Infectious disease: Tough choices to reduce Ebola transmission

Whitty, Christopher J M; Farrar, Jeremy; Ferguson, Neil; Edmunds, W. John; Piot, Peter; Leach, Melissa; Davies, Sally C.

doi:10.1038/515192a

Cited by 51 publications

(45 citation statements)

References 4 publications

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“…In Sierra Leone, where there have been over 8,600 confirmed cases reported as of 2015 August 1, the Sierra Leone and UK governments and nongovernmental organizations have supported the gradual introduction of over 1,500 beds in Ebola Holding Centers (EHCs) and Community Care Centers (CCCs), as well as over 1,200 beds in larger-scale Ebola Treatment Units (ETUs) (2,3). As well as the humanitarian value of providing treatment and care to sick patients, there is a secondary benefit to expanding bed capacity that is more difficult to quantify; by isolating the ill and removing them from the community, further infections might be prevented.…”

Section: T He 2013-2015 Ebola Virus Disease (Evd) Epidemic In Westmentioning

confidence: 99%

Measuring the impact of Ebola control measures in Sierra Leone

Kucharski

Camacho

Glover

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

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Between September 2014 and February 2015, the number of Ebola virus disease (EVD) cases reported in Sierra Leone declined in many districts. During this period, a major international response was put in place, with thousands of treatment beds introduced alongside other infection control measures. However, assessing the impact of the response is challenging, as several factors could have influenced the decline in infections, including behavior changes and other community interventions. We developed a mathematical model of EVD transmission, and measured how transmission changed over time in the 12 districts of Sierra Leone with sustained transmission between June 2014 and February 2015. We used the model to estimate how many cases were averted as a result of the introduction of additional treatment beds in each area. Examining epidemic dynamics at the district level, we estimated that 56,600 (95% credible interval: 48,300–84,500) Ebola cases (both reported and unreported) were averted in Sierra Leone up to February 2, 2015 as a direct result of additional treatment beds being introduced. We also found that if beds had been introduced 1 month earlier, a further 12,500 cases could have been averted. Our results suggest the unprecedented local and international response led to a substantial decline in EVD transmission during 2014–2015. In particular, the introduction of beds had a direct impact on reducing EVD cases in Sierra Leone, although the effect varied considerably between districts.

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Section: T He 2013-2015 Ebola Virus Disease (Evd) Epidemic In Westmentioning

confidence: 99%

Measuring the impact of Ebola control measures in Sierra Leone

Kucharski

Camacho

Glover

et al. 2015

Proc. Natl. Acad. Sci. U.S.A.

Self Cite

100

101

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“…The key to breaking the back of the epidemic was to get R 0 below 1, and to do that four broad strategies were used: minimise transmission in hospitals by rigorous use of infection control measures; encourage early isolation of symptomatic patients in the community; provide safe burials; and encourage social distancing to minimise risks of physical contact. 8 All are easy to say and difficult to execute, but by heroic efforts by local and international medical and nursing staff and a considerable logistical exercise, including the use of troops from the affected countries, the UK and USA, this was eventually achieved and the epidemic was brought under control first in Liberia and then Sierra Leone. This demonstrated that relatively simple and old-fashioned methods targeting R 0 can avert a major infectious threat.…”

Section: Introductionmentioning

confidence: 99%

Tackling emerging infections: clinical and public health lessons from the West African Ebola virus disease outbreak, 2014–2015

Walker

Whitty

2015

Clinical Medicine

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also has the potential to infect and kill many of those involved in treating cases. In public health terms this is a difficult to catch infection, with a relatively low force of transmission (R 0 ) only passed on by direct contact with body fluids; however the infection managed to paralyze three countries, and cause a regional and international risk of an epidemic within six months of the first case. Factors contributing to the magnitude of the West African EVD outbreak: some public health lessonsIt is widely accepted that the international community was too slow in responding to this outbreak, especially between March and June 2014 when the epidemic was relatively small and probably containable, but clearly gathering momentum. A combination of geographic, sociocultural, political, host and pathogen factors contributed to failure of the early response and the severity of the eventual epidemic. It would be wrong to place responsibility for the epidemic getting out of control on any single factor, including delayed response (Table 1).The magnitude of the 2014-2015 West African Ebola virus disease outbreak was unforeseen at its onset and the initial international response was slow. The high mortality and the panic that this outbreak induced had a major effect on health systems. In this article we discuss some of the key public health and clinical lessons from this Ebola outbreak, including combining epidemiology, modelling and anthropology, and the initial evidence for the importance of fluid and antibiotic management.

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“…11 This was particularly shown by Chowell and colleagues 12 who estimated that diagnosing 60% of patients with Ebola within one day instead of five days could have dropped the population attack rate from 80% to nearly 0%.…”

Section: Introductionmentioning

confidence: 98%

Diagnostic preparedness for infectious disease outbreaks

et al. 2017

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Diagnostics are crucial in mitigating the effect of disease outbreaks. Because diagnostic development and validation are time consuming, they should be carried out in anticipation of epidemics rather than in response to them. The diagnostic response to the 2014-15 Ebola epidemic, although ultimately effective, was slow and expensive. If a focused mechanism had existed with the technical and financial resources to drive its development ahead of the outbreak, point-of-care Ebola tests supporting a less costly and more mobile response could have been available early on in the diagnosis process. A new partnering model could drive rapid development of tests and surveillance strategies for novel pathogens that emerge in future outbreaks. We look at lessons learned from the Ebola outbreak and propose specific solutions to improve the speed of new assay development and ensure their effective deployment.

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Infectious disease: Tough choices to reduce Ebola transmission

Cited by 51 publications

References 4 publications

Measuring the impact of Ebola control measures in Sierra Leone

Measuring the impact of Ebola control measures in Sierra Leone

Tackling emerging infections: clinical and public health lessons from the West African Ebola virus disease outbreak, 2014–2015

Diagnostic preparedness for infectious disease outbreaks

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