Estimating the number of secondary Ebola cases resulting from an unsafe burial and risk factors for transmission during the West Africa Ebola epidemic

Abstract

BackgroundSafely burying Ebola infected individuals is acknowledged to be important for controlling Ebola epidemics and was a major component of the 2013–2016 West Africa Ebola response. Yet, in order to understand the impact of safe burial programs it is necessary to elucidate the role of unsafe burials in sustaining chains of Ebola transmission and how the risk posed by activities surrounding unsafe burials, including care provided at home prior to death, vary with human behavior and geography.Methodology/Principal findingsInterviews with next of kin and community members were carried out for unsafe burials in Sierra Leone, Liberia and Guinea, in six districts where the Red Cross was responsible for safe and dignified burials (SDB). Districts were randomly selected from a district-specific sampling frame comprised of villages and neighborhoods that had experienced cases of Ebola. An average of 2.58 secondary cases were potentially generated per unsafe burial and varied by district (range: 0–20). Contact before and after death was reported for 142 (46%) contacts. Caregivers of a primary case were 2.63 to 5.92 times more likely to become EVD infected compared to those with post-mortem contact only. Using these estimates, the Red Cross SDB program potentially averted between 1,411 and 10,452 secondary EVD cases, reducing the epidemic by 4.9% to 36.5%.Conclusions/SignificanceSDB is a fundamental control measure that limits community transmission of Ebola; however, for those individuals having contact before and after death, it was impossible to ascertain the exposure that caused their infection. The number of infections prevented through SDB is significant, yet greater impact would be achieved by early hospitalization of the primary case during acute illness.

Adequacy of SEIR models when epidemics have spatial structure: Ebola in Sierra Leone

“…symptomatic but uninfectious [50]). In the context of Ebola, this includes transmission from individuals being prepared for burial [51].…”

“…Fitting such models would likely require that different parts of the model be fitted independently to different datasets. For example, a movement component, when employed, could first be fitted to a movement model, or in the case of EVD the infectious period could be set using the consensus level of around 9.5 days [60] (our high estimate of this quantity might be explained by our neglect of transmission during the preparation of bodies for burial [51]). Then epidemiological parameters could be obtained by fitting an SEIVD model to subsets of incidence data for which the assumption of well-mixed subpopulations is reasonable.…”

Preparedness of Health Care Systems for Ebola Outbreak Response in Kasese and Rubirizi districts, Western Uganda

“…In the rst EVD outbreak in northern Uganda, establishment of burial teams were found to be instrumental in containing the disease and stopping transmission within the community (6). Safe and digni ed burial in an important control measure in limiting transmission of Ebola at community level (34). Mbonye et al (28) recommend a national response team to train local burial teams since they form a critical infrastructural component and according to Okware (6) Uganda has started doing that.…”

Enhancing Situational Awareness to Prevent Infectious Disease Outbreaks from Becoming Catastrophic

“…For antiinfective treatments, real-time data on the susceptibility of cases will be required to assess the likely impact of these treatments, estimate trends in resistance, and inform the optimal use of these and other countermeasures (Leung et al 2017). To improve estimates of their past and potential effectiveness, data on the timing and geographic scope of nonpharmaceutical interventions, such as movement restrictions, safe burial practices (Tiffany et al 2017) or school closings and openings (Chao et al 2010;Huang et al 2014) may be gathered by traditional means (surveys or administrative data) or by some of the novel means described below (Peak et al 2018).…”