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PLoS Curr. 2017 Nov 9;9. pii: ecurrents.outbreaks.2b7f352af0866accbd7e5a82f165432a. doi: 10.1371/currents.outbreaks.2b7f352af0866accbd7e5a82f165432a.

Enhancing Ebola Virus Disease Surveillance and Prevention in Counties Without Confirmed Cases in Rural Liberia: Experiences from Sinoe County During the Flare-up in Monrovia, April to June, 2016.

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Health Promotion Division, Ministry of Health and Social Welfare, Monrovia, Liberia.
County Health Team, Ministry of Health and Social Welfare, Greenville City, Sinoe County, Liberia.
World Health Organization, Greenville City, Sinoe County, Liberia.



During the flare-ups of Ebola virus disease (EVD) in Liberia, Sinoe County reactivated the multi-sectorial EVD control strategy in order to be ready to respond to the eventual reintroduction of cases. This paper describes the impacts of the interventions implemented in Sinoe County during the last flare-up in Monrovia, from April 1 to June 9, 2016, using the resources provided during the original outbreak that ended a year ago.


We conducted a descriptive study to describe the key interventions implemented in Sinoe County, the capacity available, the implications for the reactivation of the multi-sectoral EVD control strategy, and the results of the same. We also conducted a cross-sectional study to analyze the impact of the interventions on the surveillance and on infection prevention and control (IPC).


The attrition of the staff trained during the original outbreak was low, and most of the supplies, equipment, and infrastructure from the original outbreak remained available. With an additional USD 1755, improvements were observed in the IPC indicators of triage, which increased from a mean of 60% at the first assessment to 77% (P=0.002). Additionally, personnel/staff training improved from 78% to 89% (P=0.04). The percentage of EVD death alerts per expected deaths investigated increased from 26% to 63% (P<0.0001).


The low attrition of the trained staff and the availability of most supplies, equipment, and infrastructure made the reactivation of the multi-sectoral EVD control strategy fast and affordable. The improvement of the EVD surveillance was possibly affected by the community engagement activities, awareness and mentoring of the health workers, and improved availability of clinicians in the facilities during the flare-up. The community engagement may contribute to the report of community-based events, specifically community deaths. The mentoring of the staff during the supportive supervisions also contributed to improve the IPC indicators.


EVD; Ebola Virus Disease; Enhancing surveillance; IPC; Liberia; Outbreak; Sinoe County; Surveillance; West Africa; assessment; community deaths; community engagement; community-based events; control; flare-up; infection prevention and control; infectious diseases; preparedness; prevention; public health; staff attrition

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