DOI: 10.1101/485821Dec 7, 2018Paper

Rigorous surveillance is necessary for high confidence in end-of-outbreak declarations for Ebola and other infectious diseases

BioRxiv : the Preprint Server for Biology
Robin ThompsonKatri Jalava


The World Health Organization considers an Ebola outbreak to have ended once 42 days have passed since the last possible exposure to a confirmed case. Benefits of a quick end-of-outbreak declaration, such as reductions in trade/travel restrictions, must be balanced against the chance of flare-ups from undetected residual cases. We show how epidemiological modelling can be used to estimate the surveillance level required for decision-makers to be confident that an outbreak is over. Results from a simple model characterising an Ebola outbreak suggest that a surveillance sensitivity (i.e. case reporting percentage) of 79% is necessary for 95% confidence that an outbreak is over after 42 days without symptomatic cases. With weaker surveillance, unrecognised transmission may still occur: if the surveillance sensitivity is only 40%, then 62 days must be waited for 95% certainty. By quantifying the certainty in end-of-outbreak declarations, public health decision-makers can plan and communicate more effectively.

Related Concepts

Epidemiologic Studies
Ebola virus
Kidney Failure, Chronic
World Health Organization
Disease Transmission
Infection Surveillance

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