Data Fitting and Scenario Analysis of Vaccination in the 2014 Ebola Outbreak in Liberia

OBJECTIVES: This study aimed to extend an epidemiological model (SEIHFR) to analyze epidemic trends, and evaluate intervention efficacy. METHODS: SEIHFR was modified to examine disease transmission dynamics after vaccination for the Ebola outbreak. Using existing data from Liberia, sensitivity analysis of various epidemic scenarios was used to inform the model structure, estimate the basic reproduction number ℜ₀ and investigate how the vaccination could effectively change the course of the epidemic. RESULTS: If a randomized mass vaccination strategy was adopted, vaccines would be administered prophylactically or as early as possible (depending on the availability of vaccines). An effective vaccination rate threshold for Liberia was estimated as 48.74% among susceptible individuals. If a ring vaccination strategy was adopted to control the spread of the Ebola virus, vaccines would be given to reduce the transmission rate improving the tracing rate of the contact persons of an infected individual. CONCLUSION: The extended SEIHFR model predicted the total number of infected cases, number of deaths, number of recoveries, and duration of outbreaks among others with different levels of interventions such as vaccination rate. This model may be used to better understand the spread of Ebola and develop strategies that may achieve a disease-free state.

Mortalidade em hospital secundário pediátrico na Libéria pós-conflito em 2009 / Mortality in a pediatric secondary-care hospital in post-conflict Liberia in 2009

OBJETIVO: Descrever e analisar as causas de morte em um hospital secundário pediátrico (administrado pelos Médicos sem Fronteiras) na Monróvia, Libéria, 6 anos após o fim da guerra civil, para determinar a qualidade dos cuidados e a mortalidade em uma realidade com recursos limitados. MÉTODOS: Os dados foram coletados retrospectivamente de março a outubro de 2009. Os prontuários e dados laboratoriais foram revisados para verificar a causa de morte. Além disso, prontuários de pacientes com mais de 1 mês de vida com causa de morte infecciosa foram analisados, para avaliar a presença de choque séptico descompensado ou choque séptico refratário a fluidos. RESULTADOS: Do total de 8.254 pacientes admitidos, 531 morreram, com taxa de mortalidade de 6,4%. Noventa por cento dos óbitos ocorreram em crianças <5 anos. A maioria das mortes ocorreu nas primeiras 24 horas de internação. A causa principal (76%) foi doença infecciosa. Apresentaram choque séptico 78 (23,6%) pacientes com mais de 1 mês de idade e doença infecciosa, e 28 (8,6%) apresentaram choque séptico descompensado ou refratário a fluidos. CONCLUSÃO: Desde o fim da devastadora guerra civil na Libéria, o Island Hospital tem melhorado a qualidade de cuidado e diminuído a taxa de mortalidade, apesar de atuar com recursos limitados. Com base nos dados disponíveis, a mortalidade do Island Hospital aparenta ser menor do que em outras instituições liberianas e africanas, e semelhante a de outros hospitais administrados pelos Médicos sem Fronteiras na África. A explicação para esse fato é o apoio logístico e financeiro dos Médicos sem Fronteiras. A maior carga de mortalidade está relacionada a doenças infecciosas e condições neonatais. A mortalidade por sepse variou entre diferentes infecções. Isso sugere que a mortalidade ainda pode ser reduzida ao se melhorarem o tratamento e os cuidados neonatais.

OBJECTIVE: To describe and analyze the causes of death in a pediatric secondary-care hospital (run by Médecins sans Frontières), in Monrovia, Liberia, 6 years post-civil war, to determine the quality of care and mortality in a setting with limited resources. METHODS: Data were retrospectively collected from March 2009 to October 2009. Patient charts and laboratory records were reviewed to verify cause of death. Additionally, charts of patients aged over 1 month with an infectious cause of death were analyzed for decompensated septic shock, or fluid-refractory septic shock. RESULTS: Of 8,254 admitted pediatric patients, 531 died, with a mortality rate of 6.4%. Ninety percent of deaths occurred in children <5 years old. Most deaths occurred within 24 hours of admission. The main cause of death (76%) was infectious disease. Seventy-eight (23.6%) patients >1 month old with infectious disease met the criteria for septic shock, and 28 (8.6%) for decompensated or fluid-refractory septic shock. CONCLUSION: Since the end of Liberia's devastating civil war, Island Hospital has improved care and mortality outcomes, despite operating with limited resources. Based on the available data, mortality in Island Hospital appears to be lower than that of other Liberian and African institutions and similar to other hospitals run by Médecins sans Frontières across Africa. This can be explained by the financial and logistic support of Médecins sans Frontières. The highest mortality burden is related to infectious diseases and neonatal conditions. The mortality of sepsis varied among different infections. This suggests that further mortality reduction can be obtained by tackling sepsis management and improving neonatal care.

Transactional Sex among Youths in Post-conflict Liberia.

This paper presents findings on sexual risk behaviours of Liberian youths based on five focus-group discussions conducted with 6th and 7th graders (n=36) attending an elementary/middle school in Monrovia, Liberia. The purpose of the focus-group discussions was to gain an understanding of the sexual behaviours of in-school Liberian adolescents. The focus-group discussions were part of a larger study to adapt an evidence- based HIV-prevention intervention—Making Proud Choices!—for in-school youths. Post-conflict conditions were discussed as a contributor to the emergence of high-risk sexual behaviours, including transactional sex, sexual violence, and lack of condom-use. Transactional sex was often described by the focus-group participants as occurring between young females and older, more financially-secure males to obtain cash, food, clothing, western commodities, and school-fees and was often encouraged by parents and promoted by peers. The findings also indicate that female adolescents make choices to engage in transactional sex to gain access to a continuum of material and consumer needs. These findings suggest that individual risk-taking behaviours are nested within complex sexual economies and that HIV-prevention interventions should be considered that leverage females’ agency and control.

An overview of epidemics in Liberia and its revelation for epidemic prevention during peacekeeping operations / 军事医学科学院院刊

Communicable diseases are the major threats to the health and security of all the people living in Liberia, including UN peacekeepers from China. The most prevalent communicable diseases in Liberia include malaria, HIV/AIDS, acute respiratory infection, sexual transmitted disease, schistosomiasis, onchocerciasis, tuberculosis, cholera, pertussis, hepatitis, meningococcal disease, typhoid fever, Lassa fever and yellow fever. An insight into the profiles and epidemiology of the above epidemics in Liberia would greatly help peacekeepers with disease diagnosis and epidemic prevention. According to the profiles of epidemics in Liberia and the authors' experience in epidemic prevention in Liberia, the authors recommend that peacekeepers strengthen their epidemic prevention as follows. Firstly, a combined vector control strategy is suggested for the prevention and control of vector-borne diseases. Secondly, water safety should be highlighted by water disinfection and regular water quality testing. Thirdly, vaccines, diagnostic reagents and medications should be accordingly outfitted. Then, the awareness of epidemic prevention and individual hygiene should be improved by education and strict management. Finally, the daily life management for peacekeepers is also very important. The epidemic overviews and strategies for epidemic prevention described in this paper are also useful for all the other peacekeepers deployed in Africa.