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BACKGROUND: The 2014 Ebola Virus Disease (EVD) outbreak in West Africa has necessitated a large and complex public health and medical response, which has put many healthcare workers (HCWs) at risk of contracting EVD themselves. We analyzed data among HCWs in Sierra Leone to describe the impact of the epidemic on these workers.
METHODS: We analyzed data from the national Viral Hemorrhagic Fever database (VHF). Persons under investigation were classified as suspect, probable, or confirmed cases per Sierra Leone Ministry of Health guidelines. Within the VHF data, HCWs were further defined as those marked as “Health care worker” and those with relevant information in the occupation text fields. Descriptive analyses were performed in SAS. Attack rates by occupational group were estimated using public sector employee counts from the Ministry of Health and Sanitation as denominators. Possible exposure settings (e.g., workplace, home) were analyzed. We also collected reports of affected HCWs from key informants at select healthcare facilities and public health agencies. These reports were compared to VHF records.
RESULTS: As of November 17, there were a total of 333 confirmed, probable, or suspect EVD case records in the Sierra Leone VHF database that were identified as part of the healthcare workforce through occupational fields. Of 210 HCWs with data on work location, 10 (4.8%) were working in Ebola-specific wards/facilities, 77 (36.7%) were working in general hospital wards, 69 (32.9%) worked in peripheral health units, and 37 (17.6%) worked in community locations. Of 294 HCWs with data on occupation, 124 (42.2%) were nursing staff, 48 (16.3%) were in clinical support occupations (e.g., lab technicians, cleaners, porters, documenters), and 38 (12.9%) were public health practitioners (e.g., community health workers, community health officers, community health assistants (CHAs), contact tracers, surveillance officers, vaccinators). The highest attack rate was among lab techs (6.0%), followed by dispensary/pharmacy staff (4.1%), and CHAs (4.0%). Of 94 HCWs with data on primary exposure contacts, 19 (20.2%) reported ill patients, 23 (24.5%) reported ill co-workers, and 35 (37.2%) reported ill family members. An additional 85 affected HCWs were identified through anecdotal reports.
CONCLUSIONS: Hundreds of HCWs from various settings and occupations have been affected by EVD in Sierra Leone, and there is evidence that HCWs are underreported in VHF. Many of the affected HCWs reported workplace exposures. Prevention interventions such as infection control training and provision of appropriate personal protective equipment should be targeted to all HCWs.