The Impact of Different Types of Violence on Ebola Virus Transmission During the 2018–2020 Outbreak in the Democratic Republic of the Congo. (7th April 2020)

• Record Type: Journal Article
• Authors: Kelly, John Daniel; Wannier, Sarah Rae; Sinai, Cyrus; Moe, Caitlin A; Hoff, Nicole A; Blumberg, Seth; Selo, Bernice; Mossoko, Mathais; Chowell-Puente, Gerardo; Jones, James Holland; Okitolonda-Wemakoy, Emile; Rutherford, George W; Lietman, Thomas M; Muyembe-Tamfum, Jean Jacques; Rimoin, Anne W; Porco, Travis C; Richardson, Eugene T
• Is Part Of: Journal of infectious diseases. Volume 222:Number 12(2020)
• Page Start: 2021
• Page End: 2029
• Publication Date: 2020-04-07
• Subjects: Ebola virus disease -- violence -- transmission -- Democratic Republic of the Congo -- Africa; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiaa163
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Background: Our understanding of the different effects of targeted versus nontargeted violence on Ebola virus (EBOV) transmission in Democratic Republic of the Congo (DRC) is limited. Methods: We used time-series data of case counts to compare individuals in Ebola-affected health zones in DRC, April 2018–August 2019. Exposure was number of violent events per health zone, categorized into Ebola-targeted or Ebola-untargeted, and into civilian-induced, (para)military/political, or protests. Outcome was estimated daily reproduction number ( R t ) by health zone. We fit linear time-series regression to model the relationship. Results: Average R t was 1.06 (95% confidence interval [CI], 1.02–1.11). A mean of 2.92 violent events resulted in cumulative absolute increase in R t of 0.10 (95% CI, .05–.15). More violent events increased EBOV transmission ( P = .03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on R t, Ebola-targeted events corresponded to R t of 1.52 (95% CI, 1.30–1.74), while civilian-induced events corresponded to R t of 1.43 (95% CI, 1.21–1.35). Untargeted events corresponded to R t of 1.18 (95% CI, 1.02–1.35); among these, militia/political or ville morte events increased transmission. Conclusions: Ebola-targeted violence, primarily driven by civilian-induced events, had the largest impact on EBOV transmission. Abstract : A time-series study of the 2018–2020 Ebola virus disease outbreak in the Democratic Republic of the Congo found both Ebola-targeted and untargeted violence increased transmission, though targeted violence, primarily driven by civilian-involved events, had the largest impact.