Filovirus Outbreak Detection and Surveillance: Lessons From Bundibugyo

Abstract

The first outbreak of Ebola hemorrhagic fever (EHF) due to Bundibugyo ebolavirus occurred in Uganda from August to December 2007. During outbreak response and assessment, we identified 131 EHF cases (44 suspect, 31 probable, and 56 confirmed). Consistent with previous large filovirus outbreaks, a long temporal lag (approximately 3 months) occurred between initial EHF cases and the subsequent identification of Ebola virus and outbreak response, which allowed for prolonged person-to-person transmission of the virus. Although effective control measures for filovirus outbreaks, such as patient isolation and contact tracing, are well established, our observations from the Bundibugyo EHF outbreak demonstrate the need for improved filovirus surveillance, reporting, and diagnostics, in endemic locations in Africa.

Diagnostic schemes for reducing epidemic size of african viral hemorrhagic fever outbreaks

“…Protecting health workers also ensures that there will be sufficient personnel to maintain infection control and attend to patients in on-going as well as future epidemics [15,42]. This intervention can also bring other benefits, including improved health worker morale, which would be valuable because African health workers have been justifiably reluctant to serve in some hemorrhagic viral outbreaks [16], and increased confidence in the allopathic health care systems as access to them, and their affordability, increases [15,21,35,43].…”

“…As most in-patients in often overcrowded, under-resourced and understaffed hospitals in equatorial Africa have a fever of infectious origin, highest-level barrier precautions cannot feasibly be implemented, nor do most common infections require them. Notwithstanding, appropriate barrier practices can be, and have been, rapidly instituted in African hospitals during hemorrhagic fever outbreaks [16][17][18][19], and have led to rapid abatement of all documented Ebola and Marburg outbreaks [20,21].…”

Ebola virus – from neglected threat to global emergency state

“…13 The index case in the outbreaks is often not identified, but typically starts with one or a few cases of zoonotic transmission, which subsequently extends through intra-familiar transmission chains and is associated with health units (nosocomial). 20,21 On March 23, 2014 the WHO announced a new Ebola outbreak, caused by the ZEBOV species. It began at FIGURE 1 Chronology of Ebola outbreaks.…”

“…This results in the preservation of a person-person transmission chain in the community and in hospitals. 21 penetrate the body through mucosa, skin abrasions or accidental injections. 30 Several pathophysiological mechanisms explain how the infection caused by the Ebola virus causes severe hemorrhagic fever.…”

How Prepared is Cameroon in the Wake of the Current Ebola Outbreak: Drawing Experiences from the Recent West African Outbreak Crisis

“…Human to human transmission is responsible for the high transmission rates [9]. The Zaire ebolavirus holds an estimated case-fatality ratio ranging from 25% to 90% and out of the 20,331 cases recorded from December 2013 to February 2015, 7,905 were reported dead [1, 11,12].…”