Control of Ebola virus disease outbreaks: Comparison of health care worker-targeted and community vaccination strategies

Alexis Robert; Anton Camacho; William Edmunds; Marc Baguelin; Jean Jacques Muyembe Tamfum; Alicia Rosello; Sakoba Kéïta; Rosalind M. Eggo

doi:10.1016/j.epidem.2019.03.001

Control of Ebola virus disease outbreaks: Comparison of health care worker-targeted and community vaccination strategies

Alexis Robert, Anton Camacho, William Edmunds, Marc Baguelin, Jean Jacques Muyembe Tamfum, Alicia Rosello, Sakoba Kéïta, Rosalind M. Eggo^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

14 Citations (Scopus)

Abstract

Background: Health care workers (HCW) are at risk of infection during Ebola virus disease outbreaks and therefore may be targeted for vaccination before or during outbreaks. The effect of these strategies depends on the role of HCW in transmission which is understudied. Methods: To evaluate the effect of HCW-targeted or community vaccination strategies, we used a transmission model to explore the relative contribution of HCW and the community to transmission. We calibrated the model to data from multiple Ebola outbreaks. We quantified the impact of ahead-of-time HCW-targeted strategies, and reactive HCW and community vaccination. Results: We found that for some outbreaks (we call “type 1″) HCW amplified transmission both to other HCW and the community, and in these outbreaks prophylactic vaccination of HCW decreased outbreak size. Reactive vaccination strategies had little effect because type 1 outbreaks ended quickly. However, in outbreaks with longer time courses (“type 2 outbreaks”), reactive community vaccination decreased the number of cases, with or without prophylactic HCW-targeted vaccination. For both outbreak types, we found that ahead-of-time HCW-targeted strategies had an impact at coverage of 30%. Conclusions: The vaccine strategies tested had a different impact depending on the transmission dynamics and previous control measures. Although we will not know the characteristics of a new outbreak, ahead-of-time HCW-targeted vaccination can decrease the total outbreak size, even at low vaccine coverage.

Original language	English
Pages (from-to)	106-114
Number of pages	9
Journal	Epidemics
Volume	27
DOIs	https://doi.org/10.1016/j.epidem.2019.03.001
Publication status	Published - Jun 2019

Bibliographical note

Funding Information:
AR1 was supported by the Norwegian Institute for Public Health “A randomised trial of ring vaccination to evaluate Ebola vaccine efficacy and Safety in Guinea, West Africa”. AC was funded by the Medical Research Council (MR/J01432X/1). RME and WJE were supported by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under grant agreement EBOVAC1 (grant 115854). The IMI2 was supported by the European Union Horizon 2020 Research and Innovation Programme and the European Federation of Pharmaceutical Industries and Associations. AR2 was supported by the Fischer Family Trust and MB by the National Institute for Health Research Health Protection Research Unit in Immunisation at the London School of Hygiene & Tropical Medicine in partnership with Public Health England. The views expressed are those of the authors and not necessarily those of the funders. The funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. We acknowledge Sebastian Funk for technical support.

Funding Information:
AR 1 was supported by the Norwegian Institute for Public Health “A randomised trial of ring vaccination to evaluate Ebola vaccine efficacy and Safety in Guinea, West Africa”. AC was funded by the Medical Research Council (MR/J01432X/1). RME and WJE were supported by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under grant agreement EBOVAC1 (grant 115854 ). The IMI2 was supported by the European Union Horizon 2020 Research and Innovation Programme and the European Federation of Pharmaceutical Industries and Associations . AR 2 was supported by the Fischer Family Trust and MB by the National Institute for Health Research Health Protection Research Unit in Immunisation at the London School of Hygiene & Tropical Medicine in partnership with Public Health England . The views expressed are those of the authors and not necessarily those of the funders. The funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Funding Information:
RME and WJE were supported by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under grant agreement EBOVAC1 (grant 115,854). The IMI2 is supported by the European Union Horizon 2020 Research and Innovation Programme and the European Federation of Pharmaceutical Industries and Associations.

Publisher Copyright:
© 2019 The Authors

Keywords

Ebola
Health care workers
Outbreak control
Public health
Vaccination

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.epidem.2019.03.001

Cite this

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title = "Control of Ebola virus disease outbreaks: Comparison of health care worker-targeted and community vaccination strategies",

abstract = "Background: Health care workers (HCW) are at risk of infection during Ebola virus disease outbreaks and therefore may be targeted for vaccination before or during outbreaks. The effect of these strategies depends on the role of HCW in transmission which is understudied. Methods: To evaluate the effect of HCW-targeted or community vaccination strategies, we used a transmission model to explore the relative contribution of HCW and the community to transmission. We calibrated the model to data from multiple Ebola outbreaks. We quantified the impact of ahead-of-time HCW-targeted strategies, and reactive HCW and community vaccination. Results: We found that for some outbreaks (we call “type 1″) HCW amplified transmission both to other HCW and the community, and in these outbreaks prophylactic vaccination of HCW decreased outbreak size. Reactive vaccination strategies had little effect because type 1 outbreaks ended quickly. However, in outbreaks with longer time courses (“type 2 outbreaks”), reactive community vaccination decreased the number of cases, with or without prophylactic HCW-targeted vaccination. For both outbreak types, we found that ahead-of-time HCW-targeted strategies had an impact at coverage of 30%. Conclusions: The vaccine strategies tested had a different impact depending on the transmission dynamics and previous control measures. Although we will not know the characteristics of a new outbreak, ahead-of-time HCW-targeted vaccination can decrease the total outbreak size, even at low vaccine coverage.",

keywords = "Ebola, Health care workers, Outbreak control, Public health, Vaccination",

author = "Alexis Robert and Anton Camacho and William Edmunds and Marc Baguelin and {Muyembe Tamfum}, {Jean Jacques} and Alicia Rosello and Sakoba K{\'e}{\"i}ta and Eggo, {Rosalind M.}",

note = "Funding Information: AR1 was supported by the Norwegian Institute for Public Health “A randomised trial of ring vaccination to evaluate Ebola vaccine efficacy and Safety in Guinea, West Africa”. AC was funded by the Medical Research Council (MR/J01432X/1). RME and WJE were supported by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under grant agreement EBOVAC1 (grant 115854). The IMI2 was supported by the European Union Horizon 2020 Research and Innovation Programme and the European Federation of Pharmaceutical Industries and Associations. AR2 was supported by the Fischer Family Trust and MB by the National Institute for Health Research Health Protection Research Unit in Immunisation at the London School of Hygiene & Tropical Medicine in partnership with Public Health England. The views expressed are those of the authors and not necessarily those of the funders. The funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. We acknowledge Sebastian Funk for technical support. Funding Information: AR 1 was supported by the Norwegian Institute for Public Health “A randomised trial of ring vaccination to evaluate Ebola vaccine efficacy and Safety in Guinea, West Africa”. AC was funded by the Medical Research Council (MR/J01432X/1). RME and WJE were supported by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under grant agreement EBOVAC1 (grant 115854 ). The IMI2 was supported by the European Union Horizon 2020 Research and Innovation Programme and the European Federation of Pharmaceutical Industries and Associations . AR 2 was supported by the Fischer Family Trust and MB by the National Institute for Health Research Health Protection Research Unit in Immunisation at the London School of Hygiene & Tropical Medicine in partnership with Public Health England . The views expressed are those of the authors and not necessarily those of the funders. The funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. Funding Information: RME and WJE were supported by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under grant agreement EBOVAC1 (grant 115,854). The IMI2 is supported by the European Union Horizon 2020 Research and Innovation Programme and the European Federation of Pharmaceutical Industries and Associations. Publisher Copyright: {\textcopyright} 2019 The Authors",

year = "2019",

month = jun,

doi = "10.1016/j.epidem.2019.03.001",

language = "English",

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T2 - Comparison of health care worker-targeted and community vaccination strategies

AU - Robert, Alexis

AU - Camacho, Anton

AU - Edmunds, William

AU - Baguelin, Marc

AU - Muyembe Tamfum, Jean Jacques

AU - Rosello, Alicia

AU - Kéïta, Sakoba

AU - Eggo, Rosalind M.

N1 - Funding Information: AR1 was supported by the Norwegian Institute for Public Health “A randomised trial of ring vaccination to evaluate Ebola vaccine efficacy and Safety in Guinea, West Africa”. AC was funded by the Medical Research Council (MR/J01432X/1). RME and WJE were supported by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under grant agreement EBOVAC1 (grant 115854). The IMI2 was supported by the European Union Horizon 2020 Research and Innovation Programme and the European Federation of Pharmaceutical Industries and Associations. AR2 was supported by the Fischer Family Trust and MB by the National Institute for Health Research Health Protection Research Unit in Immunisation at the London School of Hygiene & Tropical Medicine in partnership with Public Health England. The views expressed are those of the authors and not necessarily those of the funders. The funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. We acknowledge Sebastian Funk for technical support. Funding Information: AR 1 was supported by the Norwegian Institute for Public Health “A randomised trial of ring vaccination to evaluate Ebola vaccine efficacy and Safety in Guinea, West Africa”. AC was funded by the Medical Research Council (MR/J01432X/1). RME and WJE were supported by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under grant agreement EBOVAC1 (grant 115854 ). The IMI2 was supported by the European Union Horizon 2020 Research and Innovation Programme and the European Federation of Pharmaceutical Industries and Associations . AR 2 was supported by the Fischer Family Trust and MB by the National Institute for Health Research Health Protection Research Unit in Immunisation at the London School of Hygiene & Tropical Medicine in partnership with Public Health England . The views expressed are those of the authors and not necessarily those of the funders. The funders had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication. Funding Information: RME and WJE were supported by the Innovative Medicines Initiative 2 (IMI2) Joint Undertaking under grant agreement EBOVAC1 (grant 115,854). The IMI2 is supported by the European Union Horizon 2020 Research and Innovation Programme and the European Federation of Pharmaceutical Industries and Associations. Publisher Copyright: © 2019 The Authors

PY - 2019/6

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N2 - Background: Health care workers (HCW) are at risk of infection during Ebola virus disease outbreaks and therefore may be targeted for vaccination before or during outbreaks. The effect of these strategies depends on the role of HCW in transmission which is understudied. Methods: To evaluate the effect of HCW-targeted or community vaccination strategies, we used a transmission model to explore the relative contribution of HCW and the community to transmission. We calibrated the model to data from multiple Ebola outbreaks. We quantified the impact of ahead-of-time HCW-targeted strategies, and reactive HCW and community vaccination. Results: We found that for some outbreaks (we call “type 1″) HCW amplified transmission both to other HCW and the community, and in these outbreaks prophylactic vaccination of HCW decreased outbreak size. Reactive vaccination strategies had little effect because type 1 outbreaks ended quickly. However, in outbreaks with longer time courses (“type 2 outbreaks”), reactive community vaccination decreased the number of cases, with or without prophylactic HCW-targeted vaccination. For both outbreak types, we found that ahead-of-time HCW-targeted strategies had an impact at coverage of 30%. Conclusions: The vaccine strategies tested had a different impact depending on the transmission dynamics and previous control measures. Although we will not know the characteristics of a new outbreak, ahead-of-time HCW-targeted vaccination can decrease the total outbreak size, even at low vaccine coverage.

AB - Background: Health care workers (HCW) are at risk of infection during Ebola virus disease outbreaks and therefore may be targeted for vaccination before or during outbreaks. The effect of these strategies depends on the role of HCW in transmission which is understudied. Methods: To evaluate the effect of HCW-targeted or community vaccination strategies, we used a transmission model to explore the relative contribution of HCW and the community to transmission. We calibrated the model to data from multiple Ebola outbreaks. We quantified the impact of ahead-of-time HCW-targeted strategies, and reactive HCW and community vaccination. Results: We found that for some outbreaks (we call “type 1″) HCW amplified transmission both to other HCW and the community, and in these outbreaks prophylactic vaccination of HCW decreased outbreak size. Reactive vaccination strategies had little effect because type 1 outbreaks ended quickly. However, in outbreaks with longer time courses (“type 2 outbreaks”), reactive community vaccination decreased the number of cases, with or without prophylactic HCW-targeted vaccination. For both outbreak types, we found that ahead-of-time HCW-targeted strategies had an impact at coverage of 30%. Conclusions: The vaccine strategies tested had a different impact depending on the transmission dynamics and previous control measures. Although we will not know the characteristics of a new outbreak, ahead-of-time HCW-targeted vaccination can decrease the total outbreak size, even at low vaccine coverage.

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KW - Public health

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Control of Ebola virus disease outbreaks: Comparison of health care worker-targeted and community vaccination strategies

Abstract

Bibliographical note

Keywords

UN SDGs

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