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Chitre S, Barrie MB, Kanu JS, Conteh TS, Bayoh M, Kamara MN, Bangura HF, Lascher JS, Frankfurter R, Goldberg SA, Glidden DV, Kelly JD, Lakoh S, Richardson ET. Post-Omicron SARS-CoV-2 antibody prevalence in Sierra Leone: A cross-sectional, nationally representative, follow-up serosurvey. PLOS GLOBAL PUBLIC HEALTH 2025; 5:e0004273. [PMID: 40238730 PMCID: PMC12002446 DOI: 10.1371/journal.pgph.0004273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Accepted: 01/22/2025] [Indexed: 04/18/2025]
Abstract
Based on a serosurvey conducted in March 2021, Barrie and colleagues published the first nationally representative SARS-CoV-2 serosurvey in Africa, estimating a SARS-CoV-2 seroprevalence of 2.6% in Sierra Leone, 43 times higher than the reported number of cases at that time. Over the following two years, increasingly transmissible variants-specifically Delta and Omicron-proliferated across the globe, and their impact in Africa is poorly understood. Additional nationally representative seroprevalence data are therefore necessary to understand the pandemic's progression on the continent and for evaluating containment measures and future preparedness. Our follow-up nationally representative survey was conducted in Sierra Leone from February to March 2023. We returned to the 120 Enumeration Areas throughout the country collecting blood samples from one or more individuals per household as well as information on sociodemographic characteristics, history of COVID-19 infection and immunization, and attitudes towards vaccination. The weighted overall seroprevalence (vaccinated and/or SARS-CoV-2 infection) for individuals >19 years of age was 33% (95% CI 29-37). Using the data and distributions from our previous serosurvey, the weighted predicted seroprevalence (any prior SARS-CoV-2 infection) for the general population was 28% (95% CI 15-41). The weighted predicted seroprevalence was ~11 times higher than the pre-Delta/Omicron prevalence. It was also over 300 times higher than the reported number of cases. Despite this, overall seroprevalence was low compared with countries in Europe and the Americas (pointing towards lower transmission in Sierra Leone). In addition, our results suggest the following regarding prevention campaigns claiming to have vaccinated 70% of adults in Sierra Leone as of December 2022: 1) they resulted in limited seroconversion; 2) there was significant waning of immunity; and/or 3) many less individuals were vaccinated than reported. Regardless of the cause, the utility of COVID-19 Vaccine Delivery Partnership (CoVDP) efforts three years into the pandemic is called into question.
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Affiliation(s)
- Smit Chitre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mohamed Bailor Barrie
- Partners In Health, Kono, Sierra Leone
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Joseph Sam Kanu
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Theophilus S. Conteh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | | | - Matilda N. Kamara
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Haja Fatmata Bangura
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
| | - Jonathan S. Lascher
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Raphael Frankfurter
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Sarah A. Goldberg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - David V. Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - J. Daniel Kelly
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Sulaiman Lakoh
- Ministry of Health and Sanitation, Government of Sierra Leone, Freetown, Sierra Leone
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Eugene T. Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
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Drainas AP, McIlwain DR, Dallas A, Chu T, Delgado-González A, Baron M, Angulo-Ibáñez M, Trejo A, Bai Y, Hickey JW, Lu G, Lu S, Pineda-Ramirez J, Anglin K, Richardson ET, Prostko JC, Frias E, Servellita V, Brazer N, Chiu CY, Peluso MJ, Martin JN, Wirz OF, Pham TD, Boyd SD, Kelly JD, Sage J, Nolan GP, Rovira-Clavé X. High-throughput multiplexed serology via the mass-spectrometric analysis of isotopically barcoded beads. Nat Biomed Eng 2025:10.1038/s41551-025-01349-0. [PMID: 39939547 DOI: 10.1038/s41551-025-01349-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/12/2025] [Indexed: 02/14/2025]
Abstract
In serology, each sample is typically tested individually, one antigen at a time. This is costly and time consuming. Serology techniques should ideally allow recurrent measurements in parallel in small sample volumes and be inexpensive and fast. Here we show that mass cytometry can be used to scale up multiplexed serology testing by leveraging polystyrene beads uniformly loaded with combinations of stable isotopes. We generated 18,480 unique isotopically barcoded beads to simultaneously detect, in a single tube with 924 serum samples, the levels of immunoglobulins G and M against 19 proteins from SARS-CoV-2 (a total of 36,960 tests in 400 nl of sample volume and 30 μl of reaction volume). As a rapid, high-throughput and cost-effective technique, serology by mass cytometry may contribute to the effective management of public health emergencies originating from infectious diseases.
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Affiliation(s)
- Alexandros P Drainas
- Department of Pediatrics, Stanford University, Stanford, CA, USA.
- Department of Genetics, Stanford University, Stanford, CA, USA.
| | - David R McIlwain
- Department of Pathology, Stanford University, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
- Department of Microbiology and Immunology, University of Nevada Reno, Reno, NV, USA
| | - Alec Dallas
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Theresa Chu
- Department of Pathology, Stanford University, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Antonio Delgado-González
- Department of Pathology, Stanford University, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Maya Baron
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Genetics, Stanford University, Stanford, CA, USA
| | | | - Angelica Trejo
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
| | - Yunhao Bai
- Department of Pathology, Stanford University, Stanford, CA, USA
- Department of Chemistry, Stanford University, Stanford, CA, USA
| | - John W Hickey
- Department of Pathology, Stanford University, Stanford, CA, USA
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Guolan Lu
- Department of Pathology, Stanford University, Stanford, CA, USA
- Otolaryngology, Stanford University, Stanford, CA, USA
| | - Scott Lu
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jesus Pineda-Ramirez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Khamal Anglin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John C Prostko
- Applied Research and Technology, Abbott Laboratories Inc., Abbott Park, IL, USA
| | - Edwin Frias
- Applied Research and Technology, Abbott Laboratories Inc., Abbott Park, IL, USA
| | - Venice Servellita
- Department of Laboratory Medicine, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Noah Brazer
- Department of Laboratory Medicine, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Charles Y Chiu
- Department of Laboratory Medicine, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael J Peluso
- Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Oliver F Wirz
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Tho D Pham
- Department of Pathology, Stanford University, Stanford, CA, USA
- Stanford Blood Center, Palo Alto, CA, USA
| | - Scott D Boyd
- Department of Pathology, Stanford University, Stanford, CA, USA
- Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Stanford, CA, USA
| | - J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Department of Medicine, Infectious Diseases and Global Medicine, University of California San Francisco, San Francisco, CA, USA
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
- F.I. Proctor Foundation, University of California San Francisco, San Francisco, CA, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Julien Sage
- Department of Pediatrics, Stanford University, Stanford, CA, USA
- Department of Genetics, Stanford University, Stanford, CA, USA
| | - Garry P Nolan
- Department of Pathology, Stanford University, Stanford, CA, USA.
| | - Xavier Rovira-Clavé
- Department of Pathology, Stanford University, Stanford, CA, USA.
- Department of Microbiology and Immunology, Stanford University, Stanford, CA, USA.
- Institute for Bioengineering of Catalonia, Barcelona Institute of Science and Technology, Barcelona, Spain.
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Semancik CS, Whitworth HS, Price MA, Yun H, Postler TS, Zaric M, Kilianski A, Cooper CL, Kuteesa M, Talasila S, Malkevich N, Gupta SB, Francis SC. Seroprevalence of Antibodies to Filoviruses with Outbreak Potential in Sub-Saharan Africa: A Systematic Review to Inform Vaccine Development and Deployment. Vaccines (Basel) 2024; 12:1394. [PMID: 39772055 PMCID: PMC11726543 DOI: 10.3390/vaccines12121394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 11/27/2024] [Accepted: 12/09/2024] [Indexed: 01/16/2025] Open
Abstract
Background/Objectives: Orthoebolaviruses and orthomarburgviruses are filoviruses that can cause viral hemorrhagic fever and significant morbidity and mortality in humans. The evaluation and deployment of vaccines to prevent and control Ebola and Marburg outbreaks must be informed by an understanding of the transmission and natural history of the causative infections, but little is known about the burden of asymptomatic infection or undiagnosed disease. This systematic review of the published literature examined the seroprevalence of antibodies to orthoebolaviruses and orthomarburgviruses in sub-Saharan Africa. Methods: The review protocol was registered on PROSPERO (ID: CRD42023415358) and previously published. Eighty-seven articles describing 85 studies were included, of which seventy-six measured antibodies to orthoebolaviruses and forty-one measured antibodies to orthomarburgviruses. Results: The results highlight three central findings that may have implications for vaccine development and deployment. First, substantial antibody seropositivity to Ebola virus (EBOV) and Sudan virus (SUDV) was observed in populations from outbreak-affected areas (≤33% seroprevalence among general populations; ≤41% seroprevalence among healthcare workers and close contacts of disease cases). Second, antibody seropositivity to EBOV, SUDV, and Marburg virus (MARV) was observed among populations from areas without reported outbreaks, with seroprevalence ranging from <1 to 21%. Third, in Central and East Africa, MARV antibody seroprevalence was substantially lower than EBOV or SUDV antibody seroprevalence, even in outbreak-affected areas and in populations at a moderate or high risk of infection (with MARV seroprevalence mostly ranging from 0 to 3%). Conclusions: Whilst gaps remain in our understanding of the significance of antibody seropositivity in some settings and contexts, these findings may be important in considering target indications for novel filovirus vaccines, in defining study designs and strategies for demonstrating vaccine efficacy or effectiveness, and in planning and evaluating vaccine deployment strategies to prevent and control outbreaks.
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Affiliation(s)
- Christopher S. Semancik
- IAVI, 125 Broad St, New York, NY 10004, USA
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA 02111, USA
| | | | - Matt A. Price
- IAVI, 125 Broad St, New York, NY 10004, USA
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA 94143, USA
| | - Heejin Yun
- IAVI, 125 Broad St, New York, NY 10004, USA
| | - Thomas S. Postler
- Vaccine Design and Development Laboratory, IAVI, Brooklyn, NY 11220, USA
| | | | | | | | | | | | | | | | - Suzanna C. Francis
- IAVI, 125 Broad St, New York, NY 10004, USA
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
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Frankfurter RG, Willet V, Richardson ET, Rutherford GW, Baller A, Kelly JD. Infection prevention and control studies for care of patients with suspected or confirmed filovirus disease in healthcare settings, with focus on Ebola and Marburg: an integrative review. BMJ PUBLIC HEALTH 2024; 2:e000556. [PMID: 39015119 PMCID: PMC11251729 DOI: 10.1136/bmjph-2023-000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Objective To review evidence pertaining to methods for preventing healthcare-associated filovirus infections (including the survivability of filoviruses in clinical environments and the chlorine concentration required for effective disinfection), and to assess protocols for determining the risk of health worker (HW) exposures to filoviruses. Design Integrative review. Data sources PubMed, Embase, Google Scholar, internet-based sources of international health organisations (eg, WHO, CDC), references of the included literature and grey literature. Study selection Laboratory science, clinical research and real-world observational studies identified through comprehensive search strings that pertained to Ebola disease and Marburg disease and the three research objectives. Methods Using the framework of population, intervention or exposure, outcomes, study types and report characteristics, reviewers extracted data and critically appraised the evidence using predefined data extraction forms and summary tables. The extraction forms, summary tables and critical appraisals varied based on the included literature; we used both the QUIPS Risk-of-Bias tool when possible and an internally developed instrument to systematically extract and review the evidence from observational and experimental studies. Evidence was then synthesised and summarised to create summary recommendations. Results Thirty-six studies (including duplicates across research questions) were included in our reviews. All studies that related to the review questions were either (1) descriptive, real-world studies (ie, environmental audits of various surfaces in operational Ebola Treatment Units) or (2) controlled, laboratory studies (ie, experimental studies on the survivability of ebolaviruses in controlled conditions), presenting a range of concerns pertaining to bias and external validity. Our reviews of viral survivability evidence revealed significant disconnections between laboratory-based and real-world findings. However, there is greater viral persistence in liquid than dried body fluids, with the possible exception of blood, and ebolaviruses can survive for significant periods of time in dried substrate. Evidence suggests that 0.5% hypochlorite solution should be used for disinfection activity. Spills should be cleaned with covering and soaking for 15 min. Existing literature suggests that within a well-resourced clinical environment with trained, foreign HWs and established protocols, transmission of ebolaviruses as an occupational risk is a rare event. Despite the high rates of HW infections within public African healthcare settings, no evidence with low risk of bias exists to assess the risk of various occupational exposures given that all high-quality studies were conducted on foreign Ebola clinicians who had low overall rates of infection. This review underscores the critical need for better-quality evidence to inform best practices to ensure HW safety during filovirus disease epidemics.
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Affiliation(s)
- Raphael G Frankfurter
- University of California San Francisco School of Medicine,
San Francisco, California, USA
| | | | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard
Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
| | - George W Rutherford
- Department of Epidemiology and Biostatistics, University of
California San Francisco, San Francisco, California, USA
| | - April Baller
- WHO Health Emergencies (WHE) Programme, Geneva,
Switzerland
| | - J Daniel Kelly
- University of California San Francisco School of Medicine,
San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of
California San Francisco, San Francisco, California, USA
- Department of Medicine, University of California San
Francisco, San Francisco, California, USA
- Francis I. Proctor Foundation, San Francisco, CA, USA
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Muzembo BA, Kitahara K, Mitra D, Ntontolo NP, Ngatu NR, Ohno A, Khatiwada J, Dutta S, Miyoshi SI. The basic reproduction number (R 0) of ebola virus disease: A systematic review and meta-analysis. Travel Med Infect Dis 2024; 57:102685. [PMID: 38181864 DOI: 10.1016/j.tmaid.2023.102685] [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: 08/07/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Ebola virus disease (Ebola) is highly pathogenic, transmissible, and often deadly, with debilitating consequences. Superspreading within a cluster is also possible. In this study, we aim to document Ebola basic reproduction number (R0): the average number of new cases associated with an Ebola case in a completely susceptible population. METHODS We undertook a systematic review and meta-analysis. We searched PubMed, EMBASE, and Web of Science for studies published between 1976 and February 27, 2023. We also manually searched the reference lists of the reviewed studies to identify additional studies. We included studies that reported R0 during Ebola outbreaks in Africa. We excluded studies that reported only the effective reproduction number (Rt). Abstracting data from included studies was performed using a pilot-tested standard form. Two investigators reviewed the studies, extracted the data, and assessed quality. The pooled R0 was determined by a random-effects meta-analysis. R0 was stratified by country. We also estimated the theoretically required immunization coverage to reach herd-immunity using the formula of (1-1/R0) × 100 %. RESULTS The search yielded 2042 studies. We included 53 studies from six African countries in the systematic review providing 97 Ebola mean R0 estimates. 27 (with 46 data points) studies were included in the meta-analysis. The overall pooled mean Ebola R0 was 1.95 (95 % CI 1.74-2.15), with high heterogeneity (I2 = 99.99 %; τ2 = 0.38; and p < 0.001) and evidence of small-study effects (Egger's statistics: Z = 4.67; p < 0.001). Mean Ebola R0 values ranged from 1.2 to 10.0 in Nigeria, 1.1 to 7 in Guinea, 1.14 to 8.33 in Sierra Leone, 1.13 to 5 in Liberia, 1.2 to 5.2 in DR Congo, 1.34 to 2.7 in Uganda, and from 1.40 to 2.55 for all West African countries combined. Pooled mean Ebola R0 was 9.38 (95 % CI 4.16-14.59) in Nigeria, 3.31 (95 % CI 2.30-4.32) in DR Congo, 2.0 (95 % CI 1.25-2.76) in Uganda, 1.83 (95 % CI 1.61-2.05) in Liberia, 1.73 (95 % CI 1.47-2.0) in Sierra Leonne, and 1.44 (95 % CI 1.29-1.60) in Guinea. In theory, 50 % of the population needs to be vaccinated to achieve herd immunity, assuming that Ebola vaccine would be 100 % effective. CONCLUSIONS Ebola R0 varies widely across countries. Ebola has a much wider R0 range than is often claimed (1.3-2.0). It is possible for an Ebola index case to infect more than two susceptible individuals.
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Affiliation(s)
- Basilua Andre Muzembo
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
| | - Kei Kitahara
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan; Collaborative Research Centre of Okayama University for Infectious Diseases in India at ICMR-NICED, Kolkata, India
| | - Debmalya Mitra
- Collaborative Research Centre of Okayama University for Infectious Diseases in India at ICMR-NICED, Kolkata, India
| | - Ngangu Patrick Ntontolo
- Institut Médical Evangélique (IME), Kimpese, Congo; Department of Family Medicine and PHC, Protestant University of Congo, Congo
| | - Nlandu Roger Ngatu
- Department of Public Health, Kagawa University Faculty of Medicine, Miki, Japan
| | - Ayumu Ohno
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan; Collaborative Research Centre of Okayama University for Infectious Diseases in India at ICMR-NICED, Kolkata, India
| | | | - Shanta Dutta
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shin-Ichi Miyoshi
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Gayedyu-Dennis D, Fallah MP, Drew C, Badio M, Moses JS, Fayiah T, Johnson K, Richardson ET, Weiser SD, Porco TC, Martin JN, Sneller MC, Rutherford GW, Reilly C, Lindan CP, Kelly JD. Identifying Paucisymptomatic or Asymptomatic and Unrecognized Ebola Virus Disease Among Close Contacts Based on Exposure Risk Assessments and Screening Algorithms. J Infect Dis 2023; 227:878-887. [PMID: 36047331 PMCID: PMC10319948 DOI: 10.1093/infdis/jiac359] [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: 04/18/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is limited evidence to evaluate screening algorithms with rapid antigen testing and exposure assessments as identification strategies for paucisymptomatic or asymptomatic Ebola virus (EBOV) infection and unrecognized EBOV disease (EVD). METHODS We used serostatus and self-reported postexposure symptoms from a cohort study to classify contact-participants as having no infection, paucisymptomatic or asymptomatic infection, or unrecognized EVD. Exposure risk was categorized as low, intermediate, or high. We created hypothetical scenarios to evaluate the World Health Organization (WHO) case definition with or without rapid diagnostic testing (RDT) or exposure assessments. RESULTS This analysis included 990 EVD survivors and 1909 contacts, of whom 115 (6%) had paucisymptomatic or asymptomatic EBOV infection, 107 (6%) had unrecognized EVD, and 1687 (88%) were uninfected. High-risk exposures were drivers of unrecognized EVD (adjusted odds ratio, 3.5 [95% confidence interval, 2.4-4.9]). To identify contacts with unrecognized EVD who test negative by the WHO case definition, the sensitivity was 96% with RDT (95% confidence interval, 91%-99%), 87% with high-risk exposure (82%-92%), and 97% with intermediate- to high-risk exposures (93%-99%). The proportion of false-positives was 2% with RDT and 53%-93% with intermediate- and/or high-risk exposures. CONCLUSION We demonstrated the utility and trade-offs of sequential screening algorithms with RDT or exposure risk assessments as identification strategies for contacts with unrecognized EVD.
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Affiliation(s)
- Dehkontee Gayedyu-Dennis
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Mosoka P Fallah
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
- A.M. Dogliotti College of Medicine, University of Liberia, Monrovia, Liberia
| | - Clara Drew
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Moses Badio
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - J S Moses
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Tamba Fayiah
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Kumblytee Johnson
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
| | - Eugene T Richardson
- Department of Medicine, Brigham and Women’s Hospital, Boston, Minnesota, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Minnesota, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Jeffrey N Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Michael C Sneller
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - George W Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Cavan Reilly
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Christina P Lindan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - J D Kelly
- Partnership for Research on Vaccines and Infectious Diseases in Liberia (PREVAIL), Monrovia, Liberia
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Francis I. Proctor Foundation, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
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7
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Reddy M. Flattening the curve: voluntary association participation and the 2013-16 West Africa Ebola epidemic. DISASTERS 2023; 47:366-388. [PMID: 35612956 DOI: 10.1111/disa.12548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To what extent does voluntary association participation correlate with reduced Ebola duration in districts of Guinea, Liberia, and Sierra Leone during the epidemic in West Africa in 2013-16? This study, the first cross-national quantitative analysis of Ebola outcomes across these countries, answers this question by investigating how social capital influences epidemic outcomes. Ebola virus disease struck along the borders of three countries with similar levels of human development as well as cultural practices, yet resulted in different outcomes. This study examines the role of social trust, political trust, voluntary association participation, religious organisation membership, and community meeting attendance in explaining international policy failure to reduce Ebola outcomes. Overall, in districts with a culture of raising issues and participating in voluntary and religious organisations, Ebola duration rates were lower. These findings have implications not only for health crisis response, but also for disaster response and the provision of international aid to civil society.
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Affiliation(s)
- Michelle Reddy
- Postdoctoral Fellow, Center for International Studies (CERI), Sciences Po, France
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Hazel A, Davidson MC, Rogers A, Barrie MB, Freeman A, Mbayoh M, Kamara M, Blumberg S, Lietman TM, Rutherford GW, Jones JH, Porco TC, Richardson ET, Kelly JD. Social Network Analysis of Ebola Virus Disease During the 2014 Outbreak in Sukudu, Sierra Leone. Open Forum Infect Dis 2022; 9:ofac593. [PMID: 36467298 PMCID: PMC9709704 DOI: 10.1093/ofid/ofac593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/01/2022] [Indexed: 08/02/2023] Open
Abstract
Background Transmission by unreported cases has been proposed as a reason for the 2013-2016 Ebola virus (EBOV) epidemic decline in West Africa, but studies that test this hypothesis are lacking. We examined a transmission chain within social networks in Sukudu village to assess spread and transmission burnout. Methods Network data were collected in 2 phases: (1) serological and contact information from Ebola cases (n = 48, including unreported); and (2) interviews (n = 148), including Ebola survivors (n = 13), to identify key social interactions. Social links to the transmission chain were used to calculate cumulative incidence proportion as the number of EBOV-infected people in the network divided by total network size. Results The sample included 148 participants and 1522 contacts, comprising 10 social networks: 3 had strong links (>50% of cases) to the transmission chain: household sharing (largely kinship), leisure time, and talking about important things (both largely non-kin). Overall cumulative incidence for these networks was 37 of 311 (12%). Unreported cases did not have higher network centrality than reported cases. Conclusions Although this study did not find evidence that explained epidemic decline in Sukudu, it excluded potential reasons (eg, unreported cases, herd immunity) and identified 3 social interactions in EBOV transmission.
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Affiliation(s)
- Ashley Hazel
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Michelle C Davidson
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Abu Rogers
- School of Medicine, Stanford University, Stanford, California, USA
| | - M Bailor Barrie
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Partners in Health, Freetown, Sierra Leone
| | | | | | | | - Seth Blumberg
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
| | - George W Rutherford
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - James Holland Jones
- Division of Social Sciences, Doerr School of Sustainability and the Environment, Stanford University, Stanford, California, USA
| | - Travis C Porco
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Eugene T Richardson
- Partners in Health, Freetown, Sierra Leone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - J Daniel Kelly
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
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9
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Kelly JD, Frankfurter RG, Tavs JM, Barrie MB, McGinnis T, Kamara M, Freeman A, Quiwah K, Davidson MC, Dighero-Kemp B, Gichini H, Elliott E, Reilly C, Hensley LE, Lane HC, Weiser SD, Porco TC, Rutherford GW, Richardson ET. Association of Lower Exposure Risk With Paucisymptomatic/Asymptomatic Infection, Less Severe Disease, and Unrecognized Ebola Virus Disease: A Seroepidemiological Study. Open Forum Infect Dis 2022; 9:ofac052. [PMID: 35265726 PMCID: PMC8900924 DOI: 10.1093/ofid/ofac052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/31/2022] [Indexed: 01/12/2023] Open
Abstract
Background It remains unclear if there is a dose-dependent relationship between exposure risk to Ebola virus (EBOV) and severity of illness. Methods From September 2016 to July 2017, we conducted a cross-sectional, community-based study of Ebola virus disease (EVD) cases and household contacts of several transmission chains in Kono District, Sierra Leone. We analyzed 154 quarantined households, comprising both reported EVD cases and their close contacts. We used epidemiological surveys and blood samples to define severity of illness as no infection, pauci-/asymptomatic infection, unrecognized EVD, reported EVD cases who survived, or reported EVD decedents. We determine seropositivity with the Filovirus Animal Nonclinical Group EBOV glycoprotein immunoglobulin G antibody test. We defined levels of exposure risk from 8 questions and considered contact with body fluid as maximum exposure risk. Results Our analysis included 76 reported EVD cases (both decedents and survivors) and 421 close contacts. Among these contacts, 40 were seropositive (22 paucisymptomatic and 18 unrecognized EVD), accounting for 34% of the total 116 EBOV infections. Higher exposure risks were associated with having had EBOV infection (maximum risk: adjusted odds ratio [AOR], 12.1 [95% confidence interval {CI}, 5.8-25.4; trend test: P < .001) and more severe illness (maximum risk: AOR, 25.2 [95% CI, 6.2-102.4]; trend test: P < .001). Conclusions This community-based study of EVD cases and contacts provides epidemiological evidence of a dose-dependent relationship between exposure risk and severity of illness, which may partially explain why pauci-/asymptomatic EBOV infection, less severe disease, and unrecognized EVD occurs.
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Affiliation(s)
- J Daniel Kelly
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- F. I. Proctor Foundation, University of California, San Francisco, California, USA
- Partners In Health, Freetown, Sierra Leone
| | | | - Jacqueline M Tavs
- F. I. Proctor Foundation, University of California, San Francisco, California, USA
| | - Mohamed Bailor Barrie
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
- Partners In Health, Freetown, Sierra Leone
| | - Timothy McGinnis
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | - Michelle C Davidson
- School of Medicine, University of California, San Francisco, California, USA
| | - Bonnie Dighero-Kemp
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, Maryland, USA
| | - Harrison Gichini
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, Maryland, USA
| | - Elizabeth Elliott
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, Maryland, USA
| | - Cavan Reilly
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lisa E Hensley
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, Maryland, USA
| | - H Clifford Lane
- Integrated Research Facility, National Institute of Allergy and Infectious Diseases, Fort Detrick, Maryland, USA
| | - Sheri D Weiser
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- F. I. Proctor Foundation, University of California, San Francisco, California, USA
| | - George W Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Eugene T Richardson
- Partners In Health, Freetown, Sierra Leone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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10
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Barrie MB, Lakoh S, Kelly JD, Kanu JS, Squire JS, Koroma Z, Bah S, Sankoh O, Brima A, Ansumana R, Goldberg SA, Chitre S, Osuagwu C, Frankfurter R, Maeda J, Barekye B, Numbere TW, Abdulaziz M, Mounts A, Blanton C, Singh T, Samai M, Vandi M, Richardson ET. SARS-CoV-2 antibody prevalence in Sierra Leone, March 2021: a cross-sectional, nationally representative, age-stratified serosurvey. BMJ Glob Health 2021; 6:e007271. [PMID: 34764148 PMCID: PMC8587532 DOI: 10.1136/bmjgh-2021-007271] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 10/20/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION As of 26 March 2021, the Africa Centres for Disease Control and Prevention had reported 4 159 055 cases of COVID-19 and 111 357 deaths among the 55 African Union member states; however, no country has published a nationally representative serosurvey as of October 2021. Such data are vital for understanding the pandemic's progression on the continent, evaluating containment measures, and policy planning. METHODS We conducted a cross-sectional, nationally representative, age-stratified serosurvey in Sierra Leone in March 2021 by randomly selecting 120 Enumeration Areas throughout the country and 10 randomly selected households in each of these. One to two persons per selected household were interviewed to collect information on sociodemographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. Capillary blood was collected by fingerstick, and blood samples were tested using the Hangzhou Biotest Biotech RightSign COVID-19 IgG/IgM Rapid Test Cassette. Total seroprevalence was estimated after applying sampling weights. RESULTS The overall weighted seroprevalence was 2.6% (95% CI 1.9% to 3.4%). This was 43 times higher than the reported number of cases. Rural seropositivity was 1.8% (95% CI 1.0% to 2.5%), and urban seropositivity was 4.2% (95% CI 2.6% to 5.7%). DISCUSSION Overall seroprevalence was low compared with countries in Europe and the Americas (suggesting relatively successful containment in Sierra Leone). This has ramifications for the country's third wave (which started in June 2021), during which the average number of daily reported cases was 87 by the end of the month:this could potentially be on the order of 3700 actual infections per day, calling for stronger containment measures in a country with only 0.2% of people fully vaccinated. It may also reflect significant under-reporting of incidence and mortality across the continent.
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Affiliation(s)
- Mohamed Bailor Barrie
- Institute for Global Health Sciences, UCSF, San Francisco, California, USA
- Partners In Health, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - J Daniel Kelly
- Institute for Global Health Sciences, UCSF, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | - Joseph Sam Kanu
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - James Sylvester Squire
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - Zikan Koroma
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - Silleh Bah
- Statistics Sierra Leone, Freetown, Sierra Leone
| | - Osman Sankoh
- Statistics Sierra Leone, Freetown, Sierra Leone
- Njala University, Bo, Sierra Leone
- HIGH, University of Heidelberg, Heidelberg, Germany
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Sarah A Goldberg
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, California, USA
| | - Smit Chitre
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Chidinma Osuagwu
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Raphael Frankfurter
- Department of Humanities and Social Sciences, UCSF, San Francisco, California, USA
| | - Justin Maeda
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Bernard Barekye
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Mohammed Abdulaziz
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Anthony Mounts
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Curtis Blanton
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tushar Singh
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Mohamed Vandi
- Sierra Leone Ministry of Health and Sanitation, Freetown, Western Area Urban, Sierra Leone
| | - Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
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11
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Barrie MB, Lakoh S, Kelly JD, Kanu JS, Squire J, Koroma Z, Bah S, Sankoh O, Brima A, Ansumana R, Goldberg SA, Chitre S, Osuagwu C, Maeda J, Barekye B, Numbere TW, Abdulaziz M, Mounts A, Blanton C, Singh T, Samai M, Vandi MA, Richardson ET. SARS-CoV-2 antibody prevalence in Sierra Leone, March 2021: a cross-sectional, nationally representative, age-stratified serosurvey. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.06.27.21259271. [PMID: 34230939 PMCID: PMC8259916 DOI: 10.1101/2021.06.27.21259271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background As of 26 March 2021, the Africa CDC had reported 4,159,055 cases of COVID-19 and 111,357 deaths among the 55 African Union Member States; however, no country has published a nationally representative serosurvey as of May 2021. Such data are vital for understanding the pandemic's progression on the continent, evaluating containment measures, and policy planning. Methods We conducted a cross-sectional, nationally representative, age-stratified serosurvey in Sierra Leone in March 2021 by randomly selecting 120 Enumeration Areas throughout the country and 10 randomly selected households in each of these. One to two persons per selected household were interviewed to collect information on socio-demographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. Capillary blood was collected by fingerstick, and blood samples were tested using the Hangzhou Biotest Biotech RightSign COVID-19 IgG/IgM Rapid Test Cassette. Total seroprevalence was was estimated after applying sampling weights. Findings The overall weighted seroprevalence was 2.6% (95% CI 1.9-3.4). This is 43 times higher than the reported number of cases. Rural seropositivity was 1.8% (95% CI 1.0-2.5), and urban seropositivity was 4.2% (95% CI 2.6-5.7). Interpretation Although overall seroprevalence was low compared to countries in Europe and the Americas (suggesting relatively successful containment in Sierra Leone), our findings indicate enormous underreporting of active cases. This has ramifications for the country's third wave (which started in June 2021), where the average number of daily reported cases was 87 by the end of the month: this could potentially be on the order of 3,700 actual infections, calling for stronger containment measures in a country with only 0.2% of people fully vaccinated. It may also reflect significant underreporting of incidence and mortality across the continent.
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Affiliation(s)
- Mohamed Bailor Barrie
- Institute for Global Health Sciences, University of California, San Francisco, USA
- Partners In Health, Sierra Leone
| | - Sulaiman Lakoh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | | | - Joseph Sam Kanu
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - James Squire
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Zikan Koroma
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | | | - Osman Sankoh
- Statistics Sierra Leone
- Njala University, Sierra Leone
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Heath, University of Heidelberg Medical School, Germany
| | | | | | - Sarah A. Goldberg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Smit Chitre
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Chidinma Osuagwu
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Justin Maeda
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Bernard Barekye
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Mohammed Abdulaziz
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Anthony Mounts
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Curtis Blanton
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tushar Singh
- U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mohamed Samai
- College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Mohamed A. Vandi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Eugene T. Richardson
- Department of Global Health & Social Medicine, Harvard Medical School, Boston, MA, USA
- Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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12
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Kelly JD, Wannier SR, Sinai C, Moe CA, Hoff NA, Blumberg S, Selo B, Mossoko M, Chowell-Puente G, Jones JH, Okitolonda-Wemakoy E, Rutherford GW, Lietman TM, Muyembe-Tamfum JJ, Rimoin AW, Porco TC, Richardson ET. The Impact of Different Types of Violence on Ebola Virus Transmission During the 2018-2020 Outbreak in the Democratic Republic of the Congo. J Infect Dis 2020; 222:2021-2029. [PMID: 32255180 PMCID: PMC7661768 DOI: 10.1093/infdis/jiaa163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/05/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Our understanding of the different effects of targeted versus nontargeted violence on Ebola virus (EBOV) transmission in Democratic Republic of the Congo (DRC) is limited. METHODS We used time-series data of case counts to compare individuals in Ebola-affected health zones in DRC, April 2018-August 2019. Exposure was number of violent events per health zone, categorized into Ebola-targeted or Ebola-untargeted, and into civilian-induced, (para)military/political, or protests. Outcome was estimated daily reproduction number (Rt) by health zone. We fit linear time-series regression to model the relationship. RESULTS Average Rt was 1.06 (95% confidence interval [CI], 1.02-1.11). A mean of 2.92 violent events resulted in cumulative absolute increase in Rt of 0.10 (95% CI, .05-.15). More violent events increased EBOV transmission (P = .03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on Rt, Ebola-targeted events corresponded to Rt of 1.52 (95% CI, 1.30-1.74), while civilian-induced events corresponded to Rt of 1.43 (95% CI, 1.21-1.35). Untargeted events corresponded to Rt of 1.18 (95% CI, 1.02-1.35); among these, militia/political or ville morte events increased transmission. CONCLUSIONS Ebola-targeted violence, primarily driven by civilian-induced events, had the largest impact on EBOV transmission.
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Affiliation(s)
- John Daniel Kelly
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
- F. I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Sarah Rae Wannier
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
- F. I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA
| | - Cyrus Sinai
- Department of Geography, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Caitlin A Moe
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
- Firearm Injury Policy and Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA
| | - Nicole A Hoff
- School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Seth Blumberg
- F. I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA
| | - Bernice Selo
- Ministry of Health, Kinshasa, Democratic Republic of Congo
| | | | - Gerardo Chowell-Puente
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - James Holland Jones
- Department of Earth Systems Science, Stanford University, Stanford, California, USA
| | | | - George W Rutherford
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Institute of Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Thomas M Lietman
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Anne W Rimoin
- School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
- F. I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA
| | - Eugene T Richardson
- Harvard Medical School, Boston, Massachusetts, USA
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
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13
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Kumar M, Thakur AK, Mazumder P, Kuroda K, Mohapatra S, Rinklebe J, Ramanathan A, Cetecioglu Z, Jain S, Tyagi VK, Gikas P, Chakraborty S, Tahmidul Islam M, Ahmad A, Shah AV, Patel AK, Watanabe T, Vithanage M, Bibby K, Kitajima M, Bhattacharya P. Frontier review on the propensity and repercussion of SARS-CoV-2 migration to aquatic environment. JOURNAL OF HAZARDOUS MATERIALS LETTERS 2020; 1:100001. [PMID: 34977840 PMCID: PMC7456799 DOI: 10.1016/j.hazl.2020.100001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 05/16/2023]
Abstract
Increased concern has recently emerged pertaining to the occurrence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in aquatic environment during the current coronavirus disease 2019 (COVID-19) pandemic. While infectious SARS-CoV-2 has yet to be identified in the aquatic environment, the virus potentially enters the wastewater stream from patient excretions and a precautionary approach dictates evaluating transmission pathways to ensure public health and safety. Although enveloped viruses have presumed low persistence in water and are generally susceptible to inactivation by environmental stressors, previously identified enveloped viruses persist in the aqueous environment from days to several weeks. Our analysis suggests that not only the surface water, but also groundwater, represent SARS-CoV-2 control points through possible leaching and infiltrations of effluents from health care facilities, sewage, and drainage water. Most fecally transmitted viruses are highly persistent in the aquatic environment, and therefore, the persistence of SARS-CoV-2 in water is essential to inform its fate in water, wastewater and groundwater and subsequent human exposure.
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Affiliation(s)
- Manish Kumar
- Discipline of Earth Science, Indian Institute of Technology Gandhinagar, Gujarat 382 355, India
| | - Alok Kumar Thakur
- Discipline of Earth Science, Indian Institute of Technology Gandhinagar, Gujarat 382 355, India
| | - Payal Mazumder
- Centre for the Environment, Indian Institute of Technology Guwahati, Guwahati, Assam 781039, India
| | - Keisuke Kuroda
- Department of Environmental and Civil Engineering, Toyama Prefectural University, Toyama 9390398, Japan
| | - Sanjeeb Mohapatra
- Environmental Science and Engineering Department, Indian Institute of Technology, Bombay, India
| | - Jörg Rinklebe
- Laboratory of Soil- and Groundwater-Management, School of Architecture and Civil Engineering, University of Wuppertal, Wuppertal 42285, Germany
- Department of Environment, Energy and Geoinformatics, University of Sejong, Seoul, Republic of Korea
| | - Al Ramanathan
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi 110067, India
| | - Zeynep Cetecioglu
- Department of Chemical Engineering, KTH Royal Institute of Technology, Teknikringen 42, SE100 44 Stockholm, Sweden
| | - Sharad Jain
- Department of Civil Engineering, Indian Institute of Technology Roorkee, Uttarakhand 247667, India
| | - Vinay Kumar Tyagi
- Department of Civil Engineering, Indian Institute of Technology Roorkee, Uttarakhand 247667, India
| | - Petros Gikas
- School of Environmental Engineering, Technical University of Crete, Chania 73100, Greece
| | - Sudip Chakraborty
- Department of IngegneriaModellisticaElettronica&Sistemistica,University of Calabria, Via P. Bucci, Cubo 42/a, 87036 Rende (CS), Italy
| | - M Tahmidul Islam
- Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 10B, SE-10044 Stockholm, Sweden
| | - Arslan Ahmad
- KWR Water Cycle Research Institute, Groningenhaven 7, 3433 PE Nieuwegein, The Netherlands
- Department of Environmental Technology, Wageningen University and Research (WUR), The Netherlands
| | - Anil V Shah
- Gujarat Pollution Control Board, Sector-10A, Gandhinagar 382010, Gujarat, India
| | - Arbind Kumar Patel
- Discipline of Earth Science, Indian Institute of Technology Gandhinagar, Gujarat 382 355, India
| | - Toru Watanabe
- Department of Food, Life and Environmental Sciences, Yamagata University, Tsuruoka, Yamagata, Japan
| | - Meththika Vithanage
- Ecosphere Resilience Research Centre, Faculty of Applied Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - Kyle Bibby
- Department of Civil and Environmental Engineering and Earth Sciences, University of Notre Dame, 156 Fitzpatrick Hall, Notre Dame, IN 46556, United States
| | - Masaaki Kitajima
- Division of Environmental Engineering, Hokkaido University, North 13 West 8, Kita-ku, Sapporo, Hokkaido 060-8628, Japan
- Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 10B, SE-10044 Stockholm, Sweden
| | - Prosun Bhattacharya
- Department of Sustainable Development, Environmental Science and Engineering, KTH Royal Institute of Technology, Teknikringen 10B, SE-10044 Stockholm, Sweden
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14
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Abstract
The continued inordinate demise from communicable pathogens in the global South is not the result of an intractable problem thwarting our best efforts to prevent and cure disease; we have the means. Rather, as an accomplice to contemporary imperialism, public health manages (as a profession) and maintains (as an academic discipline) global health inequity. It does this through 'bourgeois empiricist' models of disease causation, which serve protected affluence by uncritically reifying inequitable social relations in the modern/colonial matrix of power and making them appear commonsensical.
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15
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Wannier SR, Worden L, Hoff NA, Amezcua E, Selo B, Sinai C, Mossoko M, Njoloko B, Okitolonda-Wemakoy E, Mbala-Kingebeni P, Ahuka-Mundeke S, Muyembe-Tamfum JJ, Richardson ET, Rutherford GW, Jones JH, Lietman TM, Rimoin AW, Porco TC, Kelly JD. Estimating the impact of violent events on transmission in Ebola virus disease outbreak, Democratic Republic of the Congo, 2018-2019. Epidemics 2019; 28:100353. [PMID: 31378584 PMCID: PMC7363034 DOI: 10.1016/j.epidem.2019.100353] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/22/2019] [Accepted: 07/09/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION As of April 2019, the current Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) is occurring in a longstanding conflict zone and has become the second largest EVD outbreak in history. It is suspected that after violent events occur, EVD transmission will increase; however, empirical studies to understand the impact of violence on transmission are lacking. Here, we use spatial and temporal trends of EVD case counts to compare transmission rates between health zones that have versus have not experienced recent violent events during the outbreak. METHODS We collected daily EVD case counts from DRC Ministry of Health. A time-varying indicator of recent violence in each health zone was derived from events documented in the WHO situation reports. We used the Wallinga-Teunis technique to estimate the reproduction number R for each case by day per zone in the 2018-2019 outbreak. We fit an exponentially decaying curve to estimates of R overall and by health zone, for comparison to past outbreaks. RESULTS As of 16 April 2019, the mean overall R for the entire outbreak was 1.11. We found evidence of an increase in the estimated transmission rates in health zones with recently reported violent events versus those without (p = 0.008). The average R was estimated as between 0.61 and 0.86 in regions not affected by recent violent events, and between 1.01 and 1.07 in zones affected by violent events within the last 21 days, leading to an increase in R between 0.17 and 0.53. Within zones with recent violent events, the mean estimated quenching rate was lower than for all past outbreaks except the 2013-2016 West African outbreak. CONCLUSION The difference in the estimated transmission rates between zones affected by recent violent events suggests that violent events are contributing to increased transmission and the ongoing nature of this outbreak.
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Affiliation(s)
- S Rae Wannier
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lee Worden
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA
| | - Nicole A Hoff
- Department of Epidemiology, School of Public Health University of California, Los Angeles, CA, USA
| | - Eduardo Amezcua
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Bernice Selo
- Ministry of Health, Kinshasa, Democratic Republic of Congo
| | - Cyrus Sinai
- Department of Geography at University of North Carolina, Chapel Hill, NC, USA
| | | | - Bathe Njoloko
- Ministry of Health, Kinshasa, Democratic Republic of Congo
| | | | | | - Steve Ahuka-Mundeke
- Insitut National de Recherche Biomedicale, Kinshasa, Democratic Republic of Congo
| | | | | | - George W Rutherford
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA
| | - James H Jones
- Department of Earth System Science, Stanford University, Stanford, CA, USA; Woods Institute for the Environment, Stanford University, Stanford, CA, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Anne W Rimoin
- Department of Epidemiology, School of Public Health University of California, Los Angeles, CA, USA
| | - Travis C Porco
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - J Daniel Kelly
- Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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16
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Huynh N, Baumann A, Loeb M. Reporting quality of the 2014 Ebola outbreak in Africa: A systematic analysis. PLoS One 2019; 14:e0218170. [PMID: 31237909 PMCID: PMC6592536 DOI: 10.1371/journal.pone.0218170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 05/28/2019] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to conduct a systematic analysis of the reporting quality of the Ebola Virus Disease (EVD) outbreak in West Africa from 2014-2018 using the Modified STROBE statement. We included studies on the 2014 EVD outbreak alone, limited to those on human patients in Africa. We searched the following databases (MEDLINE, EMBASE, and Web of Science) for outbreak reports published between 2014-2018. We assessed factors potentially associated with the quality of reporting. A total of 69 of 131 (53%) articles within the full-text review fulfilled our eligibility criteria and underwent the Modified STROBE assessment for analyzing the quality of reporting. The Modified STROBE scores of the included studies ranged from 11-26 points and the mean was found to be 19.54 out of 30 with a standard deviation (SD) of ± 4.30. The top three reported Modified STROBE components were descriptive characteristics of study participants, scientific background and evidence rational, and clinical significance of observations. More than 75% of the studies met a majority of the criteria in the Modified STROBE assessment tool. Information that was commonly missing included addressing potential source of bias, sensitivity analysis, further results/analysis such as risk estimates and odds ratios, presence of a flowchart, and addressing missing data. In multivariable analysis, peer-reviewed publication was the only predictor that remained significantly associated with a higher Modified STROBE score. In conclusion, the large range of Modified STROBE scores observed indicates variability in the quality of outbreak reports for EVD. The review identified strong reporting in some areas, whereas other areas are in need of improvement, in particular providing an important description of the outbreak setting and identifying any external elements (potential biases and confounding factors) that could hinder the credibility of the findings.
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Affiliation(s)
- Nina Huynh
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Baumann
- Global Health Office, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Michael G DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
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17
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Timothy JWS, Hall Y, Akoi-Boré J, Diallo B, Tipton TRW, Bower H, Strecker T, Glynn JR, Carroll MW. Early transmission and case fatality of Ebola virus at the index site of the 2013-16 west African Ebola outbreak: a cross-sectional seroprevalence survey. THE LANCET. INFECTIOUS DISEASES 2019; 19:429-438. [PMID: 30799252 PMCID: PMC6437313 DOI: 10.1016/s1473-3099(18)30791-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/15/2018] [Accepted: 12/06/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND To date, epidemiological studies at the index site of the 2013-16 west African Ebola outbreak in Meliandou, Guinea, have been restricted in their scope. We aimed to determine the occurrence of previously undocumented Ebola virus disease (EVD) cases and infections, and to reconstruct transmission events. METHODS This cross-sectional seroprevalence survey of the adult population of Meliandou used a highly specific oral fluid test and detailed interviews of all households in the village and key informants. Each household was interviewed, with all members prompted to describe the events of the outbreak, any illness within the household, and possible contact with suspected cases. Information for deceased individuals was provided by relatives living in the same household. Symptoms were based on Ebola virus Makona variant EVD case definitions (focusing on fever, vomiting, and diarrhoea). For antibody testing, we used an Ebola virus glycoprotein IgG capture enzyme immunoassay developed from a previously validated assay. A maximum exposure level was assigned to every participant using a predetermined scale. We used a generalised linear model (logit function) to estimate odds ratios for the association of sociodemographic variables and exposure level with Ebola virus infection. We adjusted estimates for age and maximum exposure, as appropriate. FINDINGS Between June 22, and July 9, 2017, we enrolled 237 participants from 27 households in Meliandou. Two households refused to participate and one was absent. All adults in participating households who were present for the interview provided an oral fluid swab for testing, of which 224 were suitable for analysis. In addition to the 11 EVD deaths described previously, on the basis of clinical description and oral fluid testing, we found two probable EVD deaths and eight previously unrecognised anti-Ebola virus IgG-positive survivors, including one who had mild symptoms and one who was asymptomatic, resulting in a case fatality of 55·6% (95% CI 30·8-78·5) for adults. Health-care work (adjusted odds ratio 6·64, 1·54-28·56; p=0·001) and level of exposure (odds ratio adjusted for linear trend across five levels 2·79, 1·59-4·883; p<0·0001) were independent risk factors for infection. INTERPRETATION Ebola virus infection was more widespread in this spillover population than previously recognised (21 vs 11 cases). We show the first serological evidence of survivors in this population (eight anti-Ebola virus IgG seropositive) and report a case fatality lower than previously reported (55·6% vs 100% in adults). These data show the high community coverage achievable by using a non-invasive test and, by accurately documenting the beginnings of the west African Ebola virus outbreak, reveal important insight into transmission dynamics and risk factors that underpin Ebola virus spillover events. FUNDING US Food and Drug Administration, Wellcome Trust, and German Research Council.
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Affiliation(s)
| | - Yper Hall
- Research and Development Institute, National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Joseph Akoi-Boré
- Public Health England/Tropical Medicine Institute Berlin Reference Laboratory, Guéckédou, Guinea
| | - Boubacar Diallo
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
| | - Thomas R W Tipton
- Research and Development Institute, National Infection Service, Public Health England, Porton Down, Salisbury, UK
| | - Hilary Bower
- London School of Hygiene & Tropical Medicine, London, UK
| | - Thomas Strecker
- Institute of Virology, Philipps University, Marburg, Germany
| | - Judith R Glynn
- London School of Hygiene & Tropical Medicine, London, UK
| | - Miles W Carroll
- Research and Development Institute, National Infection Service, Public Health England, Porton Down, Salisbury, UK
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18
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Kelly JD, Worden L, Wannier SR, Hoff NA, Mukadi P, Sinai C, Ackley S, Chen X, Gao D, Selo B, Mossoko M, Okitolonda-Wemakoy E, Richardson ET, Rutherford GW, Lietman TM, Muyembe-Tamfum JJ, Rimoin AW, Porco TC. Projections of Ebola outbreak size and duration with and without vaccine use in Équateur, Democratic Republic of Congo, as of May 27, 2018. PLoS One 2019; 14:e0213190. [PMID: 30845236 PMCID: PMC6405095 DOI: 10.1371/journal.pone.0213190] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/16/2019] [Indexed: 01/08/2023] Open
Abstract
As of May 27, 2018, 6 suspected, 13 probable and 35 confirmed cases of Ebola virus disease (EVD) had been reported in Équateur Province, Democratic Republic of Congo. We used reported case counts and time series from prior outbreaks to estimate the total outbreak size and duration with and without vaccine use. We modeled Ebola virus transmission using a stochastic branching process model that included reproduction numbers from past Ebola outbreaks and a particle filtering method to generate a probabilistic projection of the outbreak size and duration conditioned on its reported trajectory to date; modeled using high (62%), low (44%), and zero (0%) estimates of vaccination coverage (after deployment). Additionally, we used the time series for 18 prior Ebola outbreaks from 1976 to 2016 to parameterize the Thiel-Sen regression model predicting the outbreak size from the number of observed cases from April 4 to May 27. We used these techniques on probable and confirmed case counts with and without inclusion of suspected cases. Probabilistic projections were scored against the actual outbreak size of 54 EVD cases, using a log-likelihood score. With the stochastic model, using high, low, and zero estimates of vaccination coverage, the median outbreak sizes for probable and confirmed cases were 82 cases (95% prediction interval [PI]: 55, 156), 104 cases (95% PI: 58, 271), and 213 cases (95% PI: 64, 1450), respectively. With the Thiel-Sen regression model, the median outbreak size was estimated to be 65.0 probable and confirmed cases (95% PI: 48.8, 119.7). Among our three mathematical models, the stochastic model with suspected cases and high vaccine coverage predicted total outbreak sizes closest to the true outcome. Relatively simple mathematical models updated in real time may inform outbreak response teams with projections of total outbreak size and duration.
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Affiliation(s)
- J. Daniel Kelly
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
- F.I. Proctor Foundation, UCSF, San Francisco, CA, United States of America
| | - Lee Worden
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
- F.I. Proctor Foundation, UCSF, San Francisco, CA, United States of America
| | - S. Rae Wannier
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
- F.I. Proctor Foundation, UCSF, San Francisco, CA, United States of America
| | - Nicole A. Hoff
- School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Patrick Mukadi
- National Institute of Biomedical Research, Kinshasa, Democratic Republic of Congo
| | - Cyrus Sinai
- School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Sarah Ackley
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
- F.I. Proctor Foundation, UCSF, San Francisco, CA, United States of America
| | - Xianyun Chen
- Mathematics and Science College, Shanghai Normal University, Shanghai, China
| | - Daozhou Gao
- Mathematics and Science College, Shanghai Normal University, Shanghai, China
| | - Bernice Selo
- Ministry of Health, Kinshasa, Democratic Republic of Congo
| | | | | | - Eugene T. Richardson
- Harvard Medical School, Boston, MA, United States of America
- Brigham and Women’s Hospital, Boston, MA, United States of America
| | - George W. Rutherford
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
| | - Thomas M. Lietman
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
- F.I. Proctor Foundation, UCSF, San Francisco, CA, United States of America
| | | | - Anne W. Rimoin
- School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Travis C. Porco
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, United States of America
- F.I. Proctor Foundation, UCSF, San Francisco, CA, United States of America
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19
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Richardson ET, Fallah MP. The genesis of the Ebola virus outbreak in west Africa. THE LANCET. INFECTIOUS DISEASES 2019; 19:348-349. [PMID: 30799253 DOI: 10.1016/s1473-3099(19)30055-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Eugene T Richardson
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Mosoka P Fallah
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA; National Public Health Institute of Liberia, Monrovia, Liberia
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20
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Diallo MSK, Rabilloud M, Ayouba A, Touré A, Thaurignac G, Keita AK, Butel C, Kpamou C, Barry TA, Sall MD, Camara I, Leroy S, Msellati P, Ecochard R, Peeters M, Sow MS, Delaporte E, Etard JF. Prevalence of infection among asymptomatic and paucisymptomatic contact persons exposed to Ebola virus in Guinea: a retrospective, cross-sectional observational study. THE LANCET. INFECTIOUS DISEASES 2019; 19:308-316. [PMID: 30765243 DOI: 10.1016/s1473-3099(18)30649-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/21/2018] [Accepted: 10/16/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The prevalence of Ebola virus infection among people who have been in contact with patients with Ebola virus disease remains unclear, but is essential to understand the dynamics of transmission. This study aimed to identify risk factors for seropositivity and to estimate the prevalence of Ebola virus infection in unvaccinated contact persons. METHODS In this retrospective, cross-sectional observational study, we recruited individuals between May 12, 2016, and Sept 8, 2017, who had been in physical contact with a patient with Ebola virus disease, from four medical centres in Guinea (Conakry, Macenta, N'zérékoré, and Forécariah). Contact persons had to be 7 years or older and not diagnosed with Ebola virus disease. Participants were selected through the Postebogui survivors' cohort. We collected self-reported information on exposure and occurrence of symptoms after exposure using a questionnaire, and tested antibody response against glycoprotein, nucleoprotein, and 40-kDa viral protein of Zaire Ebola virus by taking a blood sample. The prevalence of Ebola virus infection was estimated with a latent class model. FINDINGS 1721 contact persons were interviewed and given blood tests, 331 of whom reported a history of vaccination so were excluded, resulting in a study population of 1390. Symptoms were reported by 216 (16%) contact persons. The median age of participants was 26 years (range 7-88) and 682 (49%) were male. Seropositivity was identified in 18 (8·33%, 95% CI 5·01-12·80) of 216 paucisymptomatic contact persons and 39 (3·32%, 5·01-12·80) of 1174 (2-4) asymptomatic individuals (p=0·0021). Seropositivity increased with participation in burial rituals (adjusted odds ratio [aOR] 2·30, 95% CI 1·21-4·17; p=0·0079) and exposure to blood or vomit (aOR 2·15, 1·23-3·91; p=0·0090). Frequency of Ebola virus infection varied from 3·06% (95% CI 1·84-5·05) in asymptomatic contact persons who did not participate in burial rituals to 5·98% (2·81-8·18) in those who did, and from 7·17% (3·94-9·09) in paucisymptomatic contact persons who did not participate in burial rituals to 17·16% (12·42-22·31) among those who did. INTERPRETATION This study provides a new assessment of the prevalence of Ebola virus infection among contact persons according to exposure, provides evidence for the occurrence of paucisymptomatic cases, and reinforces the importance of closely monitoring at-risk contact persons. FUNDING Institut National de la Santé et de la Recherche Médicale, Reacting, the French Ebola Task Force, Institut de Recherche pour le Développement, and Montpellier University Of Excellence-University of Montpellier.
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Affiliation(s)
- Mamadou Saliou Kalifa Diallo
- Recherches translationnelles sur le VIH et les maladies infectieuses, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France; Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Muriel Rabilloud
- Hospices Civils de Lyon, Service de Biostatistique-Bioinformatique, Lyon, France; Université de Lyon, Lyon, France; Université Lyon 1, Villeurbanne, France; Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique Santé, Pierre-Bénite, France
| | - Ahidjo Ayouba
- Recherches translationnelles sur le VIH et les maladies infectieuses, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Abdoulaye Touré
- Recherches translationnelles sur le VIH et les maladies infectieuses, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France; Institut National de Santé Publique, Conakry, Guinea; Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Guillaume Thaurignac
- Recherches translationnelles sur le VIH et les maladies infectieuses, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Alpha Kabinet Keita
- Recherches translationnelles sur le VIH et les maladies infectieuses, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France; Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Christelle Butel
- Recherches translationnelles sur le VIH et les maladies infectieuses, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Cécé Kpamou
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Thierno Alimou Barry
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Mariama Djouldé Sall
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Ibrahima Camara
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea
| | - Sandrine Leroy
- Recherches translationnelles sur le VIH et les maladies infectieuses, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Philippe Msellati
- Recherches translationnelles sur le VIH et les maladies infectieuses, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - René Ecochard
- Hospices Civils de Lyon, Service de Biostatistique-Bioinformatique, Lyon, France; Université de Lyon, Lyon, France; Université Lyon 1, Villeurbanne, France; Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique Santé, Pierre-Bénite, France
| | - Martine Peeters
- Recherches translationnelles sur le VIH et les maladies infectieuses, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France
| | - Mamadou Saliou Sow
- Centre de Recherche et de Formation en Infectiologie de Guinée, Université Gamal Abdel Nasser de Conakry, Conakry, Guinea; Service des maladies infectieuses et tropicales, Hôpital National de Donka, Conakry, Guinea
| | - Eric Delaporte
- Recherches translationnelles sur le VIH et les maladies infectieuses, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France; University Teaching Hospital, Montpellier, France
| | - Jean-François Etard
- Recherches translationnelles sur le VIH et les maladies infectieuses, Institut de Recherche pour le Développement, Institut National de la Santé et de la Recherche Médicale, Université de Montpellier, Montpellier, France.
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21
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Kelly JD, Richardson ET, Drasher M, Barrie MB, Karku S, Kamara M, Hann K, Dierberg K, Hubbard A, Lindan CP, Farmer PE, Rutherford GW, Weiser SD. Food Insecurity as a Risk Factor for Outcomes Related to Ebola Virus Disease in Kono District, Sierra Leone: A Cross-Sectional Study. Am J Trop Med Hyg 2018; 98:1484-1488. [PMID: 29557329 DOI: 10.4269/ajtmh.17-0820] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Studies have shown that people suffering from food insecurity are at higher risk for infectious and noncommunicable diseases and have poorer health outcomes. No study, however, has examined the association between food insecurity and outcomes related to Ebola virus disease (EVD). We conducted a cross-sectional study in two Ebola-affected communities in Kono district, Sierra Leone, from November 2015 to September 2016. We enrolled persons who were determined to have been exposed to Ebola virus. We assessed the association of food insecurity, using an adapted version of the Household Food Insecurity Access Scale, a nine-item scale well validated across Africa, with having been diagnosed with EVD and having died of EVD, using logistic regression models with cluster-adjusted standard errors. We interviewed 326 persons who were exposed to Ebola virus; 61 (19%) were diagnosed with EVD and 45/61 (74%) died. We found high levels (87%) of food insecurity, but there was no association between food insecurity and having been diagnosed with EVD. Among EVD cases, those who were food insecure had 18.3 times the adjusted odds of death than those who were food secure (P = 0.03). This is the first study to demonstrate a potential relationship between food insecurity and having died of EVD, although larger prospective studies are needed to confirm these findings.
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Affiliation(s)
- J Daniel Kelly
- Partners In Health, Freetown, Sierra Leone.,Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Eugene T Richardson
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,Partners In Health, Freetown, Sierra Leone
| | | | - M Bailor Barrie
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,Partners In Health, Freetown, Sierra Leone
| | - Sahr Karku
- Partners In Health, Freetown, Sierra Leone
| | | | | | | | - Allan Hubbard
- Division of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Christina P Lindan
- Institute for Global Health Sciences, University of California, San Francisco, California
| | - Paul E Farmer
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.,Partners In Health, Freetown, Sierra Leone
| | - George W Rutherford
- Institute for Global Health Sciences, University of California, San Francisco, California
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, California
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