Sexual transmission and the probability of an end of the Ebola virus disease epidemic

• Published in: Journal of theoretical biology Vol. 471; no. C; pp. 1 - 12
• Main Authors: Lee, Hyojung, Nishiura, Hiroshi
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 21.06.2019; Elsevier
• Subjects: Africa, Western - epidemiology; Ebola virus disease; Epidemic; Epidemics; Extinction; Female; Generation time; Hemorrhagic Fever, Ebola - epidemiology; Hemorrhagic Fever, Ebola - transmission; Humans; Male; Models, Biological; Recurrence; Sexually Transmitted Diseases, Viral - epidemiology; Sexually Transmitted Diseases, Viral - transmission; Sexually transmitted infections; Unsafe Sex; Africa, Western; Epidemic; Recurrence; Generation time; Extinction; Ebola virus disease; Sexually transmitted infections
• ISSN: 0022-5193; 1095-8541; 1095-8541
• DOI: 10.1016/j.jtbi.2019.03.022

•WHO erroneously declared the end of Ebola, many of which caused by sexual transmission.•We computed the probability of the end of an Ebola, accounting for sexual transmission and under-ascertainment.•Calculating the probability of the end of epidemic outperformed the existing 42-day criteria of the WHO.•Waiting time to declare the end of Ebola depends on the sexual behaviors.•With substantial sexual transmissions, ascertaining the end of epidemic could even take 1 year. The criteria of zero Ebola cases defined by the World Health Organization did not explicitly account for the sexual transmission and led to multiple recrudescent events in West Africa from 2015 to 2016, partly indeed caused by sexual transmission from survivors. We devised a statistical model to compute the probability of the end of an Ebola virus disease epidemic, accounting for sexual transmission and under-ascertainment of cases. Analyzing the empirical data in Guinea, Liberia and Sierra Leone, the performance of the proposed model was compared with the existing criteria comprising a fixed waiting time of 42 days since the last case testing negative or burial. We showed that the waiting time can vary depending on the sexual behaviors of survivors and their adherence to refraining from unprotected sex is likely one of the key factors in determining the absence of additional cases after declaration. If the proportional weight of sexual transmission among all secondary transmission events was substantial, ascertaining the end could even require waiting 1 year from the purported last case. While our proposed method offers an objectively interpretable probability of the end of an epidemic, it highlights that the computation requires a good knowledge of sexual contact.