Ebola

Port Loko District has had over 1400 confirmed EVD cases during this outbreak. However, transmission declined rapidly in early 2015; by mid-April, a few weeks had passed with no known cases. Simultaneously, reporting of sick persons had plummeted across the district and the number of deaths reported in some areas was fewer than expected. These circumstances signaled the need for the EVD surveillance system to broaden its focus from using district surveillance officers (DSOs) to respond to reports of ill and deceased persons (hereafter, “sick and death alerts”) to a more proactive and comprehensive system that relied strongly on community engagement and surveillance through existing structures such as Peripheral Health Units (PHUs), schools and local authorities. While the involvement of local authorities and the community had been central to reporting suspected EVD cases earlier in the outbreak, the decrease in alerts suggested that engagement was diminishing. The reopening of schools and reemergence of the primary healthcare system provided opportunities to decentralize surveillance and strengthen the involvement of these structures. The primary objective was improving EVD surveillance, but the effort was also used to bolster routine surveillance, in preparation for implementating Integrated Disease Surveillance and Reporting.

Objective

Describe the evolution of Ebola Virus Disease (EVD) surveillance from a largely reactive system structured primarily around responding to reports of illness and death, to one that was more methodical, proactive and comprehensive

Communities and sections that are consistently underreporting both illness and death pose a significant risk to surveillance and their efficacy is dependent upon the reporting of community structures such as government structures (primary health units (PHUs), schools), EVD response structures (contact tracers, community events based surveillance (CEBS), social mobilization), and traditional structures (chiefs, traditional healers, village task forces, religious institutions). All structures are required to report to the District Ebola Response Center (DERC) as depicted in Figure 1. Frequent and protocolized information sharing is central to the reporting efficacy within this structure to ensure early capture of all EVD-related incidents.

Objective

Systematically assess and strengthen the capacity of communities and sections in Port Loko District, Sierra Leone to detect significant events related to the reporting of Ebola virus disease (EVD) such as sick persons, secret burials and deaths. The components of the enhanced surveillance system will be described.

As the lead for coordinating domestic incident management across all Federal departments and agencies, Department of Homeland Security is responsible for identifying emergency response resources. The 2014 Ebola – Zaire outbreak in West Africa that became a Public Health Emergency of International Concern highlighted the need to understand the current and potential availability of diagnostic assays for a number of viral hemorrhagic fevers that may require similar response actions. A concatenated list of publically reported potential viral hemorrhagic fever diagnostic assays was therefore compiled. Etiologic agents in the families of Arena-, Bunya-, Filo-, and Flaviviridae were included in the analysis. This list identifies assays in various stages of development that could be submitted, at some point, to the Food and Drug Administration (FDA) under an Emergency Use Authorization (EUA) should such a need arise.

Objective

Provide a succinct review of potential developmental and commercial viral hemorrhagic fever diagnostic assays published in peer-reviewed literature and open-source platforms.

Arguably the two most significant public health issues over the past two years have been the outbreak of ebola in West Africa and the rising epidemic of heroin use and overdoses. In the case of Ebola, the CDC issued guidance for inpatient facilities to screen for potential cases, however, there was little guidance for screening patients that presented to EMS workers. The West African pateint aht presented to the Emergency Department in Dallas was transported, unknowingly, by EMS, potentially exposing them and others to this deadly disease. Likewise, heroin has become an exploding epidemic in the United States with deaths from overdoses skyrocketing across the country. There are few data sources for overdoses that can alert and track real time instances of heroin overdose which are arguably the highest risk patients in the community. This will make it difficult for interventions in the community as expressed recently by the White House.

Objective

The objective of this oral presentation is to describe the use of near real time 911 Emergency Medical Services data in looking for suspected cases of Ebola and heroin cases in the community.

Traditional disease surveillance systems suffer from several disadvantages, including reporting lags and antiquated technology, that have caused a movement towards internet-based disease surveillance systems. Recently, Wikipedia access logs (e.g., McIver 2014, Generous 2014) have been shown to be effective in this arena. Much richer Wikipedia data are available, though, including the entire Wikipedia article content and edit histories.

We study two different aspects of Wikipedia content as it relates to unfolding disease events: 1) we demonstrate how to capture case, death, and hospitalization counts from the article text, and 2) we show there are valuable time series data present in the tables found in certain articles.

We argue that Wikipedia data cannot only be used for disease surveillance but also as a centralized repository system for collecting disease-related data in near real-time.

Objective

To improve traditional outbreak surveillance systems by utilizing the content of Wikipedia articles.

The recent Ebola outbreak has been described as unprecedented and its public health impact in terms of morbidity, mortality and coverage has been far greater than previously experienced. This outbreak has revealed many weaknesses and inadequacies for disease surveillance and response systems in Africa due to underqualified staff, cultural beliefs and sometimes, lack of trust for formal health care sector performance. Since 2014, Ghana had high risk of seeing EVD cases.

Objective

The objective of this study was to assess the EVD surveillance and response preparedness among frontline health workers in northern Ghana.

West Africa recently experienced the most persistent epidemic of EVD recorded in history. The reported morbidity and mortality of the highly virulent, emerging zoonotic filovirus infection is far larger than all previous epidemics combined. Its spread to Nigeria (Africa’s most populous country) and to densely populated Lagos (a city in Nigeria with approximate combined population of Guinea, Sierra Leone, and Liberia) raised significant public health concern. The Federal Ministry of Health was notified of a suspected case of viral haemorrhagic fever on the 22nd July, 2014. A 40-year old male Liberian presented in a private health facility on account of fever, vomiting and diarrhea. On the 23rd July, the index case was confirmed to have EVD and on 25th July, he died.

Objective

To describe the socio-demographic characteristics of Ebola virus disease (EVD) patients and their contacts, magnitude of the outbreak and factors associated with outcome in patients.

The outbreak of the Ebola Virus Disease (EVD) in Africa in 2014 presented a major threat and concern across the world, spreading to two other continents (Europe and North America). Though the epidemic is on a downward trend, there is a need to evaluate the performance of the systems in place to detect and control such outbreaks and determine the need for improvement in countries affected.

With its first traceable case reported to have been in Guinea, the outbreak spread to Nigeria through an air traveler from Liberia which led to an outbreak in the country that luckily, was quickly contained. This imported case was initially managed at a private health facility (PHF) eventually leading to 20 cases and eight deaths, four of which were health workers from the initial managing PHF. Despite effort to contact the authorities about the suspected imported case by the PHF, it reportedly took some time before the health authorities could be reached and action at control instituted. This might suggest an inefficiency of the IDSR system which was previously adopted by Nigeria as a means of implementing the International Health Regulation (IHR) of 1969. The IHR is a set of regulations that the World Health Assembly uses to implement its constitutional responsibility to prevent the international spread of diseases.

Hemorrhagic fevers like EVD ought to be reported immediately upon suspicion to the health authorities but the delay despite effort suggests this system is not efficient. This is important as PHFs are noted to attend to over 60% of the Nigerian population. Thus, it is important to carry out an assessment of the IDSR system in PHFs to forestall a repeat episode and limit the impact of outbreak of infectious diseases in future.

Objective

To investigate the compliance of private health facilities to the integrated disease surveillance and response (IDSR) system in Nigeria.

Stemming from the 2014-6 Ebola virus disease (EVD) outbreak, community event based surveillance (CEBS) was implemented in Sierra Leone using community health workers to generate alerts for trigger events suggestive of EVD transmission. Through September 30, 2015 (last month of active EVD transmission), the majority (86%) of alerts reflected community deaths; this was beneficial as Ebolarelated deaths were detected with delay during the epidemic’s peak. The Government had implemented a policy of mandatory swabbing and testing of all dead bodies. The policy changed on June 30, 2016 wherein only swabbing of deaths deemed to be high-risk for EVD is required. To assess whether this policy change has begun to affect community death reporting, we analyzed trends in death reporting before and after the policy change.

Objective

To assess whether the change in death swabbing policy in Sierra Leon has begun to affect community death reporting, we analyzed trends in death reporting before and after the policy change

Mitigating the spread of infectious disease is of great importance for policy makers. Taking the recent outbreak of Ebola as an example, it was difficult for policy makers to identify the best course of action based on the cost-effectiveness of what was available. In effort to address the needs of policy makers to mitigate the spread of infectious disease before an outbreak becomes uncontrollable, we have devised a cost-benefit disease control model to simulate the effect of various control methods on disease incidence and the cost associated with each of the scenarios. Here, we present a case study of Ebola used to quantify the cost effectiveness of vaccination and isolation methods to minimize the spread of the disease.

Objective

We evaluate the impact of changing strategy levels on the incidence of the disease and address the benefits of choosing one strategy over the other with regards to cost of vaccine and isolation.