{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T05:40:26Z","timestamp":1793598026170,"version":"4.5.0"},"reference-count":17,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T00:00:00Z","timestamp":1744675200000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by\/3.0\/igo\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/X020258\/1"],"award-info":[{"award-number":["MR\/X020258\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR200908"],"award-info":[{"award-number":["NIHR200908"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2025,2,28]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>The 10th outbreak of Ebola Virus Disease (EVD) in the Democratic Republic of the Congo (DRC) in 2018\u20132020 was the largest in DRC\u2019s history and the second largest worldwide. Different strategic response plans (SRPs) were implemented, and the outbreak was eventually stopped after a large scale-up of operations with the SRP 4, which benefited from all public health measures deployed during SRPs 1-3, upon which it developed a more holistic approach including community engagement, logistics and security.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used modelling to characterise EVD transmission and assess the epidemiological impact of the two main response strategies (SRPs 1\u20133 vs SRP 4). We simulated potential future epidemics with different intervention scenarios, combined with a costing model to evaluate the incremental cost-effectiveness of different strategies.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We estimated a mean effective reproduction number <jats:italic>R<\/jats:italic> of 1.19 (credible interval (95% CrI) = (1.13 ; 1.25)). The spatial spread was moderate with an average 4.4% (95% CrI = (3.5%; 5.4%)) of transmissions moving to different health zones. The scale-up of operations in SRP 4 coincided with a threefold reduction in transmission, and 30% faster control of EVD waves. In simulations, SRP 4 appears cost-saving, although most simulated outbreaks remain small even with SRPs 1\u20133.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Most EVD outbreaks are expected to be small and can be contained with SRPs 1\u20133. In outbreaks with increased transmissibility or in the presence of insecurity, rapid scale-up to SRP 4 is likely to save lives and be cost-effective.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-015822","type":"journal-article","created":{"date-parts":[[2025,4,15]],"date-time":"2025-04-15T16:20:46Z","timestamp":1744734046000},"page":"e015822","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Contrasting the impact and cost-effectiveness of successive intervention strategies in response to Ebola in the Democratic Republic of the Congo, 2018\u20132020"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2226-8692","authenticated-orcid":false,"given":"Thibaut","family":"Jombart","sequence":"first","affiliation":[{"name":"MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3473-3638","authenticated-orcid":false,"given":"Wu","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Global Health, Georgetown University, Georgetown University, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Yao","sequence":"additional","affiliation":[{"name":"World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8443-9162","authenticated-orcid":false,"given":"Anne","family":"Cori","sequence":"additional","affiliation":[{"name":"MRC Centre for Global Infectious Disease Analysis, Jameel Institute, School of Public Health, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Ahuka-Mundeke","sequence":"additional","affiliation":[{"name":"Institut National de Recherche Biom\u00e9dicale, Kinshasa, Democratic Republic of Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadia","family":"Samaha","sequence":"additional","affiliation":[{"name":"Health, Nutrition and Population, World Bank Group, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Health, Nutrition and Population, World Bank Group, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias","family":"Mossoko","sequence":"additional","affiliation":[{"name":"Ministry of Health, Kinshasa, Democratic Republic of Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Pierre","family":"Lokonga","sequence":"additional","affiliation":[{"name":"Health System Development Project, Kinshasa, Democratic Republic of Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominique","family":"Baabo","sequence":"additional","affiliation":[{"name":"UNICEF, Kinshasa, Democratic Republic of Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fatima","family":"El Kadiri El Yamini","sequence":"additional","affiliation":[{"name":"Health, Nutrition and Population, World Bank Group, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick Hoang-Vu","family":"Eozenou","sequence":"additional","affiliation":[{"name":"Health, Nutrition and Population, World Bank Group, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvain","family":"Yuma","sequence":"additional","affiliation":[{"name":"Ministry of Health, Kinshasa, Democratic Republic of Congo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Mobula","sequence":"additional","affiliation":[{"name":"Health, Nutrition and Population, World Bank Group, Washington, District of Columbia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,15]]},"reference":[{"key":"2025073015174944000_10.4.e015822.1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1056\/NEJMsr1904253","article-title":"The Ongoing Ebola Epidemic in the Democratic Republic of Congo, 2018-2019","volume":"381","author":"Ilunga Kalenga","year":"2019","journal-title":"N Engl J Med"},{"key":"2025073015174944000_10.4.e015822.2","unstructured":"World Health Organization . 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Available: https:\/\/storymaps.arcgis.com\/stories\/813561c780d44af38c57730418cd96cd [Accessed 10 Jul 2020]."},{"key":"2025073015174944000_10.4.e015822.3","doi-asserted-by":"crossref","DOI":"10.1016\/j.epidem.2019.100353","article-title":"Estimating the impact of violent events on transmission in Ebola virus disease outbreak, Democratic Republic of the Congo, 2018-2019","volume":"28","author":"Wannier","year":"2019","journal-title":"Epidemics"},{"key":"2025073015174944000_10.4.e015822.4","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1913980116"},{"key":"2025073015174944000_10.4.e015822.5","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2020.25.2.1900735","article-title":"The cost of insecurity: from flare-up to control of a major Ebola virus disease hotspot during the outbreak in the Democratic Republic of the Congo, 2019","volume":"25","author":"Jombart","year":"2020","journal-title":"Euro Surveill"},{"key":"2025073015174944000_10.4.e015822.6","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.epidem.2019.05.002","article-title":"Analyzing and forecasting the Ebola incidence in North Kivu, the Democratic Republic of the Congo from 2018-19 in real time","volume":"27","author":"Akhmetzhanov","year":"2019","journal-title":"Epidemics"},{"key":"2025073015174944000_10.4.e015822.7","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0007512","article-title":"Projections of epidemic transmission and estimation of vaccination impact during an ongoing Ebola virus disease outbreak in Northeastern Democratic Republic of Congo, as of Feb. 25, 2019","volume":"13","author":"Worden","year":"2019","journal-title":"PLoS Negl Trop Dis"},{"key":"2025073015174944000_10.4.e015822.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1411100"},{"key":"2025073015174944000_10.4.e015822.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1414992"},{"key":"2025073015174944000_10.4.e015822.10","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2023-012660","article-title":"The cost of public health interventions to respond to the 10th Ebola outbreak in the Democratic Republic of the Congo","volume":"8","author":"Zeng","year":"2023","journal-title":"BMJ Glob Health"},{"key":"2025073015174944000_10.4.e015822.11","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(19)30063-5"},{"key":"2025073015174944000_10.4.e015822.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pcbi.1008800","article-title":"Measuring the unknown: An estimator and simulation study for assessing case reporting during epidemics","volume":"18","author":"Jarvis","year":"2022","journal-title":"PLoS Comput Biol"},{"key":"2025073015174944000_10.4.e015822.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pcbi.1006554","article-title":"A graph-based evidence synthesis approach to detecting outbreak clusters: An application to dog rabies","volume":"14","author":"Cori","year":"2018","journal-title":"PLoS Comput Biol"},{"key":"2025073015174944000_10.4.e015822.14","unstructured":"Small helpers and tricks for epidemics analysis \u00b7 epitrix. n.d. 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