@article{ref1,
title="The impact of different types of violence on Ebola virus disease transmission during the 2018-2020 outbreak in the Democratic Republic of the Congo",
journal="Journal of infectious diseases",
year="2020",
author="Kelly, John Daniel and Wannier, Sarah Rae and Sinai, Cyrus and Moe, Caitlin A. and Hoff, Nicole A. and Blumberg, Seth and Selo, Bernice and Mossoko, Mathais and Chowell-Puente, Gerardo and Jones, James Holland and Okitolonda-Wemakoy, Emile and Rutherford, George W. and Lietman, Thomas M. and Muyembe-Tamfum, Jean Jacques and Rimoin, Anne W. and Porco, Travis C. and Richardson, Eugene T.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND:  Our understanding of the different effects of targeted versus non-targeted violence on subsequent EVD transmission in the current outbreak in the eastern Democratic Republic of the Congo (DRC) is limited. <br><br>METHODS: We used time-series data of case counts to compare individuals who lived in Ebola-affected health zones in DRC from April 2018 to August 2019. Exposure was number of violent events per health zone, categorized into &quot;Ebola-targeted&quot; or &quot;Ebola-untargeted,&quot; and into &quot;civilian-involvement,&quot; &quot;militia/political,&quot; or &quot;protests.&quot; The outcome was estimated daily reproduction number (Rt) by health zone. We fit a linear time-series regression to model the relationship. <br><br>RESULTS: The average Rt was 1.06 (95% confidence interval [CI]: 1.02-1.11). A mean of 2.92 violent events resulted in a cumulative absolute increase in Rt of 0.10 (95%CI: 0.05-0.15). More violent events increased EVD transmission (p=0.03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on Rt, Ebola-targeted events corresponded to Rt of 1.52 (95%CI: 1.30-1.74) while these civilian-involved events corresponded to Rt of 1.43 (95%CI: 1.21-1.35). Untargeted events corresponded to Rt of 1.18 (95%CI: 1.02-1.35); among these, militia/political or ville morte events increased transmission. <br><br>CONCLUSION: Ebola-targeted violence, primarily driven by civilian-involved events, had the largest impact on EVD transmission.<br><br>© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.<p /> <p>Language: en</p>",
language="en",
issn="0022-1899",
doi="10.1093/infdis/jiaa163",
url="http://dx.doi.org/10.1093/infdis/jiaa163"
}