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Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis: lessons for the Global Health security agenda

BACKGROUND: The 2014–2016 Ebola crisis in West Africa had approximately eight times as many reported deaths as the sum of all previous Ebola outbreaks. The outbreak magnitude and occurrence of multiple Ebola cases in at least seven countries beyond Liberia, Sierra Leone, and Guinea, hinted at the po...

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Autores principales: Undurraga, Eduardo A., Carias, Cristina, Meltzer, Martin I., Kahn, Emily B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710062/
https://www.ncbi.nlm.nih.gov/pubmed/29191243
http://dx.doi.org/10.1186/s40249-017-0373-4
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author Undurraga, Eduardo A.
Carias, Cristina
Meltzer, Martin I.
Kahn, Emily B.
author_facet Undurraga, Eduardo A.
Carias, Cristina
Meltzer, Martin I.
Kahn, Emily B.
author_sort Undurraga, Eduardo A.
collection PubMed
description BACKGROUND: The 2014–2016 Ebola crisis in West Africa had approximately eight times as many reported deaths as the sum of all previous Ebola outbreaks. The outbreak magnitude and occurrence of multiple Ebola cases in at least seven countries beyond Liberia, Sierra Leone, and Guinea, hinted at the possibility of broad-scale transmission of Ebola. MAIN TEXT: Using a modeling tool developed by the US Centers for Disease Control and Prevention during the Ebola outbreak, we estimated the number of Ebola cases that might have occurred had the disease spread beyond the three countries in West Africa to cities in other countries at high risk for disease transmission (based on late 2014 air travel patterns). We estimated Ebola cases in three scenarios: a delayed response, a Liberia-like response, and a fast response scenario. Based on our estimates of the number of Ebola cases that could have occurred had Ebola spread to other countries beyond the West African foci, we emphasize the need for improved levels of preparedness and response to public health threats, which is the goal of the Global Health Security Agenda. Our estimates suggest that Ebola could have potentially spread widely beyond the West Africa foci, had local and international health workers and organizations not committed to a major response effort. Our results underscore the importance of rapid detection and initiation of an effective, organized response, and the challenges faced by countries with limited public health systems. Actionable lessons for strengthening local public health systems in countries at high risk of disease transmission include increasing health personnel, bolstering primary and critical healthcare facilities, developing public health infrastructure (e.g. laboratory capacity), and improving disease surveillance. With stronger local public health systems infectious disease outbreaks would still occur, but their rapid escalation would be considerably less likely, minimizing the impact of public health threats such as Ebola. CONCLUSIONS: The Ebola outbreak could have potentially spread to other countries, where limited public health surveillance and response capabilities may have resulted in additional foci. Health security requires robust local health systems that can rapidly detect and effectively respond to an infectious disease outbreak. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40249-017-0373-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-57100622017-12-06 Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis: lessons for the Global Health security agenda Undurraga, Eduardo A. Carias, Cristina Meltzer, Martin I. Kahn, Emily B. Infect Dis Poverty Opinion BACKGROUND: The 2014–2016 Ebola crisis in West Africa had approximately eight times as many reported deaths as the sum of all previous Ebola outbreaks. The outbreak magnitude and occurrence of multiple Ebola cases in at least seven countries beyond Liberia, Sierra Leone, and Guinea, hinted at the possibility of broad-scale transmission of Ebola. MAIN TEXT: Using a modeling tool developed by the US Centers for Disease Control and Prevention during the Ebola outbreak, we estimated the number of Ebola cases that might have occurred had the disease spread beyond the three countries in West Africa to cities in other countries at high risk for disease transmission (based on late 2014 air travel patterns). We estimated Ebola cases in three scenarios: a delayed response, a Liberia-like response, and a fast response scenario. Based on our estimates of the number of Ebola cases that could have occurred had Ebola spread to other countries beyond the West African foci, we emphasize the need for improved levels of preparedness and response to public health threats, which is the goal of the Global Health Security Agenda. Our estimates suggest that Ebola could have potentially spread widely beyond the West Africa foci, had local and international health workers and organizations not committed to a major response effort. Our results underscore the importance of rapid detection and initiation of an effective, organized response, and the challenges faced by countries with limited public health systems. Actionable lessons for strengthening local public health systems in countries at high risk of disease transmission include increasing health personnel, bolstering primary and critical healthcare facilities, developing public health infrastructure (e.g. laboratory capacity), and improving disease surveillance. With stronger local public health systems infectious disease outbreaks would still occur, but their rapid escalation would be considerably less likely, minimizing the impact of public health threats such as Ebola. CONCLUSIONS: The Ebola outbreak could have potentially spread to other countries, where limited public health surveillance and response capabilities may have resulted in additional foci. Health security requires robust local health systems that can rapidly detect and effectively respond to an infectious disease outbreak. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40249-017-0373-4) contains supplementary material, which is available to authorized users. BioMed Central 2017-12-01 /pmc/articles/PMC5710062/ /pubmed/29191243 http://dx.doi.org/10.1186/s40249-017-0373-4 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Opinion
Undurraga, Eduardo A.
Carias, Cristina
Meltzer, Martin I.
Kahn, Emily B.
Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis: lessons for the Global Health security agenda
title Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis: lessons for the Global Health security agenda
title_full Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis: lessons for the Global Health security agenda
title_fullStr Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis: lessons for the Global Health security agenda
title_full_unstemmed Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis: lessons for the Global Health security agenda
title_short Potential for broad-scale transmission of Ebola virus disease during the West Africa crisis: lessons for the Global Health security agenda
title_sort potential for broad-scale transmission of ebola virus disease during the west africa crisis: lessons for the global health security agenda
topic Opinion
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710062/
https://www.ncbi.nlm.nih.gov/pubmed/29191243
http://dx.doi.org/10.1186/s40249-017-0373-4
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