Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-30 (of 43 Records) |
Query Trace: Nyenswah T[original query] |
---|
Risk Factors for Ebola Virus Persistence in Semen of Survivors - Liberia.
Dyal J , Kofman A , Kollie JZ , Fankhauser J , Orone R , Soka MJ , Glaybo U , Kiawu A , Freeman E , Giah G , Tony HD , Faikai M , Jawara M , Kamara K , Kamara S , Flowers B , Kromah ML , Desamu-Thorpe R , Graziano J , Brown S , Morales-Betoulle ME , Cannon DL , Su K , Linderman SL , Plucinski M , Rogier E , Bradbury RS , Secor WE , Bowden KE , Phillips C , Carrington MN , Park YH , Martin MP , Del Pilar Aguinaga M , Mushi R , Haberling DL , Ervin ED , Klena JD , Massaquoi M , Nyenswah T , Nichol ST , Chiriboga DE , Williams DE , Hinrichs SH , Ahmed R , Vonhm BT , Rollin PE , Purpura LJ , Choi MJ . Clin Infect Dis 2022 76 (3) e849-e856 ![]() ![]() BACKGROUND: Long-term persistence of Ebola virus (EBOV) in immunologically-privileged sites has been implicated in recent outbreaks of Ebola Virus Disease (EVD) in Guinea and the Democratic Republic of Congo. This study was designed to understand how the acute course of EVD, convalescence, and host immune and genetic factors may play a role in prolonged viral persistence in semen. METHODS: A cohort of 131 male EVD survivors in Liberia were enrolled in a case-case study. "Early clearers" were defined as those with two consecutive negative EBOV semen tests by real-time reverse transcriptase polymerase chain reaction (rRT-PCR) at least two weeks apart within 1 year after discharge from the Ebola Treatment Unit (ETU) or acute EVD. "Late clearers" had detectable EBOV RNA by rRT-PCR over one year following ETU discharge or acute EVD. Retrospective histories of their EVD clinical course were collected by questionnaire, followed by complete physical exams and blood work. RESULTS: Compared to early clearers, late clearers were older (median 42.5 years, p = 0.0001) and experienced fewer severe clinical symptoms (median 2, p = 0.006). Late clearers had more lens opacifications (OR 3.9, 95%CI 1.1-13.3, p = 0.03), after accounting for age, higher total serum IgG3 titers (p = 0.007) and increased expression of the HLA-C*03:04 allele (OR 0.14, 95% CI 0.02-0.70, p = 0.007). CONCLUSIONS: Older age, decreased illness severity, elevated total serum IgG3 and HLA-C*03:04 allele expression may be risk factors for the persistence of EBOV in the semen of EVD survivors. EBOV persistence in semen may also be associated with its persistence in other immunologically protected sites, such as the eye. |
Lassa virus circulating in Liberia: a retrospective genomic characterisation.
Wiley MR , Fakoli L , Letizia AG , Welch SR , Ladner JT , Prieto K , Reyes D , Espy N , Chitty JA , Pratt CB , Di Paola N , Taweh F , Williams D , Saindon J , Davis WG , Patel K , Holland M , Negron D , Stroher U , Nichol ST , Sozhamannan S , Rollin PE , Dogba J , Nyenswah T , Bolay F , Albarino CG , Fallah M , Palacios G . Lancet Infect Dis 2019 19 (12) 1371-1378 ![]() ![]() BACKGROUND: An alarming rise in reported Lassa fever cases continues in west Africa. Liberia has the largest reported per capita incidence of Lassa fever cases in the region, but genomic information on the circulating strains is scarce. The aim of this study was to substantially increase the available pool of data to help foster the generation of targeted diagnostics and therapeutics. METHODS: Clinical serum samples collected from 17 positive Lassa fever cases originating from Liberia (16 cases) and Guinea (one case) within the past decade were processed at the Liberian Institute for Biomedical Research using a targeted-enrichment sequencing approach, producing 17 near-complete genomes. An additional 17 Lassa virus sequences (two from Guinea, seven from Liberia, four from Nigeria, and four from Sierra Leone) were generated from viral stocks at the US Centers for Disease Control and Prevention (Atlanta, GA) from samples originating from the Mano River Union (Guinea, Liberia, and Sierra Leone) region and Nigeria. Sequences were compared with existing Lassa virus genomes and published Lassa virus assays. FINDINGS: The 23 new Liberian Lassa virus genomes grouped within two clades (IV.A and IV.B) and were genetically divergent from those circulating elsewhere in west Africa. A time-calibrated phylogeographic analysis incorporating the new genomes suggests Liberia was the entry point of Lassa virus into the Mano River Union region and estimates the introduction to have occurred between 300-350 years ago. A high level of diversity exists between the Liberian Lassa virus genomes. Nucleotide percent difference between Liberian Lassa virus genomes ranged up to 27% in the L segment and 18% in the S segment. The commonly used Lassa Josiah-MGB assay was up to 25% divergent across the target sites when aligned to the Liberian Lassa virus genomes. INTERPRETATION: The large amount of novel genomic diversity of Lassa virus observed in the Liberian cases emphasises the need to match deployed diagnostic capabilities with locally circulating strains and underscores the importance of evaluating cross-lineage protection in the development of vaccines and therapeutics. FUNDING: Defense Biological Product Assurance Office of the US Department of Defense and the Armed Forces Health Surveillance Branch and its Global Emerging Infections Surveillance and Response Section. |
Strengthening healthcare workforce capacity during and post Ebola outbreaks in Liberia: an innovative and effective approach to epidemic preparedness and response
Bemah P , Baller A , Cooper C , Massaquoi M , Skrip L , Rude JM , Twyman A , Moses P , Seifeldin R , Udhayashankar K , Enrique K , Niescierenko M , Owen C , Brown L , Boukare B , Williams D , Nyenswah T , Kateh F , Dahn B , Gasasira A , Fall IS . Pan Afr Med J 2019 33 9 Introduction: The 2014-2016 Ebola virus disease (EVD) outbreak in Liberia highlighted the importance of robust preparedness measures for a well-coordinated response; the initially delayed response contributed to the steep incidence of cases, infections among health care workers, and a collapse of the health care system. To strengthen local capacity and combat disease transmission, various healthcare worker (HCW) trainings, including the Ebola treatment unit (ETU) training, safe & quality services (SQS) training and rapid response team (RRT), were developed and implemented between 2014 and 2017. Methods: Data from the ETU, SQS and RRT trainings were analyzed to determine knowledge and confidence gained. Results: The ETU, SQS and RRT training were completed by a total of 21,248 participants. There were improvements in knowledge and confidence, an associated reduction in HCWs infection and reduced response time to subsequent public health events. Conclusion: No infections were reported by healthcare workers in Liberia since the completion of these training programs. HCW training programmes initiated during and post disease outbreak can boost public trust in the health system while providing an entry point for establishing an Epidemic Preparedness and Response (EPR) framework in resource-limited settings. |
Enhancing laboratory capacity during Ebola virus disease (EVD) heightened surveillance in Liberia: lessons learned and recommendations
Katawera V , Kohar H , Mahmoud N , Raftery P , Wasunna C , Humrighouse B , Hardy P , Saindon J , Schoepp R , Makvandi M , Hensley L , Condell O , Durski K , Singaravelu S , Gahimbare L , Olinger G , Kateh F , Naidoo D , Nsubuga P , Formenty P , Nyenswah T , Coulibaly SO , Okeibunor JC , Talisuna A , Yahaya AA , Rajatonirina S , Williams D , Dahn B , Gasasira A , Fall IS . Pan Afr Med J 2019 33 8 Introduction: Following a declaration by the World Health Organization that Liberia had successfully interrupted Ebola virus transmission on May 9th, 2015; the country entered a period of enhanced surveillance. The number of cases had significantly reduced prior to the declaration, leading to closure of eight out of eleven Ebola testing laboratories. Enhanced surveillance led to an abrupt increase in demand for laboratory services. We report interventions, achievements, lessons learned and recommendations drawn from enhancing laboratory capacity. Methods: Using archived data, we reported before and after interventions that aimed at increasing laboratory capacity. Laboratory capacity was defined by number of laboratories with Ebola Virus Disease (EVD) testing capacity, number of competent staff, number of specimens tested, specimen backlog, daily and surge testing capacity, and turnaround time. Using Stata 14 (Stata Corporation, College Station, TX, USA), medians and trends were reported for all continuous variables. Results: Between May and December 2015, interventions including recruitment and training of eight staff, establishment of one EVD laboratory facility, implementation of ten Ebola GeneXpert diagnostic platforms, and establishment of working shifts yielded an 8-fold increase in number of specimens tested, a reduction in specimens backlog to zero, and restoration of turn-around time to 24 hours. This enabled a more efficient surveillance system that facilitated timely detection and containment of two EVD clusters observed thereafter. Conclusion: Effective enhancement of laboratory services during high demand periods requires a combination of context-specific interventions. Building and ensuring sustainability of local capacity is an integral part of effective surveillance and disease outbreak response efforts. |
Rapid response to meningococcal disease cluster in Foya district, Lofa County, Liberia January to February 2018
Rude JM , Kortimai L , Mosoka F , April B , Nuha M , Katawera V , Nagbe T , Tamba A , Williams D , Mulbah R , Pierre F , Onuche EM , Chukwudi JO , Talisuna A , Yahaya AA , Rajatonirina S , Nyenswah T , Dahn B , Gasasira A , Fall IS . Pan Afr Med J 2019 33 6 Introduction: Early detection of disease outbreaks is paramount to averting associated morbidity and mortality. In January 2018, nine cases including four deaths associated with meningococcal disease were reported in three communities of Foya district, Lofa County, Liberia. Due to the porous borders between Lofa County and communities in neighboring Sierra Leone and Guinea, the possibility of epidemic spread of meningococcal disease could not be underestimated. Methods: The county incidence management system (IMS) was activated that coordinated the response activities. Daily meetings were conducted to review response activities progress and challenges. The district rapid response team (DRRT) was the frontline responders. The case based investigation form; case line list and contacts list were used for data collection. A data base was established and analysed daily for action. Tablets Ciprofloxacin were given for chemoprophylaxis. Results: Sixty-seven percent (67%) of the cases were males and also 67% of the affected age range was 3 to 14 years and attending primary school. The attack rate was 7/1,000 population and case fatality rate was 44.4 % with majority of the deaths occurring within 24-48 hours of symptoms onset. Three of the cases tested positive for Neisseria Meningitidis sero-type W while six cases were Epi-linked. None of the cases had recent meningococcal vaccination and no health-worker infections were registered. Conclusion: This cluster of cases of meningococcal disease during the meningitis season in a country that is not traditionally part of the meningitis belt emphasized the need for strengthening surveillance, preparedness and response capacity to meningitis. |
Ebola Virus Infection Associated with Transmission from Survivors.
Den Boon S , Marston BJ , Nyenswah TG , Jambai A , Barry M , Keita S , Durski K , Senesie SS , Perkins D , Shah A , Green HH , Hamblion EL , Lamunu M , Gasasira A , Mahmoud NO , Djingarey MH , Morgan O , Crozier I , Dye C . Emerg Infect Dis 2019 25 (2) 249-255 ![]() ![]() Ebola virus (EBOV) can persist in immunologically protected body sites in survivors of Ebola virus disease, creating the potential to initiate new chains of transmission. From the outbreak in West Africa during 2014-2016, we identified 13 possible events of viral persistence-derived transmission of EBOV (VPDTe) and applied predefined criteria to classify transmission events based on the strength of evidence for VPDTe and source and route of transmission. For 8 events, a recipient case was identified; possible source cases were identified for 5 of these 8. For 5 events, a recipient case or chain of transmission could not be confidently determined. Five events met our criteria for sexual transmission (male-to-female). One VPDTe event led to at least 4 generations of cases; transmission was limited after the other events. VPDTe has increased the importance of Ebola survivor services and sustained surveillance and response capacity in regions with previously widespread transmission. |
Outbreak of Neisseria meningitidis serogroup C outside the meningitis belt-Liberia, 2017: an epidemiological and laboratory investigation.
Bozio CH , Vuong J , Dokubo EK , Fallah MP , McNamara LA , Potts CC , Doedeh J , Gbanya M , Retchless AC , Patel JC , Clark TA , Kohar H , Nagbe T , Clement P , Katawera V , Mahmoud N , Djingarey HM , Perrocheau A , Naidoo D , Stone M , George RN , Williams D , Gasasira A , Nyenswah T , Wang X , Fox LM . Lancet Infect Dis 2018 18 (12) 1360-1367 ![]() ![]() BACKGROUND: On April 25, 2017, a cluster of unexplained illnesses and deaths associated with a funeral was reported in Sinoe County, Liberia. Molecular testing identified Neisseria meningitidis serogroup C (NmC) in specimens from patients. We describe the epidemiological investigation of this cluster and metagenomic characterisation of the outbreak strain. METHODS: We collected epidemiological data from the field investigation and medical records review. Confirmed, probable, and suspected cases were defined on the basis of molecular testing and signs or symptoms of meningococcal disease. Metagenomic sequences from patient specimens were compared with 141 meningococcal isolate genomes to determine strain lineage. FINDINGS: 28 meningococcal disease cases were identified, with dates of symptom onset from April 21 to April 30, 2017: 13 confirmed, three probable, and 12 suspected. 13 patients died. Six (21%) patients reported fever and 23 (82%) reported gastrointestinal symptoms. The attack rate for confirmed and probable cases among funeral attendees was 10%. Metagenomic sequences from six patient specimens were similar to a sequence type (ST) 10217 (clonal complex [CC] 10217) isolate genome from Niger, 2015. Multilocus sequencing identified five of seven alleles from one specimen that matched ST-9367, which is represented in the PubMLST database by one carriage isolate from Burkina Faso, in 2011, and belongs to CC10217. INTERPRETATION: This outbreak featured high attack and case fatality rates. Clinical presentation was broadly consistent with previous meningococcal disease outbreaks, but predominance of gastrointestinal symptoms was unusual compared with previous African meningitis epidemics. The outbreak strain was genetically similar to NmC CC10217, which caused meningococcal disease outbreaks in Niger and Nigeria. CC10217 had previously been identified only in the African meningitis belt. FUNDING: US Global Health Security. |
Persistence of Ebola virus after the end of widespread transmission in Liberia: an outbreak report.
Dokubo EK , Wendland A , Mate SE , Ladner JT , Hamblion EL , Raftery P , Blackley DJ , Laney AS , Mahmoud N , Wayne-Davies G , Hensley L , Stavale E , Fakoli L , Gregory C , Chen TH , Koryon A , Roth Allen D , Mann J , Hickey A , Saindon J , Badini M , Baller A , Clement P , Bolay F , Wapoe Y , Wiley MR , Logue J , Dighero-Kemp B , Higgs E , Gasasira A , Williams DE , Dahn B , Kateh F , Nyenswah T , Palacios G , Fallah MP . Lancet Infect Dis 2018 18 (9) 1015-1024 ![]() BACKGROUND: Outbreak response efforts for the 2014-15 Ebola virus disease epidemic in west Africa brought widespread transmission to an end. However, subsequent clusters of infection have occurred in the region. An Ebola virus disease cluster in Liberia in November, 2015, that was identified after a 15-year-old boy tested positive for Ebola virus infection in Monrovia, raised the possibility of transmission from a persistently infected individual. METHODS: Case investigations were done to ascertain previous contact with cases of Ebola virus disease or infection with Ebola virus. Molecular investigations on blood samples explored a potential linkage between Ebola virus isolated from cases in this November, 2015, cluster and epidemiologically linked cases from the 2014-15 west African outbreak, according to the national case database. FINDINGS: The cluster investigated was the family of the index case (mother, father, three siblings). Ebola virus genomes assembled from two cases in the November, 2015, cluster, and an epidemiologically linked Ebola virus disease case in July, 2014, were phylogenetically related within the LB5 sublineage that circulated in Liberia starting around August, 2014. Partial genomes from two additional individuals, one from each cluster, were also consistent with placement in the LB5 sublineage. Sequencing data indicate infection with a lineage of the virus from a former transmission chain in the country. Based on serology and epidemiological and genomic data, the most plausible scenario is that a female case in the November, 2015, cluster survived Ebola virus disease in 2014, had viral persistence or recurrent disease, and transmitted the virus to three family members a year later. INTERPRETATION: Investigation of the source of infection for the November, 2015, cluster provides evidence of Ebola virus persistence and highlights the risk for outbreaks after interruption of active transmission. These findings underscore the need for focused prevention efforts among survivors and sustained capacity to rapidly detect and respond to new Ebola virus disease cases to prevent recurrence of a widespread outbreak. FUNDING: US Centers for Disease Control and Prevention, Defense Threat Reduction Agency, and WHO. |
Cross-Border Transmission of Ebola Virus as the Cause of a Resurgent Outbreak in Liberia in April 2016.
Mate SE , Wiley MR , Ladner JT , Dokubo EK , Fakoli L , Fallah M , Nyenswah TG , DiClaro JW , Deboer JT , Williams DE , Bolay F , Palacios G . Clin Infect Dis 2018 67 (7) 1147-1149 ![]() ![]() We present new information regarding an outbreak of Ebola virus (EBOV) disease (EVD) in Liberia in early 2016 that was associated with a resurgent outbreak (“flare-up”) in N’zérékoré, Guinea, described by Diallo et al [1]. During the course of the Guinean flare-up, 3 EVD cases were diagnosed in Monrovia, Liberia. We describe genomic and epidemiologic evidence demonstrating that the Liberian cases were the result of cross-border transmission from the N’zérékoré flare-up [1]. On 31 March 2016, an oropharyngeal swab sample from a deceased 30-year-old Liberian woman (patient A) tested positive for EBOV RNA by quantitative reverse-transcription polymerase chain reaction performed at the National Reference Laboratory in Liberia. Blood samples collected from her 2 children, 5-year-old and 2-year-old boys, also tested EBOV positive on 2 April (patient B) and 5 April (patient C) by quantitative reverse-transcription polymerase chain reaction. Genetic and epidemiologic investigations were initiated to distinguish among 3 potential modes of infection: (1) transmission from a persistently infected survivor within Liberia, (2) reintroduction from active transmission of EBOV ongoing in Guinea, and (3) an independent spillover from a nonhuman reservoir. |
Ebola response impact on public health programs, West Africa, 2014-2017
Marston BJ , Dokubo EK , van Steelandt A , Martel L , Williams D , Hersey S , Jambai A , Keita S , Nyenswah TG , Redd JT . Emerg Infect Dis 2017 23 (13) S25-32 Events such as the 2014-2015 West Africa epidemic of Ebola virus disease highlight the importance of the capacity to detect and respond to public health threats. We describe capacity-building efforts during and after the Ebola epidemic in Liberia, Sierra Leone, and Guinea and public health progress that was made as a result of the Ebola response in 4 key areas: emergency response, laboratory capacity, surveillance, and workforce development. We further highlight ways in which capacity-building efforts such as those used in West Africa can be accelerated after a public health crisis to improve preparedness for future events. |
Establishing Ebola Virus Disease (EVD) diagnostics using GeneXpert technology at a mobile laboratory in Liberia: Impact on outbreak response, case management and laboratory systems strengthening.
Raftery P , Condell O , Wasunna C , Kpaka J , Zwizwai R , Nuha M , Fallah M , Freeman M , Harris V , Miller M , Baller A , Massaquoi M , Katawera V , Saindon J , Bemah P , Hamblion E , Castle E , Williams D , Gasasira A , Nyenswah T . PLoS Negl Trop Dis 2018 12 (1) e0006135 ![]() ![]() The 2014-16 Ebola Virus Disease (EVD) outbreak in West Africa highlighted the necessity for readily available, accurate and rapid diagnostics. The magnitude of the outbreak and the re-emergence of clusters of EVD cases following the declaration of interrupted transmission in Liberia, reinforced the need for sustained diagnostics to support surveillance and emergency preparedness. We describe implementation of the Xpert Ebola Assay, a rapid molecular diagnostic test run on the GeneXpert platform, at a mobile laboratory in Liberia and the subsequent impact on EVD outbreak response, case management and laboratory system strengthening. During the period of operation, site coordination, management and operational capacity was supported through a successful collaboration between Ministry of Health (MoH), World Health Organization (WHO) and international partners. A team of Liberian laboratory technicians were trained to conduct EVD diagnostics and the laboratory had capacity to test 64-100 blood specimens per day. Establishment of the laboratory significantly increased the daily testing capacity for EVD in Liberia, from 180 to 250 specimens at a time when the effectiveness of the surveillance system was threatened by insufficient diagnostic capacity. During the 18 months of operation, the laboratory tested a total of 9,063 blood specimens, including 21 EVD positives from six confirmed cases during two outbreaks. Following clearance of the significant backlog of untested EVD specimens in November 2015, a new cluster of EVD cases was detected at the laboratory. Collaboration between surveillance and laboratory coordination teams during this and a later outbreak in March 2016, facilitated timely and targeted response interventions. Specimens taken from cases during both outbreaks were analysed at the laboratory with results informing clinical management of patients and discharge decisions. The GeneXpert platform is easy to use, has relatively low running costs and can be integrated into other national diagnostic algorithms. The technology has on average a 2-hour sample-to-result time and allows for single specimen testing to overcome potential delays of batching. This model of a mobile laboratory equipped with Xpert Ebola test, staffed by local laboratory technicians, could serve to strengthen outbreak preparedness and response for future outbreaks of EVD in Liberia and the region. |
Rapid laboratory identification of Neisseria meningitidis serogroup C as the cause of an outbreak - Liberia, 2017
Patel JC , George J , Vuong J , Potts CC , Bozio C , Clark TA , Thomas J , Schier J , Chang A , Waller JL , Diaz MH , Whaley M , Jenkins LT , Fuller S , Williams DE , Redd JT , Arthur RR , Taweh F , Vera Walker Y , Hardy P , Freeman M , Katawera V , Gwesa G , Gbanya MZ , Clement P , Kohar H , Stone M , Fallah M , Nyenswah T , Winchell JM , Wang X , McNamara LA , Dokubo EK , Fox LM . MMWR Morb Mortal Wkly Rep 2017 66 (42) 1144-1147 On April 25, 2017, a cluster of unexplained illness and deaths among persons who had attended a funeral during April 21-22 was reported in Sinoe County, Liberia (1). Using a broad initial case definition, 31 cases were identified, including 13 (42%) deaths. Twenty-seven cases were from Sinoe County (1), and two cases each were from Grand Bassa and Monsterrado counties, respectively. On May 5, 2017, initial multipathogen testing of specimens from four fatal cases using the Taqman Array Card (TAC) assay identified Neisseria meningitidis in all specimens. Subsequent testing using direct real-time polymerase chain reaction (PCR) confirmed N. meningitidis in 14 (58%) of 24 patients with available specimens and identified N. meningitidis serogroup C (NmC) in 13 (54%) patients. N. meningitidis was detected in specimens from 11 of the 13 patients who died; no specimens were available from the other two fatal cases. On May 16, 2017, the National Public Health Institute of Liberia and the Ministry of Health of Liberia issued a press release confirming serogroup C meningococcal disease as the cause of this outbreak in Liberia. |
Ebola virus disease contact tracing activities, lessons learned and best practices during the Duport Road outbreak in Monrovia, Liberia, November 2015
Wolfe CM , Hamblion EL , Schulte J , Williams P , Koryon A , Enders J , Sanor V , Wapoe Y , Kwayon D , Blackey D , Laney AS , Weston EJ , Dokubo EK , Davies-Wayne G , Wendland A , Daw VTS , Badini M , Clement P , Mahmoud N , Williams D , Gasasira A , Nyenswah TG , Fallah M . PLoS Negl Trop Dis 2017 11 (6) e0005597 BACKGROUND: Contact tracing is one of the key response activities necessary for halting Ebola Virus Disease (EVD) transmission. Key elements of contact tracing include identification of persons who have been in contact with confirmed EVD cases and careful monitoring for EVD symptoms, but the details of implementation likely influence their effectiveness. In November 2015, several months after a major Ebola outbreak was controlled in Liberia, three members of a family were confirmed positive for EVD in the Duport Road area of Monrovia. The cluster provided an opportunity to implement and evaluate modified approaches to contact tracing. METHODS: The approaches employed for improved contact tracing included classification and risk-based management of identified contacts (including facility based isolation of some high risk contacts, provision of support to persons being monitored, and school-based surveillance for some persons with potential exposure but not listed as contacts), use of phone records to help locate missing contacts, and modifications to data management tools. We recorded details about the implementation of these approaches, report the overall outcomes of the contact tracing efforts and the challenges encountered, and provide recommendations for management of future outbreaks. RESULTS: 165 contacts were identified (with over 150 identified within 48 hours of confirmation of the EVD cases) and all initially missing contacts were located. Contacts were closely monitored and promptly tested if symptomatic; no contacts developed disease. Encountered challenges related to knowledge gaps among contact tracing staff, data management, and coordination of contact tracing activities with efforts to offer Ebola vaccine. CONCLUSIONS: The Duport Road EVD cluster was promptly controlled. Missing contacts were effectively identified, and identified contacts were effectively monitored and rapidly tested. There is a persistent risk of EVD reemergence in Liberia; the experience controlling each cluster can help inform future Ebola control efforts in Liberia and elsewhere. |
Virus genomes reveal factors that spread and sustained the Ebola epidemic.
Dudas G , Carvalho LM , Bedford T , Tatem AJ , Baele G , Faria NR , Park DJ , Ladner JT , Arias A , Asogun D , Bielejec F , Caddy SL , Cotten M , D'Ambrozio J , Dellicour S , Caro AD , Diclaro JW , Duraffour S , Elmore MJ , Fakoli LS , Faye O , Gilbert ML , Gevao SM , Gire S , Gladden-Young A , Gnirke A , Goba A , Grant DS , Haagmans BL , Hiscox JA , Jah U , Kugelman JR , Liu D , Lu J , Malboeuf CM , Mate S , Matthews DA , Matranga CB , Meredith LW , Qu J , Quick J , Pas SD , Phan MV , Pollakis G , Reusken CB , Sanchez-Lockhart M , Schaffner SF , Schieffelin JS , Sealfon RS , Simon-Loriere E , Smits SL , Stoecker K , Thorne L , Tobin EA , Vandi MA , Watson SJ , West K , Whitmer S , Wiley MR , Winnicki SM , Wohl S , Wolfel R , Yozwiak NL , Andersen KG , Blyden SO , Bolay F , Carroll MW , Dahn B , Diallo B , Formenty P , Fraser C , Gao GF , Garry RF , Goodfellow I , Gunther S , Happi CT , Holmes EC , Kargbo B , Keita S , Kellam P , Koopmans MP , Kuhn JH , Loman NJ , Magassouba N , Naidoo D , Nichol ST , Nyenswah T , Palacios G , Pybus OG , Sabeti PC , Sall A , Stroher U , Wurie I , Suchard MA , Lemey P , Rambaut A . Nature 2017 544 (7650) 309-315 ![]() The 2013-2016 West African epidemic caused by the Ebola virus was of unprecedented magnitude, duration and impact. Here we reconstruct the dispersal, proliferation and decline of Ebola virus throughout the region by analysing 1,610 Ebola virus genomes, which represent over 5% of the known cases. We test the association of geography, climate and demography with viral movement among administrative regions, inferring a classic 'gravity' model, with intense dispersal between larger and closer populations. Despite attenuation of international dispersal after border closures, cross-border transmission had already sown the seeds for an international epidemic, rendering these measures ineffective at curbing the epidemic. We address why the epidemic did not spread into neighbouring countries, showing that these countries were susceptible to substantial outbreaks but at lower risk of introductions. Finally, we reveal that this large epidemic was a heterogeneous and spatially dissociated collection of transmission clusters of varying size, duration and connectivity. These insights will help to inform interventions in future epidemics. |
Ebola Virus RNA in Semen from an HIV-Positive Survivor of Ebola.
Purpura LJ , Rogers E , Baller A , White S , Soka M , Choi MJ , Mahmoud N , Wasunna C , Massaquoi M , Kollie J , Dweh S , Bemah P , Ladele V , Kpaka J , Jawara M , Mugisha M , Subah O , Faikai M , Bailey JA , Rollin P , Marston B , Nyenswah T , Gasasira A , Knust B , Nichol S , Williams D . Emerg Infect Dis 2017 23 (4) 714-715 ![]() Ebola virus is known to persist in semen of male survivors of Ebola virus disease (EVD). However, maximum duration of, or risk factors for, virus persistence are unknown. We report an EVD survivor with preexisting HIV infection, whose semen was positive for Ebola virus RNA 565 days after recovery from EVD. |
Bolstering community cooperation in Ebola resurgence protocols: Combining field blood draw and point-of-care diagnosis
Fallah MP , Skrip LA , Raftery P , Kullie M , Borbor W , Laney AS , Blackley DJ , Christie A , Dokubo EK , Lo TQ , Coulter S , Baller A , Vonhm BT , Bemah P , Lomax S , Yeiah A , Wapoe-Sackie Y , Mann J , Clement P , Davies-Wayne G , Hamblion E , Wolfe C , Williams D , Gasasira A , Kateh F , Nyenswah TG , Galvani AP . PLoS Med 2017 14 (1) e1002227 Alison Galvani and colleagues describe a community-based protocol to improve cooperation with Ebola testing as well as contact tracing, quarantining, and treatment. |
Exposure patterns driving Ebola transmission in West Africa: a retrospective observational study
Agua-Agum J , Ariyarajah A , Aylward B , Bawo L , Bilivogui P , Blake IM , Brennan RJ , Cawthorne A , Cleary E , Clement P , Conteh R , Cori A , Dafae F , Dahl B , Dangou JM , Diallo B , Donnelly CA , Dorigatti I , Dye C , Eckmanns T , Fallah M , Ferguson NM , Fiebig L , Fraser C , Garske T , Gonzalez L , Hamblion E , Hamid N , Hersey S , Hinsley W , Jambei A , Jombart T , Kargbo D , Keita S , Kinzer M , George FK , Godefroy B , Gutierrez G , Kannangarage N , Mills HL , Moller T , Meijers S , Mohamed Y , Morgan O , Nedjati-Gilani G , Newton E , Nouvellet P , Nyenswah T , Perea W , Perkins D , Riley S , Rodier G , Rondy M , Sagrado M , Savulescu C , Schafer IJ , Schumacher D , Seyler T , Shah A , Van Kerkhove MD , Wesseh CS , Yoti Z . PLoS Med 2016 13 (11) e1002170 BACKGROUND: The ongoing West African Ebola epidemic began in December 2013 in Guinea, probably from a single zoonotic introduction. As a result of ineffective initial control efforts, an Ebola outbreak of unprecedented scale emerged. As of 4 May 2015, it had resulted in more than 19,000 probable and confirmed Ebola cases, mainly in Guinea (3,529), Liberia (5,343), and Sierra Leone (10,746). Here, we present analyses of data collected during the outbreak identifying drivers of transmission and highlighting areas where control could be improved. METHODS AND FINDINGS: Over 19,000 confirmed and probable Ebola cases were reported in West Africa by 4 May 2015. Individuals with confirmed or probable Ebola ("cases") were asked if they had exposure to other potential Ebola cases ("potential source contacts") in a funeral or non-funeral context prior to becoming ill. We performed retrospective analyses of a case line-list, collated from national databases of case investigation forms that have been reported to WHO. These analyses were initially performed to assist WHO's response during the epidemic, and have been updated for publication. We analysed data from 3,529 cases in Guinea, 5,343 in Liberia, and 10,746 in Sierra Leone; exposures were reported by 33% of cases. The proportion of cases reporting a funeral exposure decreased over time. We found a positive correlation (r = 0.35, p < 0.001) between this proportion in a given district for a given month and the within-district transmission intensity, quantified by the estimated reproduction number (R). We also found a negative correlation (r = -0.37, p < 0.001) between R and the district proportion of hospitalised cases admitted within ≤4 days of symptom onset. These two proportions were not correlated, suggesting that reduced funeral attendance and faster hospitalisation independently influenced local transmission intensity. We were able to identify 14% of potential source contacts as cases in the case line-list. Linking cases to the contacts who potentially infected them provided information on the transmission network. This revealed a high degree of heterogeneity in inferred transmissions, with only 20% of cases accounting for at least 73% of new infections, a phenomenon often called super-spreading. Multivariable regression models allowed us to identify predictors of being named as a potential source contact. These were similar for funeral and non-funeral contacts: severe symptoms, death, non-hospitalisation, older age, and travelling prior to symptom onset. Non-funeral exposures were strongly peaked around the death of the contact. There was evidence that hospitalisation reduced but did not eliminate onward exposures. We found that Ebola treatment units were better than other health care facilities at preventing exposure from hospitalised and deceased individuals. The principal limitation of our analysis is limited data quality, with cases not being entered into the database, cases not reporting exposures, or data being entered incorrectly (especially dates, and possible misclassifications). CONCLUSIONS: Achieving elimination of Ebola is challenging, partly because of super-spreading. Safe funeral practices and fast hospitalisation contributed to the containment of this Ebola epidemic. Continued real-time data capture, reporting, and analysis are vital to track transmission patterns, inform resource deployment, and thus hasten and maintain elimination of the virus from the human population. |
Secondary infections with Ebola virus in rural communities, Liberia and Guinea, 2014-2015
Lindblade KA , Nyenswah T , Keita S , Diallo B , Kateh F , Amoah A , Nagbe TK , Raghunathan P , Neatherlin JC , Kinzer M , Pillai SK , Attfield KR , Hajjeh R , Dweh E , Painter J , Barradas DT , Williams SG , Blackley DJ , Kirking HL , Patel MR , Dea M , Massoudi MS , Barskey AE , Zarecki SL , Fomba M , Grube S , Belcher L , Broyles LN , Maxwell TN , Hagan JE , Yeoman K , Westercamp M , Mott J , Mahoney F , Slutsker L , DeCock KM , Marston B , Dahl B . Emerg Infect Dis 2016 22 (9) 1653-5 Persons who died of Ebola virus disease at home in rural communities in Liberia and Guinea resulted in more secondary infections than persons admitted to Ebola treatment units. Intensified monitoring of contacts of persons who died of this disease in the community is an evidence-based approach to reduce virus transmission in rural communities. |
Implementation of a national semen testing and counseling program for male Ebola survivors - Liberia, 2015-2016
Purpura LJ , Soka M , Baller A , White S , Rogers E , Choi MJ , Mahmoud N , Wasunna C , Massaquoi M , Vanderende K , Kollie J , Dweh S , Bemah P , Christie A , Ladele V , Subah O , Pillai S , Mugisha M , Kpaka J , Nichol S , Stroher U , Abad N , Mettee-Zarecki S , Bailey JA , Rollin P , Marston B , Nyenswah T , Gasasira A , Knust B , Williams D . MMWR Morb Mortal Wkly Rep 2016 65 (36) 963-966 ![]() According to World Health Organization (WHO) data, the Ebola virus disease (Ebola) outbreak that began in West Africa in 2014 has resulted in 28,603 cases and 11,301 deaths. In March 2015, epidemiologic investigation and genetic sequencing in Liberia implicated sexual transmission from a male Ebola survivor, with Ebola virus detected by reverse transcription-polymerase chain reaction (RT-PCR) 199 days after symptom onset, far exceeding the 101 days reported from an earlier Ebola outbreak. In response, WHO released interim guidelines recommending that all male survivors, in addition to receiving condoms and sexual risk reduction counseling at discharge from an Ebola treatment unit (ETU), be offered semen testing for Ebola virus RNA by RT-PCR 3 months after disease onset, and every month thereafter until two consecutive semen specimens collected at least 1 week apart test negative for Ebola virus RNA. Male Ebola survivors should also receive counseling to promote safe sexual practices until their semen twice tests negative. When these recommendations were released, testing of semen was not widely available in Liberia. Challenges in establishing and operating the first nationwide semen testing and counseling program for male Ebola survivors included securing sufficient resources for the program, managing a public health semen testing program in the context of ongoing research studies that were also collecting and screening semen, identification of adequate numbers of trained counselors and appropriate health communication messages for the program, overcoming Ebola survivor-associated stigma, identification and recruitment of male Ebola survivors, and operation of mobile teams. |
Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors: an analysis of Ebola virus RNA results and behavioural data.
Soka MJ , Choi MJ , Baller A , White S , Rogers E , Purpura LJ , Mahmoud N , Wasunna C , Massaquoi M , Abad N , Kollie J , Dweh S , Bemah PK , Christie A , Ladele V , Subah OC , Pillai S , Mugisha M , Kpaka J , Kowalewski S , German E , Stenger M , Nichol S , Stroher U , Vanderende KE , Zarecki SM , Green HH , Bailey JA , Rollin P , Marston B , Nyenswah TG , Gasasira A , Knust B , Williams D . Lancet Glob Health 2016 4 (10) e736-43 ![]() BACKGROUND: Ebola virus has been detected in semen of Ebola virus disease survivors after recovery. Liberia's Men's Health Screening Program (MHSP) offers Ebola virus disease survivors semen testing for Ebola virus. We present preliminary results and behavioural outcomes from the first national semen testing programme for Ebola virus. METHODS: The MHSP operates out of three locations in Liberia: Redemption Hospital in Montserrado County, Phebe Hospital in Bong County, and Tellewoyan Hospital in Lofa County. Men aged 15 years and older who had an Ebola treatment unit discharge certificate are eligible for inclusion. Participants' semen samples were tested for Ebola virus RNA by real-time RT-PCR and participants received counselling on safe sexual practices. Participants graduated after receiving two consecutive negative semen tests. Counsellors collected information on sociodemographics and sexual behaviours using questionnaires administered at enrolment, follow up, and graduation visits. Because the programme is ongoing, data analysis was restricted to data obtained from July 7, 2015, to May 6, 2016. FINDINGS: As of May 6, 2016, 466 Ebola virus disease survivors had enrolled in the programme; real-time RT-PCR results were available from 429 participants. 38 participants (9%) produced at least one semen specimen that tested positive for Ebola virus RNA. Of these, 24 (63%) provided semen specimens that tested positive 12 months or longer after Ebola virus disease recovery. The longest interval between discharge from an Ebola treatment unit and collection of a positive semen sample was 565 days. Among participants who enrolled and provided specimens more than 90 days since their Ebola treatment unit discharge, men older than 40 years were more likely to have a semen sample test positive than were men aged 40 years or younger (p=0.0004). 84 (74%) of 113 participants who reported not using a condom at enrolment reported using condoms at their first follow-up visit (p<0.0001). 176 (46%) of 385 participants who reported being sexually active at enrolment reported abstinence at their follow-up visit (p<0.0001). INTERPRETATION: Duration of detection of Ebola virus RNA by real-time RT-PCR varies by individual and might be associated with age. By combining behavioural counselling and laboratory testing, the Men's Health Screening Program helps male Ebola virus disease survivors understand their individual risk and take appropriate measures to protect their sexual partners. FUNDING: World Health Organization and the US Centers for Disease Control and Prevention. |
Plasmodium Parasitemia Associated With Increased Survival in Ebola Virus-Infected Patients.
Rosenke K , Adjemian J , Munster VJ , Marzi A , Falzarano D , Onyango CO , Ochieng M , Juma B , Fischer RJ , Prescott JB , Safronetz D , Omballa V , Owuor C , Hoenen T , Groseth A , Martellaro C , van Doremalen N , Zemtsova G , Self J , Bushmaker T , McNally K , Rowe T , Emery SL , Feldmann F , Williamson BN , Best SM , Nyenswah TG , Grolla A , Strong JE , Kobinger G , Bolay FK , Zoon KC , Stassijns J , Giuliani R , de Smet M , Nichol ST , Fields B , Sprecher A , Massaquoi M , Feldmann H , de Wit E . Clin Infect Dis 2016 63 (8) 1026-33 ![]() BACKGROUND: The ongoing Ebola outbreak in West Africa has resulted in 28 646 suspected, probable, and confirmed Ebola virus infections. Nevertheless, malaria remains a large public health burden in the region affected by the outbreak. A joint Centers for Disease Control and Prevention/National Institutes of Health diagnostic laboratory was established in Monrovia, Liberia, in August 2014, to provide laboratory diagnostics for Ebola virus. METHODS: All blood samples from suspected Ebola virus-infected patients admitted to the Medecins Sans Frontieres ELWA3 Ebola treatment unit in Monrovia were tested by quantitative real-time polymerase chain reaction for the presence of Ebola virus and Plasmodium species RNA. Clinical outcome in laboratory-confirmed Ebola virus-infected patients was analyzed as a function of age, sex, Ebola viremia, and Plasmodium species parasitemia. RESULTS: The case fatality rate of 1182 patients with laboratory-confirmed Ebola virus infections was 52%. The probability of surviving decreased with increasing age and decreased with increasing Ebola viral load. Ebola virus-infected patients were 20% more likely to survive when Plasmodium species parasitemia was detected, even after controlling for Ebola viral load and age; those with the highest levels of parasitemia had a survival rate of 83%. This effect was independent of treatment with antimalarials, as this was provided to all patients. Moreover, treatment with antimalarials did not affect survival in the Ebola virus mouse model. CONCLUSIONS: Plasmodium species parasitemia is associated with an increase in the probability of surviving Ebola virus infection. More research is needed to understand the molecular mechanism underlying this remarkable phenomenon and translate it into treatment options for Ebola virus infection. |
Reduced evolutionary rate in reemerged Ebola virus transmission chains.
Blackley DJ , Wiley MR , Ladner JT , Fallah M , Lo T , Gilbert ML , Gregory C , D'Ambrozio J , Coulter S , Mate S , Balogun Z , Kugelman J , Nwachukwu W , Prieto K , Yeiah A , Amegashie F , Kearney B , Wisniewski M , Saindon J , Schroth G , Fakoli L , Diclaro JW 2nd , Kuhn JH , Hensley LE , Jahrling PB , Stroher U , Nichol ST , Massaquoi M , Kateh F , Clement P , Gasasira A , Bolay F , Monroe SS , Rambaut A , Sanchez-Lockhart M , Scott Laney A , Nyenswah T , Christie A , Palacios G . Sci Adv 2016 2 (4) e1600378 ![]() On 29 June 2015, Liberia's respite from Ebola virus disease (EVD) was interrupted for the second time by a renewed outbreak ("flare-up") of seven confirmed cases. We demonstrate that, similar to the March 2015 flare-up associated with sexual transmission, this new flare-up was a reemergence of a Liberian transmission chain originating from a persistently infected source rather than a reintroduction from a reservoir or a neighboring country with active transmission. Although distinct, Ebola virus (EBOV) genomes from both flare-ups exhibit significantly low genetic divergence, indicating a reduced rate of EBOV evolution during persistent infection. Using this rate of change as a signature, we identified two additional EVD clusters that possibly arose from persistently infected sources. These findings highlight the risk of EVD flare-ups even after an outbreak is declared over. |
Ebola laboratory response at the Eternal Love Winning Africa Campus, Monrovia, Liberia, 2014-2015
de Wit E , Rosenke K , Fischer RJ , Marzi A , Prescott J , Bushmaker T , van Doremalen N , Emery SL , Falzarano D , Feldmann F , Groseth A , Hoenen T , Juma B , McNally KL , Ochieng M , Omballa V , Onyango CO , Owuor C , Rowe T , Safronetz D , Self J , Williamson BN , Zemtsova G , Grolla A , Kobinger G , Rayfield M , Stroher U , Strong JE , Best SM , Ebihara H , Zoon KC , Nichol ST , Nyenswah TG , Bolay FK , Massaquoi M , Feldmann H , Fields B . J Infect Dis 2016 214 S169-S176 West Africa experienced the first epidemic of Ebola virus infection, with by far the greatest number of cases in Guinea, Sierra Leone, and Liberia. The unprecedented epidemic triggered an unparalleled response, including the deployment of multiple Ebola treatment units and mobile/field diagnostic laboratories. The National Institute of Allergy and Infectious Diseases and the Centers for Disease Control and Prevention deployed a joint laboratory to Monrovia, Liberia, in August 2014 to support the newly founded Ebola treatment unit at the Eternal Love Winning Africa (ELWA) campus. The laboratory operated initially out of a tent structure but quickly moved into a fixed-wall building owing to severe weather conditions, the need for increased security, and the high sample volume. Until May 2015, when the laboratory closed, the site handled close to 6000 clinical specimens for Ebola virus diagnosis and supported the medical staff in case patient management. Laboratory operation and safety, as well as Ebola virus diagnostic assays, are described and discussed; in addition, lessons learned for future deployments are reviewed. |
The merits of malaria diagnostics during an Ebola virus disease outbreak
de Wit E , Falzarano D , Onyango C , Rosenke K , Marzi A , Ochieng M , Juma B , Fischer RJ , Prescott JB , Safronetz D , Omballa V , Owuor C , Hoenen T , Groseth A , van Doremalen N , Zemtsova G , Self J , Bushmaker T , McNally K , Rowe T , Emery SL , Feldmann F , Williamson B , Nyenswah TG , Grolla A , Strong JE , Kobinger G , Stroeher U , Rayfield M , Bolay FK , Zoon KC , Stassijns J , Tampellini L , de Smet M , Nichol ST , Fields B , Sprecher A , Feldmann H , Massaquoi M , Munster VJ . Emerg Infect Dis 2016 22 (2) 323-6 Malaria is a major public health concern in the countries affected by the Ebola virus disease epidemic in West Africa. We determined the feasibility of using molecular malaria diagnostics during an Ebola virus disease outbreak and report the incidence of Plasmodium spp. parasitemia in persons with suspected Ebola virus infection. |
Ebola and its control in Liberia, 2014-2015
Nyenswah TG , Kateh F , Bawo L , Massaquoi M , Gbanyan M , Fallah M , Nagbe TK , Karsor KK , Wesseh CS , Sieh S , Gasasira A , Graaff P , Hensley L , Rosling H , Lo T , Pillai SK , Gupta N , Montgomery JM , Ransom RL , Williams D , Laney AS , Lindblade KA , Slutsker L , Telfer JL , Christie A , Mahoney F , De Cock KM . Emerg Infect Dis 2016 22 (2) 169-77 The severe epidemic of Ebola virus disease in Liberia started in March 2014. On May 9, 2015, the World Health Organization declared Liberia free of Ebola, 42 days after safe burial of the last known case-patient. However, another 6 cases occurred during June-July; on September 3, 2015, the country was again declared free of Ebola. Liberia had by then reported 10,672 cases of Ebola and 4,808 deaths, 37.0% and 42.6%, respectively, of the 28,103 cases and 11,290 deaths reported from the 3 countries that were heavily affected at that time. Essential components of the response included government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves. Priorities after the epidemic include surveillance in case of resurgence, restoration of health services, infection control in healthcare settings, and strengthening of basic public health systems. |
Molecular Evidence of Sexual Transmission of Ebola Virus.
Mate SE , Kugelman JR , Nyenswah TG , Ladner JT , Wiley MR , Cordier-Lassalle T , Christie A , Schroth GP , Gross SM , Davies-Wayne GJ , Shinde SA , Murugan R , Sieh SB , Badio M , Fakoli L , Taweh F , de Wit E , van Doremalen N , Munster VJ , Pettitt J , Prieto K , Humrighouse BW , Stroher U , DiClaro JW , Hensley LE , Schoepp RJ , Safronetz D , Fair J , Kuhn JH , Blackley DJ , Laney AS , Williams DE , Lo T , Gasasira A , Nichol ST , Formenty P , Kateh FN , De Cock KM , Bolay F , Sanchez-Lockhart M , Palacios G . N Engl J Med 2015 373 (25) 2448-54 ![]() A suspected case of sexual transmission from a male survivor of Ebola virus disease (EVD) to his female partner (the patient in this report) occurred in Liberia in March 2015. Ebola virus (EBOV) genomes assembled from blood samples from the patient and a semen sample from the survivor were consistent with direct transmission. The genomes shared three substitutions that were absent from all other Western African EBOV sequences and that were distinct from the last documented transmission chain in Liberia before this case. Combined with epidemiologic data, the genomic analysis provides evidence of sexual transmission of EBOV and evidence of the persistence of infective EBOV in semen for 179 days or more after the onset of EVD. (Funded by the Defense Threat Reduction Agency and others.). |
Decreased Ebola transmission after rapid response to outbreaks in remote areas, Liberia, 2014
Lindblade KA , Kateh F , Nagbe TK , Neatherlin JC , Pillai SK , Attfield KR , Dweh E , Barradas DT , Williams SG , Blackley DJ , Kirking HL , Patel MR , Dea M , Massoudi MS , Wannemuehler K , Barskey AE , Zarecki SL , Fomba M , Grube S , Belcher L , Broyles LN , Maxwell TN , Hagan JE , Yeoman K , Westercamp M , Forrester J , Mott J , Mahoney F , Slutsker L , DeCock KM , Nyenswah T . Emerg Infect Dis 2015 21 (10) 1800-7 We measured the reproduction number before and after interventions were implemented to reduce Ebola transmission in 9 outbreaks in Liberia during 2014. We evaluated risk factors for secondary cases and the association between patient admission to an Ebola treatment unit (ETU) and survival. The reproduction number declined 94% from 1.7 (95% CI 1.1-2.6) to 0.1 (95% CI 0.02-0.6) after interventions began. The risk for secondary infections was 90% lower for patients admitted to an ETU (risk ratio 0.1, 95% CI 0.04-0.3) than for those who died in the community. The case-fatality rate was 68% (95% CI 60-74), and ETU admission was associated with a 50% reduction in death (hazard ratio 0.5, 95% CI 0.4-0.8). Isolation and treatment of Ebola patients had the dual benefit of interrupting community transmission and improving survival. |
Community knowledge, attitudes, and practices regarding Ebola virus disease - five counties, Liberia, September-October, 2014
Kobayashi M , Beer KD , Bjork A , Chatham-Stephens K , Cherry CC , Arzoaquoi S , Frank W , Kumeh O , Sieka J , Yeiah A , Painter JE , Yoder JS , Flannery B , Mahoney F , Nyenswah TG . MMWR Morb Mortal Wkly Rep 2015 64 (26) 714-8 As of July 1, 2015, Guinea, Liberia, and Sierra Leone have reported a total of 27,443 confirmed, probable, and suspected Ebola virus disease (Ebola) cases and 11,220 deaths. Guinea and Sierra Leone have yet to interrupt transmission of Ebola virus. In May, 2015, Liberia successfully achieved Ebola transmission-free status, with no new Ebola cases occurring during a 42-day period; however, new Ebola cases were reported beginning June 29, 2015. Local cultural practices and beliefs have posed challenges to disease control, and therefore, targeted, timely health messages are needed to address practices and misperceptions that might hinder efforts to stop the spread of Ebola. As early as September 2014, Ebola spread to most counties in Liberia. To assess Ebola-related knowledge, attitudes, and practices (KAP) in the community, CDC epidemiologists who were deployed to the counties (field team), carried out a survey conducted by local trained interviewers. The survey was conducted in September and October 2014 in five counties in Liberia with varying cumulative incidence of Ebola cases. Survey results indicated several findings. First, basic awareness of Ebola was high across all surveyed populations (median correct responses = 16 of 17 questions on knowledge of Ebola transmission; range = 2-17). Second, knowledge and understanding of Ebola symptoms were incomplete (e.g., 61% of respondents said they would know if they had Ebola symptoms). Finally, certain fears about the disease were present: >90% of respondents indicated a fear of Ebola patients, >40% a fear of cured patients, and >50% a fear of treatment units (expressions of this last fear were greater in counties with lower Ebola incidence). This survey, which was conducted at a time when case counts were rapidly increasing in Liberia, indicated limited knowledge of Ebola symptoms and widespread fear of Ebola treatment units despite awareness of communication messages. Continued efforts are needed to address cultural practices and beliefs to interrupt Ebola transmission. |
Cluster of Ebola virus disease, Bong and Montserrado counties, Liberia
Nyenswah TG , Fallah M , Calvert GM , Duwor S , Hamilton ED , Mokashi V , Arzoaquoi S , Dweh E , Burbach R , Dlouhy D , Oeltmann JE , Moonan PK . Emerg Infect Dis 2015 21 (7) 1253-6 Lack of trust in government-supported services after the death of a health care worker with symptoms of Ebola resulted in ongoing Ebola transmission in 2 Liberia counties. Ebola transmission was facilitated by attempts to avoid cremation of the deceased patient and delays in identifying and monitoring contacts. |
Controlling the last known cluster of Ebola virus disease - Liberia, January-February 2015
Nyenswah T , Fallah M , Sieh S , Kollie K , Badio M , Gray A , Dilah P , Shannon M , Duwor S , Ihekweazu C , Cordier-Lasalle T , Shinde SA , Hamblion E , Davies-Wayne G , Ratnesh M , Dye C , Yoder JS , McElroy P , Hoots B , Christie A , Vertefeuille J , Olsen SJ , Laney AS , Neal JJ , Navin TR , Coulter S , Pordell P , Lo T , Kinkade C , Mahoney F . MMWR Morb Mortal Wkly Rep 2015 64 (18) 500-4 As one of the three West African countries highly affected by the 2014-2015 Ebola virus disease (Ebola) epidemic, Liberia reported approximately 10,000 cases. The Ebola epidemic in Liberia was marked by intense urban transmission, multiple community outbreaks with source cases occurring in patients coming from the urban areas, and outbreaks in health care facilities (HCFs). This report, based on data from routine case investigations and contact tracing, describes efforts to stop the last known chain of Ebola transmission in Liberia. The index patient became ill on December 29, 2014, and the last of 21 associated cases was in a patient admitted into an Ebola treatment unit (ETU) on February 18, 2015. The chain of transmission was stopped because of early detection of new cases; identification, monitoring, and support of contacts in acceptable settings; effective triage within the health care system; and rapid isolation of symptomatic contacts. In addition, a "sector" approach, which divided Montserrado County into geographic units, facilitated the ability of response teams to rapidly respond to community needs. In the final stages of the outbreak, intensive coordination among partners and engagement of community leaders were needed to stop transmission in densely populated Montserrado County. A companion report describes the efforts to enhance infection prevention and control efforts in HCFs. After February 19, no additional clusters of Ebola cases have been detected in Liberia. On May 9, the World Health Organization declared the end of the Ebola outbreak in Liberia. |
- Page last reviewed:Feb 1, 2024
- Page last updated:Jan 27, 2025
- Content source:
- Powered by CDC PHGKB Infrastructure