Responders to recent West Africa Ebola epidemic show little evidence of infection

Responders to the West African Ebola epidemic of 2014-2016 who returned to the UK and Ireland included many who reported possible Ebola virus exposure or Ebola-associated symptoms, according to a new study published in PLOS Medicine. The study, conducted by Catherine F. Houlihan of the London School of Hygiene & Tropical Medicine, UK and colleagues, also reports that the vast majority showed no evidence of Ebola virus infection.

Using an online questionnaire, 268 clinical, laboratory, research, and other responders detailed their experiences. Oral fluid collection devices were mailed to participants and returned samples were tested for Ebola virus antibodies with follow-up blood samples collected where necessary. Despite "near-miss" exposure events for 16% (43/268) of the returnees and symptoms in 21% (57/268), 99% (266/268) showed no evidence of Ebola virus infection. Of note, 70% (40/57) of those who experienced symptoms did not get tested for Ebola virus at the time. A limitation of the study is that not all returning responders were included and participants were not a random sample.

The authors say: "The descriptions of near-miss events and the finding that many of those who experienced illness were not tested at the time suggest that protocols for the management of possible exposure to Ebola virus and for the management of illness should be reviewed and standardised across organisations that deploy staff to outbreaks."

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CFH and JRG received funding from the Wellcome Trust: Enhancing Research Activity in Epidemic Situations, grant number ER1503. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

I have read the journal's policy and the authors of this manuscript have the following competing interests: RT has received funding from the Wellcome Trust via the University of Liverpool, and has received non-financial support from NHSBT, as part of the Convalescent Plasma Study. All other authors have declared that no competing interests exist.

Houlihan CF, McGowan CR, Dicks S, Baguelin M, Moore DAJ, Mabey D, et al. (2017) Ebola exposure, illness experience, and Ebola antibody prevalence in international responders to the West African Ebola epidemic 2014-2016: A cross-sectional study. PLoS Med 14(5): e1002300. https://doi.org/10.1371/journal.pmed.1002300

Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
Faculty of Medical Sciences, University College London, London, United Kingdom
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
Humanitarian Public Health Technical Unit, Save the Children UK, London, United Kingdom
Transfusion Microbiology, National Health Service Blood and Transplant, London, United Kingdom
NHSBT/PHE Blood Borne Virus Unit, Serology Development Unit, Public Health England, London, United Kingdom
Centre of Infectious Disease Surveillance and Control, Public Health England, London, United Kingdom
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
Department of Infection and Tropical Medicine, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom

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