1400. The Spatial Distribution of Ebola Virus Disease (EVD) Cases in Liberia Using the National Surveillance Database — March – September, 2014
Session: Poster Abstract Session: All Things Ebola
Saturday, October 10, 2015
Room: Poster Hall
  • IDWeek_2015_09_MerrillRD_Ebola spatial distribution in Liberia_FINAL.pdf (522.2 kB)
  • Background: The Liberian Ministry of Health (MoH) National EPI Surveillance Committee used field surveillance officers to report Ebola Virus Disease (EVD) cases during the 2014-15 epidemic. Simultaneously, detailed epidemiological information about EVD cases was recorded on paper forms by field teams and entered in the viral hemorrhagic fever (VHF) module of EpiInfo at the national level. The VHF database has been used for periodic external reporting and small-scale data analyses but has not been utilized to explore the distribution of EVD cases across the country.

    Methods: All probable and confirmed EVD cases in the VHF database with a known date of onset on or before September 9, 2014 were included. We assigned latitude and longitude at the location of disease onset using the Liberia Institute of Statistics and Geo Information Services (LISGIS) database of village level Global Positioning System (GPS) data. We completed spatial analyses using ArcGIS, incorporating roads and points of interest provided by the MoH, to understand the distribution of location of disease onset.

    Results: Of 2462 included cases, identifiable district and village names were available to assign GPS location of onset to 1352 cases (55%; 45% and 73% of confirmed and probable cases, respectively) with an initial onset date of March 17. Sixty percent (n=800) of these cases had an onset of disease within 3 miles of the major highways. Fifty two percent (n=694) occurred within 5 miles of a hospital. After excluding cases with onset in Monsterrado county (36%, n=483), 30% (n=259/862) occurred within 5 miles of a hospital. 

    Conclusion: The distribution of EVD across Liberia as recorded in the national VHF database through September 9, 2014 suggests that for cases with sufficient data about location of disease onset a majority occurred along the major travel routes and half occurred within 5 miles of a hospital.  This pattern may reflect population density and may be biased by patient access to health facilities and testing; however, missing data limited the ability to describe thoroughly the distribution drawing attention to the need for more complete surveillance data collection and entry. This is the first analysis of the spatial distribution of EVD cases in Liberia using the national VHF database.

    Rebecca Merrill, PhD, MHS1, Luke Bawo, BPharm, MPH2, J Mike Mulbah, MPH, BSc., ASc2, Stephen Gbanyan, ASc, BSc Candidate2, Lucy Mcnamara, PhD, MS1, Erik Reaves, DO, MTM&H1, Rachel Idowu, MD, MPH1, Athalia Christie, MIA1, John Neatherlin, MPH1, Jordan Tappero, MD, MPH1, Carl Kinkade, MCRP, GISP1 and Joel Montgomery, PhD1, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)National EPI Surveillance Committee, Ministry of Health and Social Welfare, Monrovia, Liberia


    R. Merrill, None

    L. Bawo, None

    J. M. Mulbah, None

    S. Gbanyan, None

    L. Mcnamara, None

    E. Reaves, None

    R. Idowu, None

    A. Christie, None

    J. Neatherlin, None

    J. Tappero, None

    C. Kinkade, None

    J. Montgomery, None

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