PLoS Neglected Tropical Diseases
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Research Article
Containing Ebola at the Source with Ring Vaccination
Stefano Merler, Marco Ajelli, Laura Fumanelli, Stefano Parlamento, Ana Pastore y Piontti, Natalie E. Dean, Giovanni Putoto, Dante Carraro, Ira M. Longini Jr., M. Elizabeth Halloran, Alessandro Vespignani
| published 02 Nov 2016 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0005093
Abstract
Interim results from the Guinea Ebola ring vaccination trial suggest high efficacy of the rVSV-ZEBOV vaccine. These findings open the door to the use of ring vaccination strategies in which the contacts and contacts of contacts of each index case are promptly vaccinated to contain future Ebola virus disease outbreaks. To provide a numerical estimate of the effectiveness of ring vaccination strategies we introduce a spatially explicit agent-based model to simulate Ebola outbreaks in the Pujehun district, Sierra Leone, structurally similar to previous modelling approaches. We find that ring vaccination can successfully contain an outbreak for values of the effective reproduction number up to 1.6. Through an extensive sensitivity analysis of parameters characterising the readiness and capacity of the health care system, we identify interventions that, alongside ring vaccination, could increase the likelihood of containment. In particular, shortening the time from symptoms onset to hospitalisation to 2–3 days on average through improved contact tracing procedures, adding a 2km spatial component to the vaccination ring, and decreasing human mobility by quarantining affected areas might contribute increase our ability to contain outbreaks with effective reproduction number up to 2.6. These results have implications for future control of Ebola and other emerging infectious disease threats.
Author Summary
When the 2014–15 Ebola outbreak in West Africa began, no licensed vaccines for the disease were available. The rVSV-ZEBOV vaccine was developed during the course of the epidemic and underwent a clinical trial demonstrating 100% efficacy when vaccinating contacts and contacts of contacts of confirmed Ebola cases (an approach called ring vaccination). However, the trial did not provide any understanding on whether this vaccination strategy can be effective in containing future Ebola virus disease outbreaks. Through a modelling study on a region of Sierra Leone, we provide numerical estimates for the effectiveness of ring vaccination: we show that outbreaks with moderate transmission potential, with no more than 1.6 secondary cases generated by an index case on average, can be successfully contained; more extensive vaccination(e.g., including spatial rings around index cases) and reinforcement of the healthcare system would increase the likelihood of containment even if the virus were more transmissible than in the past. Our results provide implications for control plans of possible future Ebola outbreaks.
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Symposium
The Art of Writing and Implementing Standard Operating Procedures (SOPs) for Laboratories in Low-Resource Settings: Review of Guidelines and Best Practices
Barbara Barbé, Kristien Verdonck, Deby Mukendi, Veerle Lejon, Jean-Roger Lilo Kalo, Emilie Alirol, Philippe Gillet, Ninon Horié, Raffaella Ravinetto, Emmanuel Bottieau, Cedric Yansouni, Andrea S. Winkler, Harry van Loen, Marleen Boelaert, Pascal Lutumba, Jan Jacobs
| published 03 Nov 2016 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0005053
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Editorial
Clinical Research on Neglected Tropical Diseases: Challenges and Solutions
Marleen Boelaert, The NIDIAG Consortium
| published 03 Nov 2016 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004853
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Viewpoints
The Challenges of Conducting Clinical Research on Neglected Tropical Diseases in Remote Endemic Areas in Sudan
Sayda El-Safi, François Chappuis, Marleen Boelaert
| published 03 Nov 2016 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004736
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Viewpoints
Rapid Diagnostic Tests for Neglected Infectious Diseases: Case Study Highlights Need for Customer Awareness and Postmarket Surveillance
Barbara Barbé, Kristien Verdonck, Sayda El-Safi, Basudha Khanal, Syna Teav, Jean-Roger Lilo Kalo, Raffaella Ravinetto, François Chappuis, Marleen Boelaert, Jan Jacobs
Viewpoints | published 03 Nov 2016 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004655

Viewpoints
Clinical Research in Neglected Tropical Diseases: The Challenge of Implementing Good Clinical (Laboratory) Practices
Raffaella Ravinetto, Emilie Alirol, Yodi Mahendradhata, Suman Rijal, Pascal Lutumba, Moussa Sacko, Sayda El-Safi, Kruy Lim, Harry van Loen, Jan Jacobs, Rosanna W. Peeling, Francois Chappuis, Marleen Boelaert
Viewpoints | published 03 Nov 2016 PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004654