Applying Case Definitions in Ebola Virus Disease Surveillance in Ghana: Fear or True Clinical Basis for Suspicion?

Case definitions are important tools in disease surveillance and control. In Ghana, disease surveillance and case definitions are based on the Integrated Disease Surveillance and Response (IDSR) guidelines. Knowledge on and the application of case definitions has been brought to question in the light of the recent outbreak of Ebola Virus Disease in West Africa. We review 6 suspected cases and explore the perspective of clinical staffs on the application of case definitions in practice.

All 6 cases did not meet the case definition for EVD. The commonest symptom prompting investigation for EVD was bleeding even though some cases had clear basis for the bleed observed such as a road traffic injury in the case of a Liberian patient. Fear seemed an underlying factor in the decision to investigate. In addition, clinicians identified the lack of personal protective equipment as a reason for wanting EVD ruled out before managing some cases. Nationally as of the end of 2014, over a 100 samples including those from KATH, sent to the National Referral Laboratory for investigation have all been proven negative for Ebola, Marburg, Lassa and Yellow Fever viruses.

While there is the need to ensure a high sensitivity in the surveillance system, the large numbers of cases some which clearly do not meet the case definition for EVD is a cause for concern. Clinicians need to be fully aware of case definitions for such diseases particularly those with outbreak potential to ensure that resources are judiciously used.