Surface disinfection efficacy and effectiveness assessment for low-resource outbreak settings.
Gallandat, Karin.
2019
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Infectious diseases
are caused by pathogens such as bacteria, viruses, or parasites, and can be transmitted
by contaminated surfaces. In outbreaks, this transmission pathway can be interrupted by
various interventions including disinfection. Infectious diseases such as the Ebola
virus disease (EVD) and cholera, disproportionately affect low-income countries. Current
guidelines for disinfection ... read morein response to EVD and cholera outbreaks are inconsistent in
terms of recommended pre-cleaning procedures and chlorine concentration. One reason for
these inconsistencies is the lack of evidence to inform disinfection in low-resource
outbreak settings. The goal of this dissertation was to contribute to the evidence base
regarding the laboratory efficacy and field effectiveness of disinfection in Ebola and
cholera contexts. Five projects were conducted, including : 1) a systematic review of
the literature on surface disinfection efficacy, focusing on the identification of data
applicable to low-resource settings; 2) the identification of an appropriate surrogate
for the Ebola virus; 3) a laboratory-based efficacy evaluation of recommendations for
surface disinfection in Ebola outbreaks using the surrogate; 4) a laboratory-based
efficacy evaluation of surface disinfection in cholera outbreaks using Vibrio cholerae;
and, 5) two field-based evaluations of household spraying - a disinfection intervention
commonly implemented in response to cholera outbreaks. Results from this research
provide insights into surface disinfection efficacy and effectiveness in conditions
relevant to low-resource outbreak settings and were used to formulate concrete
recommendations for the optimization and harmonization of surface disinfection
interventions in response to EVD and cholera outbreaks. This work also led to the
following considerations: • A trade-off exists between the standardization of
laboratory methods and the evaluation of conditions relevant to outbreak settings;
• Surrogate organisms can be instrumental to investigate surface disinfection
efficacy; • Laboratory and field evaluations are complementary, but laboratory
and field evidence may need to be reconciled; • The identification of relevant
research questions requires the involvement of multiple stakeholders, including
researchers, responders, and policy makers; • Evaluating existing recommendations
is valuable, however researchers could have a proactive role in improving preparedness
and developing novel response approaches. While the global burden of infectious diseases
has been decreasing, populations in developing countries are still disproportionately
affected and infectious disease outbreaks are expected to become increasingly frequent
due to greater connectivity, population movements, and climate change. Further research
is needed to improve preparedness and protect vulnerable
populations.
Thesis (Ph.D.)--Tufts University, 2019.
Submitted to the Dept. of Civil Engineering.
Advisor: Daniele Lantagne.
Committee: David Gute, Richard Johnston, and Tim Julian.
Keyword: Environmental health.read less - ID:
- x059cm94k
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