The Impact of Different Types of Violence on Ebola Virus Transmission During the 2018-2020 Outbreak in the Democratic Republic of the Congo

John Daniel Kelly; Sarah Rae Wannier; Cyrus Sinai; Caitlin A Moe; Nicole A Hoff; Seth Blumberg; Bernice Selo; Mathais Mossoko; Gerardo Chowell-Puente; James Holland Jones; Emile Okitolonda-Wemakoy; George W Rutherford; Thomas M Lietman; Jean Jacques Muyembe-Tamfum; Anne W Rimoin; Travis C Porco; Eugene T Richardson

doi:10.1093/infdis/jiaa163

The Impact of Different Types of Violence on Ebola Virus Transmission During the 2018-2020 Outbreak in the Democratic Republic of the Congo

J Infect Dis. 2020 Nov 13;222(12):2021-2029. doi: 10.1093/infdis/jiaa163.

Authors

John Daniel Kelly^{1

2

3}, Sarah Rae Wannier^{1

2}, Cyrus Sinai⁴, Caitlin A Moe^{5

6}, Nicole A Hoff⁷, Seth Blumberg², Bernice Selo⁸, Mathais Mossoko⁸, Gerardo Chowell-Puente⁹, James Holland Jones¹⁰, Emile Okitolonda-Wemakoy¹¹, George W Rutherford^{1

3}, Thomas M Lietman¹, Jean Jacques Muyembe-Tamfum¹², Anne W Rimoin⁷, Travis C Porco^{1

2}, Eugene T Richardson^{13

14}

Affiliations

¹ Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA.
² F. I. Proctor Foundation, University of California San Francisco, San Francisco, California, USA.
³ Institute of Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA.
⁴ Department of Geography, University of North Carolina, Chapel Hill, North Carolina, USA.
⁵ Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA.
⁶ Firearm Injury Policy and Research Program, Harborview Injury Prevention and Research Center, University of Washington, Seattle, Washington, USA.
⁷ School of Public Health, University of California Los Angeles, Los Angeles, California, USA.
⁸ Ministry of Health, Kinshasa, Democratic Republic of Congo.
⁹ Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA.
¹⁰ Department of Earth Systems Science, Stanford University, Stanford, California, USA.
¹¹ School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
¹² National Institute of Biomedical Research, Kinshasa, Democratic Republic of Congo.
¹³ Harvard Medical School, Boston, Massachusetts, USA.
¹⁴ Brigham and Women's Hospital, Boston, Massachusetts, USA.

Abstract

Background: Our understanding of the different effects of targeted versus nontargeted violence on Ebola virus (EBOV) transmission in Democratic Republic of the Congo (DRC) is limited.

Methods: We used time-series data of case counts to compare individuals in Ebola-affected health zones in DRC, April 2018-August 2019. Exposure was number of violent events per health zone, categorized into Ebola-targeted or Ebola-untargeted, and into civilian-induced, (para)military/political, or protests. Outcome was estimated daily reproduction number (Rt) by health zone. We fit linear time-series regression to model the relationship.

Results: Average Rt was 1.06 (95% confidence interval [CI], 1.02-1.11). A mean of 2.92 violent events resulted in cumulative absolute increase in Rt of 0.10 (95% CI, .05-.15). More violent events increased EBOV transmission (P = .03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on Rt, Ebola-targeted events corresponded to Rt of 1.52 (95% CI, 1.30-1.74), while civilian-induced events corresponded to Rt of 1.43 (95% CI, 1.21-1.35). Untargeted events corresponded to Rt of 1.18 (95% CI, 1.02-1.35); among these, militia/political or ville morte events increased transmission.

Conclusions: Ebola-targeted violence, primarily driven by civilian-induced events, had the largest impact on EBOV transmission.

Keywords: Africa; Democratic Republic of the Congo; Ebola virus disease; transmission; violence.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Armed Conflicts / classification*
Civil Disorders / classification*
Democratic Republic of the Congo / epidemiology
Disease Outbreaks*
Ebolavirus
Geographic Mapping*
Hemorrhagic Fever, Ebola / epidemiology*
Hemorrhagic Fever, Ebola / transmission*
Humans

Abstract

Publication types

MeSH terms

Grants and funding