Infection prevention and control measures for Ebola and Marburg disease: a series of rapid reviews.

OBJECTIVES: An evidence synthesis informed the 2023 WHO infection prevention and control (IPC) guideline for Ebola disease (EBOD) and Marburg disease (MARD). DESIGN: A series of rapid reviews addressed 14 key questions (KQs) related to IPC measures for EBOD and MARD across three themes: (1) transmission/exposure, (2) personal protective equipment (PPE) and (3) decontamination/disinfection. DATA SOURCES: Databases (Embase, Cochrane Database of Systematic Reviews, CENTRAL, Global Index Medicus) were searched from inception to May 2024, in addition to searches in MEDLINE and bio/medRxiv servers through an artificial intelligence tool (continuous active learning, CAL). ELIGIBILITY CRITERIA: Eligible populations included health workers (HWs), staff and patients in healthcare and/or community settings. Interventions included PPE evaluation, hand hygiene/glove decontamination, spraying of HWs, handling of heavily soiled linen, management of the deceased, environmental decontamination, work exclusion and the IPC ring approach. Infection with EBOD or MARD was a primary outcome of interest and secondary outcomes of interest varied by key question. DATA EXTRACTION AND SYNTHESIS: Screening, data extraction, quality assessment (Cochrane RoB-2, Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I)) and evaluation of the certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation (GRADE)) were conducted by an independent reviewer with verification. Data and relevant contextual information were narratively synthesised. RESULTS: Following screening of 5540 studies in CAL and 1062 full texts, nine studies were included that addressed four KQs: one related to transmission/exposure (IPC ring approach), two related to PPE (head/neck skin and mucous membranes coverage; order of eye protection and head covering) and one related to disinfection/decontamination (spraying of HWs during PPE doffing). No studies were included for the remaining KQs, but relevant contextual information in reviewed studies was summarised for all KQs. Evidence was judged to be of low or very low certainty using the GRADE framework due to risk of bias, indirectness and imprecision, and substantive conclusions could not be drawn on the effectiveness of the evaluated IPC interventions. CONCLUSIONS: While providing the evidence base for the WHO IPC guideline for EBOD and MARD, this series of rapid reviews identified several critical research gaps. PROSPERO REGISTRATION NUMBER: CRD#42022331537.