title: The impact of control strategies and behavioural changes on the elimination of Ebola from Lofa County, Liberia.
abstract: The Ebola epidemic in West Africa was stopped by an enormous concerted effort of local communities and national and international organizations. It is not clear, however, how much the public health response and behavioural changes in affected communities, respectively, contributed to ending the outbreak. Here, we analyse the epidemic in Lofa County, Liberia, lasting from March to November 2014, by reporting a comprehensive time line of events and estimating the time-varying transmission intensity using a mathematical model of Ebola transmission. Model fits to the epidemic show an alternation of peaks and troughs in transmission, consistent with highly heterogeneous spread. This is combined with an overall decline in the reproduction number of Ebola transmission from early August, coinciding with an expansion of the local Ebola treatment centre. We estimate that healthcare seeking approximately doubled over the course of the outbreak, and that isolation of those seeking healthcare reduced their reproduction number by 62% (mean estimate, 95% credible interval (CI) 59-66). Both expansion of bed availability and improved healthcare seeking contributed to ending the epidemic, highlighting the importance of community engagement alongside clinical intervention.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.
authors.affiliation: Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E, UK sebastian.funk@lshtm.ac.uk.
authors.forename: Sebastian
authors.identifier: http://orcid.org/0000-0002-2842-3406
authors.initials: S
authors.lastname: Funk
authors.affiliation: Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland.
authors.forename: Iza
authors.initials: I
authors.lastname: Ciglenecki
authors.affiliation: Epicentre, 1211 Geneva, Switzerland.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tiffany
authors.affiliation: Epicentre, 1211 Geneva, Switzerland.
authors.forename: Etienne
authors.initials: E
authors.lastname: Gignoux
authors.affiliation: Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E, UK.
authors.forename: Anton
authors.initials: A
authors.lastname: Camacho
authors.affiliation: Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E, UK.
authors.forename: Rosalind M
authors.initials: RM
authors.lastname: Eggo
authors.affiliation: Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E, UK.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Kucharski
authors.affiliation: Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London WC1E, UK.
authors.forename: W John
authors.initials: WJ
authors.lastname: Edmunds
authors.affiliation: Lofa County Health Office, Ministry of Health and Social Welfare, 7500 Voinjama, Liberia.
authors.forename: Josephus
authors.initials: J
authors.lastname: Bolongei
authors.affiliation: Lofa County Health Office, Ministry of Health and Social Welfare, 7500 Voinjama, Liberia.
authors.forename: Phillip
authors.initials: P
authors.lastname: Azuma
authors.affiliation: Monrovia Country Office, World Health Organization, 1000 Monrovia, Liberia.
authors.forename: Peter
authors.initials: P
authors.lastname: Clement
authors.affiliation: Lofa County Health Office, Ministry of Health and Social Welfare, 7500 Voinjama, Liberia.
authors.forename: Tamba S
authors.initials: TS
authors.lastname: Alpha
authors.affiliation: Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland.
authors.forename: Esther
authors.initials: E
authors.lastname: Sterk
authors.affiliation: Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Telfer
authors.affiliation: Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland.
authors.forename: Gregory
authors.initials: G
authors.lastname: Engel
authors.affiliation: Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland.|CIBER Epidemiología y Salud Pública, 28029 Madrid, Spain.|Department of Public Health, Universidad Miguel Hernández, 03202 Alicante, Spain.
authors.forename: Lucy Anne
authors.initials: LA
authors.lastname: Parker
authors.affiliation: Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland.|Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
authors.forename: Motoi
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland.
authors.forename: Nico
authors.initials: N
authors.lastname: Heijenberg
authors.affiliation: Operational Centre Geneva, Médecins Sans Frontières, 1211 Geneva, Switzerland.|College of Medicine, University of Saskatchewan, Saskatoon, Canada S7N 5E5.
authors.forename: Bruce
authors.initials: B
authors.lastname: Reeder
mesh_terms: D060740:Disease Eradication / Q000706:statistics & numerical data; D058872:Epidemics / Q000517:prevention & control*; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D008962:Models, Theoretical; D010342:Patient Acceptance of Health Care; D011634:Public Health
keywords: behavioural changes; community engagement; infectious disease dynamics; interventions; isolation; mathematical model