Diagnostic schemes for reducing epidemic size of african viral hemorrhagic fever outbreaks

  • Iruka N Okeke Haverford College, Haverford, PA, United States
  • Robert S Manning Haverford College, Haverford, PA, United States
  • Thomas Pfeiffer NZ Institute for Advanced Study, Massey University, Auckland, New Zealand
Keywords: modeling, viral hemorrhagic fever, Ebola hemorrhagic fever, outbreak, health workers


Introduction: Viral hemorrhagic fever (VHF) outbreaks, with high mortality rates, have often been amplified in African health institutions due to person-to-person transmission via infected body fluids.  By collating and analyzing epidemiological data from documented outbreaks, we observed that diagnostic delay contributes to epidemic size for Ebola and Marburg hemorrhagic fever outbreaks.

Methodology: We used a susceptible-exposed-infectious-removed (SEIR) model and data from the 1995 outbreak in Kikwit, Democratic Republic of Congo, to simulate Ebola hemorrhagic fever epidemics. Our model allows us to describe the dynamics for hospital staff separately from that for the general population, and to implement health worker-specific interventions.

Results: The model illustrates that implementing World Health Organization/US Centers for Disease Control and Prevention guidelines of isolating patients who do not respond to antimalarial and antibacterial chemotherapy reduces total outbreak size, from a median of 236, by 90% or more. Routinely employing diagnostic testing in post-mortems of patients that died of refractory fevers reduces the median outbreak size by a further 60%. Even greater reductions in outbreak size were seen when all febrile patients were tested for endemic infections or when febrile health-care workers were tested.  The effect of testing strategies was not impaired by the 1-3 day delay that would occur if testing were performed by a reference laboratory.

Conclusion: In addition to improving the quality of care for common causes of febrile infections, increased and strategic use of laboratory diagnostics for fever could reduce the chance of hospital amplification of VHFs in resource-limited African health systems.


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Author Biographies

Iruka N Okeke, Haverford College, Haverford, PA, United States
Associate Professor of Biology and Branco Weiss Fellow of the Society in Science
Robert S Manning, Haverford College, Haverford, PA, United States
Mathematics Department
How to Cite
Okeke IN, Manning RS, Pfeiffer T (2014) Diagnostic schemes for reducing epidemic size of african viral hemorrhagic fever outbreaks. J Infect Dev Ctries 8:1148-1159. doi: 10.3855/jidc.4636
Original Articles