Epidemiology of ebolavirus disease (EVD) and occupational EVD in health care workers in Sub-Saharan Africa: Need for strengthened public health preparedness

Abstract

Ebolavirus disease (EVD) is a severe contagious disease in humans, and health care workers (HCW) are at risk of infection when caring for EVD patients. This paper highlights the epidemiologic profile of EVD and its impact on the health care workforce in Africa. A documentary study was conducted which consisted of a review of available literature regarding the epidemiology of EVD, occupational EVD (OEVD), and work safety issues in Sub-Saharan Africa; the literature findings are enriched by field experiences from the authors. EVD outbreaks have already caused 30,500 cases in humans of whom 12,933 died (as of September 9, 2015), and the number of infected HCW has dramatically increased. All eight HCW infected during the 2014 outbreak in Democratic Republic of the Congo died, whereas during the recent West African EVD epidemic more than 890 HCW were infected, with a case fatality rate of 57%. Occupational exposure to blood and other body fluids due to inadequate use of personal protective equipment and needle stick or sharp injuries are among factors that contribute to the occurrence of OEVD. Prevention of OEVD should be one of the top priorities in EVD outbreak preparedness and management, and research should be conducted to elucidate occupational and other factors that expose HCW to EVD. In addition to regularly training HCW to be adequately prepared to care for patients with EVD, it is critical to strengthen the general health care system and improve occupational safety in medical settings of countries at risk.

Keywords: Ebolavirus disease; Epidemiology; Occupational ebolavirus disease (OEVD); Public health preparedness; Work safety.

Fig. 1

Diagram summarizing the literature review process. Of the 1831 papers, abstracts and reports retrieved from databases, only 34 that were informative and matched the study topic and keywords were considered in this study.

Fig. 2

New map of Democratic Republic of Congo (DRC) (A) and location of the epicenter of the recent Ebolavirus disease outbreak (B) and nearby village (C) in Boende.

Fig. 3

Occupational Ebolavirus disease (OEVD) prevalence and case fatality among health care workers during recent outbreaks in Western and Central African regions. The figure was constructed using data from DRC Ministry of Social Affairs, Humanitarian Actions and National Solidarity, European Centre for Disease Prevention and Control (2015) and WHO (2015)¹⁷]. DRC, Democratic Republic of the Congo.

Fig. 4

Conceptual framework for reinforcement of work-related communicable disease prevention: case of occupational ebolavirus disease (OEVD). ICT, information and communication technology; NSI, needle stick and sharp injury; PPE, personal protective equipment; SED, safety engineered device; WASH, water, sanitation and hygiene; UP, universal precautions.