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BACKGROUND: Ebola Virus Disease (EVD) is a rare but contagious disease caused by Ebola Virus (EBOV). The first Ebola outbreaks were reported in the Democratic Republic of Congo (DRC) before subsequent reported cases in Western and East African countries, including Uganda, which borders Tanzania. Proximity to EVD-infected countries raises the prospect of cross-border transmission, raising alarm in Tanzania. This study aimed to explore the cultural practices likely to prevent or escalate EVD transmission in the event of its outbreak in the country. METHODS: This rapid ethnographic assessment employed observation, interviews, and focus group discussions to collect data from people with diverse characteristics in five regions of Tanzania Mainland namely, Kagera, Kigoma, Mwanza and Songwe regions and Zanzibar Island. The qualitative data was then subjected to thematic analysis. FINDINGS: Cultural practices may escalate the transmission of EVD and hinder its prevention and control. These cultural practices include caring sick people at home, confirmation of death, mourning, and body preparation for burial. Communal life, ceremonies, and social gatherings were other aspects observed to have the potential for compounding EVD transmission and hindering its containment in case of an outbreak. CONCLUSION: Cultural practices may escalate EVD transmission as identified in the study settings. As such, Risk Communication and Community Engagement (RCCE) activities should be interventionist in transforming cultural practices that may escalate the spread of EVD as part of preparedness, prevention, and control efforts in the event of an outbreak.

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Antropología Cultural , Brotes de Enfermedades , Grupos Focales , Fiebre Hemorrágica Ebola , Humanos , Fiebre Hemorrágica Ebola/epidemiología , Tanzanía/epidemiología , Masculino , Femenino , Adulto , Brotes de Enfermedades/prevención & control , Persona de Mediana Edad , Adulto Joven , Investigación Cualitativa , Adolescente , Entrevistas como Asunto

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BACKGROUND: On 20 September 2022, the Ugandan Ministry of Health declared an outbreak of Ebola disease caused by Sudan ebolavirus. METHODS: From 6 October 2022 to 10 January 2023, Centers for Disease Control and Prevention (CDC) staff conducted public health assessments at five US ports of entry for travellers identified as having been in Uganda in the past 21 days. CDC also recommended that state, local and territorial health departments ('health departments') conduct post-arrival monitoring of these travellers. CDC provided traveller contact information, daily to 58 health departments, and collected health department data regarding monitoring outcomes. RESULTS: Among 11 583 travellers screened, 132 (1%) required additional assessment due to potential exposures or symptoms of concern. Fifty-three (91%) health departments reported receiving traveller data from CDC for 10 114 (87%) travellers, of whom 8499 (84%) were contacted for monitoring, 1547 (15%) could not be contacted and 68 (1%) had no reported outcomes. No travellers with high-risk exposures or Ebola disease were identified. CONCLUSION: Entry risk assessment and post-arrival monitoring of travellers are resource-intensive activities that had low demonstrated yield during this and previous outbreaks. The efficiency of future responses could be improved by incorporating an assessment of risk of importation of disease, accounting for individual travellers' potential for exposure, and expanded use of methods that reduce burden to federal agencies, health departments, and travellers.

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Brotes de Enfermedades , Fiebre Hemorrágica Ebola , Viaje , Humanos , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/prevención & control , Uganda/epidemiología , Brotes de Enfermedades/prevención & control , Medición de Riesgo/métodos , Estados Unidos/epidemiología , Masculino , Femenino , Adulto , Centers for Disease Control and Prevention, U.S. , Salud Pública/métodos , Persona de Mediana Edad , Ebolavirus , Adolescente , Adulto Joven

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Background: The 2013-2016 West Africa Ebola outbreak highlighted the importance of laboratory capacity to outbreak response while also revealing its long-standing neglect. The outbreak prompted massive international investment into strengthening laboratory services across multiple healthcare settings. Objective: In this article, we explore hospital-based clinical laboratory workers' experiences and perceptions of their everyday working environment in Sierra Leone, and how recent investments in laboratory strengthening have shaped these. Methods: This qualitative study draws on in-depth interviews with eight laboratory workers and participant observation of laboratory practices at a tertiary referral hospital in Freetown between April 2019 and December 2019. Interview and observational data were coded and analysed using a reflexive thematic approach. Results: The Ebola outbreak prompted international investments in automated devices, biosafety training, and a new dedicated infectious diseases laboratory. However, little investment was made in the infrastructure and supply systems needed to sustain routine laboratory work or keep machines functioning. Laboratory workers perceived their work to be under-recognised and undervalued by the government, hospital managers and clinical staff, a perception compounded by under-use of the hospital's laboratory services by clinicians. Conclusion: Understanding laboratory technicians' views, experiences, and priorities is essential to any sustainable laboratory-strengthening effort. Investments in personnel should match investments in technologies and infrastructure for outbreak response. What this study adds: This study contributes to an understanding of how clinical laboratory personnel in Sierra Leone view and experience their work, and introduces the concept of social invisibility to explain these experiences.

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The E/S (exposed/susceptible) ratio is analyzed in the SEIR model. The ratio plays a key role in understanding epidemic dynamics during the 2014-2016 Ebola outbreak in Sierra Leone and Guinea. The maximum value of the ratio occurs immediately before or after the time-dependent reproduction number (Rt) equals 1, depending on the initial susceptible population (S(0)). It is demonstrated that transmission rate curves corresponding to various incubation periods intersect at a single point referred to as the Cross Point (CP). At this point, the E/S ratio reaches an extremum, signifying a critical shift in transmission dynamics and aligning with the time when Rt approaches 1. By plotting transmission rate curves, ß(t), for any two arbitrary incubation periods and tracking their intersections, we can trace CP over time. CP serves as an indicator of epidemic status, especially when Rt is close to 1. It provides a practical means of monitoring epidemics without prior knowledge of the incubation period. Through a case study, we estimate the transmission rate and reproduction number, identifying CP and Rt = 1 while examining the E/S ratio across various values of S(0).

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Epidemias , Fiebre Hemorrágica Ebola , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/transmisión , Humanos , Sierra Leona/epidemiología , Guinea/epidemiología , Brotes de Enfermedades , África Occidental/epidemiología , Número Básico de Reproducción

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This research investigates the complex dynamics of Uganda's recent Ebola outbreaks, emphasizing the interplay between disease spread, misinformation, and existing societal vulnerabilities. Highlighting poverty as a core element, it delves into how socioeconomic factors exacerbate health crises. The study scrutinizes the role of political economy, medical pluralism, health systems, and informal networks in spreading misinformation, further complicating response efforts. Through a comprehensive analysis, this study aims to shed light on the multifaceted challenges faced in combating epidemics in resource-limited settings. It calls for integrated strategies that address not only the biological aspects of the disease but also the socioeconomic and informational ecosystems that influence public health outcomes. This perspective research contributes to a better understanding of how poverty, medical pluralism, political economy, misinformation, and health emergencies intersect, offering insights for future preparedness and response initiatives.

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Fiebre Hemorrágica Ebola , Humanos , Fiebre Hemorrágica Ebola/epidemiología , Uganda/epidemiología , Ecosistema , Infodemia , Brotes de Enfermedades

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The 2014 Ebola Virus disease outbreak and the COVID-19 pandemic are prominent among the viral infectious diseases that threatened our existence in the last decade. We did a retrospective review of Nigeria's responses during the two crises using different keywords: pathogenicity, risk communication, data gathering, and vaccine issues. These served as discussion points, and we ended by highlighting a few salient observations that should serve as reflection, learning points, and recommendations for better responses in the future. Based on these keywords, we noticed some differences in the two outbreaks, some of which affected the mode of response. At some point, Nigeria was commended for curtailing the Ebola outbreak. This was not the same with COVID-19 which is still very much with us. Also, the latter received more global attention. We then concluded the review by outlining salient points that should serve as reflection and learning points to serve as a guide for a better approach in future epidemics/disaster outbreaks.

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On August 21, 2022, healthcare authorities in the Democratic Republic of the Congo (DRC) announced an outbreak of Ebola virus disease in North Kivu Province, bringing the total to 15 outbreaks nationwide. On September 20, 2022, Uganda's authorities declared an outbreak of the Sudan strain of the Ebola virus following a confirmed a case in Mubende district. As of October 6, 2022, the reported numbers of cases were 63, with 29 deaths in Uganda and 1 case with 1 death in DRC, respectively. Ebola virus causes an acute and severely fatal illness, resulting in death within a very short time if left untreated. In addition, these outbreaks in DRC and Uganda pose a major threat to the health and socioeconomic well-being of the people of East Africa due to multiple cross-border activities. Adequate preparations need to be made by the healthcare authorities of the nations concerned; the government, healthcare workers, and the East-African community as a whole have important roles to play in the effective prevention and control of the spread of Ebola virus within and across their borders.

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The global outgoing outbreaks of Ebola virus disease (EVD) in different regions of Sudan, Uganda, and Western Africa have brought into focus the inadequacies and restrictions of pre-designed vaccines for use in the battle against EVD, which has affirmed the urgent need for the development of a systematic protocol to produce Ebola vaccines prior to an outbreak. There are several vaccines available being developed by preclinical trials and human-based clinical trials. The group of vaccines includes virus-like particle-based vaccines, DNA-based vaccines, whole virus recombinant vaccines, incompetent replication originated vaccines, and competent replication vaccines. The limitations and challenges faced in the development of Ebola vaccines are the selection of immunogenic, rapid-responsive, cross-protective immunity-based vaccinations with assurances of prolonged protection. Another issue for the manufacturing and distribution of vaccines involves post authorization, licensing, and surveillance to ensure a vaccine's efficacy towards combating the Ebola outbreak. The current review focuses on the development process, the current perspective on the development of an Ebola vaccine, and future challenges for combatting future emerging Ebola infectious disease.

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As there are many and sometimes ambivalent intersections of health and religion, strategic collaborations with religious opinion leaders in health campaigns have been increasingly explored. Despite the known influence of distinct contextual factors within emergency and non-emergency settings, existing research seldom distinguishes between those different factors and their impact on the inclusion of religious leaders as health messengers. To compare the contextual factors of religious leaders as health messengers during emergency and non-emergency situations in a setting with high religious affiliations, this study used a qualitative approach and triangulated the perspectives of three different samples, including (religious) opinion leaders, members of religious communities, and developers of health communication strategies in Sierra Leone. The results provide multifaceted insights into contextual factors applicable to emergency and non-emergency settings as well as the risks and opportunities. Recommendations for the incorporation of religious leaders in health promotion activities in consideration of different contextual factors are provided.

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Comunicación en Salud , Fiebre Hemorrágica Ebola , Humanos , Brotes de Enfermedades , Fiebre Hemorrágica Ebola/epidemiología , Sierra Leona , Investigación Cualitativa

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The purpose of this article is to 1) examine the role of the World Health Organization (WHO) in controlling infectious disease outbreaks, 2) evaluate if the WHO's initial response to the 2014-2016 Ebola crisis was appropriate, 3) evaluate current WHO's efforts to prevent future disease outbreaks after the Ebola elimination, and 4) suggest how WHO should be further reformed to provide prompt and accurate guidance to multi-sectoral health stakeholders at local, national, regional and global level for effective surveillance preparedness and response. This is a non-systematic narrative literature review. The articles from PubMed, Scopus, Medline, books, WHO documents and websites, and mass media were collected to be analyzed. WHO is the only specialized agency in the United Nations (UN) that promotes people's health with legitimacy around the globe. Due to the lack of funding and health workforce, weak global health governance, and political and economic concerns about afflicted countries, WHO failed to respond promptly to the 2014-2016 Ebola outbreak in West Africa. WHO has a central role in the architecture of global health governance. Although WHO was not the only one to be responsible for devastating 2014-2016 Ebola Virus Disease (EVD) outbreak in West Africa, it is undeniable that WHO was unprepared to respond to the EVD and failed to govern the global health response system. Furthermore, WHO should always remember its unique responsibility of taking the initiative to respond to the infectious disease outbreak by alarming a distress call.

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Ebola virus disease (EVD) is a dangerous viral zoonotic hemorrhagic fever caused by a deadly pathogenic filovirus. Frugivorous bats are recognized as being the natural reservoir, playing a pivotal role in the epidemiological dynamics. Since its discovery in 1976, the disease has been shown to be endemic in the Democratic Republic of the Congo (DRC). So far, thirteen outbreaks have occurred, and EVD has been prioritized in the national surveillance system. Additionally, EVD is targeted by the Integrated Disease Surveillance and Response (IDSR) strategy in DRC. The IDSR strategy is a collaborative, comprehensive and innovative surveillance approach developed and adopted by WHO's African region member states (WHO/Afro) to strengthen their surveillance capacity at all levels for early detection, response and recovery from priority diseases and public health events. We provide an overview of the IDSR strategy and the issues that can prevent its expected outcome (early detection for timely response) in eastern DRC where there are still delays in EVD outbreaks detection and weaknesses in response capacity and health crisis recovery. Therefore, this paper highlights the advantages linked to the implementation of the IDSR and calls for an urgent need to scale up its materialization against the recurrent Ebola outbreaks in eastern DRC. Consequently, the paper advocates for rapidly addressing the obstacles hindering its operationalization and adapting the approach to the local context using implementation science.

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Stochastic epidemic models (SEMs) fit to incidence data are critical to elucidating outbreak dynamics, shaping response strategies, and preparing for future epidemics. SEMs typically represent counts of individuals in discrete infection states using Markov jump processes (MJPs), but are computationally challenging as imperfect surveillance, lack of subject-level information, and temporal coarseness of the data obscure the true epidemic. Analytic integration over the latent epidemic process is impossible, and integration via Markov chain Monte Carlo (MCMC) is cumbersome due to the dimensionality and discreteness of the latent state space. Simulation-based computational approaches can address the intractability of the MJP likelihood, but are numerically fragile and prohibitively expensive for complex models. A linear noise approximation (LNA) that approximates the MJP transition density with a Gaussian density has been explored for analyzing prevalence data in large-population settings, but requires modification for analyzing incidence counts without assuming that the data are normally distributed. We demonstrate how to reparameterize SEMs to appropriately analyze incidence data, and fold the LNA into a data augmentation MCMC framework that outperforms deterministic methods, statistically, and simulation-based methods, computationally. Our framework is computationally robust when the model dynamics are complex and applies to a broad class of SEMs. We evaluate our method in simulations that reflect Ebola, influenza, and SARS-CoV-2 dynamics, and apply our method to national surveillance counts from the 2013-2015 West Africa Ebola outbreak.

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COVID-19 , Epidemias , Fiebre Hemorrágica Ebola , Humanos , Fiebre Hemorrágica Ebola/epidemiología , Incidencia , COVID-19/epidemiología , SARS-CoV-2 , Cadenas de Markov , Método de Montecarlo , Procesos Estocásticos , Teorema de Bayes

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This study utilized modeling and simulation to examine the effectiveness of current and potential future COVID-19 response interventions in the West African countries of Guinea, Liberia, and Sierra Leone. A comparison between simulations can highlight which interventions could have an effect on the pandemic in these countries. An extended compartmental model was used to run simulations incorporating multiple vaccination strategies and non-pharmaceutical interventions (NPIs). In addition to the customary categories of susceptible, exposed, infected, and recovered (SEIR) compartments, this COVID-19 model incorporated early and late disease states, isolation, treatment, and death. Lessons learned from the 2014-2016 Ebola virus disease outbreak-especially the optimization of each country's resource allocation-were incorporated in the presented models. For each country, models were calibrated to an estimated number of infections based on actual reported cases and deaths. Simulations were run to test the potential future effects of vaccination and NPIs. Multiple levels of vaccination were considered, based on announced vaccine allocation plans and notional scenarios. Increased vaccination combined with NPI mitigation strategies resulted in thousands of fewer COVID-19 infections in each country. This study demonstrates the importance of increased vaccinations. The levels of vaccination in this study would require substantial increases in vaccination supplies obtained through national purchases or international aid. While this study does not aim to develop a model that predicts the future, it can provide useful information for decision-makers in low- and middle-income nations. Such information can be used to prioritize and optimize limited available resources for targeted interventions that will have the greatest impact on COVID-19 pandemic response.

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Infecciones Virales del Ojo/diagnóstico , Fiebre Hemorrágica Ebola/diagnóstico , Segmento Posterior del Ojo/patología , Uveítis Posterior/diagnóstico , Adolescente , Adulto , Catarata/diagnóstico , Catarata/virología , Brotes de Enfermedades , Ebolavirus/aislamiento & purificación , Membrana Epirretinal/diagnóstico , Membrana Epirretinal/epidemiología , Membrana Epirretinal/virología , Oftalmopatías/diagnóstico , Oftalmopatías/epidemiología , Oftalmopatías/virología , Infecciones Virales del Ojo/epidemiología , Infecciones Virales del Ojo/virología , Femenino , Fiebre Hemorrágica Ebola/epidemiología , Fiebre Hemorrágica Ebola/virología , Humanos , Masculino , Persona de Mediana Edad , Segmento Posterior del Ojo/virología , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/epidemiología , Desprendimiento de Retina/virología , Sierra Leona/epidemiología , Sobrevivientes , Uveítis Posterior/epidemiología , Uveítis Posterior/virología , Cuerpo Vítreo/patología , Adulto Joven

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INTRODUCTION: While it is suspected that some ages were misreported during the 2014-2016 West African Ebola outbreak, an analysis examining age data quality has not been conducted. The study objective was to examine age heaping and terminal digit preference as indicators for quality of age data collected in the Sierra Leone Ebola Database (SLED). METHODS: Age data quality for adult patients was analyzed within SLED for the Viral Hemorrhagic Fever (VHF) database and the laboratory testing dataset by calculating Whipple´s index and Myers´s blended index, stratified by sex and region. RESULTS: Age data quality was low in both the VHF database (Whipple´s index for the 5-year range, 229.2) and the laboratory testing dataset (Whipple´s index for the 5-year range, 236.4). Age was reported more accurately in the Western Area and least accurately in the Eastern Province. Age data for females were less accurate than for males. CONCLUSION: Age data quality was low in adult patients during the 2014-2016 Ebola outbreak in Sierra Leone, which may reduce its use as an identifying or stratifying variable. These findings inform future analyses using this database and describe a phenomenon that has relevance in data collection methods and analyses for future outbreaks in developing countries.

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Bases de Datos Factuales/estadística & datos numéricos , Brotes de Enfermedades/estadística & datos numéricos , Fiebre Hemorrágica Ebola/epidemiología , Adulto , Distribución por Edad , Anciano , Bases de Datos Factuales/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Sierra Leona/epidemiología , Adulto Joven

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AIM: To describe nurses' experiences of health concerns, teamwork, leadership and management and knowledge transfer during an Ebola outbreak in West Africa. DESIGN: The study has a qualitative descriptive design. METHODS: The 44 nurses who had worked in an Ebola Treatment Centre in Kenema in 2014 and 2015 were invited by email to respond to a questionnaire. The qualitative, open-ended answers were analysed using a thematic analysis. Data have been coded systematically, with the identification of semantic patterns presented in four themes. RESULTS: The themes are as follows: personal health management-a way to feel safe and secure for delegates and affiliates; pre-deployment training-crucial for a joint value base and future collaboration; the importance of a professional democratic approach and being a good role model; and the value of timely in-depth knowledge transfer of experienced former delegates.

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INTRODUCTION: The 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017. METHODS: Data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained. RESULTS: The ETU, SQS and RRT training were completed by a total of 21,248 participants. There were improvements in knowledge and confidence, an associated reduction in HCWs infection and reduced response time to subsequent public health events. CONCLUSION: No infections were reported by healthcare workers in Liberia since the completion of these training programs. HCW training programmes initiated during and post disease outbreak can boost public trust in the health system while providing an entry point for establishing an Epidemic Preparedness and Response (EPR) framework in resource-limited settings.

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Brotes de Enfermedades/prevención & control , Personal de Salud/organización & administración , Fuerza Laboral en Salud/organización & administración , Fiebre Hemorrágica Ebola/prevención & control , Creación de Capacidad , Atención a la Salud/organización & administración , Epidemias/prevención & control , Fiebre Hemorrágica Ebola/epidemiología , Humanos , Liberia/epidemiología , Salud Pública

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The Ebola epidemic in West Africa between 2014 and 2015 was the deadliest since the discovery of the virus four decades ago. With the second-largest outbreak of Ebola virus disease currently raging in the Democratic Republic of the Congo, (DRC) it is clear that lessons from the past can be quickly forgotten-or be incomplete in the first instance. In this article, we seek to understand the health challenges facing marginalised people by elaborating on the multiple dimensions of marginalisation in the case of the West Africa Ebola epidemic. We trace and unpack modes of marginalisation, beginning with the "outbreak narrative" and its main components and go on to examine other framings, including the prioritisation of the present over the past, the positioning of 'Us versus Them'; and the marginalisation-in responses to the outbreak-of traditional medicine, cultural practices and other practices around farming and hunting. Finally, we reflect on the 'lessons learned' framing, highlighting what is included and what is left out. In conclusion, we stress the need to acknowledge-and be responsive to-the ethical, normative framings of such marginalisation.

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Fiebre Hemorrágica Ebola/epidemiología , África Occidental/epidemiología , Brotes de Enfermedades , Humanos , Marginación Social

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This paper presents a study of regional optimal control strategies of a spatiotemporal SIR epidemic model which is formulated from existing SIR epidemic models by including a diffusion term. Our main objective is to characterize the two optimal controls that minimize the number of infected individuals, the corresponding vaccination and treatment costs. For that matter, we prove the existence of a pair of control and provide a characterization of optimal controls in terms of state and adjoint functions. Finally, we present numerical simulations on data concerning the evolution of the zoonotic Ebola virus in Africa. Results show that control is effective if regional treatment and vaccine strategies are used simultaneously.

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Brotes de Enfermedades , Epidemias , Modelos Biológicos , Simulación por Computador , Epidemias/prevención & control , Humanos , Conceptos Matemáticos , Vacunación

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INTRODUCTION: Guinea is a country with a critical deficit and maldistribution of healthcare workers along with a high risk of epidemics' occurrence. However, actors in the health sector have missed opportunities for more than a decade to attract political attention. This article aims to explain why this situation exists and what were the roles of actors in the agenda-setting process of the post-Ebola health system strengthening programme. It also assesses threats and opportunities for this programme's sustainability. METHODS: We used Kingdon's agenda-setting methodological framework to explain why actors promptly focused on the health sector reform after the Ebola outbreak. We conducted a qualitative explanatory study using a literature review and key informant interviews. RESULTS: We found that, in the problem stream, the Ebola epidemic caused considerable fear among national as well as international actors, a social crisis and an economic system failure. This social crisis was entertained by communities' suspicion of an 'Ebola-business'. In response to these problems, policy actors identified three sets of solutions: the temporary external funds generated by the Ebola response; the availability of experienced health workers in the Ebola control team; and the overproduction of health graduates in the labour market. We also found that the politics agenda was dominated by two major factors: the global health security agenda and the political and financial interests of national policy actors. Although the opening of the policy window has improved human resources, finance and logistics, and infrastructures pillars of the health system, it, however, disproportionally focuses on epidemic preparedness and response. and neglects patients' financial affordability of essential health services. CONCLUSION: Domestic policy entrepreneurs must realise that agenda-setting of health issues in the Guinean context strongly depends on the construction of the problem definition and how this is influenced by international actors.