title: Deliberate exposure of humans to chlorine-the aftermath of Ebola in West Africa.
abstract: BACKGROUND
  During the recent Ebola outbreak, spraying of the environment and humans, including healthcare workers, with chlorine was wide spread in affected African countries; adverse clinical effects are reported here.
  
  
  METHODS
  A cross sectional survey by interview of 1550 volunteers consisting of 500 healthcare workers (HCW), 550 Ebola survivors (EVD) and 500 quarantined asymptomatic Ebola contacts (NEVD) was conducted. Demographics, frequency of exposure to chlorine, clinical condition after chlorine exposure particularly eye, respiratory and skin conditions were noted. The length of time HCWs worked in Ebola Treatment Units (ETU), and use of personal protective equipment was recorded. Verbal consent was obtained from all participants and all responses remained anonymous. Permission and assistance from the guardian or parent was sought for those below 18 years of age.
  
  
  RESULTS
  493/500 HCW, 550/550 EVD and 477/500 NEVD were sprayed at least once with 0 · 5 % chlorine. Following even a single exposure, an increase in the number of eye (all three groups) and respiratory symptoms (in HCW & EVD) was reported (p< 0 · 001); after multiple exposure, respiratory and skin symptoms increased. In HCW, multiple vs single exposure was associated with an increase in respiratory (OR = 32 (95 % CI 22 -49)p< 0.001), eyes (OR = 30 (95 % CI 21 -43)p< 0.001) and skin conditions (OR = 22 (95 % CI 15-32)p< 0.001). The available personal protective equipment neither reduced nor prevented the adverse effects of chlorine.
  
  
  CONCLUSIONS
  Reported exposure to chlorine has usually been accidental. Despite the lack of evidence as a recognised outbreak control measure, deliberate exposure of humans to chlorine spray was wide spread in Africa during the Ebola epidemic resulting in serious detrimental health effects on humans. We strongly recommend that this practice be banned and that alternative safer methods be used.
authors.affiliation: Infection Control Africa Network, Cape Town, South Africa ; Unit for IPC, H9 Floor, Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Cape Town, South Africa.
authors.forename: Shaheen
authors.identifier: 0000-0002-3165-5566
authors.initials: S
authors.lastname: Mehtar
authors.affiliation: Infection Control Africa Network, Cape Town, South Africa ; Unit for IPC, H9 Floor, Tygerberg Hospital, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Cape Town, South Africa.
authors.forename: Andre N H
authors.initials: AN
authors.lastname: Bulabula
authors.affiliation: Ministry of Health & Sanitation, Freetown, Sierra Leone.
authors.forename: Haurace
authors.initials: H
authors.lastname: Nyandemoh
authors.affiliation: Ministry of Health & Sanitation, Freetown, Sierra Leone.
authors.forename: Steve
authors.initials: S
authors.lastname: Jambawai
keywords: Adverse events; Chlorine; Decontamination; Deliberate exposure; Ebola; Healthcare workers; Humans; Infection control; Occupational exposure; Side effects; Spray; West Africa