Article Text

An outbreak inside an epidemic: managing an infectious disease outbreak while treating Ebola
  1. Simon Horne1,2,
  2. K Forbes3,
  3. D Burns4 and
  4. JJH Tuck5
  1. 1Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
  2. 216 Medical Regiment, Colchester, UK
  3. 31st Bn Coldstream Guards, Windsor, UK
  4. 4Department of Infection and Tropical Medicine, Birmingham Heartlands Hospital, Birmingham, UK
  5. 5Defence Health Strategy, Ministry of Defence, London, UK
  1. Correspondence to Lt Col Simon Horne, Emergency Department, Derriford Hospital, Plymouth PL6 8DH; Simon.horne{at}


Even in the middle of an epidemic of a very serious illness, outbreaks of other infectious diseases will continue. Clinicians need to be able to make rapid decisions about the nature of the outbreak and how to manage it. A balance needs to be struck between managing all patients as if they have the worst-case scenario illness and the resultant risks to themselves, their colleagues and the mission. This paper reviews basic epidemiological tools that inform robust decision-making in the management of such outbreaks. It then describes how a pragmatic approach, combined with effective use of these techniques, rapid diagnostics and remote specialist support, allowed a large outbreak of gastroenteritis to be safely and effectively managed during the response to the Ebola virus disease epidemic in Sierra Leone.

  • ebola

Statistics from


  • Contributors KF, SH and JT were involved in the management of the outbreak. DB provided the interpretation of the microbiological analysis and all information about PCR testing. KF provided the figures. SH and JT were the primary authors.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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