American Journal of Tropical Medicine and Hygiene
April 2016; 94 (4)
http://www.ajtmh.org/content/current

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Perspective Piece
An Improved Ward Architecture for Treatment of Patients with Ebola Virus Disease in Liberia
Jianping You and Qing Mao
Am J Trop Med Hyg 2016 94:701-703; Published online January 11, 2016, doi:10.4269/ajtmh.15-0209
Abstract
During the recent outbreak of Ebola virus disease (EVD) in west Africa, we established an Ebola treatment center (ETC) with improved ward architecture. The ETC was built with movable prefabricated boards according to infectious disease unit standard requirements. The clinical staff ensured their own security while providing patients with effective treatment. Of the 180 admissions to the ETC, 10 cases were confirmed with EVD of which six patients survived. None of the clinical staff was infected. We hope that our experience will enable others to avoid unnecessary risks while delivering EVD care.

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Infectious Diseases in Sub-Saharan Immigrants to Spain
Núria Serre Delcor, Begoña Treviño Maruri, Antoni Soriano Arandes, Isabel Claveria Guiu, Hakima Ouaarab Essadik, Mateu Espasa Soley, Israel Molina Romero, and Carlos Ascaso
Am J Trop Med Hyg 2016 94:750-756; Published online February 15, 2016, doi:10.4269/ajtmh.15-0583
Abstract
Immigrants may be carriers of infectious diseases because of the prevalence of these diseases in their country of origin, exposure during migration, or conditions during resettlement, with this prevalence being particularly high in sub-Saharan Africans. We performed a retrospective review of 180 sub-Saharan immigrants screened for infectious diseases at an International Health Center from January 2009 to December 2012. At least one pathogenic infectious disease was diagnosed in 72.8% patients: 60.6% latent tuberculosis infection, 36.8% intestinal parasites (intestinal protozoa or helminths), 28.1% helminths, 14.8% hepatitis B surface antigen positive, 1.2% anti-hepatitis C virus positive, 1.2% human immunodeficiency virus–positive, and 1.2% malaria. Coinfections were present in 28.4%. There was significant association between eosinophilia (absolute count or percentage) or hyper-IgE and the presence of helminths (P < 0.001). Relative eosinophilia and hyper-IgE were better indicators of helminth infection than absolute eosinophilia, particularly for schistosomiasis and strongyloidiasis. We found a high prevalence of infectious diseases in sub-Saharan immigrants, which could lead to severe health problems (in the absence of prompt treatment), representing a high cost to the public health system and possible transmission in the host country. Accurate screening and tailored protocols for infectious diseases are recommended in sub-Saharan immigrants.

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Retrospective Analysis of the 2014–2015 Ebola Epidemic in Liberia
Katherine E. Atkins, Abhishek Pandey, Natasha S. Wenzel, Laura Skrip, Dan Yamin, Tolbert G. Nyenswah, Mosoka Fallah, Luke Bawo, Jan Medlock, Frederick L. Altice, Jeffrey Townsend,
Martial L. Ndeffo-Mbah, and Alison P. Galvani
Am J Trop Med Hyg 2016 94:833-839; Published online February 29, 2016, doi:10.4269/ajtmh.15-0328
Abstract
The 2014–2015 Ebola epidemic has been the most protracted and devastating in the history of the disease. To prevent future outbreaks on this scale, it is imperative to understand the reasons that led to eventual disease control. Here, we evaluated the shifts of Ebola dynamics at national and local scales during the epidemic in Liberia. We used a transmission model calibrated to epidemiological data between June 9 and December 31, 2014, to estimate the extent of community and hospital transmission. We found that despite varied local epidemic patterns, community transmission was reduced by 40–80% in all the counties analyzed. Our model suggests that the tapering of the epidemic was achieved through reductions in community transmission, rather than accumulation of immune individuals through asymptomatic infection and unreported cases. Although the times at which this transmission reduction occurred in the majority of the Liberian counties started before any large expansion in hospital capacity and the distribution of home protection kits, it remains difficult to associate the presence of interventions with reductions in Ebola incidence.