Cluster of Ebola Virus Disease, Bong and Montserrado Counties, Liberia

Details

• Alternative Title:
  Emerg Infect Dis
• Journal Article:
  Emerging Infectious Diseases
• Personal Author:
  Nyenswah, Tolbert G. ; Fallah, Mosoka ; Calvert, Geoffrey M. ; Duwor, Stanley ; Hamilton, E. Dutch ; Mokashi, Vishwesh ; Arzoaquoi, Samson K. ; Dweh, Emmanuel ; Burbach, Ryan ; Dlouhy, Diane ; Oeltmann, John E. ; Moonan, Patrick K.
• Description:
  Lack of trust in government-supported services after the death of a health care worker with symptoms of Ebola resulted in ongoing Ebola transmission in 2 Liberia counties. Ebola transmission was facilitated by attempts to avoid cremation of the deceased patient and delays in identifying and monitoring contacts. Identifying sources of infection for index patients and tracing contacts are major components of EVD prevention and control efforts, yet carrying out these policies is challenging when those ill with EVD do not reveal the names of possible sources or contacts who could have been exposed to disease. Detection delays and ineffective contact tracing occurred in this cluster in part because the family believed that the mandatory cremation and property destruction taken as public health actions in Monrovia harmed more than helped. Consequently, some family members sought care in Bong County, riding 4 hours in a taxi from their home in Monrovia, a distance of .197 kilometers. Furthermore, family members were reluctant to reveal contact names in Monrovia and initially concealed knowledge of symptomatic persons. This cluster may have been prevented if patient 0, presumably infected at the clinic where he worked, had been trained in infection control procedures and had access to personal protective equipment. Additional exposures and subsequent infections could have been prevented if he had been identified earlier as a suspected EVD patient, if testing had been performed on his body, if the results had been reported to the family, and if the Monrovia contacts had been followed daily to identify, isolate, and treat symptomatic persons. Had contact tracing identified patients 1-3 as patient 0's contacts and isolated them immediately after symptoms developed, 6 cases of EVD (in patients 4-9) and 4 deaths (patients 4, 5, 7, and 8) might have been prevented. Rapid implementation of contact tracing to prevent disease transmission and increased coordination and communication between jurisdictions are critical to control of EVD. These efforts can identify case-patients who may have entered the community from another jurisdiction (to better understand importation and transmission patterns) and improve case finding and contact tracing to ensure that no cases are missed. The effectiveness of these efforts depends on trust between public health officials and the communities they serve. [Description provided by NIOSH]
• Subjects:
  Cluster Analysis Communicable Diseases Contact Tracing Disease Vectors Fatal Outcome Health Personnel Hemorrhagic Fever, Ebola Mortality Occupational Health Personal Protective Equipment Risk Assessment Risk Factors Safety

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• Keywords:
  Diseases; Disease-transmission; Disease-control; Disease-vectors; Health-care-personnel; Medical-personnel; Infectious-diseases; Monitoring-systems; Exposure-levels; Risk-factors; Personal-protection; Personal-protective-equipment; Surveillance
• Source:
  Emerg Infect Dis 2015 Jul; 21(7):1253-1256
• ISSN:
  1080-6040
• Pubmed ID:
  26079309
• Pubmed Central ID:
  PMC4480411
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  California ; Georgia ; Maryland ; Ohio ; OSHA Region 3 ; OSHA Region 4 ; OSHA Region 5 ; OSHA Region 9 ; Liberia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DSHEFS - Division of Surveillance, Hazard Evaluations, and Field Studies
• Topic:
  Global Health
• Location:
  Africa
• Pages in Document:
  4 pdf pages
• Volume:
  21
• Issue:
  7
• NIOSHTIC Number:
  nn:20046440
• Contact Point Address:
  Patrick K. Moonan, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E10, Atlanta, GA 30329-4027
• Email:
  pmoonan@cdc.gov
• Federal Fiscal Year:
  2015
• Peer Reviewed:
  True
• Collection(s):
  Emerging Infectious Diseases National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:47b740f4287a25e6bbe6731757e7284b69d1a89b7cf6799ed131f61bd03578aa0644735065ea7f4ecb5d2e069fd45bd897acbb4942381956cdc9f13fb08080a2
• Download URL:
  https://stacks.cdc.gov/view/cdc/31851/cdc_31851_DS1.pdf
• File Type:
  [PDF - 688.91 KB ]