Lessons learned by surveillance during the tail-end of the Ebola outbreak in Guinea, June-October 2015: a case series

Abstract

BackgroundBy the end of the 2013–2016 West African Ebola Virus Disease (EVD) outbreaks, a total of 3814 cases (probable and confirmed) and 2544 deaths were reported in Guinea. Clearly, surveillance activities aiming at stopping human-to-human transmission have been the breakthrough of EVD outbreak management, but their application has been at times easier said than done. This article presents five confirmed or probable EVD cases that arose in Conakry towards the end of the Guinea epidemic, which demonstrate flaws in surveillance and follow-up.Case presentationFor case 1, safe burial requirements were not followed. For cases 1 and 2, negative Polymerase Chain Reaction (PCR) results were interpreted as no infection. For the first case, the sample may have not been taken properly while for the second the disease was possibly at its early stage. Case 3 was stopped at a border health checkpoint and despite her high temperature she was allowed to continue the bus journey. For case 4, an oral swab sample was supposedly taken after death but could not be found for retrospective testing. Despite characteristic symptomatology, case 5 was not identified as a suspect case for as long as 3 weeks.ConclusionIn epidemic contexts, health systems must be able to track all samples of suspect cases and deaths, regardless of their laboratory results. Social mobilization in communities and training in health care facilities must be strengthened at the tail of an outbreak, to avoid the natural slackening of disease surveillance, in particular for long-lasting and deadly epidemics.

Ebola Virus Transmission Caused by Persistently Infected Survivors of the 2014–2016 Outbreak in West Africa

“…During the Ebola outbreak in West Africa, the investigation of each confirmed EVD case had 2 main components: (1) epidemiological investigation, which aimed at finding the link of acute EVD cases with ongoing chains of transmission, identifying high- and low-risk contacts and performing contact tracing (ie, following them up for 21 days and isolating them as soon as they manifest EVD-like symptoms) [ 2 , 3 ]; (2) molecular investigation, which utilized whole-genome sequencing to identify cluster of infections by mapping genetic relationships between virus variants from different patients, particularly when a clear epidemiological link could not be established [ 4–6 ].…”

How has Guinea learnt from the response to outbreaks? A learning health system analysis

“…Prioritising investment in health personnel (training and capacity building, increasing the number through recruitment and retention strategies)85 132 137 142–145…”

Fighting Ebola in the Shadow of Conspiracy Theories and Sorcery Suspicions

“…Unlike past outbreaks, the West African case lasted for more than two years. By March 2016, there had been more than 28,646 cases of evd and over 11,323 deaths worldwide, primarily in Guinea, Liberia and Sierra Leone, making the outbreak significantly larger and deadlier than all previous Ebola outbreaks combined (Keita et al 2017).…”

“…Forty-two days had then passed since the last person confirmed to have Ebola virus disease tested negative (who 2016). In Guinea, where the outbreak originated, there were a total of 3,355 confirmed and 456 probable cases, including 2,544 deaths (Keita et al 2017).…”