Detecting Ebola with limited laboratory access in the Democratic Republic of Congo: evaluation of a clinical passive surveillance reporting system

Ashbaugh, Hayley; Kuang, Brandon; Gadoth, Adva; Alfonso, Vivian H.; Mukadi, Patrick; Doshi, Reena H.; Hoff, Nicole A.; Sinai, Cyrus; Mossoko, Mathias; Kebela, Benoit; Muyembe, Jean‐Jacques; Wemakoy, Emile Okitolonda; Rimoin, Anne W.

doi:10.1111/tmi.12917

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…These two programmes have been in place since the 1980s and the late 1990s for the expanded programme for immunisation and the IDSR, respectively. The IDSR strategy was adopted by the WHO African region in 1998 and has contributed to the strengthening of real-time surveillance (indicator and event-based) in human health 19–29. However, in several countries, major disparities were observed between the human and animal health sectors.…”

Section: Putting the Current Ihr Capacities Status Into Context And Pmentioning

confidence: 99%

“…In the WHO African region, the implementation of the IHR has previously been facilitated by the implementation of the integrated disease surveillance and response (IDSR) and the disaster risk management strategies 19–29. However, the Ebola virus disease outbreak of 2013–2016 in West Africa highlighted major gaps in IHR implementation 30–33.…”

Section: Introductionmentioning

confidence: 99%

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Joint external evaluation of the International Health Regulation (2005) capacities: current status and lessons learnt in the WHO African region

et al. 2019

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The International Health Regulations (IHR, 2005) are an essential vehicle for addressing global health security. Here, we report the IHR capacities in the WHO African from independent joint external evaluation (JEE). The JEE is a voluntary component of the IHR monitoring and evaluation framework. It evaluates IHR capacities in 19 technical areas in four broad themes: ‘Prevent’ (7 technical areas, 15 indicators); ‘Detect’ (4 technical areas, 13 indicators); ‘Respond’ (5 technical areas, 14 indicators), points of entry (PoE) and other IHR hazards (chemical and radiation) (3 technical areas, 6 indicators). The IHR capacity scores are graded from level 1 (no capacity) to level 5 (sustainable capacity). From February 2016 to March 2019, 40 of 47 WHO African region countries (81% coverage) evaluated their IHR capacities using the JEE tool. No country had the required IHR capacities. Under the theme ‘Prevent’, no country scored level 5 for 12 of 15 indicators. Over 80% of them scored level 1 or 2 for most indicators. For ‘Detect’, none scored level 5 for 12 of 13 indicators. However, many scored level 3 or 4 for several indicators. For ‘Respond’, none scored level 5 for 13 of 14 indicators, and less than 10% had a national multihazard public health emergency preparedness and response plan. For PoE and other IHR hazards, most countries scored level 1 or 2 and none scored level 5. Countries in the WHO African region are commended for embracing the JEE to assess their IHR capacities. However, major gaps have been identified. Urgent collective action is needed now to protect the WHO African region from health security threats.

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Section: Putting the Current Ihr Capacities Status Into Context And Pmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Joint external evaluation of the International Health Regulation (2005) capacities: current status and lessons learnt in the WHO African region

et al. 2019

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“…Historically, HCWs have perpetuated the spread and amplification of EVD and serve as axes of viral transmission, often before ebolavirus is even recognized as the causative agent [14][15][16][17][18][19][20][21]. The symptoms of EVD are frequently nonspecific, characterized by fever, headache, fatigue, muscle pain, vomiting, diarrhea, and abdominal pain [22], and can easily be confused with other endemic diseases such as typhoid or malaria [23]. The difficulties associated with clinical recognition and diagnostic capabilities make prevention efforts for HCWs complex because infected workers may transmit disease before any symptoms are accurately diagnosed.…”

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confidence: 99%

Serologic Markers for Ebolavirus Among Healthcare Workers in the Democratic Republic of the Congo

Hoff

Mukadi²,

Doshi

et al. 2018

The Journal of Infectious Diseases

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Healthcare settings have played a major role in propagation of Ebola virus (EBOV) outbreaks. Healthcare workers (HCWs) have elevated risk of contact with EBOV-infected patients, particularly if safety precautions are not rigorously practiced. We conducted a serosurvey to determine seroprevalence against multiple EBOV antigens among HCWs of Boende Health Zone, Democratic Republic of the Congo, the site of a 2014 EBOV outbreak. Interviews and specimens were collected from 565 consenting HCWs. Overall, 234 (41.4%) of enrolled HCWs were reactive to at least 1 EBOV protein: 159 (28.1%) were seroreactive for anti-glycoprotein immunoglobulin G (IgG), 89 (15.8%) were seroreactive for anti-nucleoprotein IgG, and 54 (9.5%) were VP40 positive. Additionally, sera from 16 (2.8%) HCWs demonstrated neutralization capacity. These data demonstrate that a significant proportion of HCWs have the ability to neutralize virus, despite never having developed Ebola virus disease symptoms, highlighting an important and poorly documented aspect of EBOV infection and progression.

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“…The 47 studies included in this review focused on 17 countries, ordered by number of publications: Nigeria (10 [14-23]), Ghana (7 [24][25][26][27][28][29][30]), Uganda (5 [31][32][33][34][35]), Liberia (4 [36][37][38][39]), the Democratic Republic of Congo (3 [17,40,41]), Ethiopia (3 [17,42,43]), Kenya (3 [44][45][46]), Sierra Leone (2 [47,48]), Zimbabwe (2 [49,50] [17]), and Zambia (1 [55]). Four studies examined IDSR strategy on a regional level [56][57][58][59] (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Systematic review of Integrated Disease Surveillance and Response (IDSR) implementation in the African region

et al. 2021

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Background The WHO African region frequently experiences outbreaks and epidemics of infectious diseases often exacerbated by weak health systems and infrastructure, late detection, and ineffective outbreak response. To address this, the WHO Regional Office for Africa developed and began implementing the Integrated Disease Surveillance and Response strategy in 1998. Objectives This systematic review aims to document the identified successes and challenges surrounding the implementation of IDSR in the region available in published literature to highlight areas for prioritization, further research, and to inform further strengthening of IDSR implementation. Methods A systematic review of peer-reviewed literature published in English and French from 1 July 2012 to 13 November 2019 was conducted using PubMed and Web of Science. Included articles focused on the WHO African region and discussed the use of IDSR strategies and implementation, assessment of IDSR strategies, or surveillance of diseases covered in the IDSR framework. Data were analyzed descriptively using Microsoft Excel and Tableau Desktop 2019. Results The number of peer-reviewed articles discussing IDSR remained low, with 47 included articles focused on 17 countries and regional level systems. Most commonly discussed topics were data reporting (n = 39) and challenges with IDSR implementation (n = 38). Barriers to effective implementation were identified across all IDSR core and support functions assessed in this review: priority disease detection; data reporting, management, and analysis; information dissemination; laboratory functionality; and staff training. Successful implementation was noted where existing surveillance systems and infrastructure were utilized and streamlined with efforts to increase access to healthcare. Conclusions and implications of findings These findings highlighted areas where IDSR is performing well and where implementation remains weak. While challenges related to IDSR implementation since the first edition of the technical guidelines were released are not novel, adequately addressing them requires sustained investments in stronger national public health capabilities, infrastructure, and surveillance processes.

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Detecting Ebola with limited laboratory access in the Democratic Republic of Congo: evaluation of a clinical passive surveillance reporting system

Cited by 7 publications

References 26 publications

Joint external evaluation of the International Health Regulation (2005) capacities: current status and lessons learnt in the WHO African region

Joint external evaluation of the International Health Regulation (2005) capacities: current status and lessons learnt in the WHO African region

Serologic Markers for Ebolavirus Among Healthcare Workers in the Democratic Republic of the Congo

Systematic review of Integrated Disease Surveillance and Response (IDSR) implementation in the African region

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