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The Transmission Chain Analysis of 2014–2015 Ebola Virus Disease Outbreak in Koinadugu District, Sierra Leone: An Observational Study
INTRODUCTION: Sierra Leone experienced an unprecedented Ebola virus disease (EVD) outbreak in all its districts. Koinadugu District was the last to report an EVD case. Several outbreak response strategies were implemented. As part of lessons learnt, we conducted an observational study to describe th...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5502283/ https://www.ncbi.nlm.nih.gov/pubmed/28740846 http://dx.doi.org/10.3389/fpubh.2017.00160 |
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author | Muoghalu, Ifeanyi-Stanley Moses, Francis Conteh, Ishata Swaray, Patrick Ajudua, Anthonia Nordström, Anders |
author_facet | Muoghalu, Ifeanyi-Stanley Moses, Francis Conteh, Ishata Swaray, Patrick Ajudua, Anthonia Nordström, Anders |
author_sort | Muoghalu, Ifeanyi-Stanley |
collection | PubMed |
description | INTRODUCTION: Sierra Leone experienced an unprecedented Ebola virus disease (EVD) outbreak in all its districts. Koinadugu District was the last to report an EVD case. Several outbreak response strategies were implemented. As part of lessons learnt, we conducted an observational study to describe the transmission chain in the district and the impact of the control measures implemented to contain the outbreak. METHODS: We reconstructed the transmission chain, positioning both confirmed and probable cases, described the distribution of the EVD confirmed cases in the context of the routes of transmission (Community, Funeral or Health facility setting) and assessed the impact of control measures using the surveillance data collected during the outbreak. RESULTS: All 142 confirmed and probable EVD cases registered were fully resolved in the transmission chain. 72.5% of all the EVD cases in the district were exposed in the community, 26.1% exposed during funerals, and 1.4% exposed in the health facility setting. Health-care workers contributed little to the EVD outbreak. 71.1% of EVD transmission occurred among family members. Female EVD cases generated more secondary cases than their male counterparts (P = 0.03). With removal of EVD cases from the community and admission to the community care center (CCC), the EVD transmission in the community decreased to substantially lower rates. In addition, transmission due to exposure in health facilities was further reduced with the implementation of full infection and prevention controls. CONCLUSION: This study details the transmission chain of EVD in a rural district setting and the public health interventions implemented to successfully limit the outbreak to just one of 11 chiefdoms. Heightened community-based surveillance for early case detection, swift isolation of suspect cases, efficient contact tracing and monitoring, and good infection prevention and control measures in health facilities were highly effective in limiting transmission and, eventually, breaking the transmission chain. CCCs were also instrumental in achieving early isolation and basic care for suspect cases, while ensuring that their family members who were close contacts remained in the community for easy contact tracing and monitoring. These were very useful lessons learnt that would inform the management of future outbreaks. |
format | Online Article Text |
id | pubmed-5502283 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-55022832017-07-24 The Transmission Chain Analysis of 2014–2015 Ebola Virus Disease Outbreak in Koinadugu District, Sierra Leone: An Observational Study Muoghalu, Ifeanyi-Stanley Moses, Francis Conteh, Ishata Swaray, Patrick Ajudua, Anthonia Nordström, Anders Front Public Health Public Health INTRODUCTION: Sierra Leone experienced an unprecedented Ebola virus disease (EVD) outbreak in all its districts. Koinadugu District was the last to report an EVD case. Several outbreak response strategies were implemented. As part of lessons learnt, we conducted an observational study to describe the transmission chain in the district and the impact of the control measures implemented to contain the outbreak. METHODS: We reconstructed the transmission chain, positioning both confirmed and probable cases, described the distribution of the EVD confirmed cases in the context of the routes of transmission (Community, Funeral or Health facility setting) and assessed the impact of control measures using the surveillance data collected during the outbreak. RESULTS: All 142 confirmed and probable EVD cases registered were fully resolved in the transmission chain. 72.5% of all the EVD cases in the district were exposed in the community, 26.1% exposed during funerals, and 1.4% exposed in the health facility setting. Health-care workers contributed little to the EVD outbreak. 71.1% of EVD transmission occurred among family members. Female EVD cases generated more secondary cases than their male counterparts (P = 0.03). With removal of EVD cases from the community and admission to the community care center (CCC), the EVD transmission in the community decreased to substantially lower rates. In addition, transmission due to exposure in health facilities was further reduced with the implementation of full infection and prevention controls. CONCLUSION: This study details the transmission chain of EVD in a rural district setting and the public health interventions implemented to successfully limit the outbreak to just one of 11 chiefdoms. Heightened community-based surveillance for early case detection, swift isolation of suspect cases, efficient contact tracing and monitoring, and good infection prevention and control measures in health facilities were highly effective in limiting transmission and, eventually, breaking the transmission chain. CCCs were also instrumental in achieving early isolation and basic care for suspect cases, while ensuring that their family members who were close contacts remained in the community for easy contact tracing and monitoring. These were very useful lessons learnt that would inform the management of future outbreaks. Frontiers Media S.A. 2017-07-10 /pmc/articles/PMC5502283/ /pubmed/28740846 http://dx.doi.org/10.3389/fpubh.2017.00160 Text en Copyright © 2017 Muoghalu, Moses, Conteh, Swaray, Ajudua and Nordström. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Public Health Muoghalu, Ifeanyi-Stanley Moses, Francis Conteh, Ishata Swaray, Patrick Ajudua, Anthonia Nordström, Anders The Transmission Chain Analysis of 2014–2015 Ebola Virus Disease Outbreak in Koinadugu District, Sierra Leone: An Observational Study |
title | The Transmission Chain Analysis of 2014–2015 Ebola Virus Disease Outbreak in Koinadugu District, Sierra Leone: An Observational Study |
title_full | The Transmission Chain Analysis of 2014–2015 Ebola Virus Disease Outbreak in Koinadugu District, Sierra Leone: An Observational Study |
title_fullStr | The Transmission Chain Analysis of 2014–2015 Ebola Virus Disease Outbreak in Koinadugu District, Sierra Leone: An Observational Study |
title_full_unstemmed | The Transmission Chain Analysis of 2014–2015 Ebola Virus Disease Outbreak in Koinadugu District, Sierra Leone: An Observational Study |
title_short | The Transmission Chain Analysis of 2014–2015 Ebola Virus Disease Outbreak in Koinadugu District, Sierra Leone: An Observational Study |
title_sort | transmission chain analysis of 2014–2015 ebola virus disease outbreak in koinadugu district, sierra leone: an observational study |
topic | Public Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5502283/ https://www.ncbi.nlm.nih.gov/pubmed/28740846 http://dx.doi.org/10.3389/fpubh.2017.00160 |
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