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Migamba SM, Ardiet DL, Migisha R, Nansikombi HT, Agaba B, Naiga HN, Wanyana M, Zalwango JF, Atuhaire I, Kawungezi PC, Zalwango MG, Simbwa B, Kadobera D, Ario AR, Harris JR. Individual and household risk factors for Ebola disease among household contacts in Mubende and Kassanda districts, Uganda, 2022. BMC Infect Dis 2024; 24:543. [PMID: 38816800 PMCID: PMC11138048 DOI: 10.1186/s12879-024-09439-1] [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: 02/23/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND In 2022, an Ebola disease outbreak caused by Sudan virus (SUDV) occurred in Uganda, primarily affecting Mubende and Kassanda districts. We determined risk factors for SUDV infection among household members (HHM) of cases. METHODS We conducted a case-control and retrospective cohort study in January 2023. Cases were RT-PCR-confirmed SUDV infection in residents of Mubende or Kassanda districts during the outbreak. Case-households housed a symptomatic, primary case-patient for ≥ 24 h and had ≥ 1 secondary case-patient with onset < 2 weeks after their last exposure to the primary case-patient. Control households housed a case-patient and other HHM but no secondary cases. A risk factor questionnaire was administered to the primary case-patient or another adult who lived at home while the primary case-patient was ill. We conducted a retrospective cohort study among case-household members and categorized their interactions with primary case-patients during their illnesses as none, minimal, indirect, and direct contact. We conducted logistic regression to explore associations between exposures and case-household status, and Poisson regression to identify risk factors for SUDV infection among HHM. RESULTS Case- and control-households had similar median sizes. Among 19 case-households and 51 control households, primary case-patient death (adjusted odds ratio [ORadj] = 7.6, 95% CI 1.4-41) and ≥ 2 household bedrooms (ORadj=0.19, 95% CI 0.056-0.71) were associated with case-household status. In the cohort of 76 case-HHM, 44 (58%) were tested for SUDV < 2 weeks from their last contact with the primary case-patient; 29 (38%) were positive. Being aged ≥ 18 years (adjusted risk ratio [aRRadj] = 1.9, 95%CI: 1.01-3.7) and having direct or indirect contact with the primary case-patient (aRRadj=3.2, 95%CI: 1.1-9.7) compared to minimal or no contact increased risk of Sudan virus disease (SVD). Access to a handwashing facility decreased risk (aRRadj=0.52, 95%CI: 0.31-0.88). CONCLUSION Direct contact, particularly providing nursing care for and sharing sleeping space with SVD patients, increased infection risk among HHM. Risk assessments during contact tracing may provide evidence to justify closer monitoring of some HHM. Health messaging should highlight the risk of sharing sleeping spaces and providing nursing care for persons with Ebola disease symptoms and emphasize hand hygiene to aid early case identification and reduce transmission.
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Affiliation(s)
- Stella M Migamba
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda.
| | - Denis-Luc Ardiet
- Department of Epidemiology and Training, Epicentre, Paris, France
| | - Richard Migisha
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Hildah T Nansikombi
- 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
| | - Helen Nelly Naiga
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Mercy Wanyana
- 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
| | - Immaculate Atuhaire
- 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
| | - Marie Goretti Zalwango
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Brenda Simbwa
- 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
| | - Alex R Ario
- Uganda Public Health Fellowship Program, Uganda National Institute of Public Health, Kampala, Uganda
| | - Julie R Harris
- Division of Global Health Protection, U.S. Centers for Disease Control and Prevention, Kampala, Uganda
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Alarid-Escudero F, Andrews JR, Goldhaber-Fiebert JD. Effects of Mitigation and Control Policies in Realistic Epidemic Models Accounting for Household Transmission Dynamics. Med Decis Making 2024; 44:5-17. [PMID: 37953597 DOI: 10.1177/0272989x231205565] [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] [Indexed: 11/14/2023]
Abstract
BACKGROUND Compartmental infectious disease (ID) models are often used to evaluate nonpharmaceutical interventions (NPIs) and vaccines. Such models rarely separate within-household and community transmission, potentially introducing biases in situations in which multiple transmission routes exist. We formulated an approach that incorporates household structure into ID models, extending the work of House and Keeling. DESIGN We developed a multicompartment susceptible-exposed-infectious-recovered-susceptible-vaccinated (MC-SEIRSV) modeling framework, allowing nonexponentially distributed duration in exposed and infectious compartments, that tracks within-household and community transmission. We simulated epidemics that varied by community and household transmission rates, waning immunity rate, household size (3 or 5 members), and numbers of exposed and infectious compartments (1-3 each). We calibrated otherwise identical models without household structure to the early phase of each parameter combination's epidemic curve. We compared each model pair in terms of epidemic forecasts and predicted NPI and vaccine impacts on the timing and magnitude of the epidemic peak and its total size. Meta-analytic regressions characterized the relationship between household structure inclusion and the size and direction of biases. RESULTS Otherwise similar models with and without household structure produced equivalent early epidemic curves. However, forecasts from models without household structure were biased. Without intervention, they were upward biased on peak size and total epidemic size, with biases also depending on the number of exposed and infectious compartments. Model-estimated NPI effects of a 60% reduction in community contacts on peak time and size were systematically overestimated without household structure. Biases were smaller with a 20% reduction NPI. Because vaccination affected both community and household transmission, their biases were smaller. CONCLUSIONS ID models without household structure can produce biased outcomes in settings in which within-household and community transmission differ. HIGHLIGHTS Infectious disease models rarely separate household transmission from community transmission. The pace of household transmission may differ from community transmission, depends on household size, and can accelerate epidemic growth.Many infectious disease models assume exponential duration distributions for infected states. However, the duration of most infections is not exponentially distributed, and distributional choice alters modeled epidemic dynamics and intervention effectiveness.We propose a mathematical framework for household and community transmission that allows for nonexponential duration times and a suite of interventions and quantified the effect of accounting for household transmission by varying household size and duration distributions of infected states on modeled epidemic dynamics.Failure to include household structure induces biases in the modeled overall course of an epidemic and the effects of interventions delivered differentially in community settings. Epidemic dynamics are faster and more intense in populations with larger household sizes and for diseases with nonexponentially distributed infectious durations. Modelers should consider explicitly incorporating household structure to quantify the effects of non-pharmaceutical interventions (e.g., shelter-in-place).
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Affiliation(s)
- Fernando Alarid-Escudero
- Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA
- Center for Health Policy, Freeman Spogli Institute, Stanford University, Stanford, CA, USA
| | - Jason R Andrews
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jeremy D Goldhaber-Fiebert
- Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA
- Center for Health Policy, Freeman Spogli Institute, Stanford University, Stanford, CA, USA
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Chavez S, Koyfman A, Gottlieb M, Brady WJ, Carius BM, Liang SY, Long B. Ebola virus disease: A review for the emergency medicine clinician. Am J Emerg Med 2023; 70:30-40. [PMID: 37196593 DOI: 10.1016/j.ajem.2023.04.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Ebolavirus, the causative agent of Ebola virus disease (EVD) has been responsible for sporadic outbreaks mainly in sub-Saharan Africa since 1976. EVD is associated with high risk of transmission, especially to healthcare workers during patient care. OBJECTIVE The purpose of this review is to provide a concise review of EVD presentation, diagnosis, and management for emergency clinicians. DISCUSSION EVD is spread through direct contact, including blood, bodily fluids or contact with a contaminated object. Patients may present with non-specific symptoms such as fevers, myalgias, vomiting, or diarrhea that overlap with other viral illnesses, but rash, bruising, and bleeding may also occur. Laboratory analysis may reveal transaminitis, coagulopathy, and disseminated intravascular coagulation. The average clinical course is approximately 8-10 days with an average case fatality rate of 50%. The mainstay of treatment is supportive care, with two U.S. Food and Drug Administration-approved monoclonal antibody treatments (Ebanga and Inmazeb). Survivors of the disease may have a complicated recovery, marked by long-term symptoms. CONCLUSION EVD is a potentially deadly condition that can present with a wide range of signs and symptoms. Emergency clinicians must be aware of the presentation, evaluation, and management to optimize the care of these patients.
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Affiliation(s)
- Summer Chavez
- Department of Health Systems and Population Health Sciences, Tilman J. Fertitta Family College of Medicine, United States of America.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas 75390, TX, United States of America
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America.
| | | | - Stephen Y Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis 63110, MO, United States of America.
| | - Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, United States of America
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Duffy N, Bruden D, Thomas H, Nichols E, Knust B, Hennessy T, Reichler MR. Risk factors for Ebola virus disease among household care providers, Sierra Leone, 2015. Int J Epidemiol 2022; 51:1457-1468. [PMID: 35441222 DOI: 10.1093/ije/dyac081] [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: 02/28/2021] [Accepted: 04/04/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Household contacts who provide care to an Ebola virus disease (EVD) case have a 3-fold higher risk of EVD compared with contacts who do not provide care. METHODS We enrolled persons with confirmed EVD from December 2014 to April 2015 in Freetown, Sierra Leone, and their household contacts. Index cases and contacts were interviewed, and contacts were followed for 21 days to identify secondary cases. Epidemiological data were analysed to describe household care and to identify risk factors for developing EVD. RESULTS Of 838 contacts in 147 households, 156 (17%) self-reported providing care to the index case; 56 households had no care provider, 52 a single care provider and 39 multiple care providers. The median care provider age was 29 years, 68% were female and 32% were the index case's spouse. Care providers were more likely to report physical contact, contact with body fluids or sharing clothing, bed linens or utensils with an index case, compared with non-care providers (P <0.01). EVD risk among non-care providers was greater when the number of care providers in the household increased (odds ratio: 1.61; 95% confidence interval: 1.1, 2.4). In multivariable analysis, factors associated with care provider EVD risk included no piped water access and absence of index case fever, and protective factors included age <20 years and avoiding the index case. CONCLUSIONS Limiting the number of care providers in a household could reduce the risk of EVD transmission to both care providers and non-care providers. Strategies to protect care providers from EVD exposure are needed.
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Affiliation(s)
- Nadezhda Duffy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dana Bruden
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Harold Thomas
- Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Erin Nichols
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - Barbara Knust
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thomas Hennessy
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic diseases, Centers for Disease Control and Prevention, Anchorage, AK, USA
| | - Mary R Reichler
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Shakiba N, Edholm CJ, Emerenini BO, Murillo AL, Peace A, Saucedo O, Wang X, Allen LJ. Effects of environmental variability on superspreading transmission events in stochastic epidemic models. Infect Dis Model 2021; 6:560-583. [PMID: 33754134 PMCID: PMC7969833 DOI: 10.1016/j.idm.2021.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 11/02/2022] Open
Abstract
Superspreaders (individuals with a high propensity for disease spread) have played a pivotal role in recent emerging and re-emerging diseases. In disease outbreak studies, host heterogeneity based on demographic (e.g. age, sex, vaccination status) and environmental (e.g. climate, urban/rural residence, clinics) factors are critical for the spread of infectious diseases, such as Ebola and Middle East Respiratory Syndrome (MERS). Transmission rates can vary as demographic and environmental factors are altered naturally or due to modified behaviors in response to the implementation of public health strategies. In this work, we develop stochastic models to explore the effects of demographic and environmental variability on human-to-human disease transmission rates among superspreaders in the case of Ebola and MERS. We show that the addition of environmental variability results in reduced probability of outbreak occurrence, however the severity of outbreaks that do occur increases. These observations have implications for public health strategies that aim to control environmental variables.
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Affiliation(s)
- Nika Shakiba
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | | | - Blessing O. Emerenini
- Department of Mathematics, Oregon State University, Corvallis, OR, USA
- School of Mathematical Sciences, Rochester Institute of Technology, Rochester, NY, USA
| | - Anarina L. Murillo
- Department of Pediatrics and Center for Statistical Sciences, Brown University, Providence, RI, USA
| | - Angela Peace
- Department of Mathematics and Statistics, Texas Tech University, Lubbock, TX, USA
| | - Omar Saucedo
- Department of Mathematics, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Xueying Wang
- Department of Mathematics and Statistics, Washington State University, Pullman, WA, USA
| | - Linda J.S. Allen
- Department of Mathematics and Statistics, Texas Tech University, Lubbock, TX, USA
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Sharker Y, Kenah E. Estimating and interpreting secondary attack risk: Binomial considered biased. PLoS Comput Biol 2021; 17:e1008601. [PMID: 33471806 PMCID: PMC7850487 DOI: 10.1371/journal.pcbi.1008601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 02/01/2021] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
The household secondary attack risk (SAR), often called the secondary attack rate or secondary infection risk, is the probability of infectious contact from an infectious household member A to a given household member B, where we define infectious contact to be a contact sufficient to infect B if he or she is susceptible. Estimation of the SAR is an important part of understanding and controlling the transmission of infectious diseases. In practice, it is most often estimated using binomial models such as logistic regression, which implicitly attribute all secondary infections in a household to the primary case. In the simplest case, the number of secondary infections in a household with m susceptibles and a single primary case is modeled as a binomial(m, p) random variable where p is the SAR. Although it has long been understood that transmission within households is not binomial, it is thought that multiple generations of transmission can be neglected safely when p is small. We use probability generating functions and simulations to show that this is a mistake. The proportion of susceptible household members infected can be substantially larger than the SAR even when p is small. As a result, binomial estimates of the SAR are biased upward and their confidence intervals have poor coverage probabilities even if adjusted for clustering. Accurate point and interval estimates of the SAR can be obtained using longitudinal chain binomial models or pairwise survival analysis, which account for multiple generations of transmission within households, the ongoing risk of infection from outside the household, and incomplete follow-up. We illustrate the practical implications of these results in an analysis of household surveillance data collected by the Los Angeles County Department of Public Health during the 2009 influenza A (H1N1) pandemic. The household secondary attack risk (SAR), often called the secondary attack rate or secondary infection risk, is the probability of infectious contact from an infectious household member A to a given household member B, where we define infectious contact to be a contact sufficient to infect B if he or she is susceptible. The most common statistical models used to estimate the SAR are binomial models such as logistic regression, which implicitly assume that all secondary infections in a household are infected by the primary case. Here, we use analytical calculations and simulations to show that estimation of the SAR must account for multiple generations of transmission within households. As an example, we show that binomial models and statistical models that account for multiple generations of within-household transmission reach different conclusions about the household SAR for 2009 influenza A (H1N1) in Los Angeles County, with the latter models fitting the data better. In an epidemic, accurate estimation of the SAR allows rigorous evaluation of the effectiveness of public health interventions such as social distancing, prophylaxis or treatment, and vaccination.
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Affiliation(s)
- Yushuf Sharker
- Division of Biometrics, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, United States of America
| | - Eben Kenah
- Biostatistics Division, College of Public Health, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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Masys AJ, Izurieta R, Reina Ortiz M. The Emerging Threat of Ebola. ADVANCED SCIENCES AND TECHNOLOGIES FOR SECURITY APPLICATIONS 2020. [PMCID: PMC7123219 DOI: 10.1007/978-3-030-23491-1_6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ebola is one of the deadliest infectious disease of the modern era. Over 50% of those infected die. Prior to 1976, the disease was unknown. No one knows exactly where it came from, but it is postulated that a mutation in an animal virus allowed it to jump species and infect humans. In 1976 simultaneous outbreaks of Ebola occurred in what is now South Sudan and the Democratic Republic of the Congo (DRC). For 20 years, only sporadic cases were seen, but in 1995 a new outbreak occurred killing hundreds in the DRC. Since that time the frequency of these outbreaks has been increasing. It is uncertain why this is occurring, but many associate it with increasing human encroachment into forested areas bringing people and animals into more intimate contact and increased mobility of previously remote population. This chapter will navigate Ebola in the context of global health and security. There are multiple objectives of this chapter. First is to provide a basic understanding of Ebola disease processes and outbreak patterns. Second, is to explore the interplay between social determinants of health and Ebola. The role of technology in spreading Ebola outbreaks will be explained as will Ebola’s potential as a bioweapon. Readers will gain understanding of the link between environmental degradation and Ebola outbreaks. This chapter will be divided into five main sections. These are (1) a case study; (2) Ebola Disease process; (3) Social determinants of health and Ebola; (4) Ebola in the modern era, and (5) the link between Ebola and environmental degradation.
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Affiliation(s)
- Anthony J. Masys
- College of Public Health, University of South Florida, Tampa, FL USA
| | - Ricardo Izurieta
- College of Public Health, University of South Florida, Tampa, FL USA
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Reichler MR, Bangura J, Bruden D, Keimbe C, Duffy N, Thomas H, Knust B, Farmar I, Nichols E, Jambai A, Morgan O, Hennessy T. Household Transmission of Ebola Virus: Risks and Preventive Factors, Freetown, Sierra Leone, 2015. J Infect Dis 2019; 218:757-767. [PMID: 29659910 DOI: 10.1093/infdis/jiy204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/05/2018] [Indexed: 11/15/2022] Open
Abstract
Background Knowing risk factors for household transmission of Ebola virus is important to guide preventive measures during Ebola outbreaks. Methods We enrolled all confirmed persons with Ebola who were the first case in a household, December 2014-April 2015, in Freetown, Sierra Leone, and their household contacts. Cases and contacts were interviewed, contacts followed prospectively through the 21-day incubation period, and secondary cases confirmed by laboratory testing. Results We enrolled 150 index Ebola cases and 838 contacts; 83 (9.9%) contacts developed Ebola during 21-day follow-up. In multivariable analysis, risk factors for transmission included index case death in the household, Ebola symptoms but no reported fever, age <20 years, more days with wet symptoms; and providing care to the index case (P < .01 for each). Protective factors included avoiding the index case after illness onset and a piped household drinking water source (P < .01 for each). Conclusions To reduce Ebola transmission, communities should rapidly identify and follow-up all household contacts; isolate those with Ebola symptoms, including those without reported fever; and consider closer monitoring of contacts who provided care to cases. Households could consider efforts to minimize risk by designating one care provider for ill persons with all others avoiding the suspected case.
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Affiliation(s)
- Mary R Reichler
- Division of Tuberculosis Elimination, National Center for HIV/AIDS, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James Bangura
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Dana Bruden
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
| | - Charles Keimbe
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Harold Thomas
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Barbara Knust
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ishmail Farmar
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Erin Nichols
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Amara Jambai
- Directorate of Disease Prevention and Control, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Oliver Morgan
- Health Emergencies Program, World Health Organization, Geneva, Switzerland
| | - Thomas Hennessy
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska
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Cousien A, Abel S, Monthieux A, Andronico A, Calmont I, Cervantes M, Césaire R, Gallian P, de Lamballerie X, Laouénan C, Najioullah F, Pierre-François S, Pircher M, Salje H, ten Bosch QA, Cabié A, Cauchemez S. Assessing Zika Virus Transmission Within Households During an Outbreak in Martinique, 2015-2016. Am J Epidemiol 2019; 188:1389-1396. [PMID: 30995296 PMCID: PMC6601520 DOI: 10.1093/aje/kwz091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 03/27/2019] [Accepted: 03/27/2019] [Indexed: 12/12/2022] Open
Abstract
Since 2015, Zika virus (ZIKV) has caused large epidemics in the Americas. Households are natural targets for control interventions, but quantification of the contribution of household transmission to overall spread is needed to guide policy. We developed a modeling framework to evaluate this contribution and key epidemic features of the ZIKV epidemic in Martinique in 2015-2016 from the joint analysis of a household transmission study (n = 68 households), a study among symptomatic pregnant women (n = 281), and seroprevalence surveys of blood donors (n = 457). We estimated that the probability of mosquito-mediated within-household transmission (from an infected member to a susceptible one) was 21% (95% credible interval (CrI): 5, 51), and the overall probability of infection from outside the household (i.e., in the community) was 39% (95% CrI: 27, 50). Overall, 50% (95% CrI: 43, 58) of the population was infected, with 22% (95% CrI: 5, 46) of infections acquired in households and 40% (95% CrI: 23, 56) being asymptomatic. The probability of presenting with Zika-like symptoms due to another cause was 16% (95% CrI: 10, 23). This study characterized the contribution of household transmission in ZIKV epidemics, demonstrating the benefits of integrating multiple data sets to gain more insight into epidemic dynamics.
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Affiliation(s)
- Anthony Cousien
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Unité Mixte de Recherche 2000, Centre National de la Recherche Scientifique, Paris, France
| | - Sylvie Abel
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Alice Monthieux
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Alessio Andronico
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Unité Mixte de Recherche 2000, Centre National de la Recherche Scientifique, Paris, France
| | - Isabelle Calmont
- Institut National de la Santé et de la Recherche Médicale Centre d’Investigation Clinique 1424, Fort-de-France, Martinique
| | - Minerva Cervantes
- Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot, Paris, France
- Département d’Épidémiologie, Biostatistique et Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France
| | - Raymond Césaire
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Pierre Gallian
- Unité Mixte de Recherche Émergence des Pathologies Virales, Aix-Marseille University, Institut de Recherche pour le Développement 190, Institut National de la Santé et de la Recherche Médicale 1207, École des Hautes Études en Santé Publique, Instituts Hospitalo-Universitaires Méditerranée Infection, Marseille, France
- Etablissement Français du Sang Provence Alpes Côte d’Azur et Corse, Marseille, France
| | - Xavier de Lamballerie
- Unité Mixte de Recherche Émergence des Pathologies Virales, Aix-Marseille University, Institut de Recherche pour le Développement 190, Institut National de la Santé et de la Recherche Médicale 1207, École des Hautes Études en Santé Publique, Instituts Hospitalo-Universitaires Méditerranée Infection, Marseille, France
| | - Cédric Laouénan
- Infection Antimicrobials Modelling Evolution, Unité Mixte de Recherche 1137, Institut National de la Santé et de la Recherche Médicale, Université Paris Diderot, Paris, France
- Département d’Épidémiologie, Biostatistique et Recherche Clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat Claude Bernard, Paris, France
| | - Fatiha Najioullah
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Sandrine Pierre-François
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Mathilde Pircher
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
| | - Henrik Salje
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Unité Mixte de Recherche 2000, Centre National de la Recherche Scientifique, Paris, France
| | - Quirine A ten Bosch
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Unité Mixte de Recherche 2000, Centre National de la Recherche Scientifique, Paris, France
| | - André Cabié
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Martinique, Fort-de-France, Martinique
- Institut National de la Santé et de la Recherche Médicale Centre d’Investigation Clinique 1424, Fort-de-France, Martinique
- Equipe d’Accueil 4537, Université des Antilles, Fort-de-France, Martinique
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Unité Mixte de Recherche 2000, Centre National de la Recherche Scientifique, Paris, France
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10
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Abstract
The clinical management of Ebola created a significant challenge during the outbreak in West Africa, due to the paucity of previous research conducted into the optimum treatment regimen. That left many centres, to some extent, having to ‘work out’ best practice as they went along, and attempting to conduct real time prospective research. Médecins Sans Frontières (MSF) [1] were the only organization to have provided relatively in depth practical guidance prior to the outbreak and this manual was the basis of further planning between the WHO, national Ministry of Health and Sanitation in Sierra Leone, and other relevant stakeholders. Additionally, guidance changed over the epidemic as experience grew. This chapter will describe four key areas in the management of Ebola in West Africa. Firstly, it outlines the most recent WHO guidance; secondly, it looks back at how Ebola was managed in differing low and high resource settings; thirdly it outlines possible and optimal options for managing complications, paying particular attention to some of the controversies faced; fourthly it describes recent and ongoing studies into potential novel therapies that may shape future practice.
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Affiliation(s)
- Marta Lado
- King’s Sierra Leone Partnership, Freetown, Sierra Leone
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11
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Wing K, Oza S, Houlihan C, Glynn JR, Irvine S, Warrell CE, Simpson AJH, Boufkhed S, Sesay A, Vandi L, Sebba SC, Shetty P, Cummings R, Checchi F, McGowan CR. Surviving Ebola: A historical cohort study of Ebola mortality and survival in Sierra Leone 2014-2015. PLoS One 2018; 13:e0209655. [PMID: 30589913 PMCID: PMC6307710 DOI: 10.1371/journal.pone.0209655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022] Open
Abstract
Background While a number of predictors for Ebola mortality have been identified, less is known about post-viral symptoms. The identification of acute-illness predictors for post-viral symptoms could allow the selection of patients for more active follow up in the future, and those in whom early interventions may be beneficial in the long term. Studying predictors of both mortality and post-viral symptoms within a single cohort of patients could also further our understanding of the pathophysiology of survivor sequelae. Methods/Principal findings We performed a historical cohort study using data collected as part of routine clinical care from an Ebola Treatment Centre (ETC) in Kerry Town, Sierra Leone, in order to identify predictors of mortality and of post-viral symptoms. Variables included as potential predictors were sex, age, date of admission, first recorded viral load at the ETC and symptoms (recorded upon presentation at the ETC). Multivariable logistic regression was used to identify predictors. Of 263 Ebola-confirmed patients admitted between November 2014 and March 2015, 151 (57%) survived to ETC discharge. Viral load was the strongest predictor of mortality (adjusted OR comparing high with low viral load: 84.97, 95% CI 30.87–345.94). We did not find evidence that a high viral load predicted post-viral symptoms (ocular: 1.17, 95% CI 0.35–3.97; musculoskeletal: 1.07, 95% CI 0.28–4.08). Ocular post-viral symptoms were more common in females (2.31, 95% CI 0.98–5.43) and in those who had experienced hiccups during the acute phase (4.73, 95% CI 0.90–24.73). Conclusions/Significance These findings may add epidemiological support to the hypothesis that post-viral symptoms have an immune-mediated aspect and may not only be a consequence of high viral load and disease severity.
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Affiliation(s)
- Kevin Wing
- Save the Children International, Kerry Town, Sierra Leone
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Shefali Oza
- Save the Children International, Kerry Town, Sierra Leone
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine Houlihan
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Judith R. Glynn
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sharon Irvine
- Save the Children International, Kerry Town, Sierra Leone
| | | | - Andrew J. H. Simpson
- Rare and Imported Pathogens Laboratory, Public Health England, Porton, Wilts, United Kingdom
| | - Sabah Boufkhed
- Save the Children International, Kerry Town, Sierra Leone
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Alieu Sesay
- Save the Children International, Kerry Town, Sierra Leone
| | - Lahai Vandi
- Save the Children International, Kerry Town, Sierra Leone
| | | | - Pranav Shetty
- Humanitarian Public Health Technical Unit, Save the Children, London, United Kingdom
| | - Rachael Cummings
- Humanitarian Public Health Technical Unit, Save the Children, London, United Kingdom
| | - Francesco Checchi
- Save the Children International, Kerry Town, Sierra Leone
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine R. McGowan
- Save the Children International, Kerry Town, Sierra Leone
- London School of Hygiene & Tropical Medicine, London, United Kingdom
- Humanitarian Public Health Technical Unit, Save the Children, London, United Kingdom
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