title: Evaluating the frequency of asymptomatic Ebola virus infection.
abstract: The potential for asymptomatic infection from Ebola viruses has long been questioned. Knowing the proportion of infections that are asymptomatic substantially changes the predictions made by mathematical models and alters the corresponding decisions based upon these models. To assess the degree of asymptomatic infection occurring during an Ebola virus disease (EVD) outbreak, we carried out a serological survey in the Djera district of the Equateur province of the Democratic Republic of the Congo affected by an Ebola outbreak in 2014. We sampled all asymptomatic residents (n= 182) of 48 households where at least one case of EVD was detected. To control for potential background seroprevalence of Ebola antibodies in the population, we also sampled 188 individuals from 92 households in an unaffected area with a similar demographic background. We tested the sera collected for anti-Ebola IgG and IgM antibodies at four different dilutions. We then developed a mixture model to estimate the likely number of asymptomatic patients who developed IgM and IgG responses to Ebola antigens in both groups. While we detected an association between medium to high titres and age, we did not detect any evidence of increased asymptomatic infection in the individuals who resided in the same household as cases.This article is part of the themed issue 'The 2013-2016 West African Ebola epidemic: data, decision-making and disease control'.
authors.affiliation: Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo.|METABIOTA, Kinshasa, Democratic Republic of Congo.
authors.forename: Placide
authors.initials: P
authors.lastname: Mbala
authors.affiliation: Modelling and Economics Department, Public Health England, London NW9 5EQ, UK marc.baguelin@phe.gov.uk.|Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors.forename: Marc
authors.identifier: http://orcid.org/0000-0003-3867-1953
authors.initials: M
authors.lastname: Baguelin
authors.affiliation: Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo.|METABIOTA, Kinshasa, Democratic Republic of Congo.
authors.forename: Ipos
authors.initials: I
authors.lastname: Ngay
authors.affiliation: Modelling and Economics Department, Public Health England, London NW9 5EQ, UK.|Institute of Health Informatics, University College London, London WC1E 6BT, UK.
authors.forename: Alicia
authors.initials: A
authors.lastname: Rosello
authors.affiliation: METABIOTA, Kinshasa, Democratic Republic of Congo.
authors.forename: Prime
authors.initials: P
authors.lastname: Mulembakani
authors.affiliation: Department of Statistics, Athens University of Economics and Business, Athens 10434, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Demiris
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
authors.forename: W John
authors.initials: WJ
authors.lastname: Edmunds
authors.affiliation: Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of Congo.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Muyembe
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D058345:Asymptomatic Infections / Q000453:epidemiology*; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D029043:Ebolavirus / Q000502:physiology*; D005260:Female; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008962:Models, Theoretical; D015995:Prevalence; D016036:Seroepidemiologic Studies; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: Ebola virus disease; asymptomatic infection; household survey; serology