Ebola outbreak in rural West Africa: epidemiology, clinical features and outcomes

Abstract

ObjectiveTo describe Ebola cases in the district Ebola management centre of in Kailahun, a remote rural district of Sierra Leone, in terms of geographic origin, patient and hospitalisation characteristics, treatment outcomes and time from symptom onset to admission.MethodsData of all Ebola cases from June 23rd to October 5th 2014 were reviewed. Ebola was confirmed by reverse-transcriptase-polymerase-chain-reaction assay.ResultsOf 489 confirmed cases (51% male, median age 28 years), 166 (34%) originated outside Kailahun district. Twenty-eight (6%) were health workers: 2 doctors, 11 nurses, 2 laboratory technicians, 7 community health workers and 6 other cadres. More than 50% of patients had fever, headache, abdominal pain, diarrhoea/vomiting. An unusual feature was cough in 40%. Unexplained bleeding was reported in 5%. Outcomes for the 489 confirmed cases were 227 (47%) discharges, 259 (53%) deaths and 3 transfers. Case fatality in health workers (68%) was higher than other occupations (52%, P = 0.05). The median community infectivity time was 6.5 days for both general population and health workers (P = 0.4).ConclusionsOne in three admitted cases originated outside Kailahun district due to limited national access to Ebola management centres – complicating contact tracing, safe burial and disinfection measures. The comparatively high case fatality among health workers requires attention. The community infectivity time needs to be reduced to prevent continued transmission.

Measuring the impact of Ebola control measures in Sierra Leone

“…In reality, however, infectious individuals occasionally traveled between different areas (20). To assess how this could affect our estimates of cases averted, we resimulated outbreaks using the fitted model, but with additional infectious individuals introduced at a rate of either one per day or one per week in each district.…”

“…However, in the early stages of the epidemic, several cases admitted to the ETU in Kailahun were from outside the district (20). This may have increased the benefits of bed introduction, by reducing transmission in locations without treatment beds; it may also have impeded control efforts, by making contact tracing and safe burials more difficult (20).…”

“…However, in the early stages of the epidemic, several cases admitted to the ETU in Kailahun were from outside the district (20). This may have increased the benefits of bed introduction, by reducing transmission in locations without treatment beds; it may also have impeded control efforts, by making contact tracing and safe burials more difficult (20). In addition, faster turnaround time in laboratory testing may have reduced the time spent in EHCs/ CCCs before moving to ETUs (Sierra Leone Ebola labs projectbeating the outbreak at source; https://publichealthmatters.blog.…”

Regression Modelling and Analysis of Cell phone-Based Syndromic Surveillance Data for Ebola in Sierra Leone

“…The 2014 Ebola outbreak is the largest so far and recorded more than 20,000 cases and 10,000 deaths [3]. Sierra Leone was one of the countries greatly affected by the 2014 West Africa Ebola outbreak [4]. Sierra Leone's first Ebola case was confirmed on 27 th May 2014.…”

Ebola virus – from neglected threat to global emergency state

“…1,4,7 All species originating from Africa cause EVD in humans and NHPs. 12 The only species not originating from Africa, the Reston ebolavirus, was isolated for the first time in monkeys (Macaca fascicularis) imported from the Philippines to a quarantine unit in Reston, United States, in 1989. In 2008, it was reisolated from cynomolgus monkeys and, for the first time, in pigs from the Philippines.…”