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      A review of epidemiological parameters from Ebola outbreaks to inform early public health decision-making

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          Abstract

          The unprecedented scale of the Ebola outbreak in West Africa has, as of 29 April 2015, resulted in more than 10,884 deaths among 26,277 cases. Prior to the ongoing outbreak, Ebola virus disease (EVD) caused relatively small outbreaks (maximum outbreak size 425 in Gulu, Uganda) in isolated populations in central Africa. Here, we have compiled a comprehensive database of estimates of epidemiological parameters based on data from past outbreaks, including the incubation period distribution, case fatality rate, basic reproduction number ( R 0 ), effective reproduction number ( R t ) and delay distributions. We have compared these to parameter estimates from the ongoing outbreak in West Africa. The ongoing outbreak, because of its size, provides a unique opportunity to better understand transmission patterns of EVD. We have not performed a meta-analysis of the data, but rather summarize the estimates by virus from comprehensive investigations of EVD and Marburg outbreaks over the past 40 years. These estimates can be used to parameterize transmission models to improve understanding of initial spread of EVD outbreaks and to inform surveillance and control guidelines.

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          The reemergence of Ebola hemorrhagic fever, Democratic Republic of the Congo, 1995. Commission de Lutte contre les Epidémies à Kikwit.

          A Khan, F. Tshioko, D. L. Heymann … (1999)
          In May 1995, an international team characterized and contained an outbreak of Ebola hemorrhagic fever (EHF) in Kikwit, Democratic Republic of the Congo. Active surveillance was instituted using several methods, including house-to-house search, review of hospital and dispensary logs, interview of health care personnel, retrospective contact tracing, and direct follow-up of suspect cases. In the field, a clinical case was defined as fever and hemorrhagic signs, fever plus contact with a case-patient, or fever plus at least 3 of 10 symptoms. A total of 315 cases of EHF, with an 81% case fatality, were identified, excluding 10 clinical cases with negative laboratory results. The earliest documented case-patient had onset on 6 January, and the last case-patient died on 16 July. Eighty cases (25%) occurred among health care workers. Two individuals may have been the source of infection for >50 cases. The outbreak was terminated by the initiation of barrier-nursing techniques, health education efforts, and rapid identification of cases.
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            Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients.

            Mpia A. Bwaka, Marie‐José Bonnet, Philippe Calain … (1999)
            During the 1995 outbreak of Ebola hemorrhagic fever in the Democratic Republic of the Congo, a series of 103 cases (one-third of the total number of cases) had clinical symptoms and signs accurately recorded by medical workers, mainly in the setting of the urban hospital in Kikwit. Clinical diagnosis was confirmed retrospectively in cases for which serum samples were available (n = 63, 61% of the cases). The disease began unspecifically with fever, asthenia, diarrhea, headaches, myalgia, arthralgia, vomiting, and abdominal pain. Early inconsistent signs and symptoms included conjunctival injection, sore throat, and rash. Overall, bleeding signs were observed in <45% of the cases. Typically, terminally ill patients presented with obtundation, anuria, shock, tachypnea, and normothermia. Late manifestations, most frequently arthralgia and ocular diseases, occurred in convalescent patients. This series is the most extensive number of cases of Ebola hemorrhagic fever observed during an outbreak.
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              A brief history of R0 and a recipe for its calculation.

              J. A. P. (Hans) Heesterbeek (2002)
              In this paper I present the genesis of R0 in demography, ecology and epidemiology, from embryo to its current adult form. I argue on why it has taken so long for the concept to mature in epidemiology when there were ample opportunities for cross-fertilisation from demography and ecology from where it reached adulthood fifty years earlier. Today, R0 is a more fully developed adult in epidemiology than in demography. In the final section I give an algorithm for its calculation in heterogeneous populations.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Sci Data
                Journal ID (iso-abbrev): Sci Data
                Title: Scientific Data
                Publisher: Nature Publishing Group
                ISSN (Electronic): 2052-4463
                Publication date (Electronic): 26 May 2015
                Publication date Collection: 2015
                Volume: 2
                Electronic Location Identifier: 150019
                Affiliations
                [1 ] MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London , London W2 1PG, UK
                [2 ] Center for Global Health, Institut Pasteur , Paris 75015, France
                Author notes
                []

                M.V.K., A.I.B. and H.L.M. conducted the literature review and extracted relevant parameters. M.V.K. and A.I.B. drafted the manuscript. M.V.K., A.I.B., H.L.M., N.M.F. and C.A.D. reviewed and edited versions of the manuscript. All authors agree with the conclusions of the manuscript.

                Article
                Publisher Item ID: sdata201519
                DOI: 10.1038/sdata.2015.19
                PMC ID: 4443880
                PubMed ID: 26029377
                SO-VID: 337de3d4-0048-4dca-ae8a-73d209f84e02
                Copyright © Copyright © 2015, Macmillan Publishers Limited
                License:

                This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0 Metadata associated with this Data Descriptor is available at http://www.nature.com/sdata/ and is released under the CC0 waiver to maximize reuse.

                History
                Date received : 08 October 2014
                Date accepted : 13 April 2015
                Categories
                Subject: Data Descriptor

                Data availability:

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