RESUMO
This paper looks into the MaxEnt model in a trial to comprehend the ecological and environmental conditions that propagate and drive the spread of Ebola Virus Disease in Africa. We use the MaxEnt model to assess risk determinants associated with the occurrence and distribution of EVD, taking into account non-correlated variables such as neighborhood mean temperature, rainfall, and human population density. Our findings indicate that among the factors that significantly shape the geographical distribution of EVD risk are human population density, annual rainfall, temperature variability, and seasonality. The model used is both reliable and accurate (the average value for training AUC was 0.987); it can be used as a valuable approach for the prediction of infectious disease outbreaks. High-risk areas are primarily identified in the western and central regions of Africa, with some of the others in the east also vulnerable. This further calls for specified public health interventions and enhanced surveillance in specified hotspots, contributing to global efforts to predict and mitigate risks associated with EVD outbreaks more adequately. The findings further support that it remains imperative to conduct additional research, including socio-economic and cultural variables, to enhance the understanding of how environmental factors contribute to the emergence and transmission of Ebola.
Assuntos
Surtos de Doenças , Doença pelo Vírus Ebola , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/transmissão , Humanos , África/epidemiologia , Ebolavirus , Densidade Demográfica , Modelos TeóricosRESUMO
This emerging infectious disease poses one of the most severe threats to public health in these locations, but there are not many reliable therapies yet. In this work, we developed the Ebola virus dynamics and control factors epidemic model with a piecewise hybrid fractional Operator in time scale measure insight of Mittag-Leffler kernel. Patterns and structures that repeat at various scales are the focus of fractal analysis, which has applications in complex systems such as biological ones. Both qualitatively and statistically, a proposed model with the Lipschitz criteria and linear growth is examined, considering positive solutions, boundedness, and uniqueness at equilibrium points with Leray-Schauder results under time scale ideas. The regulation for linear responses approach will be used by Chaos Control to stabilize the system after its equilibrium points. A fractional-order framework with a controlled design will be considered, where solutions are bounded in the feasible domain of relations of different compartments. Ulam-Hyers stability results in the solution are treated when function (constant or rising) for the component of qualitative inquiry in generalized form. The dynamical behaviors of the suggested model are discussed with the Newton polynomial approach used to implement on model in the sense of classical piecewise and Mittag-Leffler kernel at different fractional order values. The model shows that solutions are stable and confined within a feasible range, ensuring reliability. Through detailed simulations, it effectively captures how different interventions and infection rates influence Ebola spread. This fractional-order model enhances understanding of Ebola transmission, providing a strong basis for predicting outbreaks and planning effective control measures, with practical applications for analyzing real-world data.
Assuntos
Ebolavirus , Epidemias , Doença pelo Vírus Ebola , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/virologia , Doença pelo Vírus Ebola/transmissão , Humanos , Algoritmos , Simulação por ComputadorRESUMO
The low specificity of Ebola virus disease clinical signs increases the risk for nosocomial transmission to patients and healthcare workers during outbreaks. Reducing this risk requires identifying patients with a high likelihood of Ebola virus infection. Analyses of retrospective data from patients suspected of having Ebola virus infection identified 13 strong predictors and time from disease onset as constituents of a prediction score for Ebola virus disease. We also noted 4 highly predictive variables that could distinguish patients at high risk for infection, independent of their scores. External validation of this algorithm on retrospective data revealed the probability of infection continuously increased with the score.
Assuntos
Algoritmos , Surtos de Doenças , Doença pelo Vírus Ebola , Triagem , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/transmissão , Humanos , Triagem/métodos , Estudos Retrospectivos , Masculino , Feminino , Ebolavirus , Adulto , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Tanzania faces ever-rising concerns due to the recurrence of the Ebola Virus Disease (EVD) in neighbouring Democratic Republic of Congo (DRC) and Uganda. This necessitates a better understanding of the community perspectives in high-risk regions for effective risk communication and preparedness. METHODS: This rapid ethnographic assessment study used explorative qualitative methods to collect data. People from diverse backgrounds participated in 59 in-depth interviews, 57 Key Informant interviews, and 35 focus group discussions. Data was analysed using a thematic analysis approach. FINDING: The study revealed existence of awareness of EVD and its symptoms, with radio and television being the main sources of information. However, there were varied perceptions of EVD's cause and transmission, some attributed it to bats, monkeys, and wild animal meat, while others associated it with high fever, a dirty environment, changing dietary patterns, and the COVID-19 virus. Physical contact with an infected person's body fluids and eating meat from infected animals were perceived as EVD transmission routes. Women, school children, boda-boda (motorcycle) riders, and fishermen were considered the most susceptible to EVD infections due to their daily activities. Preventive measures included avoiding physical contact, touching fluids, and refraining from eating wild animal meat. Prompt reporting of suspected cases to health facilities was deemed crucial for earlier outbreak identification and containment. CONCLUSION: The high-risk regions of Tanzania had a high level of awareness and perceived susceptibility to EVD, coupled with varying degrees of misperception about the etiology and its transmission. To improve community perspectives and preparedness in the case of an outbreak, there is a need for ongoing risk communication and participation in EVD prevention and responses.
Assuntos
Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Doença pelo Vírus Ebola , Pesquisa Qualitativa , Tanzânia/epidemiologia , Humanos , Doença pelo Vírus Ebola/transmissão , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Adolescente , Entrevistas como Assunto , IdosoRESUMO
Filoviruses are negative-sense single-stranded RNA viruses often associated with severe and highly lethal hemorrhagic fever in humans and nonhuman primates, with case fatality rates as high as 90%. Of the known filoviruses, Ebola virus (EBOV), the prototype of the genus Orthoebolavirus, has been a major public health concern as it frequently causes outbreaks and was associated with an unprecedented outbreak in several Western African countries in 2013-2016, affecting 28,610 people, 11,308 of whom died. Thereafter, filovirus research mostly focused on EBOV, paying less attention to other equally deadly orthoebolaviruses (Sudan, Bundibugyo, and Taï Forest viruses) and orthomarburgviruses (Marburg and Ravn viruses). Some of these filoviruses have emerged in nonendemic areas, as exemplified by four Marburg disease outbreaks recorded in Guinea, Ghana, Tanzania, and Equatorial Guinea between 2021 and 2023. Similarly, the Sudan virus has reemerged in Uganda 10 years after the last recorded outbreak. Moreover, several novel bat-derived filoviruses have been discovered in the last 15 years (Lloviu virus, Bombali virus, Menglà virus, and Dehong virus), most of which are poorly characterized but may display a wide host range. These novel viruses have the potential to cause outbreaks in humans. Several gaps are yet to be addressed regarding known and emerging filoviruses. These gaps include the virus ecology and pathogenicity, mechanisms of zoonotic transmission, host range and susceptibility, and the development of specific medical countermeasures. In this review, we summarize the current knowledge on non-Ebola filoviruses (Bombali virus, Bundibugyo virus, Reston virus, Sudan virus, Tai Forest virus, Marburg virus, Ravn virus, Lloviu virus, Menglà virus, and Dehong virus) and suggest some strategies to accelerate specific countermeasure development.
Assuntos
Surtos de Doenças , Infecções por Filoviridae , Filoviridae , Saúde Global , Humanos , Animais , Filoviridae/patogenicidade , Infecções por Filoviridae/epidemiologia , Infecções por Filoviridae/virologia , Ebolavirus/fisiologia , Ebolavirus/patogenicidade , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/virologia , Doença pelo Vírus Ebola/transmissão , Zoonoses/epidemiologia , Zoonoses/virologiaRESUMO
Epidemic models of susceptibles, exposed, infected, recovered and deceased (SΕIRD) presume homogeneity, constant rates and fixed, bilinear structure. They produce short-range, single-peak responses, hardly attained under restrictive measures. Tuned via uncertain I,R,D data, they cannot faithfully represent long-range evolution. A robust epidemic model is presented that relates infected with the entry rate to health care units (HCUs) via population averages. Model uncertainty is circumvented by not presuming any specific model structure, or constant rates. The model is tuned via data of low uncertainty, by direct monitoring: (a) of entries to HCUs (accurately known, in contrast to delayed and non-reliable I,R,D data) and (b) of scaled model parameters, representing population averages. The model encompasses random propagation of infections, delayed, randomly distributed entries to HCUs and varying exodus of non-hospitalized, as disease severity subdues. It closely follows multi-pattern growth of epidemics with possible recurrency, viral strains and mutations, varying environmental conditions, immunity levels, control measures and efficacy thereof, including vaccination. The results enable real-time identification of infected and infection rate. They allow design of resilient, cost-effective policy in real time, targeting directly the key variable to be controlled (entries to HCUs) below current HCU capacity. As demonstrated in ex post case studies, the policy can lead to lower overall cost of epidemics, by balancing the trade-off between the social cost of infected and the economic contraction associated with social distancing and mobility restriction measures.
Assuntos
COVID-19 , Epidemias , Humanos , Epidemias/estatística & dados numéricos , COVID-19/transmissão , COVID-19/epidemiologia , COVID-19/prevenção & controle , Conceitos Matemáticos , Modelos Epidemiológicos , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/transmissão , SARS-CoV-2 , Número Básico de Reprodução/estatística & dados numéricos , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/transmissão , Doença pelo Vírus Ebola/prevenção & controle , Política de SaúdeRESUMO
The Ebola virus disease (EVD) has been endemic since 1976, and the case fatality rate is extremely high. EVD is spread by infected animals, symptomatic individuals, dead bodies, and contaminated environment. In this paper, we formulate an EVD model with four transmission modes and a time delay describing the incubation period. Through dynamical analysis, we verify the importance of blocking the infection source of infected animals. We get the basic reproduction number without considering the infection source of infected animals. And, it is proven that the model has a globally attractive disease-free equilibrium when the basic reproduction number is less than unity; the disease eventually becomes endemic when the basic reproduction number is greater than unity. Taking the EVD epidemic in Sierra Leone in 2014-2016 as an example, we complete the data fitting by combining the effect of the media to obtain the unknown parameters, the basic reproduction number and its time-varying reproduction number. It is shown by parameter sensitivity analysis that the contact rate and the removal rate of infected group have the greatest influence on the prevalence of the disease. And, the disease-controlling thresholds of these two parameters are obtained. In addition, according to the existing vaccination strategy, only the inoculation ratio in high-risk areas is greater than 0.4, the effective reproduction number can be less than unity. And, the earlier the vaccination time, the greater the inoculation ratio, and the faster the disease can be controlled.
Assuntos
Número Básico de Reprodução , Ebolavirus , Doença pelo Vírus Ebola , Conceitos Matemáticos , Modelos Biológicos , Doença pelo Vírus Ebola/transmissão , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/epidemiologia , Número Básico de Reprodução/estatística & dados numéricos , Humanos , Animais , Serra Leoa/epidemiologia , Ebolavirus/patogenicidade , Ebolavirus/fisiologia , Epidemias/estatística & dados numéricos , Epidemias/prevenção & controle , Simulação por Computador , Modelos Epidemiológicos , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricosRESUMO
The 2013-2016 Ebola virus disease epidemic and the coronavirus disease 2019 pandemic galvanized tremendous growth in models for emerging zoonotic and vector-borne viruses. Therefore, we have reviewed the main goals and methods of models to guide scientists and decision-makers. The elements of models for emerging viruses vary across spectrums: from understanding the past to forecasting the future, using data across space and time, and using statistical versus mechanistic methods. Hybrid/ensemble models and artificial intelligence offer new opportunities for modeling. Despite this progress, challenges remain in translating models into actionable decisions, particularly in areas at highest risk for viral disease outbreaks. To address this issue, we must identify gaps in models for specific viruses, strengthen validation, and involve policymakers in model development.
Assuntos
Zoonoses , Animais , Humanos , Zoonoses/virologia , Zoonoses/transmissão , Zoonoses/epidemiologia , Doenças Transmitidas por Vetores/virologia , Doenças Transmitidas por Vetores/epidemiologia , Doenças Transmitidas por Vetores/transmissão , COVID-19/virologia , COVID-19/epidemiologia , COVID-19/transmissão , Viroses/virologia , Viroses/transmissão , Viroses/epidemiologia , Doença pelo Vírus Ebola/virologia , Doença pelo Vírus Ebola/transmissão , Doença pelo Vírus Ebola/epidemiologia , SARS-CoV-2 , Vetores de Doenças , Surtos de Doenças , Vírus/patogenicidade , Vírus/genéticaAssuntos
Surtos de Doenças , Ebolavirus , Pessoal de Saúde , Doença pelo Vírus Ebola , Adulto , Feminino , Humanos , Masculino , Uganda/epidemiologia , Doença pelo Vírus Ebola/diagnóstico , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/terapia , Doença pelo Vírus Ebola/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional , Antivirais/uso terapêutico , Anticorpos/uso terapêuticoRESUMO
Vaginal transmission from semen of male Ebola virus (EBOV) survivors has been implicated as a potential origin of Ebola virus disease (EVD) outbreaks. While EBOV in semen must traverse cervicovaginal mucus (CVM) to reach target cells, the behaviour of EBOV in CVM is poorly understood. CVM contains substantial quantities of IgG, and arrays of IgG bound to a virion can develop multiple Fc-mucin bonds, immobilizing the IgG/virion complex in mucus. Here, we measured the real-time mobility of fluorescent Ebola virus-like-particles (VLP) in 50 CVM specimens from 17 women, with and without ZMapp, a cocktail of 3 monoclonal IgGs against EBOV. ZMapp-mediated effective trapping of Ebola VLPs in CVM from a subset of women across the menstrual cycle, primarily those with Lactobacillus crispatus dominant microbiota. Our work underscores the influence of the vaginal microbiome on IgG-mucin crosslinking against EBOV and identifies bottlenecks in the sexual transmission of EBOV.
Assuntos
Ebolavirus , Doença pelo Vírus Ebola , Vagina , Humanos , Feminino , Ebolavirus/fisiologia , Vagina/virologia , Doença pelo Vírus Ebola/virologia , Doença pelo Vírus Ebola/transmissão , Vírion , Imunoglobulina G , Adulto , Muco do Colo Uterino/virologia , Muco/virologiaRESUMO
Human Ebola virus (EBOV) outbreaks caused by persistent EBOV infection raises questions on the role of zoonotic spillover in filovirus epidemiology. To characterise filovirus zoonotic exposure, we collected cross-sectional serum samples from bushmeat hunters (n = 498) in Macenta Prefecture Guinea, adjacent to the index site of the 2013 EBOV-Makona spillover event. We identified distinct immune signatures (20/498, 4.0%) to multiple EBOV antigens (GP, NP, VP40) using stepwise ELISA and Western blot analysis and, live EBOV neutralisation (5/20; 25%). Using comparative serological data from PCR-confirmed survivors of the 2013-2016 EBOV outbreak, we demonstrated that most signatures (15/20) were not plausibly explained by prior EBOV-Makona exposure. Subsequent data-driven modelling of EBOV immunological outcomes to remote-sensing environmental data also revealed consistent associations with intact closed canopy forest. Together our findings suggest exposure to other closely related filoviruses prior to the 2013-2016 West Africa epidemic and highlight future surveillance priorities.
Assuntos
Anticorpos Antivirais , Ebolavirus , Doença pelo Vírus Ebola , Humanos , Animais , Guiné/epidemiologia , Ebolavirus/imunologia , Ebolavirus/isolamento & purificação , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/imunologia , Doença pelo Vírus Ebola/virologia , Doença pelo Vírus Ebola/sangue , Doença pelo Vírus Ebola/transmissão , Adulto , Masculino , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Pessoa de Meia-Idade , Zoonoses/virologia , Zoonoses/epidemiologia , Zoonoses/transmissão , Feminino , Estudos Transversais , Surtos de Doenças , Adulto Jovem , Idoso , Ensaio de Imunoadsorção Enzimática , Zoonoses Virais/epidemiologia , Zoonoses Virais/transmissão , Zoonoses Virais/virologia , Antígenos Virais/imunologiaRESUMO
BACKGROUND: In 2022, an Ebola disease outbreak caused by Sudan virus (SUDV) occurred in Uganda, primarily affecting Mubende and Kassanda districts. We determined risk factors for SUDV infection among household members (HHM) of cases. METHODS: We conducted a case-control and retrospective cohort study in January 2023. Cases were RT-PCR-confirmed SUDV infection in residents of Mubende or Kassanda districts during the outbreak. Case-households housed a symptomatic, primary case-patient for ≥ 24 h and had ≥ 1 secondary case-patient with onset < 2 weeks after their last exposure to the primary case-patient. Control households housed a case-patient and other HHM but no secondary cases. A risk factor questionnaire was administered to the primary case-patient or another adult who lived at home while the primary case-patient was ill. We conducted a retrospective cohort study among case-household members and categorized their interactions with primary case-patients during their illnesses as none, minimal, indirect, and direct contact. We conducted logistic regression to explore associations between exposures and case-household status, and Poisson regression to identify risk factors for SUDV infection among HHM. RESULTS: Case- and control-households had similar median sizes. Among 19 case-households and 51 control households, primary case-patient death (adjusted odds ratio [ORadj] = 7.6, 95% CI 1.4-41) and ≥ 2 household bedrooms (ORadj=0.19, 95% CI 0.056-0.71) were associated with case-household status. In the cohort of 76 case-HHM, 44 (58%) were tested for SUDV < 2 weeks from their last contact with the primary case-patient; 29 (38%) were positive. Being aged ≥ 18 years (adjusted risk ratio [aRRadj] = 1.9, 95%CI: 1.01-3.7) and having direct or indirect contact with the primary case-patient (aRRadj=3.2, 95%CI: 1.1-9.7) compared to minimal or no contact increased risk of Sudan virus disease (SVD). Access to a handwashing facility decreased risk (aRRadj=0.52, 95%CI: 0.31-0.88). CONCLUSION: Direct contact, particularly providing nursing care for and sharing sleeping space with SVD patients, increased infection risk among HHM. Risk assessments during contact tracing may provide evidence to justify closer monitoring of some HHM. Health messaging should highlight the risk of sharing sleeping spaces and providing nursing care for persons with Ebola disease symptoms and emphasize hand hygiene to aid early case identification and reduce transmission.
Assuntos
Surtos de Doenças , Características da Família , Doença pelo Vírus Ebola , Humanos , Uganda/epidemiologia , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/transmissão , Fatores de Risco , Masculino , Adulto , Feminino , Estudos Retrospectivos , Estudos de Casos e Controles , Adolescente , Adulto Jovem , Pessoa de Meia-Idade , Criança , Pré-Escolar , Ebolavirus , LactenteRESUMO
The E/S (exposed/susceptible) ratio is analyzed in the SEIR model. The ratio plays a key role in understanding epidemic dynamics during the 2014-2016 Ebola outbreak in Sierra Leone and Guinea. The maximum value of the ratio occurs immediately before or after the time-dependent reproduction number (Rt) equals 1, depending on the initial susceptible population (S(0)). It is demonstrated that transmission rate curves corresponding to various incubation periods intersect at a single point referred to as the Cross Point (CP). At this point, the E/S ratio reaches an extremum, signifying a critical shift in transmission dynamics and aligning with the time when Rt approaches 1. By plotting transmission rate curves, ß(t), for any two arbitrary incubation periods and tracking their intersections, we can trace CP over time. CP serves as an indicator of epidemic status, especially when Rt is close to 1. It provides a practical means of monitoring epidemics without prior knowledge of the incubation period. Through a case study, we estimate the transmission rate and reproduction number, identifying CP and Rt = 1 while examining the E/S ratio across various values of S(0).
Assuntos
Epidemias , Doença pelo Vírus Ebola , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/transmissão , Humanos , Serra Leoa/epidemiologia , Guiné/epidemiologia , Surtos de Doenças , África Ocidental/epidemiologia , Número Básico de ReproduçãoRESUMO
IMPORTANCE: Ebola disease (EBOD) is a public health threat with a high case fatality rate. Most EBOD outbreaks have occurred in remote locations, but the 2013-2016 Western Africa outbreak demonstrated how devastating EBOD can be when it reaches an urban population. Here, the 2022 Sudan virus disease (SVD) outbreak in Mubende District, Uganda, is summarized, and the genetic relatedness of the new variant is evaluated. The Mubende variant exhibited 96% amino acid similarity with historic SUDV sequences from the 1970s and a high degree of conservation throughout the outbreak, which was important for ongoing diagnostics and highly promising for future therapy development. Genetic differences between viruses identified during the Mubende SVD outbreak were linked with epidemiological data to better interpret viral spread and contact tracing chains. This methodology should be used to better integrate discrete epidemiological and sequence data for future viral outbreaks.
Assuntos
Surtos de Doenças , Ebolavirus , Variação Genética , Doença pelo Vírus Ebola , Humanos , Surtos de Doenças/estatística & dados numéricos , Ebolavirus/química , Ebolavirus/classificação , Ebolavirus/genética , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/transmissão , Doença pelo Vírus Ebola/virologia , Uganda/epidemiologia , Busca de ComunicanteRESUMO
Zaïre ebolavirus (EBOV) causes Ebola virus disease (EVD), a devastating viral hemorrhagic fever in humans. Nonhuman primate (NHP) models of EVD traditionally use intramuscular infection with higher case fatality rates and reduced mean time-to-death compared to contact transmission typical of human cases of EVD. A cynomolgus macaque model of oral and conjunctival EBOV was used to further characterize the more clinically relevant contact transmission of EVD. NHPs challenged via the oral route had an overall 50% survival rate. NHPs challenged with a target dose of 1 × 102 PFU or 1 × 104 PFU of EBOV via the conjunctival route had 40% and 100% mortality, respectively. Classic signs of lethal EVD-like disease were observed in all NHPs that succumbed to EBOV infection including viremia, hematological abnormalities, clinical chemistries indicative of hepatic and renal disease, and histopathological findings. Evidence of EBOV viral persistence in the eye was observed in NHPs challenged via the conjunctival route. IMPORTANCE This study is the first to examine the Kikwit strain of EBOV, the most commonly used strain, in the gold-standard macaque model of infection. Additionally, this is the first description of the detection of virus in the vitreous fluid, an immune privileged site that has been proposed as a viral reservoir, following conjunctival challenge. The oral and conjunctival macaque challenge model of EVD described here more faithfully recapitulates the prodrome that has been reported for human EVD. This work paves the way for more advanced studies to model contact transmission of EVD, including early events in mucosal infection and immunity, as well as the establishment of persistent viral infection and the emergence from these reservoirs.
Assuntos
Ebolavirus , Doença pelo Vírus Ebola , Animais , Humanos , Ebolavirus/fisiologia , Doença pelo Vírus Ebola/transmissão , Macaca fascicularis , Modelos Animais de Doenças , Túnica Conjuntiva/virologia , Transmissão de Doença InfecciosaRESUMO
The Ebola Virus Disease (EVD) remains a global public health concern with multiple outbreaks over the last five years. This scoping review aimed to synthesize the current state of knowledge on awareness, education, and community mobilization programs on EVD prevention. A comprehensive search strategy was executed in October 2021 across eight databases (APA PsycInfo, CINAHL, Cochrane CENTRAL, Embase, Global Health, MEDLINE, Scopus, and Web of Science). According to the PRISMA flow diagram, out of the 4815 studies generated by the search, 33 were retained for extraction and were included in this scoping review. Findings revealed that cultural practices that increased the risk of Ebola transmission remain very prevalent, even educational and awareness campaigns. Levels of Ebola-related knowledge by community members varied widely. A large proportion of the Ebola-affected populations were not aware of modes of transmission and half were unaware of signs and symptoms. Interventions with deep community mobilization, collaboration and engagement were effective in changing cultural practices, and reducing rates of infection. Interventions in the health sector helped increase willingness to practice preventive methods and the maintenance of social distancing and patient handwashing. A majority of the population members received their information about EVD from the community and mass media (in most instances, through broadcasting stations). Community interventions with a collaborative approach are effective to prevent EVD. It is needed to build trust between communities and health care, but also to use local resources and cultural factors combined with the use of technologies of information to prevent EVD.
Assuntos
Surtos de Doenças , Promoção da Saúde , Doença pelo Vírus Ebola , Humanos , Surtos de Doenças/prevenção & controle , Escolaridade , Conhecimentos, Atitudes e Prática em Saúde , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/transmissão , Saúde Pública , Promoção da Saúde/métodosRESUMO
In the Democratic Republic of Congo (DRC) which contains the greatest area of the second largest rainforest on Earth, people have long been connected to the forest for subsistence and livelihood from wild animals and bushmeat. This qualitative study sought to characterize the bushmeat movement-from hunting wild animals to market sale-and the roles of participants in the animal value chain, as well as their beliefs surrounding zoonotic disease and occupational risk. Actors in in eight bushmeat markets and two ports in Kinshasa, DRC completed semi-structured interviews between 2016 and 2018 in which they expressed belief in transmission of illness from domestic animals to humans, but not from wild animals to humans. Wild animals were viewed as pure and natural, in contrast to domestic animals which were considered tainted by human interference. Participants reported cutting themselves during the process of butchering yet did not consider butchering bushmeat to be a risky activity. Instead, they adopted safety practices learned over time from butchering experts and taught themselves how to butcher in a fashion that reduced the frequency of cutting. In general, butcherers rejected the idea of personal protective equipment use. Port markets were identified as important access points for meat coming from the Congo river and plane transport was identified as important for fresh and live meat coming from Équateur province. Most participants reported having heard about Ebola, but their mistrust in government messaging privileged a word-of-mouth story of witchcraft to be propagated about Ebola's origins. It is critical to better understand how public health messaging about outbreaks can successfully reach high risk communities, and to develop creative risk mitigation strategies for populations in regular contact with animal blood and body fluids. In this paper, we offer suggestions for formal and informal trusted channels through which health messages surrounding zoonotic risk could be conveyed to high-risk populations in Kinshasa.
Assuntos
Carne/economia , Zoonoses/transmissão , Animais , Animais Selvagens , República Democrática do Congo/epidemiologia , Surtos de Doenças , Feminino , Grupos Focais , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/transmissão , Humanos , Entrevistas como Assunto , Masculino , Carne/microbiologia , Carne/virologia , Exposição Ocupacional , Percepção , Fatores de Risco , Zoonoses/epidemiologia , Zoonoses/psicologiaRESUMO
The Democratic Republic of the Congo (DRC) declared an Ebola virus disease (EVD) outbreak in North Kivu in August 2018. By June 2019, the outbreak had spread to 26 health zones in northeastern DRC, causing >2,000 reported cases and >1,000 deaths. On June 10, 2019, three members of a Congolese family with EVD-like symptoms traveled to western Uganda's Kasese District to seek medical care. Shortly thereafter, the Viral Hemorrhagic Fever Surveillance and Laboratory Program (VHF program) at the Uganda Virus Research Institute (UVRI) confirmed that all three patients had EVD. The Ugandan Ministry of Health declared an outbreak of EVD in Uganda's Kasese District, notified the World Health Organization, and initiated a rapid response to contain the outbreak. As part of this response, UVRI and the United States Centers for Disease Control and Prevention, with the support of Uganda's Public Health Emergency Operations Center, the Kasese District Health Team, the Superintendent of Bwera General Hospital, the United States Department of Defense's Makerere University Walter Reed Project, and the United States Mission to Kampala's Global Health Security Technical Working Group, jointly established an Ebola Field Laboratory in Kasese District at Bwera General Hospital, proximal to an Ebola Treatment Unit (ETU). The laboratory consisted of a rapid containment kit for viral inactivation of patient specimens and a GeneXpert Instrument for performing Xpert Ebola assays. Laboratory staff tested 76 specimens from alert and suspect cases of EVD; the majority were admitted to the ETU (89.3%) and reported recent travel to the DRC (58.9%). Although no EVD cases were detected by the field laboratory, it played an important role in patient management and epidemiological surveillance by providing diagnostic results in <3 hours. The integration of the field laboratory into Uganda's National VHF Program also enabled patient specimens to be referred to Entebbe for confirmatory EBOV testing and testing for other hemorrhagic fever viruses that circulate in Uganda.
Assuntos
Academias e Institutos/organização & administração , Doenças Transmissíveis Importadas/prevenção & controle , Doenças Transmissíveis Importadas/virologia , Surtos de Doenças/estatística & dados numéricos , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/prevenção & controle , Laboratórios/organização & administração , Laboratórios/normas , Bioensaio , Criança , Pré-Escolar , Doenças Transmissíveis Importadas/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Doença pelo Vírus Ebola/transmissão , Humanos , Laboratórios/provisão & distribuição , Masculino , Pessoa de Meia-Idade , Viagem , Uganda/epidemiologia , Estados Unidos , Universidades , Organização Mundial da SaúdeRESUMO
Improving the provision of supportive care for patients with Ebola is an important quality improvement initiative. We designed a simulated Ebola Treatment Unit (ETU) to assess performance and safety of healthcare workers (HCWs) performing tasks wearing personal protective equipment (PPE) in hot (35 °C, 60% relative humidity) or thermo-neutral (20 °C, 20% relative humidity) conditions. In this pilot phase to determine the feasibility of study procedures, HCWs in PPE were non-randomly allocated to hot or thermo-neutral conditions to perform peripheral intravenous (PIV) and midline catheter (MLC) insertion and endotracheal intubation (ETI) on mannequins. Eighteen HCWs (13 physicians, 4 nurses, 1 nurse practitioner; 2 with prior ETU experience; 10 in hot conditions) spent 69 (10) (mean (SD)) minutes in the simulated ETU. Mean (SD) task completion times were 16 (6) min for PIV insertion; 33 (5) min for MLC insertion; and 16 (8) min for ETI. Satisfactory task completion was numerically higher for physicians vs. nurses. Participants' blood pressure was similar, but heart rate was higher (p = 0.0005) post-simulation vs. baseline. Participants had a median (range) of 2.0 (0.0-10.0) minor PPE breaches, 2.0 (0.0-6.0) near-miss incidents, and 2.0 (0.0-6.0) health symptoms and concerns. There were eight health-assessment triggers in five participants, of whom four were in hot conditions. We terminated the simulation of two participants in hot conditions due to thermal discomfort. In summary, study tasks were suitable for physician participants, but they require redesign to match nurses' expertise for the subsequent randomized phase of the study. One-quarter of participants had a health-assessment trigger. This research model may be useful in future training and research regarding clinical care for patients with highly infectious pathogens in austere settings.
Assuntos
Cuidados Críticos , Pessoal de Saúde , Doença pelo Vírus Ebola/prevenção & controle , Doença pelo Vírus Ebola/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional , Adulto , Estado Terminal , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Equipamento de Proteção Individual , Projetos PilotoRESUMO
When pharmaceutical interventions are unavailable to deal with an epidemic outbreak, adequate management of communication strategies can be key to reduce the contagion risks. On the one hand, accessibility to trustworthy and timely information, whilst on the other, the adoption of preventive behaviors may be both crucial. However, despite the abundance of communication strategies, their effectiveness has been scarcely evaluated or merely circumscribed to the scrutiny of public affairs. To study the influence of communication strategies on the spreading dynamics of an infectious disease, we implemented a susceptible-exposed-infected-removed-dead (SEIRD) epidemiological model, using an agent-based approach. Agents in our systems can obtain information modulating their behavior from two sources: (i) through the local interaction with other neighboring agents and, (ii) from a central entity delivering information with a certain periodicity. In doing so, we highlight how global information delivered from a central entity can reduce the impact of an infectious disease and how informing even a small fraction of the population has a remarkable impact, when compared to not informing the population at all. Moreover, having a scheme of delivering daily messages makes a stark difference on the reduction of cases, compared to the other evaluated strategies, denoting that daily delivery of information produces the largest decrease in the number of cases. Furthermore, when the information spreading relies only on local interactions between agents, and no central entity takes actions along the dynamics, then the epidemic spreading is virtually independent of the initial amount of informed agents. On top of that, we found that local communication plays an important role in an intermediate regime where information coming from a central entity is scarce. As a whole, our results highlight the importance of proper communication strategies, both accurate and daily, to tackle epidemic outbreaks.