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Wanyana MW, Akunzirwe R, King P, Atuhaire I, Zavuga R, Lubwama B, Kabami Z, Ahirirwe SR, Ninsiima M, Naiga HN, Zalwango JF, Zalwango MG, Kawungezi PC, Simbwa BN, Kizito SN, Kiggundu T, Agaba B, Migisha R, Kadobera D, Kwesiga B, Bulage L, Ario AR, Harris JR. Performance and impact of contact tracing in the Sudan virus outbreak in Uganda, September 2022-January 2023. Int J Infect Dis 2024; 141:106959. [PMID: 38340782 DOI: 10.1016/j.ijid.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Contact tracing (CT) is critical for ebolavirus outbreak response. Ideally, all new cases after the index case should be previously-known contacts (PKC) before their onset, and spend minimal time ill in the community. We assessed the impact of CT during the 2022 Sudan Virus Disease (SVD) outbreak in Uganda. METHODS We collated anonymized data from the SVD case and contacts database to obtain and analyze data on CT performance indicators, comparing confirmed cases that were PKC and were not PKC (NPKC) before onset. We assessed the effect of being PKC on the number of people infected using Poisson regression. RESULTS There were 3844 contacts of 142 confirmed cases (mean: 22 contacts/case). Forty-seven (33%) confirmed cases were PKC. PKCs had fewer median days from onset to isolation (4 vs 6; P<0.007) and laboratory confirmation (4 vs 7; P<0.001) than NPKC. Being a PKC vs NPKC reduced risk of transmitting infection by 84% (IRR=0.16, 95% CI 0.08-0.32). CONCLUSION Contact identification was sub-optimal during the outbreak. However, CT reduced the time SVD cases spent in the community before isolation and the number of persons infected in Uganda. Approaches to improve contact tracing, especially contact listing, may improve control in future outbreaks.
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Affiliation(s)
- Mercy Wendy Wanyana
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda.
| | - Rebecca Akunzirwe
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Patrick King
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Immaculate Atuhaire
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Robert Zavuga
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Zainah Kabami
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Sherry Rita Ahirirwe
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Mackline Ninsiima
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Hellen Nelly Naiga
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Jane Frances Zalwango
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Marie Gorreti Zalwango
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Peter Chris Kawungezi
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Brenda Nakafeero Simbwa
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Saudah Namubiru Kizito
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Thomas Kiggundu
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Brian Agaba
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Richard Migisha
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program-Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Julie R Harris
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Kampala, Uganda
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Koehler JW, Stefan CP, Hall AT, Delp KL, O'Hearn AE, Taylor-Howell CL, Wauquier N, Schoepp RJ, Minogue TD. Sequence optimized diagnostic assay for Ebola virus detection. Sci Rep 2023; 13:18840. [PMID: 37914767 PMCID: PMC10620139 DOI: 10.1038/s41598-023-29390-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2023] Open
Abstract
Rapid pathogen identification is a critical first step in patient isolation, treatment, and controlling an outbreak. Real-time PCR is a highly sensitive and specific approach commonly used for infectious disease diagnostics. However, mismatches in the primer or probe sequence and the target organism can cause decreased sensitivity, assay failure, and false negative results. Limited genomic sequences for rare pathogens such as Ebola virus (EBOV) can negatively impact assay performance due to undiscovered genetic diversity. We previously developed and validated several EBOV assays prior to the 2013-2016 EBOV outbreak in West Africa, and sequencing EBOV Makona identified sequence variants that could impact assay performance. Here, we assessed the impact sequence mismatches have on EBOV assay performance, finding one or two primer or probe mismatches resulted in a range of impact from minimal to almost two log sensitivity reduction. Redesigning this assay improved detection of all EBOV variants tested. Comparing the performance of the new assay with the previous assays across a panel of human EBOV samples confirmed increased assay sensitivity as reflected in decreased Cq values with detection of three positive that tested negative with the original assay.
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Affiliation(s)
- Jeffrey W Koehler
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD, 20102, USA
| | - Christopher P Stefan
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD, 20102, USA
| | - Adrienne T Hall
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD, 20102, USA
| | - Korey L Delp
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD, 20102, USA
| | - Aileen E O'Hearn
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD, 20102, USA
| | - Cheryl L Taylor-Howell
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD, 20102, USA
| | | | - Randal J Schoepp
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD, 20102, USA
| | - Timothy D Minogue
- Diagnostic Systems Division, United States Army Medical Research Institute of Infectious Diseases (USAMRIID), 1425 Porter Street, Fort Detrick, MD, 20102, USA.
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Slembrouck S, Vandenbroucke M, De Timmerman R, Bafort AS, Van de Geuchte S. Transformative practice and its interactional challenges in COVID-19 telephone contact tracing in Flanders. Front Psychol 2023; 14:1203897. [PMID: 37711333 PMCID: PMC10498462 DOI: 10.3389/fpsyg.2023.1203897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/20/2023] [Indexed: 09/16/2023] Open
Abstract
This article focuses on transformative interactional practice in COVID-19 contact tracing telephone calls in Flanders (Belgium). It is based on a large corpus of recorded telephone conversations conducted by COVID-19 contact tracers with index patients in the period mid-2020 to mid-2022. The calls were conducted through government-contracted commercial call centers. For nearly 2 years and applied country-wide, this was the most prominent strategy in Belgium for breaking transmission chains. COVID-19 telephone contact tracing with infected patients counts as transformative professional work in two ways. First, in addition to the registration of recent contacts in a relevant time window, the work is oriented to awareness-raising about how patients and their co-dwellers can and should adjust their behavior by attending actively to critical aspects of the pandemic during an individual period of (potential) infection. This is the terrain of advice, interdictions and recommendations about quarantine, isolation, personal hygiene, etc. In addition, the focus on interactional attention indexes patients' affect and emotions (e.g., anxiety, worry, or anger) in a period of health uncertainty and social isolation. The transformative work thus depends on successfully established rapport and empathetic, responsive behavior. Our analysis of the recorded conversational sequences focuses on the complexities of client-sensitive and responsive transformative sequences and highlights the constraints and affordances which surround the interactional task of 'instructional awareness raising' which is central to telephone contact tracing. Specifically, we detail the following dimensions of transformative sequences: (i) how do contact tracers deal with the knowledge status of clients, (ii) their use of upgrading/downgrading formulations, (iii) the use of humor and other mitigating strategies, and (iv) how contact tracers attend to interactional displays of affect and emotion. In a final section, we tie together our observations about the communication of particularized advice in a context of general measures through the twin notions of categorization/particularization-work. The findings in this paper are limited to the first step in the chain of contact tracing, i.e., telephone calls with tested and infected citizens.
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Affiliation(s)
| | | | | | | | - Sofie Van de Geuchte
- Department of Linguistics, Ghent University, Ghent, Belgium
- Department of Linguistics, University of Antwerp, Antwerp, Belgium
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Keita M, Polonsky JA, Ahuka-Mundeke S, Ilumbulumbu MK, Dakissaga A, Boiro H, Anoko JN, Diassy L, Ngwama JK, Bah H, Tosalisana MK, Kitenge Omasumbu R, Chérif IS, Boland ST, Delamou A, Yam A, Flahault A, Dagron S, Gueye AS, Keiser O, Fall IS. A community-based contact isolation strategy to reduce the spread of Ebola virus disease: an analysis of the 2018-2020 outbreak in the Democratic Republic of the Congo. BMJ Glob Health 2023; 8:e011907. [PMID: 37263672 PMCID: PMC10254818 DOI: 10.1136/bmjgh-2023-011907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/06/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Despite tremendous progress in the development of diagnostics, vaccines and therapeutics for Ebola virus disease (EVD), challenges remain in the implementation of holistic strategies to rapidly curtail outbreaks. We investigated the effectiveness of a community-based contact isolation strategy to limit the spread of the disease in the Democratic Republic of Congo (DRC). METHODS We did a quasi-experimental comparison study. Eligible participants were EVD contacts registered from 12 June 2019 to 18 May 2020 in Beni and Mabalako Health Zones. Intervention group participants were isolated to specific community sites for the duration of their follow-up. Comparison group participants underwent contact tracing without isolation. The primary outcome was measured as the reproduction number (R) in the two groups. Secondary outcomes were the delay from symptom onset to isolation and case management, case fatality rate (CFR) and vaccination uptake. RESULTS 27 324 EVD contacts were included in the study; 585 in the intervention group and 26 739 in the comparison group. The intervention group generated 32 confirmed cases (5.5%) in the first generation, while the comparison group generated 87 (0.3%). However, the 32 confirmed cases arising from the intervention contacts did not generate any additional transmission (R=0.00), whereas the 87 confirmed cases arising from the comparison group generated 99 secondary cases (R=1.14). The average delay between symptom onset and case isolation was shorter (1.3 vs 4.8 days; p<0.0001), CFR lower (12.5% vs 48.4%; p=0.0001) and postexposure vaccination uptake higher (86.0% vs 56.8%; p<0.0001) in the intervention group compared with the comparison group. A significant difference was also found between intervention and comparison groups in survival rate at the discharge of hospitalised confirmed patients (87.9% vs 47.7%, respectively; p=0.0004). CONCLUSION The community-based contact isolation strategy used in DRC shows promise as a potentially effective approach for the rapid cessation of EVD transmission, highlighting the importance of rapidly implemented, community-oriented and trust-building control strategies.
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Affiliation(s)
- Mory Keita
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jonathan A Polonsky
- Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland
| | - Steve Ahuka-Mundeke
- Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Congo (the Democratic Republic of the)
| | | | - Adama Dakissaga
- Direction Régionale de la Santé du Plateau Central, Ministère de la Santé et de l'Hygiène Publique, Ziniaré, Burkina Faso
| | - Hamadou Boiro
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Julienne Ngoundoung Anoko
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Lamine Diassy
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - John Kombe Ngwama
- Direction Générale de la Lutte contre la Maladie, Ministère de la Santé, Kinshasa, Democratic Republic of Congo
| | - Houssainatou Bah
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Richard Kitenge Omasumbu
- Equipe Médicale d'Urgence, Ministère de la Santé Publique, Kinshasa, Congo (the Democratic Republic of the)
| | | | | | - Alexandre Delamou
- African Centre of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
| | - Abdoulaye Yam
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphanie Dagron
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Abdou Salam Gueye
- Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Olivia Keiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ibrahima Socé Fall
- Global Neglected Tropical Diseases programme, World Health Organization, Geneva, Switzerland
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Asare IT, Douglas M, Kye-Duodu G, Manu E. Challenges and opportunities for improved contact tracing in Ghana: experiences from Coronavirus disease-2019-related contact tracing in the Bono region. BMC Infect Dis 2023; 23:335. [PMID: 37202733 DOI: 10.1186/s12879-023-08317-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/09/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND In Ghana, contact tracing received heightened attention in the fight against the COVID-19 pandemic during its peak period. Despite the successes achieved, numerous challenges continue to limit the efforts of contact tracing in completely curtailing the effect of the pandemic. Despite these challenges, there are still opportunities that could be harnessed from the COVID-19 contact tracing experience for future eventualities. This study thus identified the challenges and opportunities associated with COVID-19 contact tracing in the Bono Region of Ghana. METHODS Using a focus group discussion (FGD) approach, an exploratory qualitative design was conducted in six selected districts of the Bono region of Ghana in this study. The purposeful sampling technique was employed to recruit 39 contact tracers who were grouped into six focus groups. A thematic content analysis approach via ATLAS ti version 9.0 software was used to analyse the data and presented under two broad themes. RESULTS The discussants reported twelve (12) challenges that hindered effective contact tracing in the Bono region. These include inadequate personal protective equipment, harassment by contacts, politicisation of the discourse around the disease, stigmatization, delays in processing test results, poor remuneration and lack of insurance package, inadequate staffing, difficulty in locating contacts, poor quarantine practices, poor education on COVID-19, language barrier and transportation challenges. Opportunities for improving contact tracing include cooperation, awareness creation, leveraging on knowledge gained in contact tracing, and effective emergency plans for future pandemics. CONCLUSION There is a need for health authorities, particularly in the region, and the state as a whole to address contact tracing-related challenges while simultaneously harnessing the recommended opportunities for improved contact tracing in the future for effective pandemic control.
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Affiliation(s)
- Isaac Tachie Asare
- Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Mbuyiselo Douglas
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Private Bag X1, Mthatha, 5117, South Africa
| | - Gideon Kye-Duodu
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Emmanuel Manu
- Department of Population and Behavioural Sciences, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana.
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Ng GY, Ong BC. Contact tracing using real-time location system (RTLS): a simulation exercise in a tertiary hospital in Singapore. BMJ Open 2022; 12:e057522. [PMID: 36192104 PMCID: PMC9535253 DOI: 10.1136/bmjopen-2021-057522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We aim to assess the effectiveness of contact tracing using real-time location system (RTLS) compared with the conventional (electronic medical records (EMRs)) method via an emerging infectious disease (EID) outbreak simulation exercise. The aims of the study are: (1) to compare the time taken to perform contact tracing and list of contacts identified for RTLS versus EMR; (2) to compare manpower and manpower-hours required to perform contact tracing for RTLS versus EMR; and (3) to extrapolate the cost incurred by RTLS versus EMR. DESIGN Prospective case study. SETTING Sengkang General Hospital, a 1000-bedded public tertiary hospital in Singapore. PARTICIPANTS 1000 out of 4000 staff wore staff tags in this study. INTERVENTIONS A simulation exercise to determine and compare the list of contacts, time taken, manpower and manpower-hours required between RTLS and conventional methods of contact tracing. Cost of both methods were compared. PRIMARY AND SECONDARY OUTCOME MEASURES List of contacts, time taken, manpower required, manpower-hours required and cost incurred. RESULTS RTLS identified almost three times the number of contacts compared with conventional methods, while achieving that with a 96.2% reduction in time taken, 97.6% reduction in manpower required and 97.5% reduction in manpower-hours required. However, RTLS incurred significant equipment cost and might take many contact tracing episodes before providing economic benefit. CONCLUSION Although costly, RTLS is effective in contact tracing. RLTS might not be ready at present time to replace conventional methods, but with further refinement, RTLS has the potential to be the gold standard in contact tracing methods of the future, particularly in the current pandemic.
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El-Sadr WM, Platt J, Bernitz M, Reyes M. Contact Tracing: Barriers and Facilitators. Am J Public Health 2022; 112:1025-1033. [PMID: 35653650 DOI: 10.2105/ajph.2022.306842] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Contact tracing-the process of identifying, isolating, and managing infected persons and their contacts-is a recognized public health measure for controlling the transmission of infectious diseases. In the context of the COVID-19 pandemic, contact tracing has received intense attention. We provide a brief overview of the history of contact tracing during several major disease outbreaks in the past century: syphilis and other sexually transmitted infections, HIV infection, tuberculosis, Ebola virus disease, and COVID-19. Our discussion on the barriers to and facilitators of contact tracing offers a perspective on societal and institutional roles and dynamics, stigma as a major barrier to effective tracing efforts, and how the nature and epidemiology of the infection itself can affect its success. We explore the evolution and adaptation of contact tracing and provide insights for future programming and research. (Am J Public Health. Published online ahead of print June 2, 2022: e1-e9. https://doi.org/10.2105/AJPH.2022.306842).
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Affiliation(s)
- Wafaa M El-Sadr
- Wafaa M. El-Sadr and Joey Platt are with ICAP, Mailman School of Public Health, Columbia University, New York, NY. Melanie Bernitz is with Columbia Health, Columbia University. Melissa Reyes is with Mailman School of Public Health, Columbia University
| | - Joey Platt
- Wafaa M. El-Sadr and Joey Platt are with ICAP, Mailman School of Public Health, Columbia University, New York, NY. Melanie Bernitz is with Columbia Health, Columbia University. Melissa Reyes is with Mailman School of Public Health, Columbia University
| | - Melanie Bernitz
- Wafaa M. El-Sadr and Joey Platt are with ICAP, Mailman School of Public Health, Columbia University, New York, NY. Melanie Bernitz is with Columbia Health, Columbia University. Melissa Reyes is with Mailman School of Public Health, Columbia University
| | - Melissa Reyes
- Wafaa M. El-Sadr and Joey Platt are with ICAP, Mailman School of Public Health, Columbia University, New York, NY. Melanie Bernitz is with Columbia Health, Columbia University. Melissa Reyes is with Mailman School of Public Health, Columbia University
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Sanitary Aspects of Countering the Spread of COVID-19 in Russia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312456. [PMID: 34886181 PMCID: PMC8657366 DOI: 10.3390/ijerph182312456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022]
Abstract
Due to the conditions that cause the spread of COVID-19, national health systems worldwide are under severe strain. Most countries face similar difficulties such as a lack of medical personnel and equipment and tools for diagnosis and treatment, overrun hospitals, and forced restriction of planned medical care. Public authorities in healthcare take the following measures due to increased pressure: limiting the transmission and spread of the virus (social distancing and quarantine), mobilizing medical personnel, ensuring the availability of diagnostic and treatment tools, and providing a sufficient number of premises, which are not always suitable for the provision of medical care (buildings and structures). To date, the stages of management decision-making to counter coronavirus infection and the risk of COVID-19 transmission at various facilities have not been analyzed. The authors propose a methodology for assessing the COVID-19 transmission risk at various social and transport facilities. A survey of 1325 respondents from Moscow demonstrated the most significant risk factors, such as visitation avoidance, infection risk, and facemask wearing. Risk categories were determined and objects classified according to high, medium, and low-risk levels.
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Nachega JB, Atteh R, Ihekweazu C, Sam-Agudu NA, Adejumo P, Nsanzimana S, Rwagasore E, Condo J, Paleker M, Mahomed H, Suleman F, Ario AR, Kiguli-Malwadde E, Omaswa FG, Sewankambo NK, Viboud C, Reid MJA, Zumla A, Kilmarx PH. Contact Tracing and the COVID-19 Response in Africa: Best Practices, Key Challenges, and Lessons Learned from Nigeria, Rwanda, South Africa, and Uganda. Am J Trop Med Hyg 2021; 104:1179-1187. [PMID: 33571138 PMCID: PMC8045625 DOI: 10.4269/ajtmh.21-0033] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/25/2021] [Indexed: 01/05/2023] Open
Abstract
Most African countries have recorded relatively lower COVID-19 burdens than Western countries. This has been attributed to early and strong political commitment and robust implementation of public health measures, such as nationwide lockdowns, travel restrictions, face mask wearing, testing, contact tracing, and isolation, along with community education and engagement. Other factors include the younger population age strata and hypothesized but yet-to-be confirmed partially protective cross-immunity from parasitic diseases and/or other circulating coronaviruses. However, the true burden may also be underestimated due to operational and resource issues for COVID-19 case identification and reporting. In this perspective article, we discuss selected best practices and challenges with COVID-19 contact tracing in Nigeria, Rwanda, South Africa, and Uganda. Best practices from these country case studies include sustained, multi-platform public communications; leveraging of technology innovations; applied public health expertise; deployment of community health workers; and robust community engagement. Challenges include an overwhelming workload of contact tracing and case detection for healthcare workers, misinformation and stigma, and poorly sustained adherence to isolation and quarantine. Important lessons learned include the need for decentralization of contact tracing to the lowest geographic levels of surveillance, rigorous use of data and technology to improve decision-making, and sustainment of both community sensitization and political commitment. Further research is needed to understand the role and importance of contact tracing in controlling community transmission dynamics in African countries, including among children. Also, implementation science will be critically needed to evaluate innovative, accessible, and cost-effective digital solutions to accommodate the contact tracing workload.
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Affiliation(s)
- Jean B Nachega
- 1Department of Medicine and Center for Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa.,2Department of Epidemiology, Infectious Diseases and Microbiology, Center for Global Health, University of Pittsburgh, Pittsburgh, Pennsylvania.,3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,4Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland
| | - Rhoda Atteh
- 5Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Chikwe Ihekweazu
- 6Office of the Director-General, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Nadia A Sam-Agudu
- 7International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.,8Department of Pediatrics, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland.,9Department of Pediatrics and Child Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Prisca Adejumo
- 10Department of Nursing, University of Ibadan, Ibadan, Nigeria
| | | | - Edson Rwagasore
- 11Rwanda Biomedical Centre, Ministry of Health, Kigali, Rwanda
| | - Jeanine Condo
- 12University of Rwanda, School of Public Health, Kigali, Rwanda.,13School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Masudah Paleker
- 14South African Department of Health, Western Cape Province, Cape Town, South Africa.,15Division of Health Systems and Public Health, Department of Global Health, Stellenbosch Faculty of Medicine and Health Sciences and Western Cape Department of Health, Cape Town, South Africa
| | - Hassan Mahomed
- 14South African Department of Health, Western Cape Province, Cape Town, South Africa.,15Division of Health Systems and Public Health, Department of Global Health, Stellenbosch Faculty of Medicine and Health Sciences and Western Cape Department of Health, Cape Town, South Africa
| | - Fatima Suleman
- 16Discipline of Pharmaceutical Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Alex Riolexus Ario
- 17Uganda National Institute of Public Health, Ministry of Health, Kampala, Uganda
| | | | - Francis G Omaswa
- 18African Centre for Global Health and Social Transformation, Kampala, Uganda
| | - Nelson K Sewankambo
- 19Department of Internal Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Cecile Viboud
- 20Fogarty International Center, National Institutes of Health, Bethesda, Maryland
| | - Michael J A Reid
- 21University of California San Francisco, San Francisco, California
| | - Alimuddin Zumla
- 22Division of Infection and Immunity, University College London, London, United Kingdom.,23NIHR Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Peter H Kilmarx
- 20Fogarty International Center, National Institutes of Health, Bethesda, Maryland
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10
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Jalloh MF, Nur AA, Nur SA, Winters M, Bedson J, Pedi D, Prybylski D, Namageyo-Funa A, Hageman KM, Baker BJ, Jalloh MB, Eng E, Nordenstedt H, Hakim AJ. Behaviour adoption approaches during public health emergencies: implications for the COVID-19 pandemic and beyond. BMJ Glob Health 2021; 6:e004450. [PMID: 33514594 PMCID: PMC7849902 DOI: 10.1136/bmjgh-2020-004450] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/29/2022] Open
Abstract
Human behaviour will continue to play an important role as the world grapples with public health threats. In this paper, we draw from the emerging evidence on behaviour adoption during diverse public health emergencies to develop a framework that contextualises behaviour adoption vis-à-vis a combination of top-down, intermediary and bottom-up approaches. Using the COVID-19 pandemic as a case study, we operationalise the contextual framework to demonstrate how these three approaches differ in terms of their implementation, underlying drivers of action, enforcement, reach and uptake. We illustrate how blended strategies that include all three approaches can help accelerate and sustain protective behaviours that will remain important even when safe and effective vaccines become more widely available. As the world grapples with the COVID-19 pandemic and prepares to respond to (re)emerging public health threats, our contextual framework can inform the design, implementation, tracking and evaluation of comprehensive public health and social measures during health emergencies.
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Affiliation(s)
- Mohamed F Jalloh
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aasli A Nur
- Department of Sociology, University of Washington, Seattle, Washington, USA
| | - Sophia A Nur
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maike Winters
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Jamie Bedson
- Independent Consultant, Seattle, Washington, USA
| | - Danielle Pedi
- Bill and Melinda Gates Foundation, Seattle, Washington, USA
| | - Dimitri Prybylski
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Apophia Namageyo-Funa
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kathy M Hageman
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brian J Baker
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Eugenia Eng
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Helena Nordenstedt
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Avi J Hakim
- CDC COVID-19 Response Team, Atlanta, Georgia, USA
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11
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Mbunge E, Akinnuwesi B, Fashoto SG, Metfula AS, Mashwama P. A critical review of emerging technologies for tackling COVID-19 pandemic. HUMAN BEHAVIOR AND EMERGING TECHNOLOGIES 2020; 3:25-39. [PMID: 33363278 PMCID: PMC7753602 DOI: 10.1002/hbe2.237] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/10/2020] [Accepted: 11/14/2020] [Indexed: 12/23/2022]
Abstract
COVID‐19 pandemic affects people in various ways and continues to spread globally. Researches are ongoing to develop vaccines and traditional methods of Medicine and Biology have been applied in diagnosis and treatment. Though there are success stories of recovered cases as of November 10, 2020, there are no approved treatments and vaccines for COVID‐19. As the pandemic continues to spread, current measures rely on prevention, surveillance, and containment. In light of this, emerging technologies for tackling COVID‐19 become inevitable. Emerging technologies including geospatial technology, artificial intelligence (AI), big data, telemedicine, blockchain, 5G technology, smart applications, Internet of Medical Things (IoMT), robotics, and additive manufacturing are substantially important for COVID‐19 detecting, monitoring, diagnosing, screening, surveillance, mapping, tracking, and creating awareness. Therefore, this study aimed at providing a comprehensive review of these technologies for tackling COVID‐19 with emphasis on the features, challenges, and country of domiciliation. Our results show that performance of the emerging technologies is not yet stable due to nonavailability of enough COVID‐19 dataset, inconsistency in some of the dataset available, nonaggregation of the dataset due to contrasting data format, missing data, and noise. Moreover, the security and privacy of people's health information is not totally guaranteed. Thus, further research is required to strengthen the current technologies and there is a strong need for the emergence of a robust computationally intelligent model for early differential diagnosis of COVID‐19.
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Affiliation(s)
- Elliot Mbunge
- Department of Computer Science, Faculty of Science and Engineering University of Eswatini Manzini Swaziland
| | - Boluwaji Akinnuwesi
- Department of Computer Science, Faculty of Science and Engineering University of Eswatini Manzini Swaziland
| | - Stephen G Fashoto
- Department of Computer Science, Faculty of Science and Engineering University of Eswatini Manzini Swaziland
| | - Andile S Metfula
- Department of Computer Science, Faculty of Science and Engineering University of Eswatini Manzini Swaziland
| | - Petros Mashwama
- Department of Computer Science, Faculty of Science and Engineering University of Eswatini Manzini Swaziland
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12
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Arakpogun EO, Elsahn Z, Prime KS, Gerli P, Olan F. Digital contact-tracing and pandemics: Institutional and technological preparedness in Africa. WORLD DEVELOPMENT 2020; 136:105105. [PMID: 32834386 PMCID: PMC7396131 DOI: 10.1016/j.worlddev.2020.105105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Several countries in Africa have either deployed or considering using digital contact-tracing (DCT) as part of their Covid-19 containment strategy, amidst calls for the use of technology to improve the efficiency of traditional contact-tracing. We discuss some of the complexities entailed in using DCT in Africa. Adopting a socio-technical perspective, we argue that if DCT design and deployment are not well thought out, it can lead to unintended consequences, particularly in a continent like Africa with disproportionate levels of digital divides and other structural inequalities. We suggest that any adoption of DCT by African countries must take account of their compatibility with local resources, values, social structure, and domestic political factors. Accordingly, we propose a process of translation whereby DCT adaptation is made to accommodate the unique institutional and technological characteristics of African countries by leveraging local practices learned from previous pandemics like Ebola to develop a blended epidemiological approach to (digital) contact-tracing.
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Affiliation(s)
| | - Ziad Elsahn
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Karla Simone Prime
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Paolo Gerli
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Femi Olan
- Newcastle Business School, Northumbria University, Newcastle upon Tyne, United Kingdom
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13
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Effective Contact Tracing for COVID-19 Using Mobile Phones: An Ethical Analysis of the Mandatory Use of the Aarogya Setu Application in India. Camb Q Healthc Ethics 2020; 30:262-271. [PMID: 32993842 PMCID: PMC7642501 DOI: 10.1017/s0963180120000821] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Several digital contact tracing smartphone applications have been developed worldwide in the effort to combat COVID-19 that warn users of potential exposure to infectious patients and generate big data that helps in early identification of hotspots, complementing the manual tracing operations. In most democracies, concerns over a breach in data privacy have resulted in severe opposition toward their mandatory adoption. This paper examines India as a noticeable exception, where the compulsory installation of such a government-backed application, the “Aarogya Setu” has been deemed mandatory in certain situations. We argue that the mandatory app requirement constitutes a legitimate public health intervention during a public health emergency.
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14
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Megnin-Viggars O, Carter P, Melendez-Torres GJ, Weston D, Rubin GJ. Facilitators and barriers to engagement with contact tracing during infectious disease outbreaks: A rapid review of the evidence. PLoS One 2020; 15:e0241473. [PMID: 33120402 PMCID: PMC7595276 DOI: 10.1371/journal.pone.0241473] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Until a vaccine is developed, a test, trace and isolate strategy is the most effective method of controlling the COVID-19 outbreak. Contact tracing and case isolation are common methods for controlling infectious disease outbreaks. However, the effectiveness of any contact tracing system rests on public engagement. Numerous factors may influence an individual's willingness to engage with a contact tracing system. Understanding these factors has become urgent during the COVID-19 pandemic. OBJECTIVE To identify facilitators and barriers to uptake of, and engagement with, contact tracing during infectious disease outbreaks. METHOD A rapid systematic review was conducted to identify papers based on primary research, written in English, and that assessed facilitators, barriers, and other factors associated with the uptake of, and engagement with, a contact tracing system. PRINCIPAL FINDINGS Four themes were identified as facilitators to the uptake of, and engagement with, contact tracing: collective responsibility; personal benefit; co-production of contact tracing systems; and the perception of the system as efficient, rigorous and reliable. Five themes were identified as barriers to the uptake of, and engagement with, contact tracing: privacy concerns; mistrust and/or apprehension; unmet need for more information and support; fear of stigmatization; and mode-specific challenges. CONCLUSIONS By focusing on the factors that have been identified, contact tracing services are more likely to get people to engage with them, identify more potentially ill contacts, and reduce transmission.
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Affiliation(s)
- Odette Megnin-Viggars
- Research Department of Clinical, Centre for Outcomes Research and Effectiveness, Educational & Health Psychology, University College London, London, United Kingdom
| | - Patrice Carter
- Research Department of Clinical, Centre for Outcomes Research and Effectiveness, Educational & Health Psychology, University College London, London, United Kingdom
| | - G. J. Melendez-Torres
- Peninsula Technology Assessment Group, University of Exeter Medical School, Exeter, United Kingdom
| | - Dale Weston
- Emergency Response Department Science & Technology, Behavioural Science Team, Public Health England, Porton Down, Salisbury, United Kingdom
| | - G. James Rubin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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15
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Lee SM, Lee D. Lessons Learned from Battling COVID-19: The Korean Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7548. [PMID: 33081367 PMCID: PMC7590030 DOI: 10.3390/ijerph17207548] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/04/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The COVID-19 pandemic has swept the world like a gigantic tsunami, turning social and economic activities upside down. METHODS This paper presents some of the innovative response strategies implemented by the public health system, healthcare facilities, and government in South Korea, which has been hailed as the model country for its success in containing COVID-19. Korea reinvented its public health infrastructure with a sense of urgency. RESULTS Korea's success rests on its readiness, with the capacity for massive testing and obtaining prompt test results, effective contact tracing based on its world-leading mobile technologies, timely provision of personal protective equipment (PPE) to first responders, effective treatment of infected patients, and invoking citizens' community and civic conscience for the shared goal of defeating the pandemic. The lessons learned from Korea's response in countering the onslaught of COVID-19 provide unique implications for public healthcare administrators and operations management practitioners. CONCLUSION Since many epidemic experts warn of a second wave of COVID-19, the lessons learned from the first wave will be a valuable resource for responding to the resurgence of the virus.
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Affiliation(s)
- Sang M. Lee
- College of Business Administration, University of Nebraska-Lincoln, Lincoln, NE 68588, USA;
| | - DonHee Lee
- College of Business Administration, Inha University, Incheon 22212, Korea
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16
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Another Pandemic in Africa: Weak Healthcare, Strong Leadership, and Collective Action in Africa's COVID-19 Response. MANAGEMENT AND ORGANIZATION REVIEW 2020. [DOI: 10.1017/mor.2020.47] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Community response to the Ebola outbreak: Contribution of community-based organisations and community leaders in four health districts in Guinea. Glob Public Health 2020; 15:1767-1777. [PMID: 32673146 DOI: 10.1080/17441692.2020.1789194] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The major challenges in controlling the Ebola Virus Disease (EVD) outbreak in Guinea were contact tracing, referral of suspected cases, secure burial and mistrust in the context of a weak health system. Community involvement and uptake of key interventions were very low, contributing to the spread of the epidemic. A community engagement project, using community based organisations (CBOs) and community leaders, was implemented in four affected health districts in rural Guinea. This paper reports on the contribution of the CBOs and community leaders in controlling the EVD outbreak. Base-, mid- and end - line assessments were conducted using a mixed methods approach. In total, 422 CBOs members, 50 community leaders and 40 village birth attendants were engaged in social mobilisation, awareness raising, reaching 154,310 people and leading to the end of reluctance and mistrust. Thus, 95 suspected cases were referred to health facilities, contact tracing and secure burial increased from 88.0% to 96.6% and from 67% to 95.4%, respectively, and institutional deliveries increased from 637 to 806. Involvement of CBOs and community leaders against the EVD outbreak is an effective resource that should also be considered to better respond to possible large-scale epidemic threats in a fragile health system context.
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18
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Danquah LO, Hasham N, MacFarlane M, Conteh FE, Momoh F, Tedesco AA, Jambai A, Ross DA, Weiss HA. Use of a mobile application for Ebola contact tracing and monitoring in northern Sierra Leone: a proof-of-concept study. BMC Infect Dis 2019; 19:810. [PMID: 31533659 PMCID: PMC6749711 DOI: 10.1186/s12879-019-4354-z] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 08/05/2019] [Indexed: 11/30/2022] Open
Abstract
Background The 2014–2016 Ebola epidemic in West Africa was the largest Ebola epidemic to date. Contact tracing was a core surveillance activity. Challenges with paper-based contact tracing systems include incomplete identification of contacts, delays in communication and response, loss of contact lists, inadequate data collection and transcription errors. The aim of this study was to design and evaluate an electronic system for tracing contacts of Ebola cases in Port Loko District, Sierra Leone, and to compare this with the existing paper-based system. The electronic system featured data capture using a smartphone application, linked to an alert system to notify the District Ebola Response Centre of symptomatic contacts. Methods The intervention was a customised three-tier smartphone application developed using Dimagi’s CommCare platform known as the Ebola Contact Tracing application (ECT app). Eligible study participants were all 26 Contact Tracing Coordinators (CTCs) and 86 Contact Tracers (CTs) working in the 11 Chiefdoms of Port Loko District during the study period (April–August 2015). Case detection was from 13th April to 17th July 2015. The CTCs and their CTs were provided with smartphones installed with the ECT app which was used to conduct contact tracing activities. Completeness and timeliness of contact tracing using the app were compared with data from April 13th-June 7th 2015, when the standard paper-based system was used. Results For 25 laboratory-confirmed cases for whom paper-based contact tracing was conducted, data for only 39% of 408 contacts were returned to the District, and data were often incomplete. For 16 cases for whom app-based contact tracing was conducted, 63% of 556 contacts were recorded as having been visited on the app, and the median recorded duration from case confirmation to first contact visit was 70 h. Conclusion There were considerable challenges to conducting high-quality contact tracing in this setting using either the paper-based or the app-based system. However, the study demonstrated that it was possible to implement mobile health (mHealth) in this emergency setting. The app had the benefits of improved data completeness, storage and accuracy, but the challenges of using an app in this setting and epidemic context were substantial. Electronic supplementary material The online version of this article (10.1186/s12879-019-4354-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lisa O Danquah
- School of Public Health, Faculty of Medicine, Imperial College London, London, UK. .,MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Nadia Hasham
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Innovations for Poverty Action, Freetown, Sierra Leone
| | | | - Fatu E Conteh
- Innovations for Poverty Action, Freetown, Sierra Leone
| | - Fatoma Momoh
- Innovations for Poverty Action, Freetown, Sierra Leone
| | | | - Amara Jambai
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - David A Ross
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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19
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Monk EJM, Yee KP, Allan R, Gayton IB. Determination of true patient origin through motorcycle mapping: design and implementation of a community-defined geographic infrastructure surveillance tool in rural Sierra Leone. Trans R Soc Trop Med Hyg 2019; 113:572–575. [DOI: 10.1093/trstmh/trz063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/07/2019] [Accepted: 06/14/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Village-level geographic infrastructure data are often insufficient in low-resource settings, despite accurate patient origin determination being essential for surveillance and outbreak management. We detail a novel and seemingly reliable method for the determination of true patient origin with proof of concept in rural Sierra Leone.
Methods
Potential villages (n=2263), identified within a 7800 km2 hospital catchment area from satellite imagery, were accessed by motorcycle and surveyed in person, capturing village name and community-defined section/chiefdom/district.
Results
A survey established 1740 inhabited villages and a village of origin determination tool (gazetteer) was produced. Recording the district/chiefdom/section/village at hospital registration allowed Global Positioning System patient origin determination in 2277/2344 (97.1%) attendances.
Conclusions
Our proof of concept reports a substantial and sustained record of true patient origin in a low-resource setting.
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Affiliation(s)
- Edward J M Monk
- Nixon Memorial Methodist Hospital, Segbwema, Kailahun District, Sierra Leone
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20
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Oppenheim B, Gallivan M, Madhav NK, Brown N, Serhiyenko V, Wolfe ND, Ayscue P. Assessing global preparedness for the next pandemic: development and application of an Epidemic Preparedness Index. BMJ Glob Health 2019; 4:e001157. [PMID: 30775006 PMCID: PMC6352812 DOI: 10.1136/bmjgh-2018-001157] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/24/2018] [Accepted: 12/03/2018] [Indexed: 01/15/2023] Open
Abstract
Introduction Robust metrics for national-level preparedness are critical for assessing global resilience to epidemic and pandemic outbreaks. However, existing preparedness assessments focus primarily on public health systems or specific legislative frameworks, and do not measure other essential capacities that enable and support public health preparedness and response. Methods We developed an Epidemic Preparedness Index (EPI) to assess national-level preparedness. The EPI is global, covering 188 countries. It consists of five subindices measuring each country’s economic resources, public health communications, infrastructure, public health systems and institutional capacity. To evaluate the construct validity of the EPI, we tested its correlation with proxy measures for preparedness and response capacity, including the timeliness of outbreak detection and reporting, as well as vaccination rates during the 2009 H1N1 influenza pandemic. Results The most prepared countries were concentrated in Europe and North America, while the least prepared countries clustered in Central and West Africa and Southeast Asia. Better prepared countries were found to report infectious disease outbreaks more quickly and to have vaccinated a larger proportion of their population during the 2009 pandemic. Conclusion The EPI measures a country’s capacity to detect and respond to infectious disease events. Existing tools, such as the Joint External Evaluation (JEE), have been designed to measure preparedness within a country over time. The EPI complements the JEE by providing a holistic view of preparedness and is constructed to support comparative risk assessment between countries. The index can be updated rapidly to generate global estimates of pandemic preparedness that can inform strategy and resource allocation.
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Affiliation(s)
| | | | | | - Naor Brown
- Metabiota, San Francisco, California, USA
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21
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Swanson KC, Altare C, Wesseh CS, Nyenswah T, Ahmed T, Eyal N, Hamblion EL, Lessler J, Peters DH, Altmann M. Contact tracing performance during the Ebola epidemic in Liberia, 2014-2015. PLoS Negl Trop Dis 2018; 12:e0006762. [PMID: 30208032 PMCID: PMC6152989 DOI: 10.1371/journal.pntd.0006762] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/24/2018] [Accepted: 08/16/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND During the Ebola virus disease (EVD) epidemic in Liberia, contact tracing was implemented to rapidly detect new cases and prevent further transmission. We describe the scope and characteristics of contact tracing in Liberia and assess its performance during the 2014-2015 EVD epidemic. METHODOLOGY/PRINCIPAL FINDINGS We performed a retrospective descriptive analysis of data collection forms for contact tracing conducted in six counties during June 2014-July 2015. EVD case counts from situation reports in the same counties were used to assess contact tracing coverage and sensitivity. Contacts who presented with symptoms and/or died, and monitoring was stopped, were classified as "potential cases". Positive predictive value (PPV) was defined as the proportion of traced contacts who were identified as potential cases. Bivariate and multivariate logistic regression models were used to identify characteristics among potential cases. We analyzed 25,830 contact tracing records for contacts who had monitoring initiated or were last exposed between June 4, 2014 and July 13, 2015. Contact tracing was initiated for 26.7% of total EVD cases and detected 3.6% of all new cases during this period. Eighty-eight percent of contacts completed monitoring, and 334 contacts were identified as potential cases (PPV = 1.4%). Potential cases were more likely to be detected early in the outbreak; hail from rural areas; report multiple exposures and symptoms; have household contact or direct bodily or fluid contact; and report nausea, fever, or weakness compared to contacts who completed monitoring. CONCLUSIONS/SIGNIFICANCE Contact tracing was a critical intervention in Liberia and represented one of the largest contact tracing efforts during an epidemic in history. While there were notable improvements in implementation over time, these data suggest there were limitations to its performance-particularly in urban districts and during peak transmission. Recommendations for improving performance include integrated surveillance, decentralized management of multidisciplinary teams, comprehensive protocols, and community-led strategies.
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Affiliation(s)
| | - Chiara Altare
- Liberia Country Office, Action Contre la Faim, Paris, France
| | | | - Tolbert Nyenswah
- Public Health Emergencies, Liberia Ministry of Health, Monrovia, Liberia
| | - Tashrik Ahmed
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Nir Eyal
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | | | - Justin Lessler
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - David H. Peters
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mathias Altmann
- Liberia Country Office, Action Contre la Faim, Paris, France
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22
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Abstract
Transmissibility is the defining characteristic of infectious diseases. Quantifying transmission matters for understanding infectious disease epidemiology and designing evidence-based disease control programs. Tracing individual transmission events can be achieved by epidemiological investigation coupled with pathogen typing or genome sequencing. Individual infectiousness can be estimated by measuring pathogen loads, but few studies have directly estimated the ability of infected hosts to transmit to uninfected hosts. Individuals' opportunities to transmit infection are dependent on behavioral and other risk factors relevant given the transmission route of the pathogen concerned. Transmission at the population level can be quantified through knowledge of risk factors in the population or phylogeographic analysis of pathogen sequence data. Mathematical model-based approaches require estimation of the per capita transmission rate and basic reproduction number, obtained by fitting models to case data and/or analysis of pathogen sequence data. Heterogeneities in infectiousness, contact behavior, and susceptibility can have substantial effects on the epidemiology of an infectious disease, so estimates of only mean values may be insufficient. For some pathogens, super-shedders (infected individuals who are highly infectious) and super-spreaders (individuals with more opportunities to transmit infection) may be important. Future work on quantifying transmission should involve integrated analyses of multiple data sources.
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23
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Coltart CEM, Lindsey B, Ghinai I, Johnson AM, Heymann DL. The Ebola outbreak, 2013-2016: old lessons for new epidemics. Philos Trans R Soc Lond B Biol Sci 2017; 372:rstb.2016.0297. [PMID: 28396469 PMCID: PMC5394636 DOI: 10.1098/rstb.2016.0297] [Citation(s) in RCA: 223] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 11/12/2022] Open
Abstract
Ebola virus causes a severe haemorrhagic fever in humans with high case fatality and significant epidemic potential. The 2013-2016 outbreak in West Africa was unprecedented in scale, being larger than all previous outbreaks combined, with 28 646 reported cases and 11 323 reported deaths. It was also unique in its geographical distribution and multicountry spread. It is vital that the lessons learned from the world's largest Ebola outbreak are not lost. This article aims to provide a detailed description of the evolution of the outbreak. We contextualize this outbreak in relation to previous Ebola outbreaks and outline the theories regarding its origins and emergence. The outbreak is described by country, in chronological order, including epidemiological parameters and implementation of outbreak containment strategies. We then summarize the factors that led to rapid and extensive propagation, as well as highlight the key successes, failures and lessons learned from this outbreak and the response.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.
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Affiliation(s)
- Cordelia E M Coltart
- Research Department of Infection and Population Health, UCL, London WC1E 6JB, UK
| | | | - Isaac Ghinai
- Research Department of Infection and Population Health, UCL, London WC1E 6JB, UK
| | - Anne M Johnson
- Research Department of Infection and Population Health, UCL, London WC1E 6JB, UK
| | - David L Heymann
- Chatham House, London SW1Y 4LE, UK.,London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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24
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Ebola virus disease contact tracing activities, lessons learned and best practices during the Duport Road outbreak in Monrovia, Liberia, November 2015. PLoS Negl Trop Dis 2017; 11:e0005597. [PMID: 28575034 PMCID: PMC5470714 DOI: 10.1371/journal.pntd.0005597] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 06/14/2017] [Accepted: 04/26/2017] [Indexed: 11/19/2022] Open
Abstract
Background Contact tracing is one of the key response activities necessary for halting Ebola Virus Disease (EVD) transmission. Key elements of contact tracing include identification of persons who have been in contact with confirmed EVD cases and careful monitoring for EVD symptoms, but the details of implementation likely influence their effectiveness. In November 2015, several months after a major Ebola outbreak was controlled in Liberia, three members of a family were confirmed positive for EVD in the Duport Road area of Monrovia. The cluster provided an opportunity to implement and evaluate modified approaches to contact tracing. Methods The approaches employed for improved contact tracing included classification and risk-based management of identified contacts (including facility based isolation of some high risk contacts, provision of support to persons being monitored, and school-based surveillance for some persons with potential exposure but not listed as contacts), use of phone records to help locate missing contacts, and modifications to data management tools. We recorded details about the implementation of these approaches, report the overall outcomes of the contact tracing efforts and the challenges encountered, and provide recommendations for management of future outbreaks. Results 165 contacts were identified (with over 150 identified within 48 hours of confirmation of the EVD cases) and all initially missing contacts were located. Contacts were closely monitored and promptly tested if symptomatic; no contacts developed disease. Encountered challenges related to knowledge gaps among contact tracing staff, data management, and coordination of contact tracing activities with efforts to offer Ebola vaccine. Conclusions The Duport Road EVD cluster was promptly controlled. Missing contacts were effectively identified, and identified contacts were effectively monitored and rapidly tested. There is a persistent risk of EVD reemergence in Liberia; the experience controlling each cluster can help inform future Ebola control efforts in Liberia and elsewhere. Contact tracing is one of the key response actions necessary for controlling spread of Ebola Virus Disease (EVD). Contact tracing is comprised of several different activities: identification of persons who have been in contact with confirmed EVD cases, close monitoring contacts for EVD symptoms, and management of symptomatic persons. Closely monitoring contacts of confirmed EVD cases allows for the rapid identification of symptomatic individuals, which in turn facilitates early testing, medical intervention, and isolation of new cases. This reduces the possibility of the continued spread of the virus within communities. Delayed and ineffective contact tracing contributed to the extensive transmission of EVD during the 2014–2015 outbreak in West Africa. Clusters of EVD reemergence are likely to occur, therefore understanding and addressing the challenges of implementing and managing contact tracing remains essential to halting transmission and minimizing morbidity and mortality associated with EVD. This paper assessed the contact tracing activities in response to EVD reemergence to identify best practices for responses to future Ebola clusters. The work is also applicable to contact tracing for other infectious diseases.
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Skrip LA, Fallah MP, Gaffney SG, Yaari R, Yamin D, Huppert A, Bawo L, Nyenswah T, Galvani AP. Characterizing risk of Ebola transmission based on frequency and type of case-contact exposures. Philos Trans R Soc Lond B Biol Sci 2017; 372:20160301. [PMID: 28396472 PMCID: PMC5394639 DOI: 10.1098/rstb.2016.0301] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2017] [Indexed: 11/12/2022] Open
Abstract
During the initial months of the 2013-2016 Ebola epidemic, rapid geographical dissemination and intense transmission challenged response efforts across West Africa. Contextual behaviours associated with increased risk of exposure included travel to high-transmission settings, caring for sick and preparing the deceased for traditional funerals. Although such behaviours are widespread in West Africa, high-transmission pockets were observed. Superspreading and clustering are typical phenomena in infectious disease outbreaks, as a relatively small number of transmission chains are often responsible for the majority of events. Determining the characteristics of contacts at greatest risk of developing disease and of cases with greatest transmission potential could therefore help curb propagation of infection. Our analysis of contact tracing data from Montserrado County, Liberia, suggested that the probability of transmission was 4.5 times higher for individuals who were reported as having contact with multiple cases. The probability of individuals developing disease was not significantly associated with age or sex of their source case but was higher when they were in the same household as the infectious case. Surveillance efforts for rapidly identifying symptomatic individuals and effectively messaged campaigns encouraging household members to bring the sick to designated treatment centres without administration of home care could mitigate transmission.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.
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Affiliation(s)
- Laura A Skrip
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
| | - Mosoka P Fallah
- Ministry of Health, Congo Town, Tubman Blvd, Monrovia, Liberia
- A.M. Dogliotti College of Medicine, University of Liberia, Tubman Blvd, Monrovia, Liberia
- National Institute of Allergy and Infectious Diseases, PREVAIL-III Study, JFK Hospital, Tubman Blvd, Monrovia, Liberia
| | - Stephen G Gaffney
- Department of Biostatistics, Yale School of Public Health, New Haven, CT 06510, USA
| | - Rami Yaari
- Biostatistics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan 52621, Israel
| | - Dan Yamin
- Department of Industrial Engineering, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Amit Huppert
- Biostatistics Unit, The Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan 52621, Israel
- Department of Epidemiology and Preventive Medicine, The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Luke Bawo
- Ministry of Health, Congo Town, Tubman Blvd, Monrovia, Liberia
| | | | - Alison P Galvani
- Center for Infectious Disease Modeling and Analysis, Yale School of Public Health, New Haven, CT 06510, USA
- A.M. Dogliotti College of Medicine, University of Liberia, Tubman Blvd, Monrovia, Liberia
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Keïta M, Conté F, Diallo B, Lufwa D, Katomba J, Snacken R, Pallawo R, Tolno A, Diallo AB, Djingarey MH, Subissi L. Lessons learned by surveillance during the tail-end of the Ebola outbreak in Guinea, June-October 2015: a case series. BMC Infect Dis 2017; 17:304. [PMID: 28438127 PMCID: PMC5404295 DOI: 10.1186/s12879-017-2405-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND By the end of the 2013–2016 West African Ebola Virus Disease (EVD) outbreaks, a total of 3814 cases
(probable and confirmed) and 2544 deaths were reported in Guinea. Clearly, surveillance activities aiming at stopping human-to-human transmission have been the breakthrough of EVD outbreak management, but their application has been at times easier said than done. This article presents five confirmed or probable EVD cases that arose in Conakry towards the end of the Guinea epidemic, which demonstrate flaws in surveillance and follow-up. CASE PRESENTATION For case 1, safe burial requirements were not followed. For cases 1 and 2, negative Polymerase
Chain Reaction (PCR) results were interpreted as no infection. For the first case, the sample may have not been taken properly while for the second the disease was possibly at its early stage. Case 3 was stopped at a border health checkpoint and despite her high temperature she was allowed to continue the bus journey. For case 4, an oral swab sample was supposedly taken after death but could not be found for retrospective testing. Despite characteristic symptomatology, case 5 was not identified as a suspect case for as long as 3 weeks. CONCLUSION In epidemic contexts, health systems must be able to track all samples of suspect cases and deaths,
regardless of their laboratory results. Social mobilization in communities and training in health care facilities must be strengthened at the tail of an outbreak, to avoid the natural slackening of disease surveillance, in particular for long-lasting and deadly epidemics.
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Affiliation(s)
- Mory Keïta
- World Health Organization (WHO), Conakry, Guinea.
| | - Fatoumata Conté
- Ministry of Health and Public Hygiene of the Republic of Guinea, Conakry, Guinea
| | | | - Dieudonné Lufwa
- Ministry of Public Health of the Democratic Republic of Congo, Kinshasa, Democratic Republic of the Congo
| | - Jacques Katomba
- Ministry of Public Health of the Democratic Republic of Congo, Kinshasa, Democratic Republic of the Congo
| | - René Snacken
- World Health Organization (WHO), Conakry, Guinea.,European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Aminata Tolno
- World Health Organization (WHO), Conakry, Guinea.,National Agency for Health Security, Conakry, Guinea
| | | | | | - Lorenzo Subissi
- World Health Organization (WHO), Conakry, Guinea.,European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
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Vazquez-Prokopec GM, Montgomery BL, Horne P, Clennon JA, Ritchie SA. Combining contact tracing with targeted indoor residual spraying significantly reduces dengue transmission. SCIENCE ADVANCES 2017; 3:e1602024. [PMID: 28232955 PMCID: PMC5315446 DOI: 10.1126/sciadv.1602024] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/02/2016] [Indexed: 05/26/2023]
Abstract
The widespread transmission of dengue viruses (DENV), coupled with the alarming increase of birth defects and neurological disorders associated with Zika virus, has put the world in dire need of more efficacious tools for Aedes aegypti-borne disease mitigation. We quantitatively investigated the epidemiological value of location-based contact tracing (identifying potential out-of-home exposure locations by phone interviews) to infer transmission foci where high-quality insecticide applications can be targeted. Space-time statistical modeling of data from a large epidemic affecting Cairns, Australia, in 2008-2009 revealed a complex pattern of transmission driven primarily by human mobility (Cairns accounted for ~60% of virus transmission to and from residents of satellite towns, and 57% of all potential exposure locations were nonresidential). Targeted indoor residual spraying with insecticides in potential exposure locations reduced the probability of future DENV transmission by 86 to 96%, compared to unsprayed premises. Our findings provide strong evidence for the effectiveness of combining contact tracing with residual spraying within a developed urban center, and should be directly applicable to areas with similar characteristics (for example, southern USA, Europe, or Caribbean countries) that need to control localized Aedes-borne virus transmission or to protect pregnant women's homes in areas with active Zika transmission. Future theoretical and empirical research should focus on evaluation of the applicability and scalability of this approach to endemic areas with variable population size and force of DENV infection.
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Affiliation(s)
- Gonzalo M. Vazquez-Prokopec
- Department of Environmental Sciences, Emory University, Atlanta, GA 30322, USA
- Global Health Institute, Emory University, Atlanta, GA 30322, USA
| | - Brian L. Montgomery
- Tropical Public Health Unit Network, Queensland Health, Cairns, Queensland 4870, Australia
- Metro South Public Health Unit, Metro South Health, Coopers Plains, Brisbane, Queensland 4113, Australia
| | - Peter Horne
- Tropical Public Health Unit Network, Queensland Health, Cairns, Queensland 4870, Australia
| | - Julie A. Clennon
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Scott A. Ritchie
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland 4878, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns 4878, Australia
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Olu OO, Lamunu M, Nanyunja M, Dafae F, Samba T, Sempiira N, Kuti-George F, Abebe FZ, Sensasi B, Chimbaru A, Ganda L, Gausi K, Gilroy S, Mugume J. Contact Tracing during an Outbreak of Ebola Virus Disease in the Western Area Districts of Sierra Leone: Lessons for Future Ebola Outbreak Response. Front Public Health 2016; 4:130. [PMID: 27446896 PMCID: PMC4916168 DOI: 10.3389/fpubh.2016.00130] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/09/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Contact tracing is a critical strategy required for timely prevention and control of Ebola virus disease (EVD) outbreaks. Available evidence suggests that poor contact tracing was a driver of the EVD outbreak in West Africa, including Sierra Leone. In this article, we answered the question as to whether EVD contact tracing, as practiced in Western Area (WA) districts of Sierra Leone from 2014 to 2015, was effective. The goal is to describe contact tracing and identify obstacles to its effective implementation. METHODS Mixed methods comprising secondary data analysis of the EVD case and contact tracing data sets collected from WA during the period from 2014 to 2015, key informant interviews of contact tracers and their supervisors, and a review of available reports on contact tracing were implemented to obtain data for this study. RESULTS During the study period, 3,838 confirmed cases and 32,706 contacts were listed in the viral hemorrhagic fever and contact databases for the district (mean 8.5 contacts per case). Only 22.1% (852) of the confirmed cases in the study area were listed as contacts at the onset of their illness, which indicates incomplete identification and tracing of contacts. Challenges associated with effective contact tracing included lack of community trust, concealing of exposure information, political interference with recruitment of tracers, inadequate training of contact tracers, and incomplete EVD case and contact database. While the tracers noted the usefulness of community quarantine in facilitating their work, they also reported delayed or irregular supply of basic needs, such as food and water, which created resistance from the communities. CONCLUSION Multiple gaps in contact tracing attributed to a variety of factors associated with implementers, and communities were identified as obstacles that impeded timely control of the EVD outbreak in the WA of Sierra Leone. In future outbreaks, early community engagement and participation in contact tracing, establishment of appropriate mechanisms for selection, adequate training and supervision of qualified contact tracers, establishment of a well-managed and complete contact tracing database, and provision of basic needs to quarantined contacts are recommended as measures to enhance effective contact tracing.
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Affiliation(s)
| | | | | | - Foday Dafae
- Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Thomas Samba
- Western Area District Health Management Team, Freetown, Sierra Leone
| | - Noah Sempiira
- World Health Organization (WHO), Freetown, Sierra Leone
| | | | | | | | | | - Louisa Ganda
- World Health Organization (WHO), Freetown, Sierra Leone
| | - Khoti Gausi
- WHO Intercountry Support Team for Eastern and Southern Africa, Harare, Zimbabwe
| | - Sonia Gilroy
- United Nations Population Fund, Freetown, Sierra Leone
| | - James Mugume
- United Nations Population Fund, Freetown, Sierra Leone
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Cho SI. A New Measure for Assessing the Public Health Response to a Middle East Respiratory Syndrome Coronavirus Outbreak. J Prev Med Public Health 2015; 48:277-9. [PMID: 26639741 PMCID: PMC4676641 DOI: 10.3961/jpmph.15.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 12/04/2022] Open
Abstract
Contact monitoring is an essential component of the public health response to a Middle East respiratory syndrome coronavirus outbreak, and is required for an effective quarantine to contain the epidemic. The timeliness of a quarantine is associated with its effectiveness. This paper provides a conceptual framework to describe the process of contact monitoring, and proposes a new measure called the “timely quarantined proportion” as a tool to assess the adequacy of a public health response.
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Affiliation(s)
- Sung-il Cho
- Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Korea
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