A community-based contact isolation strategy to reduce the spread of Ebola virus disease: an analysis of the 2018-2020 outbreak in the Democratic Republic of the Congo.

Autor:	Keita M; Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo mokeita@who.int.; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland., Polonsky JA; Geneva Centre of Humanitarian Studies, University of Geneva, Geneva, Switzerland., Ahuka-Mundeke S; Département de Virologie, Institut National de Recherche Biomédicale, Kinshasa, Congo (the Democratic Republic of the)., Ilumbulumbu MK; Zone de Santé de Béni, Ministère Provinciale de la Santé, Goma, Congo (the Democratic Republic of the)., Dakissaga A; Direction Régionale de la Santé du Plateau Central, Ministère de la Santé et de l'Hygiène Publique, Ziniaré, Burkina Faso., Boiro H; Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo., Anoko JN; Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo., Diassy L; Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo., Ngwama JK; Direction Générale de la Lutte contre la Maladie, Ministère de la Santé, Kinshasa, Democratic Republic of Congo., Bah H; Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo., Tosalisana MK; Zone de Santé de Béni, Ministère Provinciale de la Santé, Goma, Congo (the Democratic Republic of the)., Kitenge Omasumbu R; Equipe Médicale d'Urgence, Ministère de la Santé Publique, Kinshasa, Congo (the Democratic Republic of the)., Chérif IS; Country Office for Guinea, World Health Organization, Conakry, Guinea., Boland ST; Centre for Universal Health, Chatham House, London, UK., Delamou A; African Centre of Excellence for the Prevention and Control of Communicable Diseases, Gamal Abdel Nasser University of Conakry, Conakry, Guinea., Yam A; Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo., Flahault A; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland., Dagron S; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland., Gueye AS; Emergency Preparedness and Response, World Health Organization Regional Office for Africa, Brazzaville, Congo., Keiser O; Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland., Fall IS; Global Neglected Tropical Diseases programme, World Health Organization, Geneva, Switzerland.
Jazyk:	angličtina
Zdroj:	BMJ global health [BMJ Glob Health] 2023 Jun; Vol. 8 (6).
DOI:	10.1136/bmjgh-2023-011907
Abstrakt:	Introduction: Despite tremendous progress in the development of diagnostics, vaccines and therapeutics for Ebola virus disease (EVD), challenges remain in the implementation of holistic strategies to rapidly curtail outbreaks. We investigated the effectiveness of a community-based contact isolation strategy to limit the spread of the disease in the Democratic Republic of Congo (DRC). Methods: We did a quasi-experimental comparison study. Eligible participants were EVD contacts registered from 12 June 2019 to 18 May 2020 in Beni and Mabalako Health Zones. Intervention group participants were isolated to specific community sites for the duration of their follow-up. Comparison group participants underwent contact tracing without isolation. The primary outcome was measured as the reproduction number (R) in the two groups. Secondary outcomes were the delay from symptom onset to isolation and case management, case fatality rate (CFR) and vaccination uptake. Results: 27 324 EVD contacts were included in the study; 585 in the intervention group and 26 739 in the comparison group. The intervention group generated 32 confirmed cases (5.5%) in the first generation, while the comparison group generated 87 (0.3%). However, the 32 confirmed cases arising from the intervention contacts did not generate any additional transmission (R=0.00), whereas the 87 confirmed cases arising from the comparison group generated 99 secondary cases (R=1.14). The average delay between symptom onset and case isolation was shorter (1.3 vs 4.8 days; p<0.0001), CFR lower (12.5% vs 48.4%; p=0.0001) and postexposure vaccination uptake higher (86.0% vs 56.8%; p<0.0001) in the intervention group compared with the comparison group. A significant difference was also found between intervention and comparison groups in survival rate at the discharge of hospitalised confirmed patients (87.9% vs 47.7%, respectively; p=0.0004). Conclusion: The community-based contact isolation strategy used in DRC shows promise as a potentially effective approach for the rapid cessation of EVD transmission, highlighting the importance of rapidly implemented, community-oriented and trust-building control strategies. Competing Interests: Competing interests: None declared. (© World Health Organization 2023. Licensee BMJ.)
Databáze:	MEDLINE
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