Rapid Response to Ebola Outbreaks in Remote Areas – Liberia, July-November 2014

Details

• Journal Article:
  Morbidity and Mortality Weekly Report (MMWR)
• Personal Author:
  Adams, Laura ; Appiah, Grace ; Arzoaquoi, Samson K. ; Attfield, Kathleen ; Barradas, Danielle ; Barskey, Albert ; Belcher, Lisa ; Blackley, David J. ; Bowah, Collin ; Broyles, Laura N. ; Calvert, Geoffrey M. ; Castro, Georgina ; Christie, Athalia ; Cole, Isaac B. ; Cooper, Lorraine ; Dea, Monica ; DeCock, Kevin M. ; Driscoll, Anne ; Dweh, Emmanuel ; Fomba, Moses ; Forrester, Joseph ; Frank, Wilmont ; Gasasira, Alex Ntale ; Gee, Samuel ; Grube, Steven ; Gupta, Sundeep ; Hagan, Jose E. ; Hennessey, Morgan ; James, Stephen ; Karmo, Ben ; Kassay, Gabriel ; Kateh, Francis N. ; Kieta, Abraham ; Kirking, Hannah L. ; Koon, Hawa ; Larway, Lawrence ; Lindblade, Kim A. ; Logan, Gorbee ; Lubogo, Mutaawe ; Mahoney, Frank ; Malibiche, Theophil ; Massoudi, Mehran ; Maxwell, Nikki ; Montgomery, Joel ; Moonan, Patrick ; Mott, Joshua A. ; Nagbe, Thomas ; Neatherlin, John C. ; Nelson, Themla ; Nyenswah, Tolbert G. ; Papowitz, Heather ; Patel, Monita ; Pillai, Satish K. ; Powell, Krista M. ; Santos, Marjorie ; Scott, Colleen ; Slutsker, Laurence ; Smith, Wilmot ; Tappero, Jordan W. ; Tucker, Anthony ; Walke, Henry T. ; Warren, Felicia ; Weinberg, Meghan P. ; Westercamp, Matthew ; Williams, Seymour G. ; Woodring, Joseph ; Yeoman, Kristin ; Yett, Sheldon ; Zarecki, Shauna M. ; Zayzay, Samuel
• Description:
  West Africa is experiencing its first epidemic of Ebola virus disease (Ebola). As of February 9, Liberia has reported 8,864 Ebola cases, of which 3,147 were laboratory-confirmed. Beginning in August 2014, the Liberia Ministry of Health and Social Welfare (MOHSW), supported by CDC, the World Health Organization (WHO), and others, began systematically investigating and responding to Ebola outbreaks in remote areas. Because many of these areas lacked mobile telephone service, easy road access, and basic infrastructure, flexible and targeted interventions often were required. Development of a national strategy for the Rapid Isolation and Treatment of Ebola (RITE) began in early October. The strategy focuses on enhancing capacity of county health teams (CHT) to investigate outbreaks in remote areas and lead tailored responses through effective and efficient coordination of technical and operational assistance from the MOHSW central level and international partners. To measure improvements in response indicators and outcomes over time, data from investigations of 12 of 15 outbreaks in remote areas with illness onset dates of index cases during July 16 - November 20, 2014, were analyzed. The times to initial outbreak alerts and durations of the outbreaks declined over that period while the proportions of patients who were isolated and treated increased. At the same time, the case-fatality rate in each outbreak declined. Implementation of strategies, such as RITE, to rapidly respond to rural outbreaks of Ebola through coordinated and tailored responses can successfully reduce transmission and improve outcomes. Outbreaks in remote areas posed a significant challenge to CHTs to mount an effective investigation and rapid response because of limited resources, personnel, and means to reach remote areas. The RITE strategy provided a framework to coordinate assistance from the central MOHSW and other agencies under the leadership of the CHT and developed several tools to help plan, manage, and track a response effort. The objectives of the investigation and response teams were to 1) rapidly isolate and treat Ebola patients, either by establishing isolation and treatment facilities in the community or by safely transporting patients to existing Ebola treatment units (ETUs); 2) ensure proper collection and safe transportation of samples for Ebola laboratory confirmation; 3) ascertain the index case (the first person in the transmission chain who entered the community from another county in Liberia) in each outbreak to better understand importation and transmission patterns; 4) identify all generations of cases by improving case finding and contact tracing to ensure no cases were missed; 5) train teams in safe burial procedures; and 6) observe contacts for 21 days from the death or ETU admission of the last case to ensure interruption of transmission. Investigation and response teams included Liberian MOHSW national and county representatives, CDC, WHO, the United Nations Children's Fund, and other multilateral and nongovernmental organizations. [Description provided by NIOSH]
• Subjects:
  Communicable Diseases Occupational Health Preventive Medicine Safety Viral Diseases
• Keywords:
  Infection-control Infectious-diseases Preventive-medicine Surveillance Viral-diseases Viral-infections
• Series:
  Weekly Report: Morbidity and Mortality Weekly Report (MMWR)
• ISSN:
  0149-2195 (print) ; 1545-861X (digital)
• Publisher:
  Centers for Disease Control and Prevention (CDC) (U.S.)
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Liberia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DSHEFS - Division of Surveillance, Hazard Evaluations, and Field Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  7 pdf pages
• Volume:
  64
• Issue:
  7
• NIOSHTIC Number:
  nn:20046114
• Citation:
  MMWR 2015 Feb; 64(7):188-192
• Federal Fiscal Year:
  2015
• Peer Reviewed:
  False
• Collection(s):
  National Institute for Occupational Safety and Health Morbidity and Mortality Weekly Report (MMWR)
• Main Document Checksum:
  urn:sha-512:738f3dd4a513731240033cf4fd79540abf57b8fc4a7a81c263ddac643b249a4592380ad2c2776faf7fe97ba5c3b7418f66613ada82b531991edca07e3bc8282a
• Download URL:
  https://stacks.cdc.gov/view/cdc/183274/cdc_183274_DS1.pdf
• File Type:
  [PDF - 707.95 KB ]