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Oeltmann JE, Vohra D, Matulewicz HH, DeLuca N, Smith JP, Couzens C, Lash RR, Harvey B, Boyette M, Edwards A, Talboy PM, Dubose O, Regan P, Loosier P, Caruso E, Katz DJ, Taylor MM, Moonan PK. Isolation and Quarantine for Coronavirus Disease 2019 in the United States, 2020-2022. Clin Infect Dis 2023; 77:212-219. [PMID: 36947142 PMCID: PMC11094624 DOI: 10.1093/cid/ciad163] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/21/2023] [Accepted: 03/17/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Public health programs varied in ability to reach people with coronavirus disease 2019 (COVID-19) and their contacts to encourage separation from others. For both adult case patients with COVID-19 and their contacts, we estimated the impact of contact tracing activities on separation behaviors from January 2020 until March 2022. METHODS We used a probability-based panel survey of a nationally representative sample to gather data for estimates and comparisons. RESULTS An estimated 64 255 351 adults reported a positive severe acute respiratory syndrome coronavirus 2 test result; 79.6% isolated for ≥5 days, 60.2% isolated for ≥10 days, and 79.2% self-notified contacts. A total of, 24 057 139 (37.7%) completed a case investigation, and 46.2% of them reported contacts to health officials. More adults who completed a case investigation isolated than those who did not complete a case investigation (≥5 days, 82.6% vs 78.2%, respectively; ≥10 days, 69.8% vs 54.8%; both P < .05). A total of 84 946 636 adults were contacts of a COVID-19 case patient. Of these, 73.1% learned of their exposure directly from a case patient; 49.4% quarantined for ≥5 days, 18.7% quarantined for ≥14 days, and 13.5% completed a contact tracing call. More quarantined among those who completed a contact tracing call than among those who did not complete a tracing call (≥5 days, 61.2% vs 48.5%, respectively; ≥14 days, 25.2% vs 18.0%; both P < .05). CONCLUSIONS Engagement in contact tracing was positively correlated with isolation and quarantine. However, most adults with COVID-19 isolated and self-notified contacts regardless of whether the public health workforce was able to reach them. Identifying and reaching contacts was challenging and limited the ability to promote quarantining, and testing.
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Affiliation(s)
- John E Oeltmann
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Divya Vohra
- Health Division, Mathematica, Princeton, New Jersey, USA
| | | | - Nickolas DeLuca
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Jonathan P Smith
- School of Public Health, Yale University, New Haven, Connecticut, USA
| | | | - R Ryan Lash
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Barrington Harvey
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Melissa Boyette
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Alicia Edwards
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Philip M Talboy
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Odessa Dubose
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Paul Regan
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Penny Loosier
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Elise Caruso
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Dolores J Katz
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Melanie M Taylor
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
| | - Patrick K Moonan
- US Centers for Disease Control and Prevention, COVID-19 Response Team, Atlanta, Georgia, USA
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Moonan PK, Zetola NM, Tobias JL, Basotli J, Boyd R, Click ES, Dima M, Fane O, Finlay AM, Ogopotse M, Wen XJ, Modongo C, Oeltmann JE. A Neighbor-Based Approach to Identify Tuberculosis Exposure, the Kopanyo Study. Emerg Infect Dis 2021; 26:1010-1013. [PMID: 32310058 PMCID: PMC7181937 DOI: 10.3201/eid2605.191568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Contact investigation is one public health measure used to prevent tuberculosis by identifying and treating persons exposed to Mycobacterium tuberculosis. Contact investigations are a major tenet of global tuberculosis elimination efforts, but for many reasons remain ineffective. We describe a novel neighbor-based approach to reframe contact investigations.
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3
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Lash RR, Moonan PK, Byers BL, Bonacci RA, Bonner KE, Donahue M, Donovan CV, Grome HN, Janssen JM, Magleby R, McLaughlin HP, Miller JS, Pratt CQ, Steinberg J, Varela K, Anschuetz GL, Cieslak PR, Fialkowski V, Fleischauer AT, Goddard C, Johnson SJ, Morris M, Moses J, Newman A, Prinzing L, Sulka AC, Va P, Willis M, Oeltmann JE. COVID-19 Case Investigation and Contact Tracing in the US, 2020. JAMA Netw Open 2021; 4:e2115850. [PMID: 34081135 PMCID: PMC8176334 DOI: 10.1001/jamanetworkopen.2021.15850] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/20/2021] [Indexed: 01/17/2023] Open
Abstract
Importance Contact tracing is a multistep process to limit SARS-CoV-2 transmission. Gaps in the process result in missed opportunities to prevent COVID-19. Objective To quantify proportions of cases and their contacts reached by public health authorities and the amount of time needed to reach them and to compare the risk of a positive COVID-19 test result between contacts and the general public during 4-week assessment periods. Design, Setting, and Participants This cross-sectional study took place at 13 health departments and 1 Indian Health Service Unit in 11 states and 1 tribal nation. Participants included all individuals with laboratory-confirmed COVID-19 and their named contacts. Local COVID-19 surveillance data were used to determine the numbers of persons reported to have laboratory-confirmed COVID-19 who were interviewed and named contacts between June and October 2020. Main Outcomes and Measures For contacts, the numbers who were identified, notified of their exposure, and agreed to monitoring were calculated. The median time from index case specimen collection to contact notification was calculated, as were numbers of named contacts subsequently notified of their exposure and monitored. The prevalence of a positive SARS-CoV-2 test among named and tested contacts was compared with that jurisdiction's general population during the same 4 weeks. Results The total number of cases reported was 74 185. Of these, 43 931 (59%) were interviewed, and 24 705 (33%) named any contacts. Among the 74 839 named contacts, 53 314 (71%) were notified of their exposure, and 34 345 (46%) agreed to monitoring. A mean of 0.7 contacts were reached by telephone by public health authorities, and only 0.5 contacts per case were monitored. In general, health departments reporting large case counts during the assessment (≥5000) conducted smaller proportions of case interviews and contact notifications. In 9 locations, the median time from specimen collection to contact notification was 6 days or less. In 6 of 8 locations with population comparison data, positive test prevalence was higher among named contacts than the general population. Conclusions and Relevance In this cross-sectional study of US local COVID-19 surveillance data, testing named contacts was a high-yield activity for case finding. However, this assessment suggests that contact tracing had suboptimal impact on SARS-CoV-2 transmission, largely because 2 of 3 cases were either not reached for interview or named no contacts when interviewed. These findings are relevant to decisions regarding the allocation of public health resources among the various prevention strategies and for the prioritization of case investigations and contact tracing efforts.
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Affiliation(s)
- R. Ryan Lash
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patrick K. Moonan
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brittany L. Byers
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert A. Bonacci
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kimberly E. Bonner
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Public Health Division, Oregon Health Authority, Portland
| | - Matthew Donahue
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Nebraska Department of Health and Human Services, Lincoln
| | - Catherine V. Donovan
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- North Carolina Department of Health and Human Services, Raleigh
| | - Heather N. Grome
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Tennessee Department of Health, Nashville
| | - Julia M. Janssen
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Reed Magleby
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- New Jersey Department of Health, Trenton
| | - Heather P. McLaughlin
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James S. Miller
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Washington State Department of Health, Tumwater
| | - Caroline Q. Pratt
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Steinberg
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- South Dakota State Health Department, Sioux Falls
| | - Kate Varela
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | - Aaron T. Fleischauer
- North Carolina Department of Health and Human Services, Raleigh
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Clay Goddard
- Springfield-Greene County Health Department, Springfield, Missouri
| | | | | | - Jill Moses
- Chinle Indian Health Service Unit, Chinle, Arizona
| | - Allison Newman
- Nebraska Department of Health and Human Services, Lincoln
| | | | - Alana C. Sulka
- Gwinnett, Newton, Rockdale Counties Health Departments, Lawrenceville, Georgia
| | - Puthiery Va
- Chinle Indian Health Service Unit, Chinle, Arizona
| | | | - John E. Oeltmann
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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Bates BR, Moncayo AL, Costales JA, Herrera-Cespedes CA, Grijalva MJ. Knowledge, Attitudes, and Practices Towards COVID-19 Among Ecuadorians During the Outbreak: An Online Cross-Sectional Survey. J Community Health 2020. [PMID: 32915380 DOI: 10.1080/17538068.2020.1842843] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Preventing the transmission of SARS-CoV-2 (causative agent for COVID-19) requires implementing contact and respiratory precautions. Modifying human behavior is challenging and requires understanding knowledge, attitudes, and practices (KAPs) regarding health threats. This study explored KAPs among people in Ecuador. A cross-sectional, internet-based questionnaire was used to assess knowledge about COVID-19, attitudes toward ability to control COVID-19, self-reported practices related to COVID-19, and demographics. A total of 2399 individuals participated. Participants had moderate to high levels of knowledge. Participants expressed mixed attitudes about the eventual control of COVID-19 in Ecuador. Participants reported high levels of adoption of preventive practices. Binomial regression analysis suggests unemployed individuals, househusbands/housewives, or manual laborers, as well as those with an elementary school education, have lower levels of knowledge. Women, people over 50 years of age, and those with higher levels of schooling were the most optimistic. Men, individuals 18-29, single, and unemployed people took the riskiest behaviors. Generally, knowledge was not associated with optimism or with practices. Our findings indicate knowledge about COVID-19 is insufficient to prompt behavioral change among Ecuadorians. Since current COVID-19 control campaigns seek to educate the public, these efforts' impacts are likely to be limited. Given attitudes determine people's actions, further investigation into the factors underlying the lack of confidence in the ability of the world, and of Ecuador, to overcome COVID-19, is warranted. Edu-communicational campaigns should be accompanied by efforts to provide economically disadvantaged populations resources to facilitate adherence to recommendations to prevent the spread of the virus.
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Affiliation(s)
- Benjamin R Bates
- School of Communication Studies, Ohio University, Athens, OH, 45701, USA
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA
| | - Ana L Moncayo
- Facultad de Ciencias Exactas y Naturales, Centro de Investigación para la Salud en América Latina, Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Jaime A Costales
- Facultad de Ciencias Exactas y Naturales, Centro de Investigación para la Salud en América Latina, Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Carolina A Herrera-Cespedes
- Facultad de Ciencias Exactas y Naturales, Centro de Investigación para la Salud en América Latina, Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Mario J Grijalva
- Facultad de Ciencias Exactas y Naturales, Centro de Investigación para la Salud en América Latina, Escuela de Ciencias Biológicas, Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
- Infectious and Tropical Disease Institute, Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, 45701, USA.
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Agua-Agum J, Ariyarajah A, Aylward B, Bawo L, Bilivogui P, Blake IM, Brennan RJ, Cawthorne A, Cleary E, Clement P, Conteh R, Cori A, Dafae F, Dahl B, Dangou JM, Diallo B, Donnelly CA, Dorigatti I, Dye C, Eckmanns T, Fallah M, Ferguson NM, Fiebig L, Fraser C, Garske T, Gonzalez L, Hamblion E, Hamid N, Hersey S, Hinsley W, Jambei A, Jombart T, Kargbo D, Keita S, Kinzer M, George FK, Godefroy B, Gutierrez G, Kannangarage N, Mills HL, Moller T, Meijers S, Mohamed Y, Morgan O, Nedjati-Gilani G, Newton E, Nouvellet P, Nyenswah T, Perea W, Perkins D, Riley S, Rodier G, Rondy M, Sagrado M, Savulescu C, Schafer IJ, Schumacher D, Seyler T, Shah A, Van Kerkhove MD, Wesseh CS, Yoti Z. Exposure Patterns Driving Ebola Transmission in West Africa: A Retrospective Observational Study. PLoS Med 2016; 13:e1002170. [PMID: 27846234 PMCID: PMC5112802 DOI: 10.1371/journal.pmed.1002170] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/07/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The ongoing West African Ebola epidemic began in December 2013 in Guinea, probably from a single zoonotic introduction. As a result of ineffective initial control efforts, an Ebola outbreak of unprecedented scale emerged. As of 4 May 2015, it had resulted in more than 19,000 probable and confirmed Ebola cases, mainly in Guinea (3,529), Liberia (5,343), and Sierra Leone (10,746). Here, we present analyses of data collected during the outbreak identifying drivers of transmission and highlighting areas where control could be improved. METHODS AND FINDINGS Over 19,000 confirmed and probable Ebola cases were reported in West Africa by 4 May 2015. Individuals with confirmed or probable Ebola ("cases") were asked if they had exposure to other potential Ebola cases ("potential source contacts") in a funeral or non-funeral context prior to becoming ill. We performed retrospective analyses of a case line-list, collated from national databases of case investigation forms that have been reported to WHO. These analyses were initially performed to assist WHO's response during the epidemic, and have been updated for publication. We analysed data from 3,529 cases in Guinea, 5,343 in Liberia, and 10,746 in Sierra Leone; exposures were reported by 33% of cases. The proportion of cases reporting a funeral exposure decreased over time. We found a positive correlation (r = 0.35, p < 0.001) between this proportion in a given district for a given month and the within-district transmission intensity, quantified by the estimated reproduction number (R). We also found a negative correlation (r = -0.37, p < 0.001) between R and the district proportion of hospitalised cases admitted within ≤4 days of symptom onset. These two proportions were not correlated, suggesting that reduced funeral attendance and faster hospitalisation independently influenced local transmission intensity. We were able to identify 14% of potential source contacts as cases in the case line-list. Linking cases to the contacts who potentially infected them provided information on the transmission network. This revealed a high degree of heterogeneity in inferred transmissions, with only 20% of cases accounting for at least 73% of new infections, a phenomenon often called super-spreading. Multivariable regression models allowed us to identify predictors of being named as a potential source contact. These were similar for funeral and non-funeral contacts: severe symptoms, death, non-hospitalisation, older age, and travelling prior to symptom onset. Non-funeral exposures were strongly peaked around the death of the contact. There was evidence that hospitalisation reduced but did not eliminate onward exposures. We found that Ebola treatment units were better than other health care facilities at preventing exposure from hospitalised and deceased individuals. The principal limitation of our analysis is limited data quality, with cases not being entered into the database, cases not reporting exposures, or data being entered incorrectly (especially dates, and possible misclassifications). CONCLUSIONS Achieving elimination of Ebola is challenging, partly because of super-spreading. Safe funeral practices and fast hospitalisation contributed to the containment of this Ebola epidemic. Continued real-time data capture, reporting, and analysis are vital to track transmission patterns, inform resource deployment, and thus hasten and maintain elimination of the virus from the human population.
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Affiliation(s)
| | | | | | | | - Luke Bawo
- Ministry of Health, Monrovia, Liberia
| | | | - Isobel M. Blake
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | | | | | | | - Anne Cori
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Benjamin Dahl
- Centers for Disease Control and Prevention, Conakry, Guinea
| | | | | | - Christl A. Donnelly
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Ilaria Dorigatti
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Tim Eckmanns
- World Health Organization, Geneva, Switzerland
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Neil M. Ferguson
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | - Lena Fiebig
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Christophe Fraser
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Tini Garske
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | - Nuha Hamid
- World Health Organization, Monrovia, Liberia
| | - Sara Hersey
- Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Wes Hinsley
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Thibaut Jombart
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | - Michael Kinzer
- Centers for Disease Control and Prevention, Conakry, Guinea
| | | | | | | | | | - Harriet L. Mills
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- School of Veterinary Sciences, University of Bristol, Bristol, United Kingdom
| | - Thomas Moller
- European Centre for Disease Prevention and Control, Conakry, Guinea
| | | | | | - Oliver Morgan
- Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Gemma Nedjati-Gilani
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Pierre Nouvellet
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | | | - Steven Riley
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | | | | | | | - Ilana J. Schafer
- Centers for Disease Control and Prevention, Freetown, Sierra Leone
| | - Dirk Schumacher
- World Health Organization, Geneva, Switzerland
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Anita Shah
- World Health Organization, Geneva, Switzerland
| | - Maria D. Van Kerkhove
- MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom
| | | | - Zabulon Yoti
- World Health Organization, Freetown, Sierra Leone
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Shao X, Ren W, Zhou F. Clinical Presentation and Care of Patients with Ebola Virus Disease in the China Ebola Treatment Unit, Liberia. Jpn J Infect Dis 2016; 70:32-37. [PMID: 27169945 DOI: 10.7883/yoken.jjid.2015.597] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In order to evaluate the clinical characteristics of confirmed Ebola Virus Disease (EVD) patients admitted to the China Ebola Treatment Unit (China ETU) between January 2015 and March 2015, we retrospectively analyzed clinical symptoms, treatment, and epidemiologic features of 5 patients with confirmed EVD, and reviewed the relevant medical literature. Of these, 3 patients survived, and 2 died. The time interval from the onset of symptoms to the negative PCR test for Ebola virus in the 3 survivors was 14-18 days. All survivors reported direct contact with confirmed EVD patients up to 21 days prior to admission. All patients developed a fever, fatigue, and anorexia. Fever was generally the first symptom to develop, followed by a gastrointestinal phase characterized by vomiting/nausea (3 cases, 60%), diarrhea (3 cases), and abdominal pain (4 cases, 80%). Three patients (60%) reported joint pain, muscle pain, and conjunctival hemorrhage, respectively, and 2 patients (40%) developed a headache. We concluded that strict isolation and interruption of the route of transmission were required for suspected or confirmed EVD patients. The main treatment strategies were supportive care, maintenance of blood volume and electrolyte balance, and the prevention of complications.
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Affiliation(s)
- Xiaoping Shao
- Emergency Department, Changzheng Hospital, The Second Military Medical University
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7
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Brainard J, Hooper L, Pond K, Edmunds K, Hunter PR. Risk factors for transmission of Ebola or Marburg virus disease: a systematic review and meta-analysis. Int J Epidemiol 2016; 45:102-16. [PMID: 26589246 PMCID: PMC4795563 DOI: 10.1093/ije/dyv307] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The Ebola virus disease outbreak that started in Western Africa in 2013 was unprecedented because it spread within densely populated urban environments and affected many thousands of people. As a result, previous advice and guidelines need to be critically reviewed, especially with regard to transmission risks in different contexts. METHODS Scientific and grey literature were searched for articles about any African filovirus. Articles were screened for information about transmission (prevalence or odds ratios especially). Data were extracted from eligible articles and summarized narratively with partial meta-analysis. Study quality was also evaluated. RESULTS A total of 31 reports were selected from 6552 found in the initial search. Eight papers gave numerical odds for contracting filovirus illness; 23 further articles provided supporting anecdotal observations about how transmission probably occurred for individuals. Many forms of contact (conversation, sharing a meal, sharing a bed, direct or indirect touching) were unlikely to result in disease transmission during incubation or early illness. Among household contacts who reported directly touching a case, the attack rate was 32% [95% confidence interval (CI) 26-38%]. Risk of disease transmission between household members without direct contact was low (1%; 95% CI 0-5%). Caring for a case in the community, especially until death, and participation in traditional funeral rites were strongly associated with acquiring disease, probably due to a high degree of direct physical contact with case or cadaver. CONCLUSIONS Transmission of filovirus is unlikely except through close contact, especially during the most severe stages of acute illness. More data are needed about the context, intimacy and timing of contact required to raise the odds of disease transmission. Risk factors specific to urban settings may need to be determined.
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Affiliation(s)
- Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Katherine Pond
- Robens Centre for Public and Environmental Health, University of Surrey, Guildford, UK
| | - Kelly Edmunds
- School of Biological Sciences, University of East Anglia, Norwich, UK
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, UK
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