NDLI: The 2014 Ebola virus disease outbreak in Pujehun, Sierra Leone: epidemiology and impact of interventions

Content Provider	Springer Nature : BioMed Central
Author	Ajelli, Marco Parlamento, Stefano Bome, David Kebbi, Atiba Atzori, Andrea Frasson, Clara Putoto, Giovanni Carraro, Dante Merler, Stefano
Abstract	Background In July 2014, an outbreak of Ebola virus disease (EVD) started in Pujehun district, Sierra Leone. On January 10th, 2015, the district was the first to be declared Ebola-free by local authorities after 49 cases and a case fatality rate of 85.7 %. The Pujehun outbreak represents a precious opportunity for improving the body of work on the transmission characteristics and effects of control interventions during the 2014–2015 EVD epidemic in West Africa. Methods By integrating hospital registers and contact tracing form data with healthcare worker and local population interviews, we reconstructed the transmission chain and investigated the key time periods of EVD transmission. The impact of intervention measures has been assessed using a microsimulation transmission model calibrated with the collected data. Results The mean incubation period was 9.7 days (range, 6–15). Hospitalization rate was 89 %. The mean time from the onset of symptoms to hospitalization was 4.5 days (range, 1–9). The mean serial interval was 13.7 days (range, 2–18). The distribution of the number of secondary cases (R 0 = 1.63) was well fitted by a negative binomial distribution with dispersion parameter k = 0.45 (95 % CI, 0.19–1.32). Overall, 74.3 % of transmission events occurred between members of the same family or extended family, 17.9 % in the community, mainly between friends, and 7.7 % in hospital. The mean number of contacts investigated per EVD case raised from 11.5 in July to 25 in September 2014. In total, 43.0 % of cases were detected through contact investigation. Model simulations suggest that the most important factors determining the probability of disease elimination are the number of EVD beds, the mean time from symptom onset to isolation, and the mean number of contacts traced per case. By assuming levels and timing of interventions performed in Pujehun, the estimated probability of eliminating an otherwise large EVD outbreak is close to 100 %. Conclusions Containment of EVD in Pujehun district is ascribable to both the natural history of the disease (mainly transmitted through physical contacts, long generation time, overdispersed distribution of secondary cases per single primary case) and intervention measures (isolation of cases and contact tracing), which in turn strongly depend on preparedness, population awareness, and compliance. Our findings are also essential to determine a successful ring vaccination strategy.
Related Links	https://bmcmedicine.biomedcentral.com/counter/pdf/10.1186/s12916-015-0524-z.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	17417015
DOI	10.1186/s12916-015-0524-z
Journal	BMC Medicine
Issue Number	1
Volume Number	13
Language	English
Publisher	BioMed Central
Publisher Date	2015-11-26
Access Restriction	Open
Subject Keyword	Medicine Public Health Biomedicine Computational model Ebola Key time periods Transmissibility Transmission chain Medicine/Public Health
Content Type	Text
Resource Type	Article
Subject	Medicine
Journal Impact Factor	7.1/2023
5-Year Journal Impact Factor	8.8/2023

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