Oliver W Morgan, Jessica K Adam, Allison Connolly, Erin Kennedy, Indu B Ahluwalia, Modupe Osinubi, Daniel R O’Leary, Tom Sesay, Sarah D Bennett
Background: In November 2014, during the West Africa Ebola epidemic, a driver contracted by the Centers for Disease Control and Prevention (CDC) in Sierra Leone developed Ebola virus disease, potentially exposing other Ebola-response staff and possibly jeopardizing outbreak response efforts.
Methods: In addition to an epidemiologic investigation with contact tracing and monitoring to limit possible Ebola virus transmission, the investigation team reviewed policies and procedures that may have contributed to the incident.
Results: The incident, investigation, and response activities occurred in Bombali, Tonkolili and Western Districts of Sierra Leone during a period of wide-spread community transmission of Ebola virus in all three districts. The driver did not immediately report his illness to relevant public health authorities, his employer, or CDC leading to a prolonged period of exposure for CDC staff and other Ebola responders. Review of policies and procedures identified a number of barriers for reporting illness during the response. To address these issues CDC Sierra Leone adopted a one team approach to ensure that all team members, regardless of employer or contracting mechanisms, were prepared to promote team safety while in the field. We also implemented new training for drivers on Ebola virus transmission and prevention measures, promoted hand hygiene in vehicles, ensured drivers stayed in accommodations approved for CDC staff and worked with vehicle companies to reduce disincentives for illness reporting.
Conclusions: The CDC Sierra Leone field teams were comprised of team members from a variety of cultural backgrounds and hired through different employment mechanisms. Not all employers promote a safe environment for illness reporting and there may be disincentives for reporting illness. A one team approach to staff safety should address these barriers.
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