title: A practical community-based response strategy to interrupt Ebola transmission in sierra Leone, 2014-2015.
abstract: BACKGROUND
  The Ebola virus disease spread rapidly in West Africa in 2014, leading to the loss of thousands of lives. Community engagement was one of the key strategies to interrupt Ebola transmission, and practical community level measures needed to be explored in the field and tailored to the specific context of communities.
  
  
  METHODS
  First, community-level education on Ebola virus disease (EVD) prevention was launched for the community's social mobilizers in six districts in Sierra Leone beginning in November 2014. Then, from January to May of 2015, in three pilot communities, local trained community members were organized to engage in implementation of EVD prevention and transmission interruption measures, by involving them in alert case report, contact tracing, and social mobilization. The epidemiological indicators of transmission interruption in three study communities were evaluated.
  
  
  RESULTS
  A total of 6 016 community social mobilizers from 185 wards were trained by holding 279 workshops in the six districts, and EVD message reached an estimated 631 680 residents. In three pilot communities, 72 EVD alert cases were reported, with 70.8 % of them detected by trained local community members, and 14 EVD cases were finally identified. Contact tracing detected 64.3 % of EVD cases. The median duration of community infectivity for the cases was 1 day. The secondary attack rate was 4.2 %, and no third generation of infection was triggered. No health worker was infected, and no unsafe burial and noncompliance to EVD control measures were recorded. The community-based measures were modeled to reduce 77 EVD cases, and the EVD-free goal was achieved four months earlier in study communities than whole country of Sierra Leone.
  
  
  CONCLUSIONS
  The community-based strategy of social mobilization and community engagement was effective in case detection and reducing the extent of Ebola transmission in a country with weak health system. The successfully practical experience to reduce the risk of Ebola transmission in the community with poor resources would potentially be helpful for the global community to fight against the EVD and the other diseases in the future.
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.lastname: Li
authors.affiliation: Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: Bureau of Disease Prevention and Control, National Health and Family Planning Commission of the People's Republic of China, Beijing, China.
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authors.affiliation: Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: National Institute of Parasitic Disease, Chinese Center for Disease Control and Prevention, Shanghai, China.
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authors.affiliation: National Institute of Parasitic Disease, Chinese Center for Disease Control and Prevention, Shanghai, China.
authors.forename: Chun-Li
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authors.affiliation: Chinese Center for Health Education, Beijing, China.
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authors.affiliation: Department of Infectious Diseases, Shanghai Public Health Clinical Center, Shanghai, China.
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authors.affiliation: Beijing Ditan Hospital, Capital Medical University, Beijing, China.
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authors.affiliation: National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: National Institute of Parasitic Disease, Chinese Center for Disease Control and Prevention, Shanghai, China.
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authors.affiliation: Department of Training, Chinese Center for Health Education, Beijing, China.
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authors.affiliation: Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.
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authors.affiliation: Infection Management, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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authors.affiliation: Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China.
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authors.affiliation: Division of Infectious Disease Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
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authors.affiliation: Division of Acute Infectious Disease Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, Wuhan, China.
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authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: Office of laboratory Management, Chinese Center for Disease Control and Prevention, Beijing, China.
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authors.affiliation: National Institute of Parasitic Disease, Chinese Center for Disease Control and Prevention, Shanghai, China.
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authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. wangyu@chinacdc.cn.|Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China. wangyu@chinacdc.cn.
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authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China. Liangxf_Chinacdc@163.com.|Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China. Liangxf_Chinacdc@163.com.
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mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control*; D029043:Ebolavirus / Q000502:physiology*; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission / Q000821:virology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012807:Sierra Leone / Q000453:epidemiology; D055815:Young Adult
keywords: Community engagement; Ebola virus disease; Health education; Outbreak control