Filovirus Surveillance in Sierra Leone Developing Interventions Before Spillover

FILOVIRUS SURVEILLANCE IN SIERRA LEONE DEVELOPING INTERVENTIONS BEFORE SPILLOVER The West Africa Ebola epidemic of 2014-2016 was the largest Ebola outbreak to date, with over 28,000 infections and 11,000 deaths reported in Guinea, Sierra Leone, and Liberia. While the events leading to the first infection are not entirely known, ecological and behavioral research conducted at the initial outbreak site suggests that the first known infection was likely the result of contact with bats. The West Africa Ebola epidemic demonstrated the urgent need to identify the wildlife reservoir of Ebola (widely thought to be bats) and to understand the ways in which humans come into contact with these bats. Following the epidemic, PREDICT launched the Ebola Host Project (EHP) to conduct Ebola virus surveillance in livestock and wildlife in the three West African countries most affected by the outbreak. In 2018, EHP found a novel species of ebolavirus (Bombali ebolavirus) in Bombali, Sierra Leone in two species of insect-eating bats that were roosting in people’s homes. Later, EHP of associated virus surveillance efforts. In particular, also identified Marburg virus, a highly lethal filovirus of we conducted interviews and focus groups in two central and southern Africa, in Sierra Leone in the fruit communities that had frequent contact with bats in bats in the districts Koinadugu, Kono, and Moyamba. Bombali. By studying the knowledge, beliefs, and practices This was the first time either of these viruses has of these individuals, we were able to understand the been found in Sierra Leone; and, through PREDICT’s contexts, motivations, and behaviors that may expose EHP surveillance, both were identified before a known individuals to diseases from livestock and wildlife. This human infection. work focused on two communities: (1) residents with EHP also conducted behavioral research with individuals household infestations of insect-eating bats and (2) a in Sierra Leone who had direct or indirect contact with group of adolescent males who hunt fruit bats for food the livestock and wildlife that were sampled as part and supplemental income. Participants from both communities reported high- to be a quick and ever-present opportunity to generate risk exposure to bats. The residents with household critical supplemental income, by providing bats to wildlife infestations reported frequent exposure to bat urine vendor for resale. and guano, as well as occasional physical contact with Following this work, PREDICT developed a prevention- living and dead bats. The fruit bat hunters also reported focused risk reduction and behavior change exposure to bat urine and guano while hunting, periodic communication resource entitled Living Safely with Bats. bites and scratches from living bats, and direct contact This moderated picture book incorporated health and with blood and viscera during animal butchering. While conservation messages with images targeted to local both groups were aware that bats were implicated in communities. Living Safely with Bats was used during the Ebola epidemic, they did not have a comprehensive community outreach and engagement campaigns across understanding of how zoonotic diseases are transmitted Africa and Asia, providing a platform for dialogue and or of the health risks that bats pose. discussion of scientific findings about bat viruses, risks In addition to assessing exposure to bats, we identified for disease transmission from bats to people, and risk- motivations in both groups that might lead to safer reduction strategies that communities could take to behavior. For residents with household infestations, prevent virus spillover. In Sierra Leone, this campaign motivations included concerns about physical health reached an estimated 1,000 individuals in 27 of the 30 and an acute annoyance with bats living in their homes. communities where EHP teams sampled animals for While few bat hunters like this activity, as long as they viruses. remain economically insecure, bat hunting will continue .

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