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Paid Content Four seasons of culture in Georgia. This good performance of EWARS can be explained by the intensive, comprehensive, and continuous reporting flow. First, the system relied on the use of various sources of alerts, involving both passive and active case reporting from the community, health structures, and other surveillance sites. Second, it built upon a stable and extensive telephone network further supported by toll-free numbers, a means of communication that is easily accessible, acceptable, and already commonly used by all stakeholders involved in surveillance.
Third, it adopted a decentralized approach for the organization of the investigation teams, which enabled comprehensive coverage of all health areas and prompt reactivity for early action. The existence of a dedicated team at the subcoordination level further supported the coordination of activities at the local level while aiding in the centralization and consolidation of the information circuit.
How fast a system detects and responds effectively to a threat is the optimal measure of performance. Continuously evaluating and improving timeliness can identify performance bottlenecks and help to accelerate progress, improving detection speed and response quality The alert system performed better in Beni for all attributes we studied.
Surveillance and investigation activities faced regular security incidents and restrictions, long distances to alert sites, and poor road networks in many health areas. In this context, the alert system was initially implemented in Beni and progressively extended and strengthened in Mutwanga and Oicha. For example, in the early phase, rapid intervention teams were staffed in the Beni subcoordination office only, such that alert investigations in Mutwanga and Oicha suffered longer delays.
Surveillance and reporting capacities were also weaker in Mutwanga and Oicha. In November , a training of response personnel registered nurses, supervisors, and investigators was organized to address the low incidence of alerts; to strengthen data management capacities, data managers were deployed, leading to a rapid increase in alerts from these health zones. Despite the effects of security incidents, the EWARS continued to operate throughout the whole period, managing an increasing volume of alerts, leading to the detection of hundreds of cases.
In a context of limited surveillance capacities and weak health systems, such an intensive and steadily reporting alert system was vital for the early detection of cases and interruption of the spread of the disease in the population. However, the system was conceived and implemented in an ad hoc manner within the framework of the Ebola outbreak response, which limited its sustainability beyond the resources and time period of the outbreak response.
The financial, logistical, and human resources needed to implement and maintain the system were made possible by dedicated response funds and the time-bound engagement of both national support teams and international financial and technical partners. An additional limitation was the challenge in assessing overall performance measures of the system, such as completeness, acceptability, and flexibility.
We evaluated EWARS with regard to its objectives, but we could not extrapolate the effects of the system on the overall outbreak dynamics. In conclusion, the magnitude and duration of the 10th and largest Ebola outbreak in DRC, occurring in an active conflict zone, highlighted the need for prompt, functional, and effective infectious disease surveillance systems. We have demonstrated that the EWARS implemented was a cost-effective component of this surveillance system.
Our findings underscore the importance of early-warning systems, along with the necessity of ensuring efficiency and sustainability beyond the duration of the emergency response phase. As such, Integrated Disease Surveillance and Response is a relevant framework to further strengthen the International Health Regulations core capacities 27 , The need to evaluate and learn from field implementation of surveillance systems in infectious disease outbreaks, even in such difficult contexts, is an opportunity to better understand response efforts and improve future responses Keita is a medical doctor and public health specialist, currently working as technical officer for risk assessment with the WHO Regional Office for Africa.
His research interests include infectious diseases epidemiology, risk assessment, public health response in humanitarian and emergency settings, health systems strengthening, healthcare management, and global health policy. Table of Contents — Volume 27, Number 12—December Please use the form below to submit correspondence to the authors or contact them at the following address:. Highlight and copy the desired format.
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Figure 1 Figure 2 Figure 3 Figure 4 Figure 5. Table 1 Table 2 Table 3 Table 4. Article Metrics. Related Articles. Keita, J. Polonsky, S. Dagron, O. Keita, A. Lucaccioni, I. Ilumbulumbu, M. Polonsky, L. Nsio-Mbeta, G.
Panda, P. Adikey, J. Figure 3 Figure 3. Timeliness An investigation was initiated within 2 hours from the time of alert for , Figure 4 Figure 4. Representativeness Figure 5 Figure 5. Usefulness and Cost The EWARS system led to the detection of confirmed and 3 probable cases, which equates to alerts notified and 38 alerts validated for each case detected by the system.
Stool culture. A small sample of stool is collected from your rectum or from a bowel movement. The sample is checked for viruses and bacteria. Sputum culture. A small sample of mucus coughed from the lungs is collected.
It is checked for viruses and bacteria. Currently no medicine is available to cure Ebola. Treatment for Ebola is done to help support your body while it fights the disease. This is known as supportive care. It includes therapies that help your body during severe illness.
Supportive care may include:. Blood, urine, and other tests may be done regularly. This is to check for chemicals that show how well the organs are working. The tests also look for signs of the virus that continue or go away.
Your blood pressure will be checked regularly. In rare cases, experimental treatment may be used. These are treatments that are not yet proven to work, but may work.
They are not approved by the FDA, but may be allowed in some cases. Experimental treatments may include:. Convalescent serum. This is the liquid part of blood serum taken from a person who is recovering from Ebola. It is then put into the body of a person sick with Ebola. This includes medicines that act on blood-clotting factors or parts of the Ebola virus. Denzel Washington on playing Macbeth and the legacy of Sidney Poitier. Why this is Canada's kindest province.
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