Novel Use of Capture-Recapture Methods to Estimate Completeness of Contact Tracing during an Ebola Outbreak, Democratic Republic of the Congo, 2018–2020

Polonsky, Jonathan; Böhning, Dankmar; Keïta, Mory; Ahuka‐Mundeke, Steve; Nsio-Mbeta, Justus; Abedi, Aaron Aruna; Mossoko, Mathias; Estill, Janne; Keiser, Olivia; Kaiser, Laurent; Yoti, Zabulon; Sangnawakij, Patarawan; Lerdsuwansri, Rattana; Vilas, Víctor J. Del Rio

doi:10.3201/eid2712.204958

Cited by 8 publications

(9 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The 2018–2020 eastern DRC outbreak lasted nearly 2 years despite the availability of effective vaccine34 and therapeutics35 from the outset of the response. Public health performance indicators were poor, with increasing community deaths, poor CT (indicated by the high number of cases that had no known contacts), and delays between symptom onset and isolation 9 19 34. The change in strategy to adapt to a difficult context was necessary, and led to a rapid and drastic reduction in transmissibility which reduced incidence and helped bring the outbreak under control 3.…”

Section: Discussionmentioning

confidence: 99%

“…The biological features of the Ebola virus, requiring contact with body fluids for a possibility of human-to-human transmission, place the notion of contact at the centre of the interruption of such virus-driven outbreaks 8. Therefore, CT is among the key EVD control measures, consisting of the identification and listing, tracing (ie, locating and establishing initial contact), and finally, regular follow-up 9. The core aim is to limit the spread of the infectious disease by offering early support and care as well as isolation if the contact develops disease 10…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A community-based contact isolation strategy to reduce the spread of Ebola virus disease: an analysis of the 2018–2020 outbreak in the Democratic Republic of the Congo

et al. 2023

Self Cite

View full text Add to dashboard Cite

IntroductionDespite tremendous progress in the development of diagnostics, vaccines and therapeutics for Ebola virus disease (EVD), challenges remain in the implementation of holistic strategies to rapidly curtail outbreaks. We investigated the effectiveness of a community-based contact isolation strategy to limit the spread of the disease in the Democratic Republic of Congo (DRC).MethodsWe did a quasi-experimental comparison study. Eligible participants were EVD contacts registered from 12 June 2019 to 18 May 2020 in Beni and Mabalako Health Zones. Intervention group participants were isolated to specific community sites for the duration of their follow-up. Comparison group participants underwent contact tracing without isolation. The primary outcome was measured as the reproduction number (R) in the two groups. Secondary outcomes were the delay from symptom onset to isolation and case management, case fatality rate (CFR) and vaccination uptake.Results27 324 EVD contacts were included in the study; 585 in the intervention group and 26 739 in the comparison group. The intervention group generated 32 confirmed cases (5.5%) in the first generation, while the comparison group generated 87 (0.3%). However, the 32 confirmed cases arising from the intervention contacts did not generate any additional transmission (R=0.00), whereas the 87 confirmed cases arising from the comparison group generated 99 secondary cases (R=1.14). The average delay between symptom onset and case isolation was shorter (1.3 vs 4.8 days; p<0.0001), CFR lower (12.5% vs 48.4%; p=0.0001) and postexposure vaccination uptake higher (86.0% vs 56.8%; p<0.0001) in the intervention group compared with the comparison group. A significant difference was also found between intervention and comparison groups in survival rate at the discharge of hospitalised confirmed patients (87.9% vs 47.7%, respectively; p=0.0004).ConclusionThe community-based contact isolation strategy used in DRC shows promise as a potentially effective approach for the rapid cessation of EVD transmission, highlighting the importance of rapidly implemented, community-oriented and trust-building control strategies.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A community-based contact isolation strategy to reduce the spread of Ebola virus disease: an analysis of the 2018–2020 outbreak in the Democratic Republic of the Congo

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…Lastly, there might have been a hidden chain of transmission, missed by the surveillance system, that was detected very late, after a number of generations of disease, which is why reinforcing surveillance activities and assessing their performance are crucial but often neglected activities [ 22 ]. However, the last hypothesis seems least likely, as it would mean that there was an undetected continued chain of transmission happening for >6 months.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, proactive listening to the concerns of different subgroups and culturally sensitive and appropriate strategies are crucial to rollout of vaccines and to minimizing vaccine hesitancy [ 23 ]. Another possible contributing factor is the fact that EVD demonstrates a highly overdispersed offspring distribution, which leads both to a tendency to transmission driven by superspreading events and to stochastic extinction of small, isolated clusters of disease [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Investigation of and Strategies to Control the Final Cluster of the 2018–2020 Ebola Virus Disease Outbreak in the Eastern Democratic Republic of Congo

Keïta

Polonsky

Finci

et al. 2022

Open Forum Infectious Diseases

Self Cite

View full text Add to dashboard Cite

Background On April 10, 2020, while the independent committee of the International Health Regulation was meeting to decide whether the 10th Ebola outbreak in the Demogratic Republic of Congo still constituted a Public Health Emergency of International Concern, a new confirmed case was reported in the city of Beni, the last epicenter of the epidemic. This study aimed to understand the source of this cluster and learn from the implemented control strategies for improved response in the future. Methods We conducted a combined epidemiological and genomic investigation to understand the origins and dynamics of transmission within this cluster and describe the strategy that successfully controlled the outbreak. Results Eight cases were identified as belonging to this final cluster. A total of 1028 contacts were identified. Whole-genome sequencing revealed that all cases belonged to the same cluster, the closest sequence to which was identified as a case from the Beni area with symptom onset in July 2019 and a difference of just 31 nucleotides. Outbreak control measures included community confinement of high-risk contacts. Conclusions This study illustrates the high risk of additional flare-ups in the period leading to the end-of-outbreak declaration and the importance of maintaining enhanced surveillance and confinement activities to rapidly control Ebola outbreaks.

show abstract

“…When several sources are available, capture-recapture analyses can be used to better estimate burden [11]. This analytic approach has been recently used to assess completeness of contact-tracing for Ebola and detection of Covid-19 infections [12, 13]. For pertussis, capture-recapture has been used to estimate the number of deaths in England and the number of cases in Ontario [10, 14].…”

Section: Introductionmentioning

confidence: 99%

Improving estimates of pertussis burden in Ontario, Canada 2010-2017 by combining validation and capture-recapture methodologies

McBurney

Kwong

Brown

et al. 2022

Preprint

View full text Add to dashboard Cite

An underestimation of pertussis burden has impeded understanding of transmission and disallows effective policy and prevention to be prioritized and enacted. Capture-recapture analyses can improve burden estimates; however, uncertainty remains around incorporating health administrative data due to accuracy limitations. The aim of this study is to explore the impact of pertussis case definitions and data accuracy on capture-recapture estimates. We used a dataset from March 7, 2010 to December 31, 2017 comprised of pertussis case report, laboratory, and health administrative data. We compared Chao capture-recapture abundance estimates using prevalence, incidence, and adjusted false positive case definitions. The latter was developed by removing the proportion of false positive physician billing code-only case episodes after validation. We calculated sensitivity by dividing the number of observed cases by abundance. Abundance estimates demonstrated that a high proportion of cases were missed by all sources. Under the primary analysis, the highest sensitivity of 78.5% (95% CI 76.2-80.9%) for those less than one year of age was obtained using all sources after adjusting for false positives, which dropped to 43.1% (95% CI 42.4-43.8%) for those one year of age or older. Most code-only episodes were false positives (91.0%), leading to considerably lower abundance estimates and improvements in laboratory testing and case report sensitivity using this definition. Accuracy limitations can be accounted for in capture-recapture analyses using different case definitions and adjustment. The latter enhanced the validity of estimates, furthering the utility of capture-recapture methods to epidemiological research. Findings demonstrated that all sources consistently fail to detect pertussis cases. This is differential by age, suggesting ascertainment and testing bias. Results demonstrate the value of incorporating real time health administrative data into public health surveillance if accuracy limitations can be addressed.

show abstract

Novel Use of Capture-Recapture Methods to Estimate Completeness of Contact Tracing during an Ebola Outbreak, Democratic Republic of the Congo, 2018–2020

Cited by 8 publications

References 31 publications

A community-based contact isolation strategy to reduce the spread of Ebola virus disease: an analysis of the 2018–2020 outbreak in the Democratic Republic of the Congo

A community-based contact isolation strategy to reduce the spread of Ebola virus disease: an analysis of the 2018–2020 outbreak in the Democratic Republic of the Congo

Investigation of and Strategies to Control the Final Cluster of the 2018–2020 Ebola Virus Disease Outbreak in the Eastern Democratic Republic of Congo

Improving estimates of pertussis burden in Ontario, Canada 2010-2017 by combining validation and capture-recapture methodologies

Contact Info

Product

Resources

About