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. 2022 Feb:115:126-133.
doi: 10.1016/j.ijid.2021.11.039. Epub 2021 Dec 7.

Ebola virus disease nosocomial infections in the Democratic Republic of the Congo: a descriptive study of cases during the 2018-2020 outbreak

April Baller  1 , Maria Clara Padoveze  2 , Patrick Mirindi  2 , Carmen Emily Hazim  3 , Jonathan Lotemo  4 , Jerome Pfaffmann  5 , Aminata Ndiaye  2 , Simone Carter  5 , Marie-Amelie Degail Chabrat  2 , Samuel Mangala  4 , Berthe Banzua  4 , Chantal Umutoni  5 , N'Deye Rosalie Niang  6 , Landry Kabego  2 , Abdoulaye Ouedraogo  2 , Bienvenue Houdjo  2 , Didier Mwesha  2 , Kevin Babila Ousman  2 , Amy Kolwaite  3 , David D Blaney  3 , Mary J Choi  3 , Raymond Pallawo  2 , Anais Legand  2 , Benjamin Park  3 , Pierre Formenty  2 , Joel M Montgomery  3 , Abdou Salam Gueye  2 , Benedetta Allegranzi  2 , N'da Kona Michel Yao  2 , Ibrahima Soce Fall  2
Affiliations

Ebola virus disease nosocomial infections in the Democratic Republic of the Congo: a descriptive study of cases during the 2018-2020 outbreak

April Baller et al. Int J Infect Dis. 2022 Feb.

Abstract

Objectives: To describe the characteristics of nosocomial cases of Ebola virus disease (EVD) in the Democratic Republic of the Congo between July 2018 and May 2020 in order to inform future interventions.

Methods: Nosocomial cases of EVD were identified during outbreak response surveillance, and a retrospective analysis of cases was conducted according to demographic characteristics and type of health facility (HF).

Results: Of 3481 cases of EVD, 579 (16.6%) were nosocomial. Of these, 332 cases occurred in women (57.3%). Patients and visitors accounted for 419 cases (72.4%), of which 79 (18.9%) were aged 6-≤18 years and 108 (25.8%) were aged ≤5 years. Health workers (HWs) accounted for the remaining 160 (27.6%) nosocomial cases. The case fatality rate (CFR) for HWs (66/160, 41.3%) was significantly lower than the CFR for patients and visitors (292/419, 69.7%) (P<0.001). The CFR was higher among cases aged 6-≤18 years (54/79, 68.4%) and ≤5 years (89/108, 82.4%). Referral HFs (>39 beds) had the highest prevalence of nosocomial EVD (148/579, 25.6%). Among HFs with at least one case of nosocomial infection, 50.0% (98/196) were privately owned.

Conclusions: Nurses and traditional healers should be targeted for infection prevention and control training, and supportive supervision should be provided to HFs to mitigate EVD transmission.

Keywords: Cross-infection; Ebola; Health worker infection; Healthcare-associated infection; Infection prevention and control; Nosocomial infection; Transmission; Viral haemorrhagic fever.

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Conflict of interest statement

Conflict of interest statement None declared.

Figures

Figure 1
Figure 1
Distribution of weekly confirmed or probable nosocomial and community cases of Ebola virus disease (EVD) during the July 2018––May 2020 outbreak in the Democratic Republic of the Congo (DRC). Note: Periods 1–3 correspond to the different inclusion criteria for nosocomial infection, which was modified as the outbreak progressed.
Figure 2
Figure 2
Timeline distribution of clusters of nosocomial cases of Ebola virus disease (EVD) in Aloya, Biakato mines, Lwemba, Masuli, and Muchanga health areas, Democratic Republic of the Congo (DRC), 2018–2020. NI, nosocomial infection.
Figure 3
Figure 3
Distribution of weekly confirmed or probable nosocomial and community cases of Ebola virus disease (EVD) according to the category of health facility (HF) during the July 2018–May 2020 outbreak in the Democratic Republic of the Congo (DRC). Note: Periods 1–3 correspond to the different inclusion criteria for nosocomial infection (NI), which was modified as the outbreak progressed.
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