A quantitative framework to define the end of an outbreak: application to Ebola Virus Disease

Bimandra A Djaafara; Natsuko Imai; Esther Hamblion; Benido Impouma; Christl A Donnelly; Anne Cori

Finally, some aspects of EVD transmission were not covered by our simulation framework, which deserve to be highlighted. The framework developed did not consider additional cases that arise from less common transmission routes such as migration, sexual transmission, and immunocompromised pregnant women. These caveats make the current policy to keep active case detection up to 90 days after the EO declaration essential if the framework and model were to be adopted. Although the framework accounts for superspreading (by allowing overdispersion in the offspring distribution), we did not explicitly model superspreading events in the context of unsafe burial practices that lead to large-scale funeral exposures (30, 38) . Nevertheless, the work presented here demonstrates the value of the development of a quantitative framework than can be used to help decision-makers to objectively assess the risk of flare-ups of cases after the EO declaration. It also highlights the limitations of the current WHO criterion for declaring the EO of EVD.