Use of Peripheral Health Units in Low-Transmission Ebola Virus Disease Surveillance
and reproduction in any medium, provided the original work is properly cited. Objective A community-based EVD surveillance system with improved symptom recording and follow-up of malaria positive patients at PHUs was implemented during low EVD transmission. The rationale and methodology in implementing a PHU-focused approach to strengthen surveillance system sensitivity is described. Introduction Existing EVD surveillance strategies in Sierra Leone use a centralized live alert system to refer suspect cases from the community to Ebola treatment centers. As EVD case burden declined in Port Loko District, so did the number of reported alerts. As EVD presents similarly to malaria, the number of alerts reported are expected to remain consistent with malaria prevalence in malaria-endemic areas, irrespective of a reduction in true EVD cases. Declines in reported suspect cases from the community alluded to the possibility that individuals were returning to healthcare centers to seek treatment for malaria, and that PHUs were not adequately reporting suspect EVD cases. District surveillance officers (DSOs) were used to investigate the usage of PHUs by community members, as well as the mechanisms that health center staff used in recording patient visits. Surveillance methods specific to PHUs were introduced to increase the number of reported EVD alerts, as well as establish the foundation for future integrated disease surveillance response strategies.