BackgroundThe 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 FindingsOver 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 mis...

Background: Accurate information about the burden of malaria infection at the district or provincial level is required both to plan and assess local malaria control efforts. Although many studies of malaria epidemiology, immunology, and drug resistance have been conducted at many sites in Indonesia, there is little published literature describing malaria prevalence at the district, provincial, or national level.

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The aim of this study was to determine the reasons for delay of antiretroviral therapy (ART) in eligible HIV-infected children after the implementation of the South African National ART programme in April 2004, and to describe implemented interventions to improve ART access. This descriptive, retrospective audit included all HIV-infected children attending an ART clinic from April to December 2004, summarizing the following: (i) demographic data; (ii) HIV disease stage; (iii) CD4+ counts/percentages; (iv) ART eligibility and (v) reasons for ART delay. There were 276 study participants with a mean age of 4 years 4 months (range: 1 month-13 years). According to the South African national guidelines, 243 children were eligible for ART, but only 96 children were initiated on treatment during the study period, which was 39.5% of the eligible group and 34.8% of the total group. Important reasons for treatment delay were: (i) co-infection with tuberculosis (26.4%); (ii) lack of human resources (20.3%); (iii) socio-economic obstacles (17.3%) and (iv) incorrect disease stage classification (13.7%). Paediatric ART clinics need to co-operate closely with existing tuberculosis clinics for the effective management of tuberculosis co-infection; address socio-economic factors of HIV-affected families, especially the legal guardianship in orphans and improve their own staff capacity and the education of medical staff in HIV/AIDS management.