The Impact of Different Types of Violence on Ebola Virus Transmission During the 2018–2020 Outbreak in the Democratic Republic of the Congo

Abstract

Background Our understanding of the different effects of targeted versus nontargeted violence on Ebola virus (EBOV) transmission in Democratic Republic of the Congo (DRC) is limited. Methods We used time-series data of case counts to compare individuals in Ebola-affected health zones in DRC, April 2018–August 2019. Exposure was number of violent events per health zone, categorized into Ebola-targeted or Ebola-untargeted, and into civilian-induced, (para)military/political, or protests. Outcome was estimated daily reproduction number (Rt) by health zone. We fit linear time-series regression to model the relationship. Results Average Rt was 1.06 (95% confidence interval [CI], 1.02–1.11). A mean of 2.92 violent events resulted in cumulative absolute increase in Rt of 0.10 (95% CI, .05–.15). More violent events increased EBOV transmission (P = .03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on Rt, Ebola-targeted events corresponded to Rt of 1.52 (95% CI, 1.30–1.74), while civilian-induced events corresponded to Rt of 1.43 (95% CI, 1.21–1.35). Untargeted events corresponded to Rt of 1.18 (95% CI, 1.02–1.35); among these, militia/political or ville morte events increased transmission. Conclusions Ebola-targeted violence, primarily driven by civilian-induced events, had the largest impact on EBOV transmission.

Association of Lower Exposure Risk With Paucisymptomatic/Asymptomatic Infection, Less Severe Disease, and Unrecognized Ebola Virus Disease: A Seroepidemiological Study

“…The short timeline within communities emphasizes the need for a rapid response and strong health system to implement control and care interventions. In such a system, we would also be more likely to identify individuals who would otherwise go on to become unrecognized EVD cases, and this could contribute to rapid epidemic decline [ 31 , 32 ].…”

Emergence of epidemic diseases: zoonoses and other origins

“…Curiously, further minor outbreaks have also occurred in Guéckédou: Ebola in June 2021 and Marburg in July–August 2021 73 . The 2018–2020 Ebola epidemic in eastern Democratic Republic of Congo may well have come from forest bats because of the upheaval and human conflict in that region 74 . Overall, despite real concerns of the erosion of pristine forests, there is no compelling evidence that deforestation or human invasion of forests is the major driver for the emergence of RNA viruses.…”