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Rapid Response to Ebola Outbreaks in Remote Areas - Liberia, July-November 2014

Francis Kateh et al. MMWR Morb Mortal Wkly Rep.

Abstract

West Africa is experiencing its first epidemic of Ebola virus disease (Ebola). As of February 9, Liberia has reported 8,864 Ebola cases, of which 3,147 were laboratory-confirmed. Beginning in August 2014, the Liberia Ministry of Health and Social Welfare (MOHSW), supported by CDC, the World Health Organization (WHO), and others, began systematically investigating and responding to Ebola outbreaks in remote areas. Because many of these areas lacked mobile telephone service, easy road access, and basic infrastructure, flexible and targeted interventions often were required. Development of a national strategy for the Rapid Isolation and Treatment of Ebola (RITE) began in early October. The strategy focuses on enhancing capacity of county health teams (CHT) to investigate outbreaks in remote areas and lead tailored responses through effective and efficient coordination of technical and operational assistance from the MOHSW central level and international partners. To measure improvements in response indicators and outcomes over time, data from investigations of 12 of 15 outbreaks in remote areas with illness onset dates of index cases during July 16-November 20, 2014, were analyzed. The times to initial outbreak alerts and durations of the outbreaks declined over that period while the proportions of patients who were isolated and treated increased. At the same time, the case-fatality rate in each outbreak declined. Implementation of strategies, such as RITE, to rapidly respond to rural outbreaks of Ebola through coordinated and tailored responses can successfully reduce transmission and improve outcomes.

Figures

FIGURE 1
FIGURE 1
Locations of 12 Ebola outbreaks in remote communities — Liberia, July 16–November 20, 2014
FIGURE 2
FIGURE 2
Number of days from Ebola symptom onset of the index patient to alert of the county health team, beginning of intervention, and the last reported case in 12 Ebola outbreaks in remote communities — Liberia, July 16–November 20, 2014 * The alert to the county health team did not come until after the last reported case on October 20. The investigation, which included contact monitoring, began on November 6.
FIGURE 3
FIGURE 3
Challenges facing Ebola teams traveling to remote communities in Liberia have included impassable roads such as this one on the way to John Logan Town (left) and difficult river crossings such as this one on the way to Bomota (right) Photo/Justin Williams Photo/Sampson Dolo

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