in semen and improved disease surveillance.
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Barker KM, Ling EJ, Fallah M, VanDeBogert B, Kodl Y, Macauley RJ, Viswanath K, Kruk ME. Community engagement for health system resilience: evidence from Liberia's Ebola epidemic. Health Policy Plan 2020; 35:416-423. [PMID: 32040166 DOI: 10.1093/heapol/czz174] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2019] [Indexed: 11/14/2022] Open
Abstract
The importance of community engagement (CE) for health system resilience is established in theoretical and empirical literature. The practical dimensions of how to operationalize theory and implement its principles have been less explored, especially within low-resource crisis settings. It is therefore unclear how CE is drawn upon and how, if at all, it facilitates health system resilience in times of health system crises. To address this critical gap, we adapt and apply existing theoretical CE frameworks to analyse qualitative data from 92 in-depth interviews and 16 focus group discussions collected with health system stakeholders in Liberia in the aftermath of the 2014-15 Ebola outbreak. Health system stakeholders indicated that CE was a crucial contributing factor in addressing the Ebola epidemic in Liberia. Multiple forms of CE were used during the outbreak; however, only some forms were perceived as meaningful, such as the formation of community-based surveillance teams. To achieve meaningful CE, participants recommended that communities be treated as active participants in-as opposed to passive recipients of-health response efforts and that communication platforms for CE be established ahead of a crisis. Participant responses highlight that meaningful CE led to improved communication with and increased trust in health authorities and programming. This facilitated health system response efforts, leading to a fortuitous cycle of increased trust, improved communication and continued meaningful CE-all necessary conditions for health system resilience. This study refines our understanding of CE and demonstrates the ways in which meaningful CE and trust work together in mutually reinforcing and beneficial ways. These findings provide empirical evidence on which to base policies and programmes aimed at improving health system resilience in low-resource settings to more effectively respond to health system crises.
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Affiliation(s)
- Kathryn M Barker
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, # 0507, San Diego, CA 92093, USA
| | - Emilia J Ling
- Department of Medicine, Stanford University School of Medicine, Medical School Office Building, Rm 328, 1265 Welch Rd, Stanford, CA 94305, USA
| | - Mosoka Fallah
- Community-Based Initiative, United Nations Development Programme and Ministry of Health.,A.M. Dogliotti College of Medicine, University of Liberia, P.O Box 10-9020, Capitol Hill, 1000 Monrovia 10, Liberia
| | - Brian VanDeBogert
- Catholic Relief Services, 228 W. Lexington St., Baltimore, MD 21201-3443, USA
| | - Yvonne Kodl
- International Rescue Committee, 1730 M St NW, Suite 505, Washington, DC 20009, USA
| | | | - K Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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12
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Walker SL, Collinson S, Timothy J, Zayzay SK, Kollie KK, Candy N, Lebas E, Halliday K, Pullan R, Fallah M, Marks M. A community-based validation of the International Alliance for the Control of Scabies Consensus Criteria by expert and non-expert examiners in Liberia. PLoS Negl Trop Dis 2020; 14:e0008717. [PMID: 33017426 PMCID: PMC7732067 DOI: 10.1371/journal.pntd.0008717] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/11/2020] [Accepted: 08/14/2020] [Indexed: 11/09/2022] Open
Abstract
Background The International Alliance for the Control of Scabies (IACS) recently published expert consensus criteria for scabies diagnosis. Formal validation of these criteria is needed to guide implementation. We conducted a study to provide detailed description of the morphology and distribution of scabies lesions as assessed by dermatologists and validate the IACS criteria for diagnosis by both expert and non-expert examiners. Methods Participants from a community in Monrovia, Liberia, were independently assessed by two dermatologists and six non-expert examiners. Lesion morphology and distribution were documented based on the dermatologist examination. Diagnoses were classified by IACS criteria and the sensitivity and specificity of non-expert examiner assessments calculated. Results Papules were the most common lesions (97.8%). Burrows were found in just under half (46.7%) and dermatoscopy was positive in a minority (13.3%). Scabies lesions were found in all body regions but more than 90% of patients could have been diagnosed by an examination of only the limbs. Severity of itch was associated with lesion number (p = 0.003). The sensitivity of non-expert examiners to detect typical scabies ranged between 69–83% and specificity 70–96%. The sensitivity of non-expert examiners was higher in more extensive disease (78–94%). Conclusions The IACS criteria proved a valid tool for scabies diagnosis. For the purposes of implementation papules and burrows represent truly ‘typical’ scabies lesions. Non-expert examiners are able to diagnose scabies with a high degree of accuracy, demonstrating they could form a key component in population-level control strategies. Scabies is a very common skin condition in both high- and low-income settings with hundreds of millions of people affected each year. Recently standardised criteria have been proposed to help improve the quality of scabies diagnosis, in particular in low income settings where the access to a skin specialist is very limited. In this study, conducted in Liberia, expert examiners conducted a thorough examination and recorded what different types of skin problems they found in participants with and without scabies. We then compared the accuracy of a diagnosis of scabies made by dermatologists to that made by non-specialist healthcare workers who had received a short training course over three days. We found that papules were the most common type of scabies lesion and were found in almost every single patient with scabies. A second type of skin lesion called a burrow was the next most common and was found in just under half of the participants. Other types of scabies lesions which have been described were rare in this study. We found that after the short training course the non-specialists were able to detect the majority of the cases of scabies correctly. Our study has helped provide detailed data on exactly what types of skin changes are typical of scabies and demonstrated how short training programmes can help improve the skill of non-specialist examiners in diagnosing scabies.
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Affiliation(s)
- Stephen L. Walker
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Hospital for Tropical Diseases and Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- * E-mail: (SLW); (MM)
| | - Shelui Collinson
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joseph Timothy
- Disease Control Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Neima Candy
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Eglantine Lebas
- Department of Dermatopathology, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Katherine Halliday
- Disease Control Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rachel Pullan
- Disease Control Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mosoka Fallah
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail: (SLW); (MM)
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13
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Kuhn JH, Adachi T, Adhikari NKJ, Arribas JR, Bah IE, Bausch DG, Bhadelia N, Borchert M, Brantsæter AB, Brett-Major DM, Burgess TH, Chertow DS, Chute CG, Cieslak TJ, Colebunders R, Crozier I, Davey RT, de Clerck H, Delgado R, Evans L, Fallah M, Fischer WA, Fletcher TE, Fowler RA, Grünewald T, Hall A, Hewlett A, Hoepelman AIM, Houlihan CF, Ippolito G, Jacob ST, Jacobs M, Jakob R, Jacquerioz FA, Kaiser L, Kalil AC, Kamara RF, Kapetshi J, Klenk HD, Kobinger G, Kortepeter MG, Kraft CS, Kratz T, Bosa HSK, Lado M, Lamontagne F, Lane HC, Lobel L, Lutwama J, Lyon GM, Massaquoi MBF, Massaquoi TA, Mehta AK, Makuma VM, Murthy S, Musoke TS, Muyembe-Tamfum JJ, Nakyeyune P, Nanclares C, Nanyunja M, Nsio-Mbeta J, O'Dempsey T, Pawęska JT, Peters CJ, Piot P, Rapp C, Renaud B, Ribner B, Sabeti PC, Schieffelin JS, Slenczka W, Soka MJ, Sprecher A, Strong J, Swanepoel R, Uyeki TM, van Herp M, Vetter P, Wohl DA, Wolf T, Wolz A, Wurie AH, Yoti Z. New filovirus disease classification and nomenclature. Nat Rev Microbiol 2020; 17:261-263. [PMID: 30926957 DOI: 10.1038/s41579-019-0187-4] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jens H Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick, MD, USA.
| | - Takuya Adachi
- Department of Infectious Diseases, Toshima Hospital, Tokyo, Japan
| | - Neill K J Adhikari
- Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Canada
| | - Jose R Arribas
- Internal Medicine Department, Infectious Diseases Unit Madrid, Hospital La Paz-Carlos III IdiPAZ, Madrid, Spain
| | | | | | | | - Matthias Borchert
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Arne Broch Brantsæter
- Division of Medicine, Department of Infectious Diseases and Norwegian National Unit for CBRNE Medicine, University of Oslo, Oslo, Norway
| | - David M Brett-Major
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Timothy H Burgess
- Department of Preventive Medicine and Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Daniel S Chertow
- Critical Care Medicine Department, Emerging Pathogens Section, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Christopher G Chute
- Schools of Medicine, Public Health, and Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Theodore J Cieslak
- Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, Omaha, NE, USA
| | | | - Ian Crozier
- Integrated Research Facility at Fort Detrick, Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research supported by the National Cancer Institute, Frederick, MD, USA
| | - Richard T Davey
- Clinical Research Section, Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Rafael Delgado
- Molecular Microbiology, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Laura Evans
- Division of Pulmonary and Critical Care Medicine, NYU Langone Medical Center, New York, NY, USA
| | | | - William A Fischer
- Department of Medicine, Division of Pulmonary Disease and Critical Care Medicine, Chapel Hill, NC, USA
| | - Tom E Fletcher
- Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool Institute of Translational Medicine and National Institute for Health Research, Liverpool, United Kingdom
| | - Robert A Fowler
- Departments of Medicine and Critical Care Medicine, Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Center, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Andy Hall
- King's Sierra Leone Partnership, King's Centre for Global Health, King's College London & King's Health Partners, London, UK
| | | | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Giuseppe Ippolito
- Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani" (National Institute for Infectious diseases "Lazzaro Spallanzani" - IRCCS), Rome, Italy
| | - Shevin T Jacob
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Michael Jacobs
- Department of Infection, Royal Free London NHS Foundation Trust, London, UK
| | | | - Frederique A Jacquerioz
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Center for Emerging Viral Diseases, Geneva, Switzerland
| | - Andre C Kalil
- University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Jimmy Kapetshi
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Hans-Dieter Klenk
- Institute of Virology, Philipps University of Marburg, Marburg an der Lahn, Hesse, Germany
| | - Gary Kobinger
- Department of Microbiology, Immunology and Infectious Diseases, Université Laval, Québec City, Québec, Canada
| | - Mark G Kortepeter
- Department of Epidemiology, University of Nebraska Medical Center, College of Public Health, Omaha, NE, USA
| | | | - Thomas Kratz
- Federal Information Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, Germany
| | - Henry S Kyobe Bosa
- College of Health Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Marta Lado
- Partners in Health (PIH), Freetown, Sierra Leone
| | | | - H Cliff Lane
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Leslie Lobel
- Shraga Segal Department of Microbiology, Immunology and Genetics, School of Pharmacy, Center for Emerging Diseases, Tropical Diseases and AIDS, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Julius Lutwama
- Uganda Virus Research Institute, Arbovirology Emerging and Re-emerging Diseases, Entebbe, Uganda
| | | | - Moses B F Massaquoi
- Sub-Regional Consortium on Ebola Vaccine and Therapeutic Trials, Clinton Health Access Initiative - Liberia, Boston, MA, USA
| | | | | | | | - Srinivas Murthy
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Jean-Jacques Muyembe-Tamfum
- Department of Microbiology, University of Kinshasa Medical School, Kinshasa, Democratic Republic of the Congo
| | - Phiona Nakyeyune
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Miriam Nanyunja
- Department of Communicable Diseases, World Health Organization, Kampala, Kampala District, Uganda
| | - Justus Nsio-Mbeta
- Direction Générale de Lutte contre la Maladie, Kinshasa, Democratic Republic of the Congo
| | - Tim O'Dempsey
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Janusz T Pawęska
- Center for Emerging, Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases of the National Health Laboratory Service, 2131, Sandringham-Johannesburg, Gauteng, South Africa
| | | | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Christophe Rapp
- Department of Infectious and Tropical Diseases, Bégin Military Teaching Hospital, Saint-Mande, France
| | - Bertrand Renaud
- Faculté de Médecine, Université de Paris Descartes, Paris, France
| | - Bruce Ribner
- Emory University School of Medicine, Atlanta, GA, USA
| | - Pardis C Sabeti
- Broad Institute of the Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | | | - Werner Slenczka
- Institute of Virology, Philipps University of Marburg, Marburg an der Lahn, Hesse, Germany
| | - Moses J Soka
- Partnership for Ebola Virus Disease Research in Liberia, Monrovia Medical Units ELWA-2 Hospital, Monrovia, Liberia
| | | | - James Strong
- Public Health Agency of Canada, Special Pathogens Program, Ottawa, Ontario, Canada
| | - Robert Swanepoel
- Vectors and Vector-Borne Diseases Research Programme, Department of Veterinary Tropical Diseases, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Pauline Vetter
- Geneva Center for Emerging Viral Diseases, Geneva, Switzerland
| | - David A Wohl
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Timo Wolf
- University Hospital, Frankfurt am Main, Germany
| | - Anja Wolz
- Médecins Sans Frontières, Brussels, Belgium
| | - Alie H Wurie
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Zabulon Yoti
- World Health Organization Regional Office for Africa, Brazzaville, Democratic Republic of the Congo
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14
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Mate SE, Wiley MR, Ladner JT, Dokubo EK, Fakoli L, Fallah M, Nyenswah TG, DiClaro JW, Deboer JT, Williams DE, Bolay F, Palacios G. Cross-Border Transmission of Ebola Virus as the Cause of a Resurgent Outbreak in Liberia in April 2016. Clin Infect Dis 2019; 67:1147-1149. [PMID: 29659740 DOI: 10.1093/cid/ciy281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Suzanne E Mate
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland
| | - Michael R Wiley
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland
| | - Jason T Ladner
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland
| | - E Kainne Dokubo
- US Centers for Disease Control and Prevention, Monrovia, Liberia.,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Mosoka Fallah
- Ministry of Health and Social Welfare, Monrovia, Liberia
| | | | | | - Jason T Deboer
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland
| | - Desmond E Williams
- US Centers for Disease Control and Prevention, Monrovia, Liberia.,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Fatorma Bolay
- Liberian Institute for Biomedical Research, Charlesville
| | - Gustavo Palacios
- Center for Genome Sciences, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, Maryland
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15
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Wiley MR, Fakoli L, Letizia AG, Welch SR, Ladner JT, Prieto K, Reyes D, Espy N, Chitty JA, Pratt CB, Di Paola N, Taweh F, Williams D, Saindon J, Davis WG, Patel K, Holland M, Negrón D, Ströher U, Nichol ST, Sozhamannan S, Rollin PE, Dogba J, Nyenswah T, Bolay F, Albariño CG, Fallah M, Palacios G. Lassa virus circulating in Liberia: a retrospective genomic characterisation. Lancet Infect Dis 2019; 19:1371-1378. [PMID: 31588039 DOI: 10.1016/s1473-3099(19)30486-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/28/2019] [Accepted: 07/18/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND An alarming rise in reported Lassa fever cases continues in west Africa. Liberia has the largest reported per capita incidence of Lassa fever cases in the region, but genomic information on the circulating strains is scarce. The aim of this study was to substantially increase the available pool of data to help foster the generation of targeted diagnostics and therapeutics. METHODS Clinical serum samples collected from 17 positive Lassa fever cases originating from Liberia (16 cases) and Guinea (one case) within the past decade were processed at the Liberian Institute for Biomedical Research using a targeted-enrichment sequencing approach, producing 17 near-complete genomes. An additional 17 Lassa virus sequences (two from Guinea, seven from Liberia, four from Nigeria, and four from Sierra Leone) were generated from viral stocks at the US Centers for Disease Control and Prevention (Atlanta, GA) from samples originating from the Mano River Union (Guinea, Liberia, and Sierra Leone) region and Nigeria. Sequences were compared with existing Lassa virus genomes and published Lassa virus assays. FINDINGS The 23 new Liberian Lassa virus genomes grouped within two clades (IV.A and IV.B) and were genetically divergent from those circulating elsewhere in west Africa. A time-calibrated phylogeographic analysis incorporating the new genomes suggests Liberia was the entry point of Lassa virus into the Mano River Union region and estimates the introduction to have occurred between 300-350 years ago. A high level of diversity exists between the Liberian Lassa virus genomes. Nucleotide percent difference between Liberian Lassa virus genomes ranged up to 27% in the L segment and 18% in the S segment. The commonly used Lassa Josiah-MGB assay was up to 25% divergent across the target sites when aligned to the Liberian Lassa virus genomes. INTERPRETATION The large amount of novel genomic diversity of Lassa virus observed in the Liberian cases emphasises the need to match deployed diagnostic capabilities with locally circulating strains and underscores the importance of evaluating cross-lineage protection in the development of vaccines and therapeutics. FUNDING Defense Biological Product Assurance Office of the US Department of Defense and the Armed Forces Health Surveillance Branch and its Global Emerging Infections Surveillance and Response Section.
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Affiliation(s)
- Michael R Wiley
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Lawrence Fakoli
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Andrew G Letizia
- Naval Medical Research Unit Three Ghana Detachment, Accra, Ghana
| | - Stephen R Welch
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jason T Ladner
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA; Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, AZ, USA
| | - Karla Prieto
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Daniel Reyes
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Nicole Espy
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Joseph A Chitty
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Catherine B Pratt
- Department of Environmental, Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Nicholas Di Paola
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA
| | - Fahn Taweh
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Desmond Williams
- US Centers for Disease Control and Prevention, Atlanta, GA, USA; US Centers for Disease Control and Prevention, Monrovia, Liberia
| | - Jon Saindon
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William G Davis
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ketan Patel
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Ute Ströher
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stuart T Nichol
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shanmuga Sozhamannan
- Defense Biological Product Assurance Office, Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense (CBRND)-Joint Project Lead, CBRND Enabling Biotechnologies, Frederick, MD, USA; Logistics Management Institute, Tysons, VA, USA
| | - Pierre E Rollin
- US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Dogba
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Fatorma Bolay
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | - Mosoka Fallah
- National Public Health Institute of Liberia, Monrovia, Liberia
| | - Gustavo Palacios
- Center for Genome Sciences, United States Army Medical Research Institute of Infectious Diseases, Frederick, MD, USA.
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16
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Fallah M, Burnham W. Dose response effects of the cannabinoids as anti-seizure drugs in amygdala kindled rats. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Fallah M, Tavakkoli-Moghaddam R, Alinaghian M, Salamatbakhsh-Varjovi A. A robust approach for a green periodic competitive VRP under uncertainty: DE and PSO algorithms. IFS 2019. [DOI: 10.3233/jifs-179323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. Fallah
- Department of Industrial Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - R. Tavakkoli-Moghaddam
- School of Industrial Engineering, College of Engineering, University of Tehran, Tehran, Iran
- Arts et Métiers ParisTech, LCFC, Metz, France
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - M. Alinaghian
- Department of Industrial and Systems Engineering, Isfahan University of Technology, Isfahan, Iran
| | - A. Salamatbakhsh-Varjovi
- Department of Industrial Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
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18
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Nagbe T, Williams GS, Rude JM, Flomo S, Yeabah T, Fallah M, Skrip L, Agbo C, Mahmoud N, Okeibunor JC, Yealue K, Talisuna A, Yahaya AA, Rajatonirina S, Clarke A, Hamblion E, Nyenswah T, Dahn B, Gasasira A, Fall IS. Lessons learned from detecting and responding to recurrent measles outbreak in Liberia post Ebola-Epidemic 2016-2017. Pan Afr Med J 2019; 33:7. [PMID: 31402966 PMCID: PMC6675928 DOI: 10.11604/pamj.supp.2019.33.2.17172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 04/15/2019] [Indexed: 12/04/2022] Open
Abstract
Introduction Measles is an acute viral disease that remains endemic in much of sub-Sahara Africa, including Liberia. The 2014 Ebola epidemic disrupted an already fragile health system contributing to low uptake of immunization services, population immunity remained low thus facilitating recurrent outbreaks of measles in Liberia. We describe lessons learnt from detecting and responding to recurrent outbreaks of measles two years post the 2014 Ebola epidemic in Liberia. Methods We conducted a descriptive study using the findings from Integrated Diseases Surveillance and Response (IDSR) 15 counties, National Public Health Institute of Liberia (NPHIL), National Public Health Reference Laboratory (NPHRL) and District Health Information Software (DIHS2) data conducted from October to December, 2017. We perused the outbreaks line lists and other key documents submitted by the counties to the national level from January 2016 to December 2017. Results From January 2016 to December 2017, 2,954 suspected cases of measles were reported through IDSR. Four hundred sixty-seven (467) were laboratory confirmed (IgM-positive), 776 epidemiologically linked, 574 clinically confirmed, and 1,137 discarded (IgM-negative). Nine deaths out of 1817 cases were reported, a case fatality rate of 0.5%; 49% were children below the age of 5 years. Twenty-two percent (405/1817) of the confirmed cases were vaccinated while the vaccination status of 55% (994/1817) was unknown. Conclusion Revitalization of IDSR contributed to increased detection and reporting of suspected cases of measles thus facilitating early identification and response to outbreaks. Priority needs to be given to increasing the uptake of routine immunization services, introducing a second dose of measles vaccine in the routine immunization program and conducting a high-quality supplementary measles immunization campaign for age group 1 to 10 years to provide protection for a huge cohort of susceptible.
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Affiliation(s)
- Thomas Nagbe
- National Public Health Institute, Monrovia, Liberia
| | | | | | - Sumor Flomo
- National Public Health Institute, Monrovia, Liberia
| | | | | | - Laura Skrip
- National Public Health Institute, Monrovia, Liberia
| | | | | | | | | | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | - Esther Hamblion
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | | | | | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Fallah M, Sohrabnezhad S. Study of synthesis of mordenite zeolite/MIL-101 (Cr) metal–organic framework compounds with various methods as bi-functional adsorbent. ADV POWDER TECHNOL 2019. [DOI: 10.1016/j.apt.2018.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Tian Y, Kharazmi E, Sundquist K, Sundquist J, Fallah M. PO-084 Familial risk of colorectal cancer in half-siblings similar to that in siblings. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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21
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Logue J, Tuznik K, Follmann D, Grandits G, Marchand J, Reilly C, Sarro YDS, Pettitt J, Stavale EJ, Fallah M, Olinger GG, Bolay FK, Hensley LE. Use of the Filovirus Animal Non-Clinical Group (FANG) Ebola virus immuno-assay requires fewer study participants to power a study than the Alpha Diagnostic International assay. J Virol Methods 2018; 255:84-90. [PMID: 29481881 PMCID: PMC5942582 DOI: 10.1016/j.jviromet.2018.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/26/2018] [Accepted: 02/21/2018] [Indexed: 11/19/2022]
Abstract
As part of the scientific community's development of medical countermeasures against Ebola virus disease, optimization of standardized assays for product evaluation is paramount. The recent outbreak heightened awareness to the scarcity of available assays and limited information on performance and reproducibility. To evaluate the immunogenicity of vaccines entering Phase I-III trials and to identify survivors, two enzyme-linked immunosorbent assays, the Filovirus Animal Non-Clinical Group assay and the Alpha Diagnostics International assay, were evaluated for detection of immunoglobulin G against Ebola virus glycoprotein. We found that the Filovirus Animal Nonclinical Group assay produced a wider range of relative antibody concentrations, higher assay precision, larger relative accuracy range, and lower regional background. Additionally, to sufficiently power a vaccine trial, use of the Filovirus Animal Nonclinical Group assay would require one third the number of participants than the Alpha Diagnostics International assay. This reduction in needed study participants will require less money, fewer man hours, and much less time to evaluate vaccine immunogenicity.
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Affiliation(s)
- James Logue
- Integrated Research Facility at Frederick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick MD, USA.
| | - Kaylie Tuznik
- Integrated Research Facility at Frederick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick MD, USA
| | - Dean Follmann
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Greg Grandits
- University of Minnesota, School of Public Health, Division of Biostatistics, Minneapolis, MN, USA
| | - Jonathan Marchand
- Integrated Research Facility at Frederick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick MD, USA
| | - Cavan Reilly
- University of Minnesota, School of Public Health, Division of Biostatistics, Minneapolis, MN, USA
| | - Yeya Dit Sadio Sarro
- University Clinical Research Center (UCRC) - SEREFO Laboratory, University of Sciences, Techniques and Technology of Bamako (USTTB), Bamako, Mali
| | - James Pettitt
- Integrated Research Facility at Frederick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick MD, USA
| | - Eric J Stavale
- Integrated Research Facility at Frederick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick MD, USA
| | | | - Gene G Olinger
- Integrated Research Facility at Frederick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick MD, USA
| | | | - Lisa E Hensley
- Integrated Research Facility at Frederick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Frederick MD, USA
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22
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Patel JC, George J, Vuong J, Potts CC, Bozio C, Clark TA, Thomas J, Schier J, Chang A, Waller JL, Diaz MH, Whaley M, Jenkins LT, Fuller S, Williams DE, Redd JT, Arthur RR, Taweh F, Vera Walker Y, Hardy P, Freeman M, Katawera V, Gwesa G, Gbanya MZ, Clement P, Kohar H, Stone M, Fallah M, Nyenswah T, Winchell JM, Wang X, McNamara LA, Dokubo EK, Fox LM. Rapid Laboratory Identification of Neisseria meningitidis Serogroup C as the Cause of an Outbreak - Liberia, 2017. MMWR Morb Mortal Wkly Rep 2017; 66:1144-1147. [PMID: 29073124 PMCID: PMC5689101 DOI: 10.15585/mmwr.mm6642a5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Gsell PS, Camacho A, Kucharski AJ, Watson CH, Bagayoko A, Nadlaou SD, Dean NE, Diallo A, Diallo A, Honora DA, Doumbia M, Enwere G, Higgs ES, Mauget T, Mory D, Riveros X, Oumar FT, Fallah M, Toure A, Vicari AS, Longini IM, Edmunds WJ, Henao-Restrepo AM, Kieny MP, Kéïta S. Ring vaccination with rVSV-ZEBOV under expanded access in response to an outbreak of Ebola virus disease in Guinea, 2016: an operational and vaccine safety report. Lancet Infect Dis 2017; 17:1276-1284. [PMID: 29033032 PMCID: PMC5700805 DOI: 10.1016/s1473-3099(17)30541-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/29/2017] [Accepted: 09/05/2017] [Indexed: 11/19/2022]
Abstract
Background In March, 2016, a flare-up of Ebola virus disease was reported in Guinea, and in response ring vaccination with the unlicensed rVSV-ZEBOV vaccine was introduced under expanded access, the first time that an Ebola vaccine has been used in an outbreak setting outside a clinical trial. Here we describe the safety of rVSV-ZEBOV candidate vaccine and operational feasibility of ring vaccination as a reactive strategy in a resource-limited rural setting. Methods Approval for expanded access and compassionate use was rapidly sought and obtained from relevant authorities. Vaccination teams and frozen vaccine were flown to the outbreak settings. Rings of contacts and contacts of contacts were defined and eligible individuals, who had given informed consent, were vaccinated and followed up for 21 days under good clinical practice conditions. Findings Between March 17 and April 21, 2016, 1510 individuals were vaccinated in four rings in Guinea, including 303 individuals aged between 6 years and 17 years and 307 front-line workers. It took 10 days to vaccinate the first participant following the confirmation of the first case of Ebola virus disease. No secondary cases of Ebola virus disease occurred among the vaccinees. Adverse events following vaccination were reported in 47 (17%) 6–17 year olds (all mild) and 412 (36%) adults (individuals older than 18 years; 98% were mild). Children reported fewer arthralgia events than adults (one [<1%] of 303 children vs 81 [7%] of 1207 adults). No severe vaccine-related adverse events were reported. Interpretation The results show that a ring vaccination strategy can be rapidly and safely implemented at scale in response to Ebola virus disease outbreaks in rural settings. Funding WHO, Gavi, and the World Food Programme.
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Affiliation(s)
| | - Anton Camacho
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Adam J Kucharski
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Conall H Watson
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Aminata Bagayoko
- World Health Organization Ebola Vaccine Trial and Compassionate Use Team, Conakry, Guinea
| | | | - Natalie E Dean
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Abdourahamane Diallo
- World Health Organization Ebola Vaccine Trial and Compassionate Use Team, Conakry, Guinea
| | - Abdourahmane Diallo
- World Health Organization Ebola Vaccine Trial and Compassionate Use Team, Conakry, Guinea
| | - Djidonou A Honora
- World Health Organization Ebola Vaccine Trial and Compassionate Use Team, Conakry, Guinea
| | - Moussa Doumbia
- Centre National d'Appui à la Lutte contre la Maladie, Bamako, Mali; World Health Organization Ebola Vaccine Trial and Compassionate Use Team, Conakry, Guinea
| | | | - Elizabeth S Higgs
- Division of Clinical Research, National Institute of Allergy and Infectious Disease, Bethesda, MD, USA
| | - Thomas Mauget
- World Health Organization Ebola Vaccine Trial and Compassionate Use Team, Conakry, Guinea
| | - Diakite Mory
- World Health Organization Ebola Vaccine Trial and Compassionate Use Team, Conakry, Guinea
| | | | - Fofana Thierno Oumar
- World Health Organization Ebola Vaccine Trial and Compassionate Use Team, Conakry, Guinea
| | - Mosoka Fallah
- National Public Health Institute of Health, Monrovia, Liberia
| | - Alhassane Toure
- World Health Organization Ebola Vaccine Trial and Compassionate Use Team, Conakry, Guinea
| | | | - Ira M Longini
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - W J Edmunds
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Sakoba Kéïta
- Ebola Response, Ministry of Health, Conakry, Guinea
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24
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Billioux B, Mith B, Bowen L, Schindler M, Azodi S, Ohayon J, Tarfeh-Burnette H, Dorbor J, Reilly C, Sneller M, Fallah M, Nath A. Longitudinal cohort study of neurological sequelae in ebola virus disease survivors in liberia. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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25
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Furuse Y, Fallah M, Oshitani H, Kituyi L, Mahmoud N, Musa E, Gasasira A, Nyenswah T, Dahn B, Bawo L. Analysis of patient data from laboratories during the Ebola virus disease outbreak in Liberia, April 2014 to March 2015. PLoS Negl Trop Dis 2017; 11:e0005804. [PMID: 28732038 PMCID: PMC5540615 DOI: 10.1371/journal.pntd.0005804] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/02/2017] [Accepted: 07/12/2017] [Indexed: 12/22/2022] Open
Abstract
An outbreak of Ebola virus disease (EVD) in Liberia began in March 2014 and ended in January 2016. Epidemiological information on the EVD cases was collected and managed nationally; however, collection and management of the data were challenging at the time because surveillance and reporting systems malfunctioned during the outbreak. EVD diagnostic laboratories, however, were able to register basic demographic and clinical information of patients more systematically. Here we present data on 16,370 laboratory samples that were tested between April 4, 2014 and March 29, 2015. A total of 10,536 traceable individuals were identified, of whom 3,897 were confirmed cases (positive for Ebola virus RNA). There were significant differences in sex, age, and place of residence between confirmed and suspected cases that tested negative for Ebola virus RNA. Age (young children and the elderly) and place of residence (rural areas) were the risk factors for death due to the disease. The case fatality rate of confirmed cases decreased from 80% to 63% during the study period. These findings may help support future investigations and lead to a fuller understanding of the outbreak in Liberia.
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Affiliation(s)
- Yuki Furuse
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Japan
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
| | - Mosoka Fallah
- Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Hitoshi Oshitani
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ling Kituyi
- United Nations Office at Nairobi, Nairobi, Kenya
| | | | | | | | | | - Bernice Dahn
- Ministry of Health and Social Welfare, Monrovia, Liberia
| | - Luke Bawo
- Ministry of Health and Social Welfare, Monrovia, Liberia
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26
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Pettitt J, Higgs E, Fallah M, Nason M, Stavale E, Marchand J, Reilly C, Jensen K, Dighero-Kemp B, Tuznik K, Logue J, Bolay F, Hensley L. Assessment and Optimization of the GeneXpert Diagnostic Platform for Detection of Ebola Virus RNA in Seminal Fluid. J Infect Dis 2017; 215:547-553. [PMID: 28003349 PMCID: PMC6075475 DOI: 10.1093/infdis/jiw599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 12/01/2016] [Indexed: 11/14/2022] Open
Abstract
Recent studies have suggested that Ebola virus (EBOV) ribonucleic acid (RNA) potentially present in the semen of a large number of survivors of Ebola virus disease (EVD) in Western Africa may contribute to sexual transmission of EVD and generate new clusters of cases in regions previously declared EVD-free. These findings drive the immediate need for a reliable, rapid, user-friendly assay for detection of EBOV RNA in semen that is deployable to multiple sites across Western Africa. In this study, we optimized the Xpert EBOV assay for semen samples by adding dithiothreitol. Compared to the assays currently in use in Liberia (including Ebola Zaire Target 1, major groove binder real-time-polymerase chain reaction assays, and original Xpert EBOV assay), the modified Xpert EBOV assay demonstrated greater sensitivity than the comparator assays. Thus, the modified Xpert EBOV assay is optimal for large-scale monitoring of EBOV RNA persistence in male survivors.
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Affiliation(s)
- James Pettitt
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Elizabeth Higgs
- Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | | | - Martha Nason
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, Bethesda, USA
| | - Eric Stavale
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Jonathan Marchand
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Cavan Reilly
- Division of Biostatistics, University of Minnesota School of Public Health, Minnesota, USA
| | - Kenneth Jensen
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Bonnie Dighero-Kemp
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Kaylie Tuznik
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - James Logue
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
| | - Fatorma Bolay
- Liberian Institute of Biomedical Research, Charlesville, Liberia
| | - Lisa Hensley
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, MD, USA
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Moon S, Leigh J, Woskie L, Checchi F, Dzau V, Fallah M, Fitzgerald G, Garrett L, Gostin L, Heymann DL, Katz R, Kickbusch I, Morrison JS, Piot P, Sands P, Sridhar D, Jha AK. Post-Ebola reforms: ample analysis, inadequate action. BMJ 2017; 356:j280. [PMID: 28115316 DOI: 10.1136/bmj.j280] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Suerie Moon
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Jennifer Leigh
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Liana Woskie
- Harvard Initiative on Global Health Quality, Cambridge, MA, USA
| | | | - Victor Dzau
- National Academy of Medicine, Washington, DC, USA
| | - Mosoka Fallah
- National Public Health Institute of Liberia, Monrovia, Liberia
| | | | | | - Lawrence Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | | | - Rebecca Katz
- Center for Global Health Science and Security, Washington, DC, USA
| | - Ilona Kickbusch
- Global Health Centre, Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - J Stephen Morrison
- Global Health Policy Center, Center for Strategic and International Studies, Washington, DC, USA
| | - Peter Piot
- London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Sands
- Mossavar Rahmani Center for Business, Cambridge, MA, USA
| | | | - Ashish K Jha
- Harvard Global Health Institute at Harvard University, Cambridge, MA, USA
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28
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Fallah F, Karimi A, Abdolghafoorian H, Mohammadzadeh A, Zahraei SM, Goudarzi H, Fallah M. Molecular analysis of the bacille Calmette-Guérin vaccine strain currently being used in Iran. Int J Tuberc Lung Dis 2017; 20:223-7. [PMID: 26792475 DOI: 10.5588/ijtld.15.0434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In developing countries, tuberculosis (TB) infection control remains a challenge. The bacille Calmette-Guérin (BCG) vaccine is the only effective vaccine available for TB control. Iran uses a local BCG vaccine strain with an unknown substrain. OBJECTIVE To investigate the molecular characteristics of the current BCG strain being used in Iran using comparative genomics of the evolutionarily late strains, including BCG vaccines Pasteur, BCG-Danish, BCG-Glaxo, BCG-Prague, BCG-Frappier, BCG-Connaught and BCG-Moreau. METHODS A total of 67 different vials of BCG vaccine were cultured. DNA was extracted using the modified cetrimonium bromide (CTAB) method, and multiplex polymerase chain reaction (PCR) was performed to determine four target genomic regions of difference (RD) 1, RD8, RD16 and SenX3-RegX3, and to see whether RD2 and RD14 were present. RESULTS Our results showed that all studied batches were Mycobacterium bovis; molecular analysis revealed that the Iranian vaccine strains possess RD8, RD16 and SenX3-RegX3 regions but not RD1, RD2 and RD14. All of the vaccine batches analysed were compatible with BCG-Pasteur 1173p2, the original strain. CONCLUSION All of the BCG strains studied were recognised as the BCG-Pasteur 1173p2 strain. No genetic diversity among stocks and ready-for-use vaccine vials were detected.
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Affiliation(s)
- F Fallah
- Paediatric Infections Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A Karimi
- Paediatric Infections Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - A Mohammadzadeh
- Department of Microbiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - S M Zahraei
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran
| | - H Goudarzi
- Department of Microbiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Fallah
- School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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29
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Abramowitz S, McKune SL, Fallah M, Monger J, Tehoungue K, Omidian PA. The Opposite of Denial: Social Learning at the Onset of the Ebola Emergency in Liberia. J Health Commun 2017; 22:59-65. [PMID: 28854129 DOI: 10.1080/10810730.2016.1209599] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study analyzes findings from a rapid-response community-based qualitative research initiative to study the content of Ebola-related communications and the transmission of Ebola-related behaviors and practices through mass media communications and social learning in Monrovia, Liberia during August-September 2014. Thirteen neighborhoods in the common Monrovia media market were studied to appraise the reach of health communications and outreach regarding Ebola prevention and response measures. A World Health Organization (WHO) research team collected data on social learning and Ebola knowledge, attitudes, and practices through focus group-based discussions and key informant interviews over a 14-day period to assess the spread of information during a period of rapidly escalating crisis. Findings show that during a 2-week period, Monrovia neighborhood residents demonstrated rapid changes in beliefs about the source of Ebola, modes of contagion, and infection prevention and control (IPC) practices, discarding incorrect information. Changes in practices tended to lag behind the acquisition of learning. Findings also show that many continued to support conspiracy theories even as correct information was acquired. The implications for community engagement are substantial: (1) Under conditions of accelerating mortality, communities rapidly assimilate health information and abandon incorrect information; (2) Behavior change is likely to lag behind changes in beliefs due to local physical, structural, sociocultural, and institutional constraints; (3) Reports of "resistance" in Monrovia during the Ebola response were overstated and based on a limited number of incidents, and failed to account for specific local conditions and constraints.
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Affiliation(s)
- Sharon Abramowitz
- a Department of Anthropology , Rutgers University , New Brunswick , New Jersey , USA
| | - Sarah Lindley McKune
- b Department of Epidemiology , University of Florida , Gainesville , Florida , USA
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30
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Fallah M. Ebola survivors: Insights on complications of EBV disease. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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31
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Agua-Agum J, Ariyarajah A, Aylward B, Bawo L, Bilivogui P, Blake IM, Brennan RJ, Cawthorne A, Cleary E, Clement P, Conteh R, Cori A, Dafae F, Dahl B, Dangou JM, Diallo B, Donnelly CA, Dorigatti I, Dye C, Eckmanns T, Fallah M, Ferguson NM, Fiebig L, Fraser C, Garske T, Gonzalez L, Hamblion E, Hamid N, Hersey S, Hinsley W, Jambei A, Jombart T, Kargbo D, Keita S, Kinzer M, George FK, Godefroy B, Gutierrez G, Kannangarage N, Mills HL, Moller T, Meijers S, Mohamed Y, Morgan O, Nedjati-Gilani G, Newton E, Nouvellet P, Nyenswah T, Perea W, Perkins D, Riley S, Rodier G, Rondy M, Sagrado M, Savulescu C, Schafer IJ, Schumacher D, Seyler T, Shah A, Van Kerkhove MD, Wesseh CS, Yoti Z. Exposure Patterns Driving Ebola Transmission in West Africa: A Retrospective Observational Study. PLoS Med 2016; 13:e1002170. [PMID: 27846234 PMCID: PMC5112802 DOI: 10.1371/journal.pmed.1002170] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/07/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The ongoing West African Ebola epidemic began in December 2013 in Guinea, probably from a single zoonotic introduction. As a result of ineffective initial control efforts, an Ebola outbreak of unprecedented scale emerged. As of 4 May 2015, it had resulted in more than 19,000 probable and confirmed Ebola cases, mainly in Guinea (3,529), Liberia (5,343), and Sierra Leone (10,746). Here, we present analyses of data collected during the outbreak identifying drivers of transmission and highlighting areas where control could be improved. METHODS AND FINDINGS Over 19,000 confirmed and probable Ebola cases were reported in West Africa by 4 May 2015. Individuals with confirmed or probable Ebola ("cases") were asked if they had exposure to other potential Ebola cases ("potential source contacts") in a funeral or non-funeral context prior to becoming ill. We performed retrospective analyses of a case line-list, collated from national databases of case investigation forms that have been reported to WHO. These analyses were initially performed to assist WHO's response during the epidemic, and have been updated for publication. We analysed data from 3,529 cases in Guinea, 5,343 in Liberia, and 10,746 in Sierra Leone; exposures were reported by 33% of cases. The proportion of cases reporting a funeral exposure decreased over time. We found a positive correlation (r = 0.35, p < 0.001) between this proportion in a given district for a given month and the within-district transmission intensity, quantified by the estimated reproduction number (R). We also found a negative correlation (r = -0.37, p < 0.001) between R and the district proportion of hospitalised cases admitted within ≤4 days of symptom onset. These two proportions were not correlated, suggesting that reduced funeral attendance and faster hospitalisation independently influenced local transmission intensity. We were able to identify 14% of potential source contacts as cases in the case line-list. Linking cases to the contacts who potentially infected them provided information on the transmission network. This revealed a high degree of heterogeneity in inferred transmissions, with only 20% of cases accounting for at least 73% of new infections, a phenomenon often called super-spreading. Multivariable regression models allowed us to identify predictors of being named as a potential source contact. These were similar for funeral and non-funeral contacts: severe symptoms, death, non-hospitalisation, older age, and travelling prior to symptom onset. Non-funeral exposures were strongly peaked around the death of the contact. There was evidence that hospitalisation reduced but did not eliminate onward exposures. We found that Ebola treatment units were better than other health care facilities at preventing exposure from hospitalised and deceased individuals. The principal limitation of our analysis is limited data quality, with cases not being entered into the database, cases not reporting exposures, or data being entered incorrectly (especially dates, and possible misclassifications). CONCLUSIONS Achieving elimination of Ebola is challenging, partly because of super-spreading. Safe funeral practices and fast hospitalisation contributed to the containment of this Ebola epidemic. Continued real-time data capture, reporting, and analysis are vital to track transmission patterns, inform resource deployment, and thus hasten and maintain elimination of the virus from the human population.
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Affiliation(s)
| | | | | | | | - Luke Bawo
- Ministry of Health, Monrovia, Liberia
| | | | - Isobel M. Blake
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | | | | | | | - Anne Cori
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Benjamin Dahl
- Centers for Disease Control and Prevention, Conakry, Guinea
| | | | | | - Christl A. Donnelly
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Ilaria Dorigatti
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Tim Eckmanns
- World Health Organization, Geneva, Switzerland
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Neil M. Ferguson
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Lena Fiebig
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Christophe Fraser
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Tini Garske
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | - Nuha Hamid
- World Health Organization, Monrovia, Liberia
| | - Sara Hersey
- Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Wes Hinsley
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Thibaut Jombart
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | - Michael Kinzer
- Centers for Disease Control and Prevention, Conakry, Guinea
| | | | | | | | | | - Harriet L. Mills
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- School of Veterinary Sciences, University of Bristol, Bristol, United Kingdom
| | - Thomas Moller
- European Centre for Disease Prevention and Control, Conakry, Guinea
| | | | | | - Oliver Morgan
- Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Gemma Nedjati-Gilani
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Pierre Nouvellet
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | | | - Steven Riley
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | | | | | - Ilana J. Schafer
- Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Dirk Schumacher
- World Health Organization, Geneva, Switzerland
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Anita Shah
- World Health Organization, Geneva, Switzerland
| | - Maria D. Van Kerkhove
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Zabulon Yoti
- World Health Organization, Freetown, Sierra Leone
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Nyenswah TG, Kateh F, Bawo L, Massaquoi M, Gbanyan M, Fallah M, Nagbe TK, Karsor KK, Wesseh CS, Sieh S, Gasasira A, Graaff P, Hensley L, Rosling H, Lo T, Pillai SK, Gupta N, Montgomery JM, Ransom RL, Williams D, Laney AS, Lindblade KA, Slutsker L, Telfer JL, Christie A, Mahoney F, De Cock KM. Ebola and Its Control in Liberia, 2014-2015. Emerg Infect Dis 2016; 22:169-77. [PMID: 26811980 PMCID: PMC4734504 DOI: 10.3201/eid2202.151456] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Several factors explain the successful response to the outbreak in this country. The severe epidemic of Ebola virus disease in Liberia started in March 2014. On May 9, 2015, the World Health Organization declared Liberia free of Ebola, 42 days after safe burial of the last known case-patient. However, another 6 cases occurred during June–July; on September 3, 2015, the country was again declared free of Ebola. Liberia had by then reported 10,672 cases of Ebola and 4,808 deaths, 37.0% and 42.6%, respectively, of the 28,103 cases and 11,290 deaths reported from the 3 countries that were heavily affected at that time. Essential components of the response included government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves. Priorities after the epidemic include surveillance in case of resurgence, restoration of health services, infection control in healthcare settings, and strengthening of basic public health systems.
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Fallah M, Heirany F. Evaluating the effect of family relations in the board of directors on profit management by applying "dechow and dichev" and "kothari" models. J Fundam and Appl Sci 2016. [DOI: 10.4314/jfas.v8i2s.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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McLean KE, Abramowitz SA, Ball JD, Monger J, Tehoungue K, McKune SL, Fallah M, Omidian PA. Community-based reports of morbidity, mortality, and health-seeking behaviours in four Monrovia communities during the West African Ebola epidemic. Glob Public Health 2016; 13:528-544. [PMID: 27463979 DOI: 10.1080/17441692.2016.1208262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The goal of this study was to assess morbidity, mortality, and health-seeking behaviours during the 2014 Ebola outbreak in Monrovia, Liberia. This study examined commonly reported symptoms of illness, pre-clinical diagnostic practices, typical healthcare-seeking strategies, and health resources available to populations, in order to identify salient needs and gaps in healthcare that would inform local emergency response efforts. Semi-structured interviews were conducted with household members in four Monrovia neighbourhoods. Researchers used a multi-stage cluster approach to recruit participants. Within 555 households sampled, 505 individuals were reported sick (69%) or recently sick (38%) or deceased (7%). Common self-diagnoses included malaria, hypertension, influenza, typhoid, and Ebola. The most cited health-seeking strategy was to purchase medications from the private sector. Respondents also obtained healthcare from community members known to have medical experience. Findings suggest that non-formal healthcare systems played an important role in managing morbidity during the West African Ebola virus disease (EVD) outbreak. Lay community members engaged in complex assessments of health symptoms and sought biomedical care at rates perhaps higher than anticipated during the response. This study highlights how informal networks of healthcare providers can play an important role in preventing and curbing future emerging disease outbreaks.
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Affiliation(s)
- Kristen E McLean
- a Department of Anthropology , Yale University , New Haven , CT , USA
| | - Sharon Alane Abramowitz
- b Department of Anthropology , Rutgers, The State University of New Jersey , East Brunswick , NJ , USA
| | - Jacob D Ball
- c Department of Epidemiology & Emerging Pathogens Institute , University of Florida , Gainesville , FL , USA
| | - Josephine Monger
- d United Nations Development Programme & Mother Patern College of Health Sciences (MPCHS) , Monrovia , Liberia
| | - Kodjo Tehoungue
- e World Health Organization & A. M. Dogliotti College of Medicine (AMDCM), University of Liberia , Monrovia , Liberia
| | - Sarah Lindley McKune
- f Department of Epidemiology, College of Public Health and Health Professions , University of Florida , Gainesville , FL , USA
| | - Mosoka Fallah
- g Emergency Operations Center, Ministry of Health , Partnership for Research on Ebola Virus in Liberia (PREVAIL) & A. M. Dogliotti College of Medicine (AMDCM), University of Liberia , Monrovia , Liberia
| | - Patricia A Omidian
- h Focusing Initiatives International, Chestnut Ridge , New York , NY , USA
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Luginaah IN, Kangmennaang J, Fallah M, Dahn B, Kateh F, Nyenswah T. Timing and utilization of antenatal care services in Liberia: Understanding the pre-Ebola epidemic context. Soc Sci Med 2016; 160:75-86. [DOI: 10.1016/j.socscimed.2016.05.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/08/2016] [Accepted: 05/10/2016] [Indexed: 02/02/2023]
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Blackley DJ, Wiley MR, Ladner JT, Fallah M, Lo T, Gilbert ML, Gregory C, D’ambrozio J, Coulter S, Mate S, Balogun Z, Kugelman J, Nwachukwu W, Prieto K, Yeiah A, Amegashie F, Kearney B, Wisniewski M, Saindon J, Schroth G, Fakoli L, Diclaro JW, Kuhn JH, Hensley LE, Jahrling PB, Ströher U, Nichol ST, Massaquoi M, Kateh F, Clement P, Gasasira A, Bolay F, Monroe SS, Rambaut A, Sanchez-Lockhart M, Scott Laney A, Nyenswah T, Christie A, Palacios G. Reduced evolutionary rate in reemerged Ebola virus transmission chains. Sci Adv 2016; 2:e1600378. [PMID: 27386513 PMCID: PMC4928956 DOI: 10.1126/sciadv.1600378] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 04/11/2016] [Indexed: 06/06/2023]
Abstract
On 29 June 2015, Liberia's respite from Ebola virus disease (EVD) was interrupted for the second time by a renewed outbreak ("flare-up") of seven confirmed cases. We demonstrate that, similar to the March 2015 flare-up associated with sexual transmission, this new flare-up was a reemergence of a Liberian transmission chain originating from a persistently infected source rather than a reintroduction from a reservoir or a neighboring country with active transmission. Although distinct, Ebola virus (EBOV) genomes from both flare-ups exhibit significantly low genetic divergence, indicating a reduced rate of EBOV evolution during persistent infection. Using this rate of change as a signature, we identified two additional EVD clusters that possibly arose from persistently infected sources. These findings highlight the risk of EVD flare-ups even after an outbreak is declared over.
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Affiliation(s)
| | - Michael R. Wiley
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | - Jason T. Ladner
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | | | - Terrence Lo
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Merle L. Gilbert
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | | | - Jonathan D’ambrozio
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | - Stewart Coulter
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Suzanne Mate
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | | | - Jeffrey Kugelman
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | | | - Karla Prieto
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | | | | | - Brian Kearney
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | - Meagan Wisniewski
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | - John Saindon
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Lawrence Fakoli
- Liberian Institute for Biomedical Research, Charlesville, Liberia
| | | | - Jens H. Kuhn
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD 21702, USA
| | - Lisa E. Hensley
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD 21702, USA
| | - Peter B. Jahrling
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, MD 21702, USA
| | - Ute Ströher
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Stuart T. Nichol
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | | | - Peter Clement
- World Health Organization, CH-1211 Geneva 27, Switzerland
| | - Alex Gasasira
- World Health Organization, CH-1211 Geneva 27, Switzerland
| | - Fatorma Bolay
- Liberian Institute for Biomedical Research, Charlesville, Liberia
| | | | - Andrew Rambaut
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh EH9 3FL, UK
- Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA
- Centre for Immunology, Infection and Evolution, University of Edinburgh, Edinburgh EH9 3FL, UK
| | - Mariano Sanchez-Lockhart
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
| | - A. Scott Laney
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Athalia Christie
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Gustavo Palacios
- U.S. Army Medical Research Institute of Infectious Diseases, Fort Detrick, Frederick, MD 21702, USA
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Fallah M, Dahn B, Nyenswah TG, Massaquoi M, Skrip LA, Yamin D, Mbah MN, Joe N, Freeman S, Harris T, Benson Z, Galvani AP. Interrupting Ebola Transmission in Liberia Through Community-Based Initiatives. Ann Intern Med 2016; 164:367-9. [PMID: 26746879 DOI: 10.7326/m15-1464] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Atkins KE, Pandey A, Wenzel NS, Skrip L, Yamin D, Nyenswah TG, Fallah M, Bawo L, Medlock J, Altice FL, Townsend J, Ndeffo-Mbah ML, Galvani AP. Retrospective Analysis of the 2014-2015 Ebola Epidemic in Liberia. Am J Trop Med Hyg 2016; 94:833-9. [PMID: 26928839 DOI: 10.4269/ajtmh.15-0328] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 12/09/2015] [Indexed: 12/22/2022] Open
Abstract
The 2014-2015 Ebola epidemic has been the most protracted and devastating in the history of the disease. To prevent future outbreaks on this scale, it is imperative to understand the reasons that led to eventual disease control. Here, we evaluated the shifts of Ebola dynamics at national and local scales during the epidemic in Liberia. We used a transmission model calibrated to epidemiological data between June 9 and December 31, 2014, to estimate the extent of community and hospital transmission. We found that despite varied local epidemic patterns, community transmission was reduced by 40-80% in all the counties analyzed. Our model suggests that the tapering of the epidemic was achieved through reductions in community transmission, rather than accumulation of immune individuals through asymptomatic infection and unreported cases. Although the times at which this transmission reduction occurred in the majority of the Liberian counties started before any large expansion in hospital capacity and the distribution of home protection kits, it remains difficult to associate the presence of interventions with reductions in Ebola incidence.
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Affiliation(s)
- Katherine E Atkins
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Abhishek Pandey
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Natasha S Wenzel
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Laura Skrip
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Dan Yamin
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Tolbert G Nyenswah
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Mosoka Fallah
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Luke Bawo
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Jan Medlock
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Frederick L Altice
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Jeffrey Townsend
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Martial L Ndeffo-Mbah
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Alison P Galvani
- Department of Infectious Disease Epidemiology, London School of Hygiene and Public Health, London, United Kingdom; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut; Ministry of Health and Social Welfare, Greater Monrovia, Liberia; Department of Biomedical Sciences, Oregon State University, Corvallis, Oregon; Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
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Moon S, Sridhar D, Pate MA, Jha AK, Clinton C, Delaunay S, Edwin V, Fallah M, Fidler DP, Garrett L, Goosby E, Gostin LO, Heymann DL, Lee K, Leung GM, Morrison JS, Saavedra J, Tanner M, Leigh JA, Hawkins B, Woskie LR, Piot P. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola. Lancet 2015; 386:2204-21. [PMID: 26615326 PMCID: PMC7137174 DOI: 10.1016/s0140-6736(15)00946-0] [Citation(s) in RCA: 255] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Suerie Moon
- Harvard Global Health Institute, Harvard University, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Harvard Kennedy School, Harvard University, Boston, MA, USA.
| | - Devi Sridhar
- University of Edinburgh Medical School, Edinburgh
| | | | - Ashish K Jha
- Harvard Global Health Institute, Harvard University, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Chelsea Clinton
- Bill, Hillary & Chelsea Clinton Foundation, New York, NY, USA
| | | | - Valnora Edwin
- Campaign for Good Governance, Freetown, Sierra Leone
| | - Mosoka Fallah
- Action Contre La Faim International, Monrovia, Liberia
| | - David P Fidler
- Indiana University Maurer School of Law, Bloomington, IN, USA
| | | | - Eric Goosby
- University of California, San Francisco, CA, USA
| | | | | | - Kelley Lee
- Simon Fraser University, Burnaby, BC, Canada
| | - Gabriel M Leung
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | | | - Marcel Tanner
- Swiss Tropical & Public Health Institute, Basel, Switzerland
| | - Jennifer A Leigh
- Harvard Global Health Institute, Harvard University, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | | | - Liana R Woskie
- Harvard Global Health Institute, Harvard University, Boston, MA, USA; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Peter Piot
- London School of Hygiene & Tropical Medicine, London, UK
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Fallah M, Kharazmi E, Pukkala E, Tretli S, Olsen JH, Tryggvadottir L, Sundquist K, Hemminki K. Familial risk of non-Hodgkin lymphoma by sex, relationship, age at diagnosis and histology: a joint study from five Nordic countries. Leukemia 2015; 30:373-8. [DOI: 10.1038/leu.2015.272] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/21/2015] [Accepted: 09/28/2015] [Indexed: 01/27/2023]
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Bawo L, Fallah M, Kateh F, Nagbe T, Clement P, Gasasira A, Mahmoud N, Musa E, Lo TQ, Pillai SK, Seeman S, Sunshine BJ, Weidle PJ, Nyensweh T. Elimination of Ebola Virus Transmission in Liberia - September 3, 2015. MMWR Morb Mortal Wkly Rep 2015; 64:979-80. [PMID: 26355323 DOI: 10.15585/mmwr.mm6435a5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Following 42 days since the last Ebola virus disease (Ebola) patient was discharged from a Liberian Ebola treatment unit (ETU), September 3, 2015, marks the second time in a 4-month period that the World Health Organization (WHO) has declared Liberia free of Ebola virus transmission (1). The first confirmed Ebola cases in West Africa were identified in southeastern Guinea on March 23, 2014, and within 1 week, cases were identified and confirmed in Liberia (1). Since then, Liberia has reported 5,036 confirmed and probable Ebola cases and 4,808 Ebola-related deaths. The epidemic in Liberia peaked in late summer and early fall of 2014, when more than 200 confirmed and probable cases were reported each week .
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Affiliation(s)
- Mosoka Fallah
- Ministry of Health and Social Welfare, 1000 Monrovia 10, Liberia; University of Liberia, Monrovia, Liberia.
| | - Laura A Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
| | | | - Alison P Galvani
- University of Liberia, Monrovia, Liberia; Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT, USA
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Fallah M, Shabanpor M, Zakerinia M, Ebrahimi S. Risk assessment of gas oil and kerosene contamination on some properties of silty clay soil. Environ Monit Assess 2015; 187:437. [PMID: 26085279 DOI: 10.1007/s10661-015-4633-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 05/21/2015] [Indexed: 06/04/2023]
Abstract
Soil and ground water resource pollution by petroleum compounds and chemical solvents has multiple negative environmental impacts. The aim of this research was to investigate the impacts of kerosene and gas oil pollutants on some physical and chemical properties, breakthrough curve (BTC), and water retention curve (SWRC) of silty clay soil during a 3-month period. Therefore, some water-saturated soils were artificially contaminated in the pulse condition inside some glassy cylinders by applying half and one pore volume of these pollutants, and then parametric investigations of the SWRC were performed using RETC software for Van Genukhten and Brooks-Corey equations in the various suctions and the soil properties were determined before and after pollution during 3 months. The results showed that gas oil and kerosene had a slight effect on soil pH and caused the cumulative enhancement in the soil respiration, increase in the bulk density and organic matter, and reduction in the soil porosity and electrical and saturated hydraulic conductivity. Furthermore, gas oil retention was significantly more than kerosene (almost 40%) in the soil. The survey of SWRC indicated that the contaminated soil samples had a little higher amount of moisture retention (just under 15% in most cases) compared to the unpolluted ones during this 3-month period. The parametric analysis of SWRC demonstrated an increase in the saturated water content, Θ s, from nearly 49% in the control sample to just under 53% in the polluted ones. Contaminants not only decreased the residual water content, Θ r, but also reduced the SWRC gradient, n, and amount of α parameter. The evaluation of both equations revealed more accurate prediction of SWRC's parameters by Van Genukhten compared to those of Brooks and Corey.
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Affiliation(s)
- M Fallah
- Faculty of Agriculture, Guilan University, Rasht, Iran,
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Babaei M, Fallah M, Sundquist K, Hemminki K. Histological concordance in familial central nervous system tumors: Evidence from nationwide Swedish Family-Cancer Database. Cancer Epidemiol 2015; 39:334-9. [DOI: 10.1016/j.canep.2015.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/02/2015] [Accepted: 03/05/2015] [Indexed: 01/03/2023]
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Narod SA, Kharazmi E, Fallah M, Sundquist K, Hemminki K. The risk of contralateral breast cancer in daughters of women with and without breast cancer. Clin Genet 2015; 89:332-5. [PMID: 25920602 DOI: 10.1111/cge.12604] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 04/24/2015] [Accepted: 04/24/2015] [Indexed: 11/27/2022]
Abstract
We aimed to estimate the 15-year and lifetime risks of contralateral breast cancer in breast cancer patients according to the age of diagnosis of the first cancer and the history of breast cancer in the mother. The risks of contralateral breast cancer were estimated for all 78,775 breast cancer patients in the Swedish Family-Cancer Database (age at diagnosis of first breast cancer <70 years). The risk of experiencing a contralateral breast cancer within 15 years of diagnosis was 8.4% [95% confidence interval (CI): 8.1-8.7%] for women with an unaffected mother, was 12% (95%CI: 11-13%) for a woman with a mother with unilateral breast cancer and was 13% (95%CI: 9.5-17%) for women with a mother with bilateral breast cancer. In early-onset diagnosed women (<50 years) with an unaffected mother, the risk of contralateral breast cancer until age 80 was 23% (95%CI: 20-26%) and for late-onset (50-69 years) diagnosed women it was 17% (95%CI: 14-21%). In a woman with a mother with an early-onset unilateral breast cancer, risk of contralateral breast cancer by age 80 was 35% (95%CI: 25-46%). Women with a mother with early-onset bilateral breast cancer had 31% (95%CI: 12-67%) lifetime risk of contralateral breast cancer. The risk of contralateral breast cancer is higher for daughters of breast cancer patients than for daughters of women without breast cancer. Maternal cancer history and age at onset of first breast cancer in women should be taken into account when counseling breast cancer patients about their risk of contralateral breast cancer.
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Affiliation(s)
- S A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - E Kharazmi
- Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - M Fallah
- Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - K Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.,Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - K Hemminki
- Division of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Nyenswah T, Fallah M, Sieh S, Kollie K, Badio M, Gray A, Dilah P, Shannon M, Duwor S, Ihekweazu C, Cordier-Lasalle T, Shinde SA, Hamblion E, Davies-Wayne G, Ratnesh M, Dye C, Yoder JS, McElroy P, Hoots B, Christie A, Vertefeuille J, Olsen SJ, Laney AS, Neal JJ, Navin TR, Coulter S, Pordell P, Lo T, Kinkade C, Mahoney F. Controlling the last known cluster of Ebola virus disease - Liberia, January-February 2015. MMWR Morb Mortal Wkly Rep 2015; 64:500-4. [PMID: 25974635 PMCID: PMC4584826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As one of the three West African countries highly affected by the 2014-2015 Ebola virus disease (Ebola) epidemic, Liberia reported approximately 10,000 cases. The Ebola epidemic in Liberia was marked by intense urban transmission, multiple community outbreaks with source cases occurring in patients coming from the urban areas, and outbreaks in health care facilities (HCFs). This report, based on data from routine case investigations and contact tracing, describes efforts to stop the last known chain of Ebola transmission in Liberia. The index patient became ill on December 29, 2014, and the last of 21 associated cases was in a patient admitted into an Ebola treatment unit (ETU) on February 18, 2015. The chain of transmission was stopped because of early detection of new cases; identification, monitoring, and support of contacts in acceptable settings; effective triage within the health care system; and rapid isolation of symptomatic contacts. In addition, a "sector" approach, which divided Montserrado County into geographic units, facilitated the ability of response teams to rapidly respond to community needs. In the final stages of the outbreak, intensive coordination among partners and engagement of community leaders were needed to stop transmission in densely populated Montserrado County. A companion report describes the efforts to enhance infection prevention and control efforts in HCFs. After February 19, no additional clusters of Ebola cases have been detected in Liberia. On May 9, the World Health Organization declared the end of the Ebola outbreak in Liberia.
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Affiliation(s)
| | | | - Sonpon Sieh
- Ministry of Health and Social Welfare, Liberia
| | | | - Moses Badio
- Ministry of Health and Social Welfare, Liberia
| | - Alvin Gray
- Ministry of Health and Social Welfare, Liberia
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Nyenswah T, Massaquoi M, Gbanya MZ, Fallah M, Amegashie F, Kenta A, Johnson KL, Yahya D, Badini M, Soro L, Pessoa-Silva CL, Roger I, Selvey L, VanderEnde K, Murphy M, Cooley LA, Olsen SJ, Christie A, Vertefeuille J, Navin T, McElroy P, Park BJ, Esswein E, Fagan R, Mahoney F. Initiation of a ring approach to infection prevention and control at non-Ebola health care facilities - Liberia, January-February 2015. MMWR Morb Mortal Wkly Rep 2015; 64:505-8. [PMID: 25974636 PMCID: PMC4584827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
From mid-January to mid-February 2015, all confirmed Ebola virus disease (Ebola) cases that occurred in Liberia were epidemiologically linked to a single index patient from the St. Paul Bridge area of Montserrado County. Of the 22 confirmed patients in this cluster, eight (36%) sought and received care from at least one of 10 non-Ebola health care facilities (HCFs), including clinics and hospitals in Montserrado and Margibi counties, before admission to an Ebola treatment unit. After recognition that three patients in this emerging cluster had received care from a non-Ebola treatment unit, and in response to the risk for Ebola transmission in non-Ebola treatment unit health care settings, a focused infection prevention and control (IPC) rapid response effort for the immediate area was developed to target facilities at increased risk for exposure to a person with Ebola (Ring IPC). The Ring IPC approach, which provided rapid, intensive, and short-term IPC support to HCFs in areas of active Ebola transmission, was an addition to Liberia's proposed longer term national IPC strategy, which focused on providing a comprehensive package of IPC training and support to all HCFs in the country. This report describes possible health care worker exposures to the cluster's eight patients who sought care from an HCF and implementation of the Ring IPC approach. On May 9, 2015, the World Health Organization (WHO) declared the end of the Ebola outbreak in Liberia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Kristin VanderEnde
- CDC,Epidemic Intelligence Service,Corresponding author: Kristin VanderEnde,
| | | | | | | | | | | | | | | | | | - Eric Esswein
- National Institute for Occupational Safety and Health, CDC,University of Witwatersrand
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Abramowitz SA, McLean KE, McKune SL, Bardosh KL, Fallah M, Monger J, Tehoungue K, Omidian PA. Correction: Community-centered responses to Ebola in urban Liberia: the view from below. PLoS Negl Trop Dis 2015; 9:e0003767. [PMID: 25951327 PMCID: PMC4423831 DOI: 10.1371/journal.pntd.0003767] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Wells C, Yamin D, Ndeffo-Mbah ML, Wenzel N, Gaffney SG, Townsend JP, Meyers LA, Fallah M, Nyenswah TG, Altice FL, Atkins KE, Galvani AP. Harnessing case isolation and ring vaccination to control Ebola. PLoS Negl Trop Dis 2015; 9:e0003794. [PMID: 26024528 PMCID: PMC4449200 DOI: 10.1371/journal.pntd.0003794] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 04/28/2015] [Indexed: 01/08/2023] Open
Abstract
As a devastating Ebola outbreak in West Africa continues, non-pharmaceutical control measures including contact tracing, quarantine, and case isolation are being implemented. In addition, public health agencies are scaling up efforts to test and deploy candidate vaccines. Given the experimental nature and limited initial supplies of vaccines, a mass vaccination campaign might not be feasible. However, ring vaccination of likely case contacts could provide an effective alternative in distributing the vaccine. To evaluate ring vaccination as a strategy for eliminating Ebola, we developed a pair approximation model of Ebola transmission, parameterized by confirmed incidence data from June 2014 to January 2015 in Liberia and Sierra Leone. Our results suggest that if a combined intervention of case isolation and ring vaccination had been initiated in the early fall of 2014, up to an additional 126 cases in Liberia and 560 cases in Sierra Leone could have been averted beyond case isolation alone. The marginal benefit of ring vaccination is predicted to be greatest in settings where there are more contacts per individual, greater clustering among individuals, when contact tracing has low efficacy or vaccination confers post-exposure protection. In such settings, ring vaccination can avert up to an additional 8% of Ebola cases. Accordingly, ring vaccination is predicted to offer a moderately beneficial supplement to ongoing non-pharmaceutical Ebola control efforts.
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Affiliation(s)
- Chad Wells
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America,
| | - Dan Yamin
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America,
| | - Martial L. Ndeffo-Mbah
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America,
| | - Natasha Wenzel
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America,
| | - Stephen G. Gaffney
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America,
| | - Jeffrey P. Townsend
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, United States of America,
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, United States of America,
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, United States of America,
| | - Lauren Ancel Meyers
- Department of Integrative Biology, University of Texas at Austin, Austin, Texas, United States of America,
- Santa Fe Institute, Santa Fe, New Mexico, United States of America,
| | - Mosoka Fallah
- Ministry of Health and Social Welfare, Monrovia, Liberia,
| | | | - Frederick L. Altice
- Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, United States of America,
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America,
| | - Katherine E. Atkins
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America,
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, Connecticut, United States of America,
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, United States of America,
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, United States of America,
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America,
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Abramowitz SA, McLean KE, McKune SL, Bardosh KL, Fallah M, Monger J, Tehoungue K, Omidian PA. Community-centered responses to Ebola in urban Liberia: the view from below. PLoS Negl Trop Dis 2015; 9:e0003706. [PMID: 25856072 PMCID: PMC4391876 DOI: 10.1371/journal.pntd.0003706] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 03/16/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The West African Ebola epidemic has demonstrated that the existing range of medical and epidemiological responses to emerging disease outbreaks is insufficient, especially in post-conflict contexts with exceedingly poor healthcare infrastructures. In this context, community-based responses have proven vital for containing Ebola virus disease (EVD) and shifting the epidemic curve. Despite a surge in interest in local innovations that effectively contained the epidemic, the mechanisms for community-based response remain unclear. This study provides baseline information on community-based epidemic control priorities and identifies innovative local strategies for containing EVD in Liberia. METHODOLOGY/PRINCIPAL FINDINGS This study was conducted in September 2014 in 15 communities in Monrovia and Montserrado County, Liberia--one of the epicenters of the Ebola outbreak. Findings from 15 focus group discussions with 386 community leaders identified strategies being undertaken and recommendations for what a community-based response to Ebola should look like under then-existing conditions. Data were collected on the following topics: prevention, surveillance, care-giving, community-based treatment and support, networks and hotlines, response teams, Ebola treatment units (ETUs) and hospitals, the management of corpses, quarantine and isolation, orphans, memorialization, and the need for community-based training and education. Findings have been presented as community-based strategies and recommendations for (1) prevention, (2) treatment and response, and (3) community sequelae and recovery. Several models for community-based management of the current Ebola outbreak were proposed. Additional findings indicate positive attitudes towards early Ebola survivors, and the need for community-based psychosocial support. CONCLUSIONS/SIGNIFICANCE Local communities' strategies and recommendations give insight into how urban Liberian communities contained the EVD outbreak while navigating the systemic failures of the initial state and international response. Communities in urban Liberia adapted to the epidemic using multiple coping strategies. In the absence of health, infrastructural and material supports, local people engaged in self-reliance in order to contain the epidemic at the micro-social level. These innovations were regarded as necessary, but as less desirable than a well-supported health-systems based response; and were seen as involving considerable individual, social, and public health costs, including heightened vulnerability to infection.
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Affiliation(s)
- Sharon Alane Abramowitz
- Department of Anthropology & Center for African Studies, University of Florida, Gainesville, Florida, United States of America
| | - Kristen E. McLean
- Department of Anthropology, Yale University, New Haven, Connecticut, United States of America
| | - Sarah Lindley McKune
- Department of Epidemiology & College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America
| | - Kevin Louis Bardosh
- Centre for Infectious Disease, The University of Edinburgh, Edinburgh, United Kingdom
- Emerging Pathogens Institute, Gainesville, Florida, United States of America
| | - Mosoka Fallah
- Ebola Emergency-Response Program, Action Contre la Faim (ACF), Monrovia, Liberia
| | - Josephine Monger
- Ebola Emergency-Response Program, Action Contre la Faim (ACF), Monrovia, Liberia
| | - Kodjo Tehoungue
- Ebola Emergency-Response Program, Action Contre la Faim (ACF), Monrovia, Liberia
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