Establishment of an Ebola Treatment Unit and Laboratory — Bombali District, Sierra Leone, July 2014–January 2015

Abstract

The first confirmed case of Ebola virus disease (Ebola) in Sierra Leone related to the ongoing epidemic in West Africa occurred in May 2014, and the outbreak quickly spread. To date, 8,704 Ebola cases and 3,955 Ebola deaths have been confirmed in Sierra Leone. The first Ebola treatment units (ETUs) in Sierra Leone were established in the eastern districts of Kenema and Kailahun, where the first Ebola cases were detected, and these districts were also the first to control the epidemic. By September and October 2014, districts in the western and northern provinces, including Bombali, had the highest case counts, but additional ETUs outside of the eastern province were not operational for weeks to months. Bombali became one of the most heavily affected districts in Sierra Leone, with 873 confirmed patients with Ebola during July-November 2014. The first ETU and laboratory in Bombali District were established in late November and early December 2014, respectively. T- evaluate the impact of the first ETU and laboratory becoming operational in Bombali on outbreak control, the Bombali Ebola surveillance team assessed epidemiologic indicators before and after the establishment of the first ETU and laboratory in Bombali. After the establishment of the ETU and laboratory, the interval from symptom onset to laboratory result and from specimen collection to laboratory result decreased. By providing treatment to Ebola patients and isolating contagious persons to halt ongoing community transmission, ETUs play a critical role in breaking chains of transmission and preventing uncontrolled spread of Ebola (4). Prioritizing and expediting the establishment of an ETU and laboratory by pre-positioning resources needed to provide capacity for isolation, testing, and treatment of Ebola are essential aspects of pre-outbreak planning.

Fears and Misperceptions of the Ebola Response System during the 2014-2015 Outbreak in Sierra Leone

“…Participants in our study reported reluctance to call the national hotline if they had a fever because they were afraid they would not return alive. Participants reported seeing many deaths at the beginning of the epidemic which provided the rationale for these fears, as did the high Ebola-related fatality rate in 2014 in Sierra Leone [ 22 , 27 ]. Although Ebola treatment and surveillance capacity had increased greatly by the time of our research [ 6 ], participants’ early impressions likely remained salient in their attitudes towards accessing the response system.…”

Phylodynamic Analysis of Ebola Virus Disease Transmission in Sierra Leone

“…Interestingly, very little transmission seemingly occurred between these two neighboring districts (Figure 2). Although the first laboratory confirmed case of EVD in Bombali was detected in July 2014, a dedicated laboratory and Ebola Treatment Unit was only established in the district in December 2014 [24]. Prior to this, patient samples were being tested by laboratories in other districts of SLE.…”

WASH activities at two Ebola treatment units in Sierra Leone

“…Like other infectious disease interventions, EVD outbreak interventions require efficiently designed and operated treatment facilities in order to ensure a low risk of nosocomial infection and easy to maintain monitoring WASH/IPC practices. [ 11 ] Our study highlights parameters that are key in designing and managing a treatment facility for future infectious disease outbreaks in resource-limited settings.…”