{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T10:04:40Z","timestamp":1790676280886,"version":"4.1.0"},"reference-count":50,"publisher":"The Royal Society","issue":"1776","license":[{"start":{"date-parts":[[2019,5,20]],"date-time":"2019-05-20T00:00:00Z","timestamp":1558310400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/royalsociety.org\/journals\/ethics-policies\/data-sharing-mining\/"}],"funder":[{"name":"Christ Church, Oxford","award":["Junior Research Fellowship"],"award-info":[{"award-number":["Junior Research Fellowship"]}]}],"content-domain":{"domain":["royalsocietypublishing.org"],"crossmark-restriction":true},"short-container-title":["Phil. Trans. R. Soc. B"],"published-print":{"date-parts":[[2019,7,8]]},"abstract":"<jats:p>The World Health Organization considers an Ebola outbreak to have ended once 42 days have passed since the last possible exposure to a confirmed case. Benefits of a quick end-of-outbreak declaration, such as reductions in trade\/travel restrictions, must be balanced against the chance of flare-ups from undetected residual cases. We show how epidemiological modelling can be used to estimate the surveillance level required for decision-makers to be confident that an outbreak is over. Results from a simple model characterizing an Ebola outbreak suggest that a surveillance sensitivity (i.e. case reporting percentage) of 79% is necessary for 95% confidence that an outbreak is over after 42 days without symptomatic cases. With weaker surveillance, unrecognized transmission may still occur: if the surveillance sensitivity is only 40%, then 62 days must be waited for 95% certainty. By quantifying the certainty in end-of-outbreak declarations, public health decision-makers can plan and communicate more effectively.<\/jats:p>\n                  <jats:p>This article is part of the theme issue \u2018Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control\u2019. This issue is linked with the earlier theme issue \u2018Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes\u2019.<\/jats:p>","DOI":"10.1098\/rstb.2018.0431","type":"journal-article","created":{"date-parts":[[2019,5,20]],"date-time":"2019-05-20T03:06:01Z","timestamp":1558321561000},"page":"20180431","update-policy":"https:\/\/doi.org\/10.1098\/crossmark-policy","source":"Crossref","is-referenced-by-count":41,"title":["Rigorous surveillance is necessary for high confidence in end-of-outbreak declarations for Ebola and other infectious diseases"],"prefix":"10.1098","volume":"374","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8545-5212","authenticated-orcid":true,"given":"Robin N.","family":"Thompson","sequence":"first","affiliation":[{"name":"Department of Zoology, University of Oxford, Oxford, UK"},{"name":"Mathematical Institute, University of Oxford, Oxford, UK"},{"name":"Christ Church, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9543-3778","authenticated-orcid":true,"given":"Oliver W.","family":"Morgan","sequence":"additional","affiliation":[{"name":"World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9106-3186","authenticated-orcid":true,"given":"Katri","family":"Jalava","sequence":"additional","affiliation":[{"name":"University of Helsinki, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"175","published-online":{"date-parts":[[2019,5,20]]},"reference":[{"key":"e_1_3_6_2_2","unstructured":"World Health Organization. 2018 Ebola virus disease\u2014Democratic Republic of the Congo. Declaration of the end of the outbreak . See http:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/273348\/SITREP_EVD_DRC_20180725-eng.pdf?ua=1 (accessed 10 August 2018)."},{"key":"e_1_3_6_3_2","unstructured":"World Health Organization. 2019 Ebola virus disease\u2014Democratic Republic of the Congo. External situation report 36 . See https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/311805\/SITREP-EVD-DRC-20190407-eng.pdf?ua=1 (accessed 10 April 2018)."},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1421551111"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31387-4"},{"key":"e_1_3_6_6_2","volume-title":"Mathematical and statistical modeling for emerging and re-emerging infectious diseases","author":"Nishiura H","year":"2016"},{"key":"e_1_3_6_7_2","article-title":"Community event-based surveillance for Ebola virus disease in Sierra Leone: implementation of a national-level system during a crisis","volume":"1","author":"Stone E","year":"2016","journal-title":"PLoS Curr."},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2208.160205"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0006161"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2201.151383"},{"key":"e_1_3_6_11_2","unstructured":"World Health Organization. 2015 Criteria for declaring the end of the Ebola outbreak in Guinea Liberia or Sierra Leone . See. http:\/\/www.who.int\/csr\/disease\/ebola\/declaration-ebola-end\/en\/ (accessed 21 May 2018)."},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1409858"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1080\/13683500108667901"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecolmodel.2015.12.014"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5877(97)00081-0"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5877(01)00184-2"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5877(01)00262-8"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.prevetmed.2006.09.008"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.prevetmed.2006.09.007"},{"key":"e_1_3_6_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5877(97)00073-1"},{"key":"e_1_3_6_21_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-018-06657-5"},{"key":"e_1_3_6_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtbi.2018.10.038"},{"key":"e_1_3_6_23_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-phyto-080516-035334"},{"key":"e_1_3_6_24_2","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1079\/9781780643595.0313","volume-title":"Biosecurity surveillance: quantitative approaches","author":"Hester S","year":"2015"},{"key":"e_1_3_6_25_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268818002236"},{"key":"e_1_3_6_26_2","article-title":"Estimating the reproduction number of Ebola virus (EBOV) during the 2014 outbreak in West Africa","volume":"6","author":"Althaus CL","year":"2014","journal-title":"PLoS Curr."},{"key":"e_1_3_6_27_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1004836"},{"key":"e_1_3_6_28_2","doi-asserted-by":"publisher","DOI":"10.1038\/sdata.2015.19"},{"key":"e_1_3_6_29_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pntd.0004867"},{"key":"e_1_3_6_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ531"},{"key":"e_1_3_6_31_2","first-page":"1","article-title":"Estimating the future number of cases in the Ebola epidemic\u2014Liberia and Sierra Leone, 2014\u20132015","volume":"63","author":"Meltzer MI","year":"2014","journal-title":"MMWR Surveill. Summ."},{"key":"e_1_3_6_32_2","doi-asserted-by":"publisher","DOI":"10.1098\/rsos.172341"},{"key":"e_1_3_6_33_2","unstructured":"World Health Organization. 2015 Implementation and management of contact tracing for Ebola virus disease . See https:\/\/www.who.int\/csr\/resources\/publications\/ebola\/contact-tracing\/en\/ (accessed 29 November 2018)."},{"key":"e_1_3_6_34_2","first-page":"6753519","article-title":"Active case finding for improved Ebola virus disease case detection in Nimba County, Liberia","volume":"1","author":"Namukose E","year":"2018","journal-title":"Adv. Public Health"},{"key":"e_1_3_6_35_2","first-page":"1","article-title":"Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group","volume":"50","author":"German RR","year":"2001","journal-title":"MMWR Recomm. Rep."},{"key":"e_1_3_6_36_2","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2016.0303"},{"key":"e_1_3_6_37_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2112.150756"},{"key":"e_1_3_6_38_2","doi-asserted-by":"publisher","DOI":"10.1098\/rstb.2016.0300"},{"key":"e_1_3_6_39_2","first-page":"183","article-title":"Implementation of Ebola case-finding using a village chieftaincy taskforce in a remote outbreak\u2014Liberia, 2014","volume":"64","author":"Hagan JE","year":"2015","journal-title":"MMWR"},{"key":"e_1_3_6_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(15)70010-0"},{"key":"e_1_3_6_41_2","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.1600378"},{"key":"e_1_3_6_42_2","article-title":"Enhancing Ebola virus disease surveillance and prevention in countries without confirmed cases in rural Liberia: experiences from Sinoe County during the flare-up in Monrovia, April to June, 2016","volume":"9","author":"Weah VD","year":"2017","journal-title":"PLoS Curr."},{"key":"e_1_3_6_43_2","unstructured":"Farge E Giahyue JH. 2015 Female survivor may be cause of Ebola flare-up in Liberia. Clin. Infect. Dis. 62 . See https:\/\/www.reuters.com\/article\/us-health-ebola-liberia-idUSKBN0U02EJ20151217 (accessed 12 April 2019)."},{"key":"e_1_3_6_44_2","first-page":"e678","article-title":"Pregnancy outcomes in Liberian women who conceived after recovery from Ebola virus disease","volume":"4","author":"Fallah MP","year":"2016","journal-title":"Lancet"},{"key":"e_1_3_6_45_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2017.09.013"},{"key":"e_1_3_6_46_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-016-0112-9"},{"key":"e_1_3_6_47_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiy280"},{"key":"e_1_3_6_48_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtbi.2019.03.022"},{"key":"e_1_3_6_49_2","first-page":"e736","article-title":"Prevention of sexual transmission of Ebola in Liberia through a national semen testing and counselling programme for survivors: an analysis of Ebola virus RNA results and behavioural data","volume":"4","author":"Soka MJ","year":"2016","journal-title":"Lancet"},{"key":"e_1_3_6_50_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1301.060779"},{"key":"e_1_3_6_51_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy248"}],"container-title":["Philosophical Transactions of the Royal Society B: Biological Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/royalsocietypublishing.org\/doi\/pdf\/10.1098\/rstb.2018.0431","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/royalsocietypublishing.org\/doi\/full-xml\/10.1098\/rstb.2018.0431","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/royalsocietypublishing.org\/doi\/pdf\/10.1098\/rstb.2018.0431","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T21:24:22Z","timestamp":1778621062000},"score":1,"resource":{"primary":{"URL":"http:\/\/royalsocietypublishing.org\/rstb\/article\/30488"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,20]]},"references-count":50,"journal-issue":{"issue":"1776","published-print":{"date-parts":[[2019,7,8]]}},"alternative-id":["10.1098\/rstb.2018.0431"],"URL":"https:\/\/doi.org\/10.1098\/rstb.2018.0431","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/485821","asserted-by":"object"}]},"ISSN":["0962-8436","1471-2970"],"issn-type":[{"value":"0962-8436","type":"print"},{"value":"1471-2970","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,20]]},"assertion":[{"value":"2018-12-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-05-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}