Contact Tracing during an Outbreak of Ebola Virus Disease in the Western Area Districts of Sierra Leone: Lessons for Future Ebola Outbreak Response

Abstract

IntroductionContact tracing is a critical strategy required for timely prevention and control of Ebola virus disease (EVD) outbreaks. Available evidence suggests that poor contact tracing was a driver of the EVD outbreak in West Africa, including Sierra Leone. In this article, we answered the question as to whether EVD contact tracing, as practiced in Western Area (WA) districts of Sierra Leone from 2014 to 2015, was effective. The goal is to describe contact tracing and identify obstacles to its effective implementation.MethodsMixed methods comprising secondary data analysis of the EVD case and contact tracing data sets collected from WA during the period from 2014 to 2015, key informant interviews of contact tracers and their supervisors, and a review of available reports on contact tracing were implemented to obtain data for this study.ResultsDuring the study period, 3,838 confirmed cases and 32,706 contacts were listed in the viral hemorrhagic fever and contact databases for the district (mean 8.5 contacts per case). Only 22.1% (852) of the confirmed cases in the study area were listed as contacts at the onset of their illness, which indicates incomplete identification and tracing of contacts. Challenges associated with effective contact tracing included lack of community trust, concealing of exposure information, political interference with recruitment of tracers, inadequate training of contact tracers, and incomplete EVD case and contact database. While the tracers noted the usefulness of community quarantine in facilitating their work, they also reported delayed or irregular supply of basic needs, such as food and water, which created resistance from the communities.ConclusionMultiple gaps in contact tracing attributed to a variety of factors associated with implementers, and communities were identified as obstacles that impeded timely control of the EVD outbreak in the WA of Sierra Leone. In future outbreaks, early community engagement and participation in contact tracing, establishment of appropriate mechanisms for selection, adequate training and supervision of qualified contact tracers, establishment of a well-managed and complete contact tracing database, and provision of basic needs to quarantined contacts are recommended as measures to enhance effective contact tracing.

Feasibility of controlling 2019-nCoV outbreaks by isolation of cases and contacts

“…We therefore reported the weekly maximum number of cases undergoing contact tracing and isolation for each scenario that results in outbreak control. Once the weekly number of cases reaches a is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint certain point, it can overwhelm the contact tracing system and affect the quality of the contact tracing effort 32 .…”

Quality improvement of health systems in an epidemic context: A framework based on lessons from the Ebola virus disease outbreak in West Africa

“…Besides, staff was not trained in case recognition or contact tracing . Different strategies to improve the quality of the surveillance systems were implemented, such as training in active surveillance, documentation of cases, laboratory capacity, and even e‐health mechanisms . Also the experiences from other African countries showed the importance to improve and strengthen the surveillance system to control the EVD epidemic …”

“…Health emergencies are “as much a social as a health phenomenon” even more in poor settings. Therefore, one of the key steps necessary to improve an outbreak response is the local population's involvement including local healers, religious authorities, community health workers, and community leaders . Medical products and services should be adapted and/or accepted by local culture.…”

What Do We Know About Controlling Ebola Virus Disease Outbreaks?

“…14 In the Western Area of Sierra Leone, including the capital Freetown, more than 75% of new confirmed EVD cases were not listed as contacts at the start of their illness. 15 Confirmed cases in urban areas had twice as many listed contacts as those in rural areas, and contacts were more likely to be unrelated neighbours as opposed to family members, with direct implications on the ease and quality of contact tracing. Several applications have been developed to assist in contact tracing and were tested during the West African outbreak, for example, an updated version of free desktop epidemiologic software 16 or smartphone applications that use Global Positioning Systems.…”

“…They conclude that in future outbreaks, early community engagement and participation in contact tracing, establishment of appropriate mechanisms for selection, adequate training and supervision of qualified contact tracers, establishment of a well-managed and complete contact tracing database, and provision of basic needs to quarantined contacts are recommended as measures to enhance effective contact tracing. 15…”