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. 2015 Nov;21(11):1897-905.
doi: 10.3201/eid2111.150949.

Ebola in West Africa--CDC's Role in Epidemic Detection, Control, and Prevention

Ebola in West Africa--CDC's Role in Epidemic Detection, Control, and Prevention

Thomas R Frieden et al. Emerg Infect Dis. 2015 Nov.

Abstract

Since Ebola virus disease was identified in West Africa on March 23, 2014, the Centers for Disease Control and Prevention (CDC) has undertaken the most intensive response in the agency's history; >3,000 staff have been involved, including >1,200 deployed to West Africa for >50,000 person workdays. Efforts have included supporting incident management systems in affected countries; mobilizing partners; and strengthening laboratory, epidemiology, contact investigation, health care infection control, communication, and border screening in West Africa, Nigeria, Mali, Senegal, and the United States. All efforts were undertaken as part of national and global response activities with many partner organizations. CDC was able to support community, national, and international health and public health staff to prevent an even worse event. The Ebola virus disease epidemic highlights the need to strengthen national and international systems to detect, respond to, and prevent the spread of future health threats.

Keywords: CDC; Centers for Disease Control and Prevention; Ebola virus; Guinea; Liberia; Sierra Leone; West Africa; epidemics; viruses.

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Figures

Figure 1
Figure 1
Decreased size and duration of outbreaks in remote areas before and after implementation of the Rapid Isolation and Treatment of Ebola (RITE) strategy, Liberia, 2014. Size of circle is proportional to number of cases in cluster.
Figure 2
Figure 2
Estimated impact of delaying intervention on daily number of Ebola virus disease cases, Liberia, 2014–2015. The intervention modeled is as follows: starting on September 23, 2014 (day 181 in model), and for the next 30 days, the percentage of all patients in Ebola treatment units increased from 10% to 13%. This percentage was again increased on October 23, 2014 (day 211 in model) to 25%, on November 22, 2014 (day 241 in model) to 40%, and finally on December 22, 2014 (day 271 in model) to 70%. Day 1 in model is March 3, 2014. The impact of a delay of starting the increase in interventions was then estimated by twice repeating the above scenario but setting the start day on either October 23, 2014, or November 22, 2014. When the intervention is started on November 22, 2014, the peak is not reached by January 20, 2015, which is the last date included in the model. Graph based on Figure 10 in Meltzer et al. (22).
Figure 3
Figure 3
Comparison of estimated weekly Ebola virus disease case rate for Liberia with intervention with actual weekly case rates for Liberia and Sierra Leone. The September 2014 modeled projection curve was based on Figures 9 and 10 in Meltzer et al. (22), by using model predictions calculated assuming that interventions started on September 24, 2014. Liberia, week 1 begins May 4, 2014; Sierra Leone, week 1 begins May 25, 2014. The model projected the incidence that would occur if the proportion of Ebola patients who were hospitalized was 25% at week 22, increased to 40% at week 26, and increased again to 70% at week 30, while the proportion in effective home isolation remained constant at 10%. The similarity in the increase and decrease in the actual epidemic curves in both Sierra Leone and Liberia closely match the model after taking into account differences in start dates and population sizes between the 2 countries, implying that the proportion of cases effectively isolated in both countries followed a similar time course as the model.
Figure 4
Figure 4
Comparison of the estimated impact of interventions on number of Ebola cases with actual cases reported, Liberia, 2014–2015. The September 2014 modeled projection curve was based on Figure 3 in Meltzer et al. (22) by using model predictions calculated assuming that interventions started on September 24, 2014. The corrected curve of projected cases is adjusted for potential underreporting by multiplying reported cases by a factor of 2.5. Actual reported cases are from World Health Organization situation report for January 21, 2015 (26).

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