Decreased Ebola Transmission after Rapid Response to Outbreaks in Remote Areas, Liberia, 2014

Lindblade, Kim A.; Kateh, Francis; Nagbe, Thomas; Neatherlin, John; Pillai, Satish K.; Attfield, Kathleen R.; Dweh, Emmanuel; Barradas, Danielle T.; Williams, Seymour; Blackley, David J.; Kirking, Hannah L.; Patel, Monita R.; Dea, Monica; Massoudi, Mehran S.; Wannemuehler, Kathleen; Barskey, Albert E.; Zarecki, Shauna L. Mettee; Fomba, Moses; Grube, Steven; Belcher, Lisa; Broyles, Laura N.; Maxwell, T. Nikki; Hagan, José E.; Yeoman, Kristin; Westercamp, Matthew; Forrester, Joseph D.; Mott, Joshua A.; Mahoney, Frank; Slutsker, Laurence; DeCock, Kevin M.; Nyenswah, Tolbert

doi:10.3201/eid2110.150912

Cited by 38 publications

(36 citation statements)

References 11 publications

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“…In a comparison of the effects of six outbreaks that occurred before the introduction of RITE and six that occurred afterward, the time between the first new case in remote areas and the notification of health authorities was reduced by nearly half, the proportion of patients isolated increased from 28% to 81%, survival improved from 13% to 50%, the case reproduction number fell below unity (the replacement rate), outbreaks became shorter (median duration declined from 53 to 25 days), and the number of generations of cases dropped from a median of four to two. 26,27 On their own, these observations made before and after the introduction of RITE do not provide the level of evidence afforded by a randomized trial, but they are consistent with the larger body of evidence on Ebola interventions.…”

Section: Effec T Of Interventionssupporting

confidence: 55%

“…22 Empirical evidence of the effect of rapid patient isolation and hospitalization comes from investigations of a series of small outbreaks in Liberia. [23][24][25][26][27] Twelve outbreaks were included in a study of the Rapid Isolation and Treatment of Ebola (RITE) strategy, applied between July and November 2014. RITE encourages active case finding and contact tracing and the use of practices that prevent infection when caring for the ill and burying the dead.…”

Section: Effec T Of Interventionsmentioning

confidence: 99%

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After Ebola in West Africa — Unpredictable Risks, Preventable Epidemics

Agua-Agum¹,

Allegranzi²,

Ariyarajah³

et al. 2016

N Engl J Med

228

111

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Section: Effec T Of Interventionssupporting

confidence: 55%

Section: Effec T Of Interventionsmentioning

confidence: 99%

After Ebola in West Africa — Unpredictable Risks, Preventable Epidemics

Agua-Agum¹,

Allegranzi²,

Ariyarajah³

et al. 2016

N Engl J Med

228

111

View full text Add to dashboard Cite

“…A study of 15 Ebola outbreaks in Liberia found R = 1.7; R was reduced to 0.1 after the implementation of immediate isolation or transfer of symptomatic persons to Ebola treatment units, contact identification and monitoring [8]. In this outbreak, all but five confirmed cases were transferred to the Ebola holding center or treatment unit, the time to transfer decreased, and contact identification improved over time.…”

Section: Discussionmentioning

confidence: 99%

The impact of active surveillance and health education on an Ebola virus disease cluster — Kono District, Sierra Leone, 2014–2015

et al. 2016

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BackgroundDuring December 2014–February 2015, an Ebola outbreak in a village in Kono district, Sierra Leone, began following unsafe funeral practices after the death of a person later confirmed to be infected with Ebola virus. In response, disease surveillance officers and community health workers, in collaboration with local leadership and international partners, conducted 1 day of active surveillance and health education for all households in the village followed by ongoing outreach. This study investigated the impact of these interventions on the outbreak.MethodsFifty confirmed Ebola cases were identified in the village between December 1, 2014 and February 28, 2015. Data from case investigations, treatment facility and laboratory records were analyzed to characterize the outbreak. The reproduction number (R) was estimated by fitting to the observed distribution of secondary cases. The impact of the active surveillance and health education was evaluated by comparing two outcomes before and after the day of the interventions: 1) the number of days from symptom onset to case-patient isolation or death and 2) a reported epidemiologic link to a prior Ebola case.ResultsThe case fatality ratio among the 50 confirmed Ebola cases was 64.0 %. Twenty-three cases occurred among females (46.0 %); the mean age was 39 years (median: 37 years; range: 5 months to 75 years). Forty-three (87.8 %) cases were linked to the index case; 30 (61.2 %) were either at the funeral of Patient 1 or had contact with him while he was ill. R was 0.93 (95 % CI: 0.15–2.3); excluding the funeral, R was 0.29 (95 % CI: 0.11–0.53). The mean number of days in the community after onset of Ebola symptoms decreased from 4.0 days (median: 3 days; 95 % CI: 3.2–4.7) before the interventions to 2.9 days (median: 2 days; 95 % CI: 1.6–4.3) afterward. An epidemiologic link was reported in 47.6 % of case investigations prior to and 100 % after the interventions.ConclusionsInitial case investigation and contact tracing were hindered by delayed reporting and under-reporting of symptomatic individuals from the community. Active surveillance and health education contributed to quicker identification of suspected cases, interrupting further transmission.

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“…The need for flexible, mobile, and rapid teams that could quickly reach new hot spots, conduct assessments, and implement early control measures was recognized, leading to development of the RITE strategy (11,12). RITE teams were deployed at the first report of new suspected outbreaks, and team members focused on village-level isolation and management of patients until safe referral to ETUs could be established.…”

Section: Liberiamentioning

confidence: 99%

“…Prefectural Ebola response teams continued to directly observe the contacts each day during the 21-day follow-up period to rapidly isolate newly symptomatic patients. This approach was partially adapted from the Rapid Isolation and Treatment of Ebola (RITE) strategy (11,12) in Liberia and the quarantine village approach from Sierra Leone. WHO declared Guinea free of Ebola transmission on December 29, 2015, after the last Ebola patient in Guinea was discharged from an ETU on November 16, 2015.…”

Section: Guineamentioning

confidence: 99%

CDC’s Response to the 2014–2016 Ebola Epidemic — Guinea, Liberia, and Sierra Leone

Dahl

Kinzer²,

Raghunathan³

et al. 2016

MMWR Suppl.

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Decreased Ebola Transmission after Rapid Response to Outbreaks in Remote Areas, Liberia, 2014

Abstract: Basic interventions and community acceptance can result in rapid control of outbreaks.

Cited by 38 publications

References 11 publications

After Ebola in West Africa — Unpredictable Risks, Preventable Epidemics

After Ebola in West Africa — Unpredictable Risks, Preventable Epidemics

The impact of active surveillance and health education on an Ebola virus disease cluster — Kono District, Sierra Leone, 2014–2015

CDC’s Response to the 2014–2016 Ebola Epidemic — Guinea, Liberia, and Sierra Leone

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