Ebola virus disease (EVD) has been shown to be associated with poor mental health in affected zones. However, no study has yet explored its impact on adolescents’ mental health.

This study aimed to assess the prevalence and risk factors associated with depression and anxiety symptoms among adolescents in EVD-affected areas in the Equateur Province of the Democratic Republic of the Congo during the COVID-19 pandemic.

A provincial sample of adolescents aged 12–17 years (M = 14.84, s.d. = 1.49) living in the 18 urban and rural areas affected by the 2018 EVD outbreak completed a two-wave longitudinal survey. Surveys assessed symptoms of depression and anxiety, exposure to Ebola, social support and sociodemographic information.

A total of 490 participants completed the baseline and follow-up surveys, 50% of whom were female. Elevated and worsened depressive symptoms were observed among participants from the baseline (56.94%) to the follow-up (91.43%; z = −11.37, P < 0.001), whereas anxiety symptoms decreased from the baseline (36.33%) to follow-up (24.90%; z = 4.06, P < 0.001). The final generalised estimating equation model showed that anxiety symptoms decreased over time (B = −3.92, P < 0.001), while depression symptoms increased (B = 4.79, P < 0.001). Stigmatisation related to Ebola positively predicted anxiety (B = 5.41, P < 0.001) and depression symptoms (B = 0.4452, P = 0.009). Social support negatively predicted anxiety (B = −1.13, P = 0.004) and depression (B = −0.98, P < 0.001) symptoms but only moderated the association between stigmatisation and depression symptoms (B = −0.67, P < 0.001).

Most adolescents living in EVD-affected areas experience mental health issues. Stigmatisation related to EVD and living in urban areas are the most consistent predictors of mental health problems. Nevertheless, social support remains a protective factor for depression and anxiety symptoms and a necessary resource for building resilience.

The aim of this study was to review the role of public health emergency operations centers in recent public health emergencies and to identify the barriers and enablers influencing the effective use of a public health emergency operations center (PHEOC) in public health emergency management.

A systematic search was conducted in 5 databases and selected grey literature websites.

Forty-two articles, consisting of 28 peer-reviewed studies and 14 grey literature sources matched the inclusion criteria. Results suggest that PHEOCs are used to prepare and respond to a range of public health emergencies, including coronavirus disease (COVID-19). Factors found to influence the use of a PHEOC include the adoption of an incident management system, internal and external communications, data management, workforce capacity, and physical infrastructure.

PHEOCs play an important role in public health emergency management. This review identified several barriers and enablers to using a PHEOC in public health emergency management. Future research should focus on addressing the barriers to using a PHEOC and looking at ways to evaluate the impact of using a PHEOC on public health emergency outcomes.

Stretcher transport isolators provide mobile, high-level biocontainment outside the hospital for patients with highly infectious diseases, such as Ebola virus disease. Air quality within this confined space may pose human health risks.

Ambient air temperature, relative humidity, and CO2 concentration were monitored within an isolator during 2 operational exercises with healthy volunteers, including a ground transport exercise of approximately 257 miles. In addition, failure of the blower unit providing ambient air to the isolator was simulated. A simple compartmental model was developed to predict CO2 and H2O concentrations within the isolator.

In both exercises, CO2 and H2O concentrations were elevated inside the isolator, reaching steady-state values of 4434 ± 1013 ppm CO2 and 22 ± 2 mbar H2O in the first exercise and 3038 ± 269 ppm CO2 and 20 ± 1 mbar H2O in the second exercise. When blower failure was simulated, CO2 concentration exceeded 10 000 ppm within 8 minutes. A simple compartmental model predicted CO2 and H2O concentrations by accounting for human emissions and blower air exchange.

Attention to air quality within stretcher transport isolators (including adequate ventilation to prevent accumulation of CO2 and other bioeffluents) is needed to optimize patient safety.

Ebola Virus Disease (EVD) is the international health emergency paradigm due to its epidemiological presentation pattern, impact on public health, resources necessary for its control, and need for a national and international response.

The objective of this work is to study the evolution and progression of the epidemiological presentation profile of Ebola disease outbreaks since its discovery in 1976 to the present, and to explore the possible reasons for this evolution from different perspectives.

Retrospective observational study of 38 outbreaks of Ebola disease occurred from 1976 through 2019, excluding laboratory accidents. United Nations agencies and programs; Ministries of Health; the US Centers for Disease Control and Prevention (CDC); ReliefWeb; emergency nongovernmental organizations; and publications indexed in PubMed, EmBase, and Clinical Key have been used as sources of data. Information on the year of the outbreak, date of beginning and end, duration of the outbreak in days, number of cases, number of deaths, population at risk, geographic extension affected in Km2, and time of notification of the first cases to the World Health Organization (WHO) have been searched and analyzed.

Populations at risk have increased (P = .024) and the geographical extent of Ebola outbreaks has grown (P = .004). Reporting time of the first cases of Ebola to WHO has been reduced (P = .017) and case fatality (P = .028) has gone from 88% to 62% in the period studied. There have been differences (P = .04) between the outbreaks produced by the Sudan and Zaire strains of the virus, both in terms of duration and case fatality ratio (Sudan strain 74.5 days on average and 62.7% of case fatality ratio versus Zaire strain with 150 days on average and 55.4% case fatality ratio).

There has been a change in the epidemiological profile of the Ebola outbreaks from 1976 through 2019 with an increase in the geographical extent of the outbreaks and the population at risk, as well as a significant decrease in the outbreaks case fatality rate. There have been advances in the detection and management capacity of outbreaks, and the notification time to the WHO has been reduced. However, there are social, economic, cultural, and political obstacles that continue to greatly hinder a more efficient epidemiological approach to Ebola disease, mainly in Central Africa.

None.

During the 2014-2015 Ebola outbreak in West Africa, the lack of infection prevention and control (IPC) measures in health care facilities amplified human-to-human transmission and contributed to the magnitude of this humanitarian disaster.

In the summer of 2014, the Geneva University Hospitals (HUG; Geneva, Switzerland) conducted an IPC assessment and developed a project based on the local needs and their expertise with the support of the Swiss Agency for Development and Cooperation and the Humanitarian Aid Unit (SDC/HA; Bern, Switzerland). The project consisted of building local capacity in the production of alcohol-based hand-rub solution (ABHRS) based on the World Health Organization (WHO; Geneva, Switzerland) formula in non-Ebola health facilities at the peak of the outbreak in Liberia (Fall 2014) and during recovery in Guinea (September 2015) to promote safer care. Twenty-one pharmacists in Liberia and 22 in Guinea were trained and one years’ worth of laboratory equipment, chemical products, containers for personal use, and bioethanol were delivered to 10 hospitals per country with more than 8,000 100 ml bottles of solution produced at the end of the project.

Hand hygiene using hand-rub solution is a critical component of safer care, especially in health care settings lacking runnable water. Throughout the Ebola outbreak, it was a timely moment to promote hand-rub solution and to reinforce IPC measures in non-Ebola health facilities. During the project implementation, a substantial challenge was the unavailability of bioethanol in Liberia and Guinea. In the long run, sustainability of the production can become an issue as it depends heavily on the local government’s financial and political commitment, the capacity to create an on-going demand for hand-rub solution in health facilities, the local purchase and replacement of the materials and chemical products, as well as the availability of continuous local partners’ support.

The project demonstrated that it was feasible to build local capacity in ABHRS production during an emergency and in limited-resource settings when materials and training are provided. Future programs in similar contexts should identify and address the factors of sustainability during the implementation phase and provide regular, long-term technical support.

Jacquerioz BauschFA, HellerO, BengalyL, Matthey-KhouityB, BonnabryP, TouréY, KervillainGJ, BahEI, ChappuisF, HagonO. Building Local Capacity in Hand-Rub Solution Production during the 2014-2016 Ebola Outbreak Disaster: The Case of Liberia and Guinea.. Prehosp Disaster Med. 2018;33(6):660–667.

This paper uses data from a cohort of parents and guardians of young children living in Monrovia, Liberia collected before and after the 2014 outbreak of Ebola virus disease (EVD) to estimate the impact of EVD exposure on implicit preferences for harsh discipline. We hypothesized that parents exposed to EVD-related sickness or death would exhibit a stronger preference for harsh discipline practices compared with non-exposed parents.

The data for this analysis come from two survey rounds conducted in Liberia as part of an intervention trial of a behavioral parenting skills intervention. Following a baseline assessment of 201 enrolled parents in July 2014, all program and study activities were halted due to the outbreak of EVD. Following the EVD crisis, we conducted a tracking survey with parents who completed the baseline survey 12 months prior. In both rounds, we presented parents with 12 digital comic strips of a child misbehaving and asked them to indicate how they would react if they were the parent in the stories.

Parents from households with reported EVD sickness or death became more ‘harsh’ (Glass's delta = 1.41) in their hypothetical decision-making compared with non-exposed parents, t (167)=−2.3, p  <  0.05. Parents from households that experienced EVD-related sickness or death not only reported significantly more household conflict and anxiety, but also reported that their child exhibited fewer difficulties.

Results support the need for family-based interventions, including strategies to help parents learn alternatives to harsh punishment.

In early 2015, a patient from a cluster of cases of Ebola Virus Disease (EVD) in Monrovia, Liberia traveled to a rural village in Margibi County, potentially exposing numerous persons. The patient died in the village and post-mortem testing confirmed Ebola Virus infection.

The Margibi County Health Team (CHT; Kakata, Margibi, Liberia) needed to prevent further transmission of EVD within and outside of the affected villages, and they needed to better understand the factors that support or impede compliance with measures to stop the spread of EVD.

In February-March 2015, the Margibi CHT instituted a 21-day quarantine and active monitoring for two villages where the patient had contact with numerous residents, and a 21-day active monitoring for five other villages where the patient had possible contact with an unknown number of persons. One contact developed EVD and quarantine was extended an additional 12 days in one village. In April 2015, the Margibi CHT conducted a household-based EVD knowledge, attitudes, and practices (KAP) survey of the seven villages. From April 24-29, 2015, interview teams approached every household in the seven villages and collected information on demographics, knowledge of EVD, attitudes about quarantine to prevent the spread of EVD, and their quarantine experiences and practices. Descriptive statistics were calculated.

One hundred fifteen interviews were conducted, representing the majority of the households in the seven villages. Most (99%) correctly identified touching an infected person’s body fluids and contact with the body of someone who has died from EVD as transmission routes. However, interviewees sometimes incorrectly identified mosquito bites (58%) and airborne spread (32%) as routes of EVD transmission, and 72% incorrectly identified the longest EVD incubation period as ≤seven days. Eight of 16 households in the two quarantined villages (50%) reported times when there was not enough water or food during quarantine. Nine of 16 (56%) reported that a household member had illnesses or injuries during quarantine; of these, all (100%) obtained care from a clinic, hospital, or Ebola treatment unit (ETU).

Residents’ knowledge of EVD transmission routes and incubation period were suboptimal. Public health authorities should consider assessing residents’ understanding of Ebola transmission routes and effectively educate them to ensure correct understanding. Quarantined residents should be provided with sufficient food, water, and access to medical care.

WilkenJA, PordellP, GoodeB, JartehR, MillerZ, SaygarBGSr., MaximoreL, BorborWM, CarmueM, WalkerGW, YeiahA. Knowledge, Attitudes, and Practices among Members of Households Actively Monitored or Quarantined to Prevent Transmission of Ebola Virus Disease — Margibi County, Liberia: February-March 2015. Prehosp Disaster Med. 2017;32(6):673–678.

An appreciation of the experience of Ebola survivors is critical for community engagement and an effective outbreak response. Few qualitative, descriptive studies have been conducted to date that concentrate on the voices of Ebola survivors.

This study aimed to explore the experiences of Ebola survivors following the West African epidemic of 2014.

An interpretive, qualitative design was selected using semi-structured interviews as the method of data collection. Data were collected in August 2015 by Médecins Sans Frontières (MSF) Belgium, for the purposes of internal evaluation. Data collection occurred at three sites in Liberia and Sierra Leone and involved 25 participants who had recovered from Ebola. Verbal consent was obtained, audio recordings were de-identified, and ethics approval was provided by Monash University (Melbourne, Australia).

Two major themes emerged from the study: “causes of distress” and “sources of resilience.” Two further sub-themes were identified from each major theme: the “multiplicity of death,” “abandonment,” “self and community protection and care,” and “coping resources and activities.” The two major themes were dominant across all three sample groups, though each survivor experienced infection, treatment, and recovery differently.

By identifying and mobilizing the inherent capacity of communities and acknowledging the importance of incorporating the social model of health into culturally competent outbreak responses, there is an opportunity to transcend the victimization effect of Ebola and empower communities, ultimately strengthening the response.

SchwerdtlePM, De ClerckV, PlummerV. Experiences of Ebola Survivors: Causes of Distress and Sources of Resilience. Prehosp Disaster Med. 2017;32(3):234–239.

An adequate level of personal protective equipment (PPE) is necessary when treating patients with highly infectious diseases or those contaminated with hazardous substances.

Following National Institute for Health Research’s Research Centre (London, United Kingdom) approval, the authors of this study conducted a survey of specialist registrars’ knowledge of the respiratory and skin protection requirements needed during a resuscitation scenario with Advanced Life Support. Participant responses were compared to UK national recommendations and to a previous survey in 2009.

A total of 98 specialist registrars (in Anesthesiology, n=51; in Emergency Medicine (EM), n=21; and in Intensive Care Medicine (ICM) n=26) completed hand-delivered surveys. The best knowledge of PPE requirements (76%) was found for severe acute respiratory syndrome (SARS), with less knowledge about PPE requirements for anthrax, plague, Ebola virus disease (EVD), and smallpox (60%). The results show limited knowledge of PPE requirements (20%-30%) for various chemical warfare agents. Personal protective equipment knowledge regarding treatment of sarin-contaminated casualties was over-rated by 80%, and for patients with EVD, it was over-rated by up to 67% of participants.

The results of the tested cohort indicate that current knowledge regarding PPE for chemical warfare agents remains very limited.

SchumacherJ, BondAR, WoodhamV, BuckinghamA, GarnhamF, BrinkerA. Survey of UK Health Care First Responders’ Knowledge of Personal Protective Equipment Requirements. Prehosp Disaster Med. 2015;30(3):15