ReviewInfectious Disease

Lessons from Ebola: Improving infectious disease surveillance to inform outbreak management

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Science Translational Medicine  30 Sep 2015:
Vol. 7, Issue 307, pp. 307rv5
DOI: 10.1126/scitranslmed.aab0191


  • Fig. 1. Time-scaled phylogenetic tree based on ebolavirus sequences [from (25)] from Kenema Government Hospital, Sierra Leone, May and June 2014, plus early samples from Guinea [from (23)].

    Branch colors represent probable location of infection with the corresponding locations shown in the inset map. In the map, the radius of the circles denotes the number of sampled sequences, and the lines represent the phylogenetic tree projected onto the map.

  • Fig. 2. Projected numbers of cases of EVD in Liberia in 2014 obtained using a branching process model with an ensemble of plausible parameter values.

    The 95% prediction intervals from 4 July 2014 (yellow shading) are compared with the observed cumulative case numbers (logarithmic scale) over the following 2 months (blue line). The 95% prediction intervals for a model that incorporates estimated levels of underreporting are also shown (blue shading). Reproduced with authors’ permission from (32).

  • Fig. 3. Predicted probability distribution of zoonotic EVD cases in Africa based on a risk mapping analysis and highlighting at-risk countries with and without index cases reported up to 2014.

    Blue, low probability; red, high probability. Reproduced with authors’ permission from (24).

  • Fig. 4. Key elements of data capture and information flows for real-time quantitative analysis to inform outbreak management.

    The at-risk population encompasses cases and, where available, a sentinel subpopulation. Three types of data capture activities are identified: case finding, including associated epidemiological investigations such as contact tracing; diagnostic information on individual patients, including serological testing and pathogen sequencing; and so-called denominator studies on the population at risk, including demography, behavior (such as social media activity), and the impact of health measures. Information flows involve communication between data gatherers, data analysts and modelers, policy-makers, and public health authorities. We note, however, that decision-making never relies solely on the outputs of real-time epidemiological analyses.


  • Table 1.

    Major emerging infectious disease outbreaks in the 21st century.

    PathogenDiseaseTime spanGeographic rangeScale
    SARS coronavirusSevere acute
    respiratory syndrome
    November 2002
    to July 2003
    29 countries: Australia, Brazil,
    Canada, China, Colombia, Finland,
    France, Germany, India, Indonesia,
    Italy, Kuwait, Malaysia, Mongolia,
    New Zealand, Philippines, Ireland,
    Romania, Russia, Singapore, South Africa,
    South Korea, Spain, Sweden, Switzerland,
    Thailand, UK, United States, Viet Nam
    >8000 cases, 916 deaths
    Chikungunya virusMosquito-borne
    viral disease
    February 2005 to
    August 2006
    8 countries: Comoros Islands,
    India, Kenya, Madagascar, Mauritius,
    Mayotte, Reunion, Seychelles
    >1,700,000 cases
    H1N1 influenza A virus*InfluenzaApril 2009 to
    August 2010
    214 countries worldwide reported
    laboratory-confirmed cases
    Estimated 150,000 to
    600,000 deaths,
    18,500 laboratory-confirmed
    E. coli O104:H4Enterobacterial infection
    (can lead to hemolytic
    uremic syndrome)
    May 2011 to
    July 2011
    14 countries: Austria, Canada,
    Czech Republic, Denmark, France,
    Germany, Greece, Luxembourg,
    Netherlands, Norway, Poland,
    Spain, Sweden, Switzerland
    4075 cases, 50 deaths
    MERS coronavirus*Viral respiratory
    September 2012 to
    23 countries: Algeria, Austria,
    Egypt, France, Germany, Greece,
    Iran, Italy, Jordan, Kuwait, Lebanon,
    Malaysia, Netherlands, Oman,
    Philippines, Qatar, Saudi Arabia,
    Turkey, Tunisia, UK, United Arab Emirates,
    United States, Yemen
    1368 laboratory-
    confirmed cases,
    487 deaths
    (as of 7 July 2015)
    H7N9 influenza A virusInfluenzaMarch 2013 to
    3 countries: China, plus travel-associated
    cases in Malaysia, Canada
    486 laboratory-
    confirmed cases, 184 deaths
    (as of 8 February 2015)
    Chikungunya virusMosquito-borne
    viral disease
    December 2013 to
    47 countries: Widespread in Caribbean and
    Central America plus Argentina, Bolivia, Brazil,
    Canada, Chile, Colombia, Guyana, Mexico,
    Paraguay, Peru, United States, Venezuela
    >1,000,000 cases, 176 deaths
    (as of January 2015)
    Zaire ebolavirus*Hemorrhagic feverMarch 2014 to
    9 countries: Guinea, Liberia, Mali, Nigeria, Senegal,
    Sierra Leone, Spain, UK, United States
    28,251 cases, 11,294 deaths
    (as of 16 September 2015)

    *Designated as “public health event of international concern” (PHEIC) according to the International Health Regulations.

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