Diagnostic schemes for reducing epidemic size of african viral hemorrhagic fever outbreaks

被引:14
作者
Okeke, Iruka N. [1 ]
Manning, Robert S. [2 ]
Pfeiffer, Thomas [3 ]
机构
[1] Haverford Coll, Dept Biol, Haverford, PA 19041 USA
[2] Haverford Coll, Dept Math, Haverford, PA 19041 USA
[3] Massey Univ, NZ Inst Adv Study, Auckland, New Zealand
来源
JOURNAL OF INFECTION IN DEVELOPING COUNTRIES | 2014年 / 8卷 / 09期
关键词
modeling; viral hemorrhagic fever; Ebola hemorrhagic fever; outbreak; health workers; LASSA FEVER; EBOLA OUTBREAK; VIRUS-DISEASE; CONGO; LESSONS; UGANDA; SURVEILLANCE; CHILDREN; MALARIA; KIKWIT;
D O I
10.3855/jidc.4636
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Introduction: Viral hemorrhagic fever (VHF) outbreaks, with high mortality rates, have often been amplified in African health institutions due to person-to-person transmission via infected body fluids. By collating and analyzing epidemiological data from documented outbreaks, we observed that diagnostic delay contributes to epidemic size for Ebola and Marburg hemorrhagic fever outbreaks. Methodology: We used a susceptible-exposed-infectious-removed (SEIR) model and data from the 1995 outbreak in Kikwit, Democratic Republic of Congo, to simulate Ebola hemorrhagic fever epidemics. Our model allows us to describe the dynamics for hospital staff separately from that for the general population, and to implement health worker-specific interventions. Results: The model illustrates that implementing World Health Organization/US Centers for Disease Control and Prevention guidelines of isolating patients who do not respond to antimalarial and antibacterial chemotherapy reduces total outbreak size, from a median of 236, by 90% or more. Routinely employing diagnostic testing in post-mortems of patients that died of refractory fevers reduces the median outbreak size by a further 60%. Even greater reductions in outbreak size were seen when all febrile patients were tested for endemic infections or when febrile health-care workers were tested. The effect of testing strategies was not impaired by the 1-3 day delay that would occur if testing were performed by a reference laboratory. Conclusion: In addition to improving the quality of care for common causes of febrile infections, increased and strategic use of laboratory diagnostics for fever could reduce the chance of hospital amplification of VHFs in resource-limited African health systems.
引用
收藏
页码:1148 / 1159
页数:12
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