1
IRUS Total
Downloads
  Altmetric

A quantitative framework for defining the end of an infectious disease outbreak: application to Ebola virus disease

File Description SizeFormat 
kwaa212.pdfPublished version1.09 MBAdobe PDFView/Open
Title: A quantitative framework for defining the end of an infectious disease outbreak: application to Ebola virus disease
Authors: Djaafara, B
Imai, N
Hamblion, E
Impouma, B
Donnelly, C
Cori, A
Item Type: Journal Article
Abstract: The end-of-outbreak declaration is an important step in controlling infectious disease outbreaks. Objective estimation of the confidence level that an outbreak is over is important to reduce the risk of postdeclaration flare-ups. We developed a simulation-based model with which to quantify that confidence and tested it on simulated Ebola virus disease data. We found that these confidence estimates were most sensitive to the instantaneous reproduction number, the reporting rate, and the time between the symptom onset and death or recovery of the last detected case. For Ebola virus disease, our results suggested that the current World Health Organization criterion of 42 days since the recovery or death of the last detected case is too short and too sensitive to underreporting. Therefore, we suggest a shift to a preliminary end-of-outbreak declaration after 63 days from the symptom onset day of the last detected case. This preliminary declaration should still be followed by 90 days of enhanced surveillance to capture potential flare-ups of cases, after which the official end of the outbreak can be declared. This sequence corresponds to more than 95% confidence that an outbreak is over in most of the scenarios examined. Our framework is generic and therefore could be adapted to estimate end-of-outbreak confidence for other infectious diseases.
Issue Date: 14-Oct-2020
Date of Acceptance: 2-Oct-2020
URI: http://hdl.handle.net/10044/1/81340
DOI: 10.1093/aje/kwaa212
ISSN: 0002-9262
Publisher: Oxford University Press (OUP)
Start Page: 642
End Page: 651
Journal / Book Title: American Journal of Epidemiology
Volume: 190
Issue: 4
Copyright Statement: © The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Medical Research Council (MRC)
Medical Research Council
Funder's Grant Number: MR/R015600/1
MR/R015600/1
Keywords: Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
basic reproduction number
disease outbreaks
Ebola virus disease
end-of-outbreak declaration
epidemics
RECRUDESCENCE
Ebola virus disease
basic reproduction number
disease outbreaks
end-of-outbreak declaration
epidemics
Disease Outbreaks
Global Health
Hemorrhagic Fever, Ebola
Humans
Infection Control
Humans
Hemorrhagic Fever, Ebola
Disease Outbreaks
Infection Control
Global Health
Epidemiology
01 Mathematical Sciences
11 Medical and Health Sciences
Publication Status: Published
Online Publication Date: 2020-10-14
Appears in Collections:Faculty of Medicine
School of Public Health



This item is licensed under a Creative Commons License Creative Commons