Real-time projections of epidemic transmission and estimation of vaccination impact during an Ebola virus disease outbreak in the Eastern region of the Democratic Republic of Congo

As of October 12, 2018, 211 cases of Ebola virus disease (EVD) were reported in North Kivu Province, Democratic Republic of Congo. Since the beginning of October the outbreak has largely shifted into regions in which active armed conflict is occurring, and in which EVD cases and their contacts are difficult for health workers to reach. We modeled EVD transmission using a branching process with gradually quenching transmission estimated from past EVD outbreaks, with outbreak trajectories conditioned on agreement with the course of the current outbreak, and with multiple levels of vaccination coverage. We used an autoregression for short-term projections, a regression model for final sizes, and a simple Gott's law rule as an ensemble of forecasts. Short-term model projections were validated against actual case counts. During validation of short-term projections, models consistently scored higher on shorter-term forecasts. Based on case counts as of October 13, the stochastic model projected a median case count of 226 by October 27 (95% prediction interval: 205-268) and 245 by November 10 (95% PI: 208-315), while the auto-regression model projected median case counts of 240 (95% PI: 215-307) and 259 (95% PI: 216-395) for those dates, respectively. Projected median final counts range from 274 to 421. Except for Gott's law, the projected probability of an outbreak surpassing 2013-2016 is exceedingly small. The stochastic model estimates that vaccine coverage in this outbreak is lower than reported in its trial. Based on our projections we believe that the epidemic had not yet peaked at the time of these estimates, though an outbreak like 2013-2016 is not likely. We estimate that transmission rates are higher than under target levels of vaccine coverage, and this model estimate may offer a surrogate indicator for the outbreak response challenges.