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Unreported cases in the 2014-2016 Ebola epidemic: Spatiotemporal variation, and implications for estimating transmission

Author(s): Dalziel, Benjamin D.; Lau, Max S.Y.; Tiffany, Amanda; McClelland, Amanda; Zelner, Jon; et al

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Abstract: In the recent 2014–2016 Ebola epidemic in West Africa, non-hospitalized cases were an important component of the chain of transmission. However, non-hospitalized cases are at increased risk of going unreported because of barriers to access to healthcare. Furthermore, underreporting rates may fluctuate over space and time, biasing estimates of disease transmission rates, which are important for understanding spread and planning control measures. We performed a retrospective analysis on community deaths during the recent Ebola epidemic in Sierra Leone to estimate the number of unreported non-hospitalized cases, and to quantify how Ebola reporting rates varied across locations and over time. We then tested if variation in reporting rates affected the estimates of disease transmission rates that were used in surveillance and response. We found significant variation in reporting rates among districts, and district-specific rates of increase in reporting over time. Correcting time series of numbers of cases for variable reporting rates led, in some instances, to different estimates of the time-varying reproduction number of the epidemic, particularly outside the capital. Future analyses that compare Ebola transmission rates over time and across locations may be improved by considering the impacts of differential reporting rates.
Publication Date: 22-Jan-2018
Electronic Publication Date: 22-Jan-2018
Citation: Dalziel, Benjamin D., Lau, Max S.Y., Tiffany, Amanda, McClelland, Amanda, Zelner, Jon, Bliss, Jessica R., Grenfell, Bryan T. (2018). Unreported cases in the 2014-2016 Ebola epidemic: Spatiotemporal variation, and implications for estimating transmission. PLOS Neglected Tropical Diseases, 12 (1), e0006161 - e0006161. doi:10.1371/journal.pntd.0006161
DOI: doi:10.1371/journal.pntd.0006161
EISSN: 1935-2735
Pages: e0006161 - e0006161
Type of Material: Journal Article
Journal/Proceeding Title: PLOS Neglected Tropical Diseases
Version: Final published version. This is an open access article.

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