Epidemiology of Ebola virus disease transmission among health care workers in Sierra Leone, May to December 2014: a retrospective descriptive study.

BACKGROUND: Anecdotal evidence suggests that much of the continuing infection of health care workers (HCWs) with Ebola virus during the current outbreak in Sierra Leone has occurred in settings other than Ebola isolation units, and it is likely that some proportion of acquisition by HCWs occurs outside the workplace. There is a critical need to define more precisely the pathways of Ebola infection among HCWs, to optimise measures for reducing risk during current and future outbreaks. METHODS: We conducted a retrospective descriptive study of Ebola acquisition among health workers in Sierra Leone during May-December 2014. The data used were obtained mainly from the national Ebola database, a cross-sectional survey conducted through administration of a structured questionnaire to infected HCWs, and key informant interviews of select health stakeholders. RESULTS: A total of 293 HCWs comprising 277 (95 %) confirmed, 6 (2 %) probable, and 10 (3 %) suspected cases of infection with Ebola virus were enrolled in the study from nine districts of the country. Over half of infected HCWs (153) were nurses; others included laboratory staff (19, 6.5 %), doctors (9, 3.1 %), cleaners and porters (9, 3.1 %), Community Health Officers (8, 2.7 %), and pharmacists (2, 0.7 %). HCW infections were mainly reported from the Western Area (24.9 %), Kailahun (18.4 %), Kenema (17.7 %), and Bombali (13.3 %) districts. Almost half of the infected HCWs (120, 47.4 %) believed that their exposure occurred in a hospital setting. Others believed that they were exposed in the home (48, 19 %), at health centres (45, 17.8 %), or at other types of health facilities (13, 5.1 %). Only 27 (10.7 %) of all HCW infections were associated with Ebola virus disease (EVD) isolation units. Over half (60 %, 150) of infected HCWs said they had been trained in infection prevention and control prior to their infection, whereas 34 % (85) reported that they had not been so trained. CONCLUSIONS: This study demonstrated the perception that most HCW infections are associated with general health care and home settings and not with dedicated EVD settings, which should provide substantial reassurance to HCWs that measures in place at dedicated EVD facilities generally provide substantial protection when fully adhered to.

Unprotected sexual practice and associated factors among People Living with HIV at Ante Retroviral Therapy clinics in Debrezeit Town, Ethiopia: a cross sectional study.

BACKGROUND: Magnitude of unprotected sexual practice among PLHIV is generally high in African countries including Ethiopia. Understanding the practice in Ethiopia could have public health significance. However little is known about the issue of unprotected sexual practice among PLHIV in Ethiopia. Hence, this study was aimed to assess unprotected sexual practice and associated factors among PLHIV at ART clinics in Debrezeit town. METHOD: Institution based cross-sectional study was conducted. A total of 667 PLHIV were included in the study. Systematic random sampling technique was used to select participants. Analyses were done using SPSS for windows version 15. A crude and adjusted odds ratio with 95% confidence interval was used to measure association between different factors and unprotected sex. RESULT: The prevalence of unprotected sexual practice among PLHIV was 22.2% [95% CI: (19.0-25.4)]. Factors associated with unprotected sexual practice include: being female (AOR=2.1, 95% CI (1.1, 3.9)), being divorced/widowed/separated (AOR=4.9, 95% CI (2.1, 11.6)), length of stay with the current partner for ≥ 49 months (AOR=3.3, 95% CI (1.9, 5.7)) and not discussing or partly discussing about safe sex and condom use with sexual partner (AOR=17.1, 95% CI (8.9, 32.8)). CONCLUSION: High proportions of PLHIV were found to engage in unprotected sex. Information Education and Communication (IEC) on safe sex for PLHIV should target females, those who stayed longer with their partner and divorced/widowed/separate ones.

Contact tracing performance during the Ebola virus disease outbreak in Kenema district, Sierra Leone.

Contact tracing in an Ebola virus disease (EVD) outbreak is the process of identifying individuals who may have been exposed to infected persons with the virus, followed by monitoring for 21 days (the maximum incubation period) from the date of the most recent exposure. The goal is to achieve early detection and isolation of any new cases in order to prevent further transmission. We performed a retrospective data analysis of 261 probable and confirmed EVD cases in the national EVD database and 2525 contacts in the Contact Line Lists in Kenema district, Sierra Leone between 27 April and 4 September 2014 to assess the performance of contact tracing during the initial stage of the outbreak. The completion rate of the 21-day monitoring period was 89% among the 2525 contacts. However, only 44% of the EVD cases had contacts registered in the Contact Line List and 6% of probable or confirmed cases had previously been identified as contacts. Touching the body fluids of the case and having direct physical contact with the body of the case conferred a 9- and 20-fold increased risk of EVD status, respectively. Our findings indicate that incompleteness of contact tracing led to considerable unmonitored transmission in the early months of the epidemic. To improve the performance of early outbreak contact tracing in resource poor settings, our results suggest the need for prioritized contact tracing after careful risk assessment and better alignment of Contact Line Listing with case ascertainment and investigation.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.