@article {Thompson485821, author = {Robin N. Thompson and Oliver W. Morgan and Katri Jalava}, title = {Rigorous surveillance is necessary for high confidence in end-of-outbreak declarations for Ebola and other infectious diseases}, elocation-id = {485821}, year = {2018}, doi = {10.1101/485821}, publisher = {Cold Spring Harbor Laboratory}, abstract = {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 characterising 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, unrecognised 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.}, URL = {https://www.biorxiv.org/content/early/2018/12/07/485821}, eprint = {https://www.biorxiv.org/content/early/2018/12/07/485821.full.pdf}, journal = {bioRxiv} }