S Rae Wannier1, Lee Worden2, Nicole A Hoff3, Eduardo Amezcua4, Bernice Selo5, Cyrus Sinai6, Mathias Mossoko5, Bathe Njoloko5, Emile Okitolonda-Wemakoy7, Placide Mbala-Kingebeni8, Steve Ahuka-Mundeke8, Jean Jacques Muyembe-Tamfum8, Eugene T Richardson9, George W Rutherford2, James H Jones10, Thomas M Lietman11, Anne W Rimoin3, Travis C Porco11, J Daniel Kelly12. 1. Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA. 2. Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA. 3. Department of Epidemiology, School of Public Health University of California, Los Angeles, CA, USA. 4. Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA. 5. Ministry of Health, Kinshasa, Democratic Republic of Congo. 6. Department of Geography at University of North Carolina, Chapel Hill, NC, USA. 7. School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo. 8. Insitut National de Recherche Biomedicale, Kinshasa, Democratic Republic of Congo. 9. Global Health and Social Medicine, Harvard Medical School, MA, USA. 10. Department of Earth System Science, Stanford University, Stanford, CA, USA; Woods Institute for the Environment, Stanford University, Stanford, CA, USA. 11. Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Ophthalmology, School of Medicine, University of California, San Francisco, San Francisco, CA, USA. 12. Francis I. Proctor Foundation for Research in Ophthalmology, San Francisco, University of California, CA, USA; Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA. Electronic address: dan.kelly@ucsf.edu.
Abstract
INTRODUCTION: As of April 2019, the current Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) is occurring in a longstanding conflict zone and has become the second largest EVD outbreak in history. It is suspected that after violent events occur, EVD transmission will increase; however, empirical studies to understand the impact of violence on transmission are lacking. Here, we use spatial and temporal trends of EVD case counts to compare transmission rates between health zones that have versus have not experienced recent violent events during the outbreak. METHODS: We collected daily EVD case counts from DRC Ministry of Health. A time-varying indicator of recent violence in each health zone was derived from events documented in the WHO situation reports. We used the Wallinga-Teunis technique to estimate the reproduction number R for each case by day per zone in the 2018-2019 outbreak. We fit an exponentially decaying curve to estimates of R overall and by health zone, for comparison to past outbreaks. RESULTS: As of 16 April 2019, the mean overall R for the entire outbreak was 1.11. We found evidence of an increase in the estimated transmission rates in health zones with recently reported violent events versus those without (p = 0.008). The average R was estimated as between 0.61 and 0.86 in regions not affected by recent violent events, and between 1.01 and 1.07 in zones affected by violent events within the last 21 days, leading to an increase in R between 0.17 and 0.53. Within zones with recent violent events, the mean estimated quenching rate was lower than for all past outbreaks except the 2013-2016 West African outbreak. CONCLUSION: The difference in the estimated transmission rates between zones affected by recent violent events suggests that violent events are contributing to increased transmission and the ongoing nature of this outbreak.
INTRODUCTION: As of April 2019, the current Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) is occurring in a longstanding conflict zone and has become the second largest EVD outbreak in history. It is suspected that after violent events occur, EVD transmission will increase; however, empirical studies to understand the impact of violence on transmission are lacking. Here, we use spatial and temporal trends of EVD case counts to compare transmission rates between health zones that have versus have not experienced recent violent events during the outbreak. METHODS: We collected daily EVD case counts from DRC Ministry of Health. A time-varying indicator of recent violence in each health zone was derived from events documented in the WHO situation reports. We used the Wallinga-Teunis technique to estimate the reproduction number R for each case by day per zone in the 2018-2019 outbreak. We fit an exponentially decaying curve to estimates of R overall and by health zone, for comparison to past outbreaks. RESULTS: As of 16 April 2019, the mean overall R for the entire outbreak was 1.11. We found evidence of an increase in the estimated transmission rates in health zones with recently reported violent events versus those without (p = 0.008). The average R was estimated as between 0.61 and 0.86 in regions not affected by recent violent events, and between 1.01 and 1.07 in zones affected by violent events within the last 21 days, leading to an increase in R between 0.17 and 0.53. Within zones with recent violent events, the mean estimated quenching rate was lower than for all past outbreaks except the 2013-2016 West African outbreak. CONCLUSION: The difference in the estimated transmission rates between zones affected by recent violent events suggests that violent events are contributing to increased transmission and the ongoing nature of this outbreak.
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Authors: Thibaut Jombart; Christopher I Jarvis; Samuel Mesfin; Nabil Tabal; Mathias Mossoko; Luigino Minikulu Mpia; Aaron Aruna Abedi; Sonia Chene; Ekokobe Elias Forbin; Marie Roseline D Belizaire; Xavier de Radiguès; Richy Ngombo; Yannick Tutu; Flavio Finger; Madeleine Crowe; W John Edmunds; Justus Nsio; Abdoulaye Yam; Boubacar Diallo; Abdou Salam Gueye; Steve Ahuka-Mundeke; Michel Yao; Ibrahima Socé Fall Journal: Euro Surveill Date: 2020-01