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. 2016 Aug 15;63(4):454-9.
doi: 10.1093/cid/ciw327. Epub 2016 May 18.

Factors Underlying Ebola Virus Infection Among Health Workers, Kenema, Sierra Leone, 2014-2015

Mikiko Senga  1 , Kimberly Pringle  2 , Andrew Ramsay  3 , David M Brett-Major  4 , Robert A Fowler  5 , Issa French  6 , Mohamed Vandi  6 , Josephine Sellu  6 , Christian Pratt  6 , Josephine Saidu  6 , Nahoko Shindo  1 , Daniel G Bausch  1 ; Sierra Leone Kenema District Task Force and Kenema Government Hospital
Affiliations

Factors Underlying Ebola Virus Infection Among Health Workers, Kenema, Sierra Leone, 2014-2015

Mikiko Senga et al. Clin Infect Dis. .

Abstract

Background: Ebola virus disease (EVD) in health workers (HWs) has been a major challenge during the 2014-2015 outbreak. We examined factors associated with Ebola virus exposure and mortality in HWs in Kenema District, Sierra Leone.

Methods: We analyzed data from the Sierra Leone National Viral Hemorrhagic Fever Database, contact tracing records, Kenema Government Hospital (KGH) staff and Ebola Treatment Unit (ETU) rosters, and burial logs.

Results: From May 2014 through January 2015, 600 cases of EVD originated in Kenema District, including 92 (15%) HWs, 66 (72%) of whom worked at KGH. Among KGH medical staff and international volunteers, 18 of 62 (29%) who worked in the ETU developed EVD, compared with 48 of 83 (58%) who worked elsewhere in the hospital. Thirteen percent of HWs with EVD reported contact with EVD patients, while 27% reported contact with other infected HWs. The number of HW EVD cases at KGH declined roughly 1 month after implementation of a new triage system at KGH and the opening of a second ETU within the district. The case fatality ratio for HWs and non-HWs with EVD was 69% and 74%, respectively.

Conclusions: The cluster of HW EVD cases in Kenema District is one of the largest ever reported. Most HWs with EVD had potential virus exposure both inside and outside of hospitals. Prevention measures for HWs must address a spectrum of infection risks in both formal and informal care settings as well as in the community.

Keywords: Ebola; health worker; infection prevention and control; outbreak; viral hemorrhagic fever.

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Figures

Figure 1.
Figure 1.
Epidemic curve for cases of Ebola virus disease, Kenema District, Sierra Leone, 1 May 2014–31 January 2015. Arrows (from left to right) indicate the beginning of the health worker strike, implementation of the new triage system at Kenema Government Hospital, and the opening of the International Federation of Red Cross Ebola Treatment Unit on the outskirts of Kenema town.
See this image and copyright information in PMC

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