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Background The second largest outbreak of Ebolavirus in history is currently ongoing in Eastern DRC. The epidemic is characterized by social resistance to foreign-led response teams. Trusted local health practitioners, including medical students, may be valuable social mobilizers in this challenging context. Methods We report on a student-led educational campaign to increase community awareness and engagement in EVD control efforts. We evaluated student and community participant satisfaction using standardized questionnaires. Results The outreach was conducted in November 2018, involving parades, speeches, branded banners and T-shirts, and interpersonal interactions in public spaces. Key messages, linked to previously identified resistant attitudes, included: "Ebola exists in Butembo," "Bring infected family members to the Ebola Treatment Unit," and "Leave burials to the official team." Medical students (n = 355) and community participants (n = 319) evaluated the outreach campaign. Satisfaction was high: 320 (90%) students agreed that medical students could contribute to the EVD response effort, and 233 (73%) community members agreed that the students had helped them understand Ebola in the area. Lower satisfaction scores were associated with self-reported "resistant" attitudes (e.g. intention to hide infected family member from authorities, ρ = -0.25, P < 0.0001), denial of the existence of Ebola in the area (ρ = -0.17, P = 0.0018), and mistrust of the foreign response team (e.g. belief in mercenary motive, ρ = -0.11, P = 0.042). Higher satisfaction scores were associated with the view that local engagement was critical to ending the epidemic (ρ = +0.13, P = 0.017). Both students (77%) and community members (71%) agreed that they were more motivated to combat Ebola as a result of the outreach, suggesting that the activities fostered empowerment. Conclusion Medical students can lead satisfactory community engagement and educational activities during an EVD epidemic. As trusted local health agents, medical students may be valuable allies in building public trust and cooperation in this epidemic complicated by social resistance. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background The current Ebola epidemic in Eastern Democratic Republic of the Congo (DRC) has surpassed 1,300 cases and 800 deaths. Social resistance is a major barrier to control efforts, and invites an exploration of community beliefs around Ebola and its origins. Methods Mixed-methods study, using focus group discussions (FGDs) with key community informants and a 19-item survey questionnaire broadly sampling the outbreak zone. Results Between 4 to 17 August, 2018, we conducted 4 FGDs (20 participants) and surveyed 286 community members across Eastern DRC. FGDs revealed a widespread rumor in Mangina early in the epidemic of two twins bewitched by their aunt after eating her cat, who developed bleeding symptoms and triggered the epidemic. However, this myth appeared to dissipate as the epidemic progressed and biomedical transmission became generally accepted (medical syncretism). In our survey, 6% of respondents endorsed supernatural origins of Ebola. This subgroup did not differ from other respondents in terms of knowledge of biomedical modes of transmission or resistant attitudes toward infection control measures, but was more likely to believe that traditional healers could cure Ebola. Wild animals of the forest were recognized as sources of the Ebola virus by 53% of survey respondents. Our findings suggest that skepticism and/or denial of the biomedical discourse, coupled with and mistrust and fear of ETUs may fuel "underground" transmission of Ebola outside western-style medical facilities, as patients seek care from traditional healers, who are ill-equipped to deal with a highly contagious biohazard. Conclusion A deeper understanding of beliefs around Ebola origins may illuminate strategies to engage communities in control efforts. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background The second largest Ebola epidemic in history is currently raging in Eastern Democratic Republic of Congo (DRC). Stubbornly persistent Ebola transmission has been associated with social resistance, ranging from passive noncompliance to overt acts of aggression toward Ebola response teams. Methods We explored community resistance using focus group discussions and assessed the prevalence of resistant views using standardized questionnaires. Results Despite being generally cooperative and appreciative of the foreign-led Ebola response, focus group participants provided eyewitness accounts of aggressive resistance to control efforts, consistent with recent media reports. Mistrust of Ebola response teams was fueled by perceived inadequacies of the response effort ("herd medicine"), suspicion of mercenary motives, and violation of cultural burial mores ("makeshift plastic morgue"). Survey questionnaires found that the majority of respondents had compliant attitudes with respect to Ebola control. Nonetheless, 78/630 (12%) respondents believed that Ebola was fabricated and did not exist in the area, 482/630 (72%) were dissatisfied with or mistrustful of the Ebola response, 60/630 (9%) sympathized with perpetrators of overt hostility, and 102/630 (15%) expressed noncompliant intentions in the case of Ebola illness or death in a family member, including hiding from the health authorities, touching the body, or refusing an official burial team. Denial of the biomedical discourse and dissatisfaction/mistrust of the Ebola response were statistically significantly associated with indicators of social resistance. Conclusion We concluded that social resistance to Ebola control efforts was prevalent among focus group and survey participants. Mistrust, with deep political and historical roots in this area besieged by chronic violence and neglected by the outside world, may fuel social resistance. Resistant attitudes may be refractory to short-lived community engagement efforts targeting the epidemic but not the broader humanitarian crisis in Eastern DRC. Disclosures All Authors: No reported Disclosures. [ABSTRACT FROM AUTHOR]