The impact of different types of violence on Ebola virus disease transmission during the 2018-2020 outbreak in the Democratic Republic of the Congo.


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 "Ebola-targeted" or "Ebola-untargeted," and into "civilian-involvement," "militia/political," or "protests." The outcome was estimated daily reproduction number (Rt) by health zone. We fit a linear time-series regression to model the relationship.

 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.

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.

Ebola-targeted violence, primarily driven by civilian-involved events, had the largest impact on EVD transmission.

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