Real-time projections of epidemic transmission and estimation of vaccination impact during an Ebola virus disease outbreak in Northeastern Democratic Republic of Congo

Lee Worden; Rae Wannier; Nicole A. Hoff; Kamy Musene; Bernice Selo; Mathias Mossoko; Emile Okitolonda-Wemakoy; Jean Jacques Muyembe-Tamfum; George W. Rutherford; Thomas M. Lietman; Anne W. Rimoin; Travis C. Porco; J. Daniel Kelly

There are limitations to our projections. Projection distributions are right-skewed, 382 with long tails (and we therefore report the median instead of the mean). We were 383 unable to include all the 23 observed EVD outbreaks with a case count greater than ten 384 cases in our estimates due to data availability. Our regression models are based entirely 385 on past outbreaks of Ebola virus disease (measured and reported in different ways), and 386 cannot account for the improved control measures and vaccination in the way that a outbreaks. The stochastic model used estimated vaccination effectiveness, reported 391 cases, and timing of onset dates affected by vaccination from studies from West Africa, 392 not DRC, and did not include vaccination of healthcare workers. Our forecasts do not 393 account for possible unreported cases or changes in reporting over time; such gaps in 394 reporting can not be ruled out, though given the intense efforts at case finding that 395 started in July and carried forward, we think it unlikely that there were large changes in 396 reporting. Furthermore, as the outbreak moved into areas affected by violent conflict as 397 the outbreak continued, we think it likely that case reporting, if anything, decreased Official reported case counts for each epidemic are given, including suspected cases ("Reported Count"). Case counts for the time series data included in the models include only probable and confirmed cases ("Time Series Count"). Case counts for historic outbreaks were pulled from publicly available literature [17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] . Lastly, each historic outbreak's inclusion in the regression, stochastic, and auto-regression models is enumerated. *Democratic Republic of Congo (formerly Zaïre)