Exploring the contribution of exposure heterogeneity to the cessation of the 2014 Ebola epidemic.

• Main Authors: Florian Uekermann, Lone Simonsen, Kim Sneppen
• Format: Article
• Language: English
• Published: Public Library of Science (PLoS) 2019-01-01
• Series: PLoS ONE
• Online Access: https://doi.org/10.1371/journal.pone.0210638

The unexpected early cessation of the recent West Africa Ebola outbreak demonstrated shortcomings of popular forecasting approaches and has not been fully understood yet. A popular hypothesis is that public health interventions mitigated the spread, such as ETUs and safe burials. We investigate whether risk heterogeneity within the population could serve as an alternative explanation. We introduce a model for spread in heterogeneous host population that is particularly well suited for early predictions due to its simplicity and ease of application. Furthermore, we explore the conditions under which the observed epidemic trajectory can be explained without taking into account the effect of public health interventions. While the obtained fits closely match the total case count time series, closer inspection of sub-population results made us conclude that risk heterogeneity is unlikely to fully explain the early cessation of Ebola; other factors such as behavioral changes and other interventions likely played a major role. More accurate predictions in a future scenario require models that allow for early sub-exponential growth, as well as access to additional data on patient occupation (risk level) and location, to allow identify local phenomena that influence spreading behavior.