Two Obstacles in Response Efforts to the Ebola Epidemic in the Provinces of North Kivu and Ituri in the Democratic Republic of the Congo: Denial of and Rumors about the Disease.

Denial and rumors are two major obstacles impairing the implementation of activities in response to the Ebola virus disease (EVD) epidemic. This study investigated the roles of denial and rumors, among other challenges, in complicating the response to the EVD outbreak in the North Kivu and Ituri provinces of the Democratic Republic of the Congo. A total of 800 randomly selected respondents were surveyed using a structured questionnaire. In-depth interviews were conducted with 17 community religious and opinion leaders, as well as Ebola survivors. Furthermore, 20 focus group discussions were conducted with adult and youth male and female participants, and health care workers. The results revealed that the existence of the disease is widely denied by many, including political leaders, village chiefs, neighborhood chiefs, street chiefs, avenue chiefs, and members of the general population. These individuals generally consider the EVD to be the result of a misbehavior or a curse; consequently, the general population, including community members, teachers, and even health care professionals, refuse to comply with the authorities' strategies to fight the epidemic. Rumors are another obstacle in response efforts. Rumors pertaining to the denial of the existence of the EVD, as well as the epidemic, Ebola treatment centers, hospitals, vaccines, and safe and dignified burials have been identified. Rumors about the EVD and the response, spread by clerics, traditional therapists, men, and women, including healthcare professionals in focus group discussions, portrayed the EVD as an invention, as if the virus had been created. The response to the EVD has been marked by these two constraints, which have often hindered the involvement of community members in the fight against the disease.

Exploring Alternative Care Platforms for Symptomatic People in the Fight against the Ebola Virus Disease Outbreak.

Treatment centers (TCs) are the only locations designed to care for people with Ebola virus disease (EVD) symptoms. These people and their families are held at a TC as soon as they arrive at an Ebola treatment center (ETC); however, some people escape from TCs. This paper explored alternative care platforms for symptomatic people in the fight against the EVD outbreak in the Democratic Republic of Congo. Eight hundred randomly selected adults aged 18 years and above were surveyed with a uniform set of structured questionnaires. In-depth interviews were conducted with 20 community/opinion leaders, while focus group discussions were held with community members who were not involved in the questionnaire study. Our findings demonstrated that people who were suspected of having EVD preferred to be treated discreetly and at home, and were more willing to be tested at home than at a TC. People were afraid of being stigmatized if the TC exposed their admittance to the general public. This article proposes an alternative to the TCs. We suggest a temporary containment facility within the community, such as a room in the suspected person's home. However, this requires negotiation between the response team and community members, with the latter having a significant responsibility in caring for their symptomatic relatives. The place or room for domestic temporary isolation should be chosen discreetly and placed far from the view of others. Community members will, thus, bear more responsibility for what happens while the patient is in isolation. The temporary containment area will assist in decentralizing the treatment of those with EVD symptoms. Its implementation will contribute to greater accountability of community members in the fight against EVD.

Survivors and the Response to the Ebola Virus Disease in the Provinces of North Kivu and Ituri in the Democratic Republic of Congo.

We explored issues around the integration of survivors in communities and the implications for the Ebola Virus Disease (EVD) response in the Democratic Republic of Congo (DRC). We conducted a survey with 800 randomly selected respondents using a structured questionnaire. Respondents were persons aged 18 years and above. Focus group discussions (FGDs) and in-depth interviews (IDIs) were employed to obtain contextual data on the issues. Community leaders, health workers, and response pillar leads engaged in IDIs, while community members were involved in FGDs. The results revealed that the survivors suffered stigmatization and, upon return to the communities, were avoided by the community members due to fear of contamination. Some thought that the survivors should be supported in adjusting to the community, while some recommended engaging the survivors in EVD response activities.

Traditional therapists in Ebola virus disease outbreak response: Lessons learned from the fight against the Ebola virus disease epidemic in North Kivu and Ituri, Democratic Republic of the Congo.

Traditional healers co-exist with orthodox medicine, especially in cases with perceived supernatural causes and during outbreaks of infectious diseases like the Ebola virus disease (EVD) in the North Kivu and Ituri provinces in the Democratic Republic of the Congo (DRC). In this study, we examined the role and potential of involving traditional healers in the national response to the Ebola virus disease outbreak in the DRC. Seventeen community leaders and 20 traditional healers were interviewed. The traditional healers managed symptoms with herbs and were not inclined to refer cases to orthodox healthcare facilities because of their confidence in their ability to handle cases with supernatural causes. The community leaders attested to the acceptance of the traditional healers in the communities, which they attributed to the efficacy of traditional healing, its uncomplicated treatment process, cause of the prolonged cough, as well as cost and the need for secrecy. Traditional healers can be educated to promptly refer cases to Ebola treatment centers for timely diagnosis and appropriate treatment.

Establishing Healthcare Worker Performance and Safety in Providing Critical Care for Patients in a Simulated Ebola Treatment Unit: Non-Randomized Pilot Study.

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.

Guidance materials from 2014 to 2019 on nutritional care for Ebola patients in Ebola Treatment Units: an analysis.

OBJECTIVE: To evaluate the inclusion and exclusion of nutritional content in guidance materials related to nutritional care for hospitalised Ebola Virus Disease (EVD) patients of any age with the aim to provide recommendations for future revised nutritional care guidelines in Ebola Treatment Units (ETU). DESIGN: Qualitative and quantitative analyses of ETU protocols and other guidance materials were conducted. Materials were obtained from practitioners, their organisations and governments active in EVD outbreaks since 2014. SETTING: Guinea, Liberia, Sierra Leone and Democratic Republic of Congo. RESULTS: Guidance materials showed a wide variety of topics. Most contained information on different feeding phases during illness, the use of specialised products, what and how to feed children aged 0-23 months, and meal and snack frequency for different age groups. Most materials lacked guidance on how to assess or accommodate patients' dietary preferences, how to obtain feedback on nutritional care from patients or how to assess whether patients need feeding support. These aspects are particularly relevant to prevent deterioration of the patients' nutritional status. There was limited guidance on operational aspects of food preparation and provision. CONCLUSIONS: Since 2014, numerous materials have been developed by organisations and governments on nutritional support in ETU. Although every EVD outbreak response must be contextualised because of the complexity of EVD and its case management, it is important to resolve technical differences and to provide comprehensive and more practical guidance. The findings of this study may inform future revised guidelines from normative UN organisations and governments of countries affected by EVD.

Severity score for predicting in-facility Ebola treatment outcome.

PURPOSE: Sierra Leone recorded the highest incidence rate for the 2013-2016 West African Ebola outbreak. In this investigation, we used the medical records of Ebola patients with different sociodemographic and clinical features to determine the factors that are associated with Ebola treatment outcome during the 2013-2016 West African Ebola outbreak in Sierra Leone and constructed a predictive in-facility mortality score. METHODS: We used the anonymized medical records of 1077 laboratory-confirmed pediatric and adult patients with EVD who received treatment at the 34 Military Hospital and the Police Training School Ebola Treatment Centers in Sierra Leone between the period of June 2014 and April 2015. We later determined the in-facility case fatality rates for Ebola, the odds of dying during Ebola treatment, and later constructed a predictive in-facility mortality score for these patients based on their clinical and sociodemographic characteristics. RESULTS: We constructed a model that partitioned the study population into three mortality risk groups of equal patient numbers, based on risk scoring: low (score ≤ -5), medium (score -4 to 1), and high-risk group (score ≥ 2). The CFR of patients with EVD belonging to the low- (≤-5), medium (-4 to 1), and high- (≥2) risk groups were 0.56%, 9.75%, and 67.41%, respectively. CONCLUSIONS: We succeeded in designing an in-facility mortality risk score that reflects EVD clinical severity and can assist in the clinical prioritization of patients with EVD.

Sociodemographic and clinical determinants of in-facility case fatality rate for 938 adult Ebola patients treated at Sierra Leone Ebola treatment center.

BACKGROUND: The 2013-2016 West Africa Ebola Virus Disease (EVD) outbreak recorded the highest incidence and mortality since the discovery of the virus in Zaire in 1976; with more than 28,000 probable and confirmed EVD cases and 11,000 deaths. Studies relating to previous outbreaks usually involved small sample sizes. In this study we are set to identify those sociodemographic and clinical features that predict in-facility mortality among EVD patients using a large sample size. METHODS: We analysed the anonymized medical records of 938 laboratory-confirmed EVD patients 15 years old and above who received treatment at The 34 Military Hospital and The Police Training School EVD Treatment Centers in Sierra Leone in the period June 2014 to April 2015. We used both univariable and multivariable logistic regression to determine the predictors for in-facility mortality of these patients based on their sociodemographic and clinical characteristics. RESULTS: The median age of the EVD cases was 33 years (interquartile range = 25 to 40 years). The majority of the EVD cases were male (59.0%) and had secondary level education (79.3%). We reported a low overall in-facility case fatality rate of 26.4%. The associations between case fatality rates and EVD patients who reported fever, abdominal pain, cough, diarrhoea, vomiting, fatigue, haemorrhage, dysphagia, conjunctival injection, dyspnea, and skin rash at the time of admission were all statistically significant (p <  0.05). Our preferred model with the age group 65 years and above alongside the following clinical symptoms; diarrhoea, vomiting, fatigue, dysphagia, conjunctival injection, dyspnea and cough produced a receiver operating characteristic (ROC) curve with an AUC (area under the curve) value of 0.93. CONCLUSIONS: We constructed a simple model that can be optimally used alongside other rapid EVD diagnostic tools to identify EVD in-facility treatment mortality predictors based on the sociodemographic characteristics and clinical symptoms of adult EVD patients. We also reported low EVD cases among patients with secondary and tertiary education. These subpopulations of our patients who are generally informed about the signs and symptoms of EVD, alongside our treatment regimen may have been responsible for our comparatively lower case fatality rate.

Update on Ebola Treatment Center Costs and Sustainability, United States, 2019.

We surveyed 56 Ebola treatment centers (ETCs) in the United States and identified costs incurred since 2014 ($1.76 million/ETC) and sustainability strategies. ETCs reported heavy reliance on federal funding. It is uncertain if, or for how long, ETCs can maintain capabilities should federal funding expire in 2020.

Ebola virus disease in children in Conakry and Coyah Ebola treatment centers and risk factors associated with death.

OBJECTIVE: To study Ebola virus disease (EVD) in children aged 15 years and below, and to identify risk factors associated with death. PATIENTS AND METHODS: Retrospective, multicenter, descriptive, and analytical study of files of children aged 15 years and below in Ebola treatment centers (ETC) of Donka from March 2014 to May 2015. We included all files of children aged 15 years and below hospitalized for EVD in the two ETCs. RESULTS: A total of 739 patients hospitalized in both ETCs, 146 children aged 15 years and below (20%) were registered during the study period. The mean age of children was 6.73±4.26 years. Most children were aged above five years (65.8%) and the mean time to consultation was 4.34±3.21 days. The main clinical signs were asthenia (78.8%), fever (75.3%), anorexia (53.4%), headache (45.9%), vomiting (41.8%), abdominal pain (29.5%), and diarrhea (28.8%). The case fatality was 48%, including 54.3% in Coyah and 45% in Conakry. Older age (aOR=0.83, 95% CI [0.76-0.95]), fever (aOR=3.28, 95% CI [1.22-8.87]), diarrhea (aOR=2.98, 95% CI [1.19-4.48]), and hemorrhage (aOR=3.13, 95% CI [1.00-10.38]) were independently associated with death due to EVD. CONCLUSION: EVD remains serious especially in children, with high case fatality. Risk factors independently associated with death were young age, diarrhea, hemorrhage, and fever. Particular attention to these risk factors and vaccination will contribute to improving the prognosis of EVD in children.

Nutritional Care for Patients with Ebola Virus Disease.

During the Ebola virus disease (EVD) outbreak of 2014-2016 in West Africa, practitioners faced challenges providing nutritional care for patients in Ebola treatment units (ETUs). The current EVD outbreak in the Democratic Republic of the Congo demonstrates the need to understand lessons learned from previous outbreaks and to update nutritional guidelines. We conducted a literature review to identify articles that included nutrition as an integral part of supportive care. We found little information on the specific nutritional care or practical challenges within an ETU. This review showed that nutritional care for EVD patients is poorly described, and therefore the optimal composition and implementation of nutritional care remain unknown. We recommend that researchers and practitioners share specific and practical details of their experiences in providing nutritional support within ETUs to expand the knowledge base and ultimately improve the nutritional care for an increasingly prevalent patient population.

Epidemiological characteristics, clinical manifestations, and treatment outcome of 139 paediatric Ebola patients treated at a Sierra Leone Ebola treatment center.

BACKGROUND: The West Africa Ebola Virus Disease (EVD) outbreak in 2014-2016 was declared by the World Health Organization (WHO) a public health emergency of international concern. Most of the previous studies done in Sierra Leone relating to the clinical and epidemiological features of EVD during the 2014-2016 West African outbreak focused on adult EVD patients. There have been conflicting reports about the effects of EVD on children during previous outbreaks. METHODS: This is an observational retrospective analysis of medical data of all laboratory confirmed paediatric EVD patients below 15 years of age who were admitted at the 34 Military Hospital Ebola Treatment Center (ETC) in Wilberforce, Sierra Leone between June 2014 to April 2015. We analyzed the sociodemographic and clinical characteristics of paediatric EVD cases contained in case report forms that were collected by Ebola surveillance officers and clinicians at the 34 Military Hospital ETC. Both univariate and multivariate logistic regression models were used to determine the sociodemographic and clinical characteristics of paediatric EVD patients that were associated with EVD facility-based mortality. RESULTS: The majority of the paediatric EVD cases in this study were female (56.1%), pupils (51.1%), and 43.2% belonged to the age group between 10 years and below 15 years. The median age of the paediatric EVD cases was 9 years (interquartile range = 4 to 11 years). Adjusting for other covariates in the model, male paediatric EVD patient (AOR = 13.4, 95% CI = [2.07-156-18], p <  0.05), EVD patient with abdominal pain (AOR = 11.0, 95% CI = [1.30-161.81], p <  0.05), vomiting (AOR = 35.7, 95% CI = [3.43-833.73], p <  0.05), signs of conjunctivitis (AOR = 17.4, 95% CI = [1.53-342.21], p <  0.05) and difficulty in breathing (AOR = 23.3, 95% CI = [1.92-713.01], p <  0.05) at the time of admission had increased odds of dying during EVD treatment. CONCLUSIONS: We recommend the adoption of case definitions currently in vigour to cater for specific characteristics of paediatric patients. Subgroups that can be identified by applying the model developed in this study may require special attention and intensified care.

Ebola Therapeutic Study and Future Directions.

The constant Ebola epidemic outbreaks in Africa arisen in waves of panic worldwide. There is a high mortality rate (30-70%) among the Ebola-infected people in virus- stricken areas. Despite these horrors, the medical capabilities against this deadly viral disease were provided by limited therapeutic agents/options. As a result, several patented agents, biotherapies or prophylactic/therapeutic vaccines need to be reviving into the global markets-including patents of small molecular chemicals, short sequences or oligomers of DNA/RNA, linkages of chemicals with bio-molecules, herbal medicine and so on. In addition, the possible mechanisms of action of these therapeutic options are underway. To promote Ebola biomedical study, the multiple characters of Ebola infections-its origin, pathologic progress, genomic changes, therapeutic context and economic considerations are outlined in this review. Finally, a great difference can be expected after these types of efforts.

Experiences and challenges in the health protection of medical teams in the Chinese Ebola treatment center, Liberia: a qualitative study.

BACKGROUND: Health care workers are at the frontline in the fight against infectious disease, and as a result are at a high risk of infection. During the 2014-2015 Ebola outbreak in West Africa, many health care workers contracted Ebola, some fatally. However, no members of the Chinese Anti-Ebola medical team, deployed to provide vital medical care in Liberia were infected. This study aims to understand how this zero infection rate was achieved. METHODS: Data was collected through 15 in-depth interviews with participants from the People's Liberation Army of China medical team which operated the Chinese Ebola Treatment Center from October 2014 to January 2015 in Liberia. Data were analysed using systematic framework analysis. RESULTS: This study found numerous bio-psycho-socio-behavioural risk factors that directly or indirectly threatened the health of the medical team working in the Chinese Ebola Treatment Center. These factors included social and emotional stress caused by: (1) the disruption of family and social networks; (2) adapting to a different culture; (3) and anxiety over social and political unrest in Liberia. Exposure to Ebola from patients and local co-workers, and the incorrect use of personal protective equipment due to fatigue was another major risk factor. Other risk factors identified were: (1) shortage of supplies; (2) lack of trained health personnel; (3) exposure to contaminated food and water; (4) and long working hours. Comprehensive efforts were taken throughout the mission to mitigate these factors. Every measure was taken to prevent the medical team's exposure to the Ebola virus, and to provide the medical team with safe, comfortable working and living environments. There were many challenges in maintaining the health safety of the team, such as the limited capability of the emergency command system (the standardized approach to the command, control, and coordination of an emergency response), and the lack of comprehensive international protocols for dealing with emerging infectious disease pandemics. CONCLUSIONS: The comprehensive and multidisciplinary measures employed to protect the health of the medical team proved successful even in Liberia's resource-limited setting. The global health community can learn valuable lessons from this experience which could improve the safety of health care workers in future emergencies. These lessons include: establishing capable command systems; implementing effective coordination mechanisms; providing adequate equipment; providing training for medical teams; investing in the development of global health professionals; and improving research on ways to protect health care workers.

Knowledge, Attitudes, and Practices among Members of Households Actively Monitored or Quarantined to Prevent Transmission of Ebola Virus Disease - Margibi County, Liberia: February-March 2015.

BACKGROUND: In early 2015, a patient from a cluster of cases of Ebola Virus Disease (EVD) in Monrovia, Liberia traveled to a rural village in Margibi County, potentially exposing numerous persons. The patient died in the village and post-mortem testing confirmed Ebola Virus infection. Problem The Margibi County Health Team (CHT; Kakata, Margibi, Liberia) needed to prevent further transmission of EVD within and outside of the affected villages, and they needed to better understand the factors that support or impede compliance with measures to stop the spread of EVD. METHODS: In February-March 2015, the Margibi CHT instituted a 21-day quarantine and active monitoring for two villages where the patient had contact with numerous residents, and a 21-day active monitoring for five other villages where the patient had possible contact with an unknown number of persons. One contact developed EVD and quarantine was extended an additional 12 days in one village. In April 2015, the Margibi CHT conducted a household-based EVD knowledge, attitudes, and practices (KAP) survey of the seven villages. From April 24-29, 2015, interview teams approached every household in the seven villages and collected information on demographics, knowledge of EVD, attitudes about quarantine to prevent the spread of EVD, and their quarantine experiences and practices. Descriptive statistics were calculated. RESULTS: One hundred fifteen interviews were conducted, representing the majority of the households in the seven villages. Most (99%) correctly identified touching an infected person's body fluids and contact with the body of someone who has died from EVD as transmission routes. However, interviewees sometimes incorrectly identified mosquito bites (58%) and airborne spread (32%) as routes of EVD transmission, and 72% incorrectly identified the longest EVD incubation period as ≤seven days. Eight of 16 households in the two quarantined villages (50%) reported times when there was not enough water or food during quarantine. Nine of 16 (56%) reported that a household member had illnesses or injuries during quarantine; of these, all (100%) obtained care from a clinic, hospital, or Ebola treatment unit (ETU). CONCLUSION: Residents' knowledge of EVD transmission routes and incubation period were suboptimal. Public health authorities should consider assessing residents' understanding of Ebola transmission routes and effectively educate them to ensure correct understanding. Quarantined residents should be provided with sufficient food, water, and access to medical care. Wilken JA , Pordell P , Goode B , Jarteh R , Miller Z , Saygar BG Sr. , Maximore L , Borbor WM , Carmue M , Walker GW , Yeiah A . Knowledge, attitudes, and practices among members of households actively monitored or quarantined to prevent transmission of Ebola Virus Disease - Margibi County, Liberia: February-March 2015. Prehosp Disaster Med. 2017;32(6):673-678.

Personal protective equipment solution for UK military medical personnel working in an Ebola virus disease treatment unit in Sierra Leone.

The combination of personal protective equipment (PPE) together with donning and doffing protocols was designed to protect British and Canadian military medical personnel in the Kerry Town Ebola Treatment Unit (ETU) in Sierra Leone. The PPE solution was selected to protect medical staff from infectious risks, notably Ebola virus, and chemical (hypochlorite) exposure. PPE maximized dexterity, enabled personnel to work in hot temperatures for periods of up to 2h, protected mucosal membranes when doffing outer layers, and minimized potential contamination of the doffing area with infectious material by reducing the requirement to spray PPE with hypochlorite. The ETU was equipped to allow medical personnel to provide a higher level of care than witnessed in many existing ETUs. This assured personnel working as part of the international response that they would receive as close to Western treatment standards as possible if they were to contract Ebola virus disease (EVD). PPE also enabled clinical interventions that are not seen routinely in West African EVD treatment regimens, whilst providing a robust protective barrier. Competency in using PPE was developed during a nine-day pre-deployment training programme. This allowed over 60 clinical personnel per deployment to practice skills in PPE in a simulated ETU and in classrooms. Overall, the training provided: (i) an evidence base underpinning the PPE solution chosen; (ii) skills in donning and doffing of PPE; (iii) personnel confidence in the selected PPE; and (iv) quantifiable testing of each individual's capability to don PPE, perform tasks and doff PPE safely.

Ebola Virus RNA in Semen from an HIV-Positive Survivor of Ebola.

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.

Influence of Referral Pathway on Ebola Virus Disease Case-Fatality Rate and Effect of Survival Selection Bias.

Case-fatality rates in Ebola treatment centers (ETCs) varied widely during the Ebola virus disease (EVD) outbreak in West Africa. We assessed the influence of referral pathway on ETC case-fatality rates with a retrospective cohort of 126 patients treated at the Mathaska ETC in Port Loko, Sierra Leone. The patients consisted of persons who had confirmed EVD when transferred to the ETC or who had been diagnosed onsite. The case-fatality rate for transferred patients was 46% versus 67% for patients diagnosed onsite (p = 0.02). The difference was mediated by Ebola viral load at diagnosis, suggesting a survival selection bias. Comparisons of case-fatality rates across ETCs and clinical management strategies should account for potential survival selection bias.

Beyond Ebola treatment units: severe infection temporary treatment units as an essential element of Ebola case management during an outbreak.

In the course of the Ebola outbreak in West Africa that was witnessed since early 2014, the response mechanisms showed deficits in terms of timeliness, volume and adequacy. The authors were deployed in the Ebola campaign in the West African country Liberia, where by September 2014 the changing epidemiological pattern made reconsiderations of guidelines and adopted procedures necessary. A temporary facility set up as a conventional Ebola Treatment Unit in the Liberian capital Monrovia was re-dedicated into a Severe Infections Temporary Treatment Unit. This facility allowed for stratification based on the nosocomial risk of exposure to Ebola virus for a growing subgroup of admitted patients that in the end would turn out as Ebola negative cases. At the same time, adequate diagnostic measures and treatment for the non-Ebola conditions of these patients could be provided without compromising work safety of the employed staff. The key elements of the new unit comprised a Suspect Cases Area similar to that of conventional Ebola treatment units for newly arriving patients, an Unlikely Cases Area for patients with a first negative Ebola PCR result, and a Confirmed Negative Cases Area for patients in whom Ebola could be ruled out. The authors, comprising representatives of the Liberian Ministry of Health and Social Welfare, as well as infectious disease specialists from the German Ebola Task Force are presenting key features of the adapted concept, and are highlighting its relevance in raising acceptance for outbreak counter-measures within the population at stake.

Experiences of Ebola Survivors: Causes of Distress and Sources of Resilience.

Introduction An appreciation of the experience of Ebola survivors is critical for community engagement and an effective outbreak response. Few qualitative, descriptive studies have been conducted to date that concentrate on the voices of Ebola survivors. Problem This study aimed to explore the experiences of Ebola survivors following the West African epidemic of 2014. METHOD: An interpretive, qualitative design was selected using semi-structured interviews as the method of data collection. Data were collected in August 2015 by Médecins Sans Frontières (MSF) Belgium, for the purposes of internal evaluation. Data collection occurred at three sites in Liberia and Sierra Leone and involved 25 participants who had recovered from Ebola. Verbal consent was obtained, audio recordings were de-identified, and ethics approval was provided by Monash University (Melbourne, Australia). Findings Two major themes emerged from the study: "causes of distress" and "sources of resilience." Two further sub-themes were identified from each major theme: the "multiplicity of death," "abandonment," "self and community protection and care," and "coping resources and activities." The two major themes were dominant across all three sample groups, though each survivor experienced infection, treatment, and recovery differently. CONCLUSIONS: By identifying and mobilizing the inherent capacity of communities and acknowledging the importance of incorporating the social model of health into culturally competent outbreak responses, there is an opportunity to transcend the victimization effect of Ebola and empower communities, ultimately strengthening the response. Schwerdtle PM , De Clerck V , Plummer V . Experiences of Ebola survivors: causes of distress and sources of resilience. Prehosp Disaster Med. 2017;32(3):234-239.