During Ebola and Marburg outbreaks, treatment centers are essential for patient care and controlling transmission. While clinical care advancements have been well-documented, the design of these centers has been less explored. This study addresses this gap by analyzing technical drawings of 48 treatment centers constructed between 2014 and 2023, using a reverse-engineering approach. The findings highlight a shift toward smaller, more manageable centers, with improved privacy and infection control features. This review offers a framework for the future development of treatment center designs to enhance outbreak management. Key contributions include the identification of trends in center size and layout, providing a foundation for future design standards that can be applied in managing infectious disease outbreaks. The study emphasizes the need for continuous adaptation in treatment center design to meet outbreak demands and calls for future research to develop indicators that measure the impact of design on health outcomes and patient experiences.

The rapid deployment of emergency tents for airborne disease containment necessitates effective and sustainable approaches. This study introduces an innovative emergency tent prototype, developed within the INITIATE ² project by WFP and WHO, that leverages natural ventilation to mitigate airborne transmission risks when humanitarian tents are deployed in response to epidemics. The tent features a two‐zone design with a transparent barrier separating the patient area from the healthcare operator zone and exploits a suitable airflow path to reduce cross‐contamination. In order to overcome the constraints imposed by the logistic of the on‐site measurements, a novel asynchronous single‐gas tracer decay methodology combined with a multizone gray box model was developed, enabling both on‐site experimental testing of ventilation effectiveness and estimation of airborne pathogen concentrations for infection transmission risk analysis. This approach allowed for the quantification of interzonal exchanges and ventilation rates under various window configurations, simulating different natural ventilation regimes. Multiple ventilation scenarios were evaluated, revealing that partial windows opening (Scenario 2, with Scenario 1 being windows closed) optimized airflow, achieving up to 15 air changes per hour (ACH), a value aligned with CDC and WHO guidelines. Instead, fully open windows (Scenario 3) increased the ACH in the patient area but compromised, to a certain extent, the containment of the pathogens in the healthcare operator zone. Results highlighted, for all the tested scenarios, an unintended air recirculation between the patient and the doctor zones. While the gray box model effectively estimated flow rates across scenarios, it encountered limitations at ACH > 20 due to the photoacoustic equipment’s sampling constraints. The relatively slow acquisition time impacted on the data accuracy during rapid decay phases, where ventilation time constants were on the order of minutes. The design of the transparent barrier reflects a deliberate trade‐off between airtightness and operational functionality, with the field methodology enabling an evidence‐based assessment of its performance. These findings emphasize the need for refined airflow management and highlight the potential of natural ventilation in emergency healthcare settings. Future research directions include the development of high sampling rate, multigas, and multipoint monitoring tools, as well as enhanced tent designs that improve airtightness of the transparent barrier.

Background: Marburg virus disease (MVD) is a severe viral infection caused by the Marburg marburgvirus species. In February 2023, Equatorial Guinea declared its first outbreak. This case series describes the natural history of MVD in 5 patients with laboratory-confirmed disease. Methods: Patients with confirmed MVD who were admitted to the national treatment center in Bata, Equatorial Guinea were monitored for vital signs and symptoms. Comprehensive clinical data were collected to understand the progression and outcome of the disease. Results: Five patients were confirmed to have MVD. Three male healthcare workers received a diagnosis diagnosed early in their disease and subsequently survived. The other 2 patients, both female, were admitted later in their disease progression and died within 24 hours of admission. Four patients received remdesivir under a protocol for the monitored emergency use of unregistered and experimental interventions. The early symptoms were nonspecific, with rapid progression to more severe conditions in the later stages of the disease. Early treatment with remdesivir showed the drug to be well tolerated. Conclusions: Contrary to some reports and the recommended case definition for MVD, our patients presented with a rash but did not exhibit vomiting or diarrhea. Hemorrhagic signs were solely observed in the terminal stage, preceding demise. Despite the limited sample size, these findings emphasize the importance of tailoring the case definition to the specific outbreak. Further evidence on the efficacy and safety of therapeutics for MVD, including remdesivir, should be gathered through well-designed trials during future epidemic responses.

During Lassa fever outbreaks, Treatment Centres (TCs) are critical for patient care and transmission control, yet their design remains underexplored. The study analyses three TC in Nigeria, using a reverse-engineering approach. Findings reveal major differences in capacity, zoning, and service integration, with implications for infection control, staff safety, and inclusivity. Recurring layout trends and critical gaps are identified. A set of spatial indicators is proposed and cross-case results are translated into design principles for LF centres. The work offers a framework for developing design standards to strengthen outbreak management, and highlights the need for adaptable facilities and future research to define indicators linking design with health outcomes and patient experience.

Objective: To assess whether wind-driven natural ventilation in the Infectious Diseases Treatment Module (IDTM) can achieve ventilation performance consistent with airborne precaution requirements [160 liters per second (L/s)] and to estimate associated pathogen-specific infection risks. Methods: An experimental campaign of air velocity measurements and CO ₂ decays were conducted to validate the developed computational fluid dynamics (CFD) model. The validated CFD model simulated wind-driven natural ventilation (1–4 m/s) for an L-shaped IDTM configuration under four structural scenarios defined by the presence or absence of patient porches and mosquito nets. Airborne infection risk was estimated using a Wells–Riley quanta-based model for seven representative airborne pathogens under short-duration healthcare worker exposure and prolonged patient co-exposure. Results: Ventilation performance varied widely based on wind speed and structural configuration. Airflow ranged from 7 L/s in the most restricted configuration (porch and mosquito nets present at 1 m/s) to over 3,100 L/s when mosquito nets were removed at 4 m/s. When mapped to infection-risk estimates, ventilation rates at 160 L/s substantially reduced short-duration healthcare worker infection risk for all pathogens (≤1%), whereas prolonged co-exposure remained associated with high risk for high-emission pathogens despite high ventilation. Conclusion: Under favorable wind conditions and optimized configurations, the IDTM can achieve ventilation rates consistent with the 160 L/s recommendation for airborne precautions. While this provides substantial protection for healthcare workers, individual-room isolation remains essential for patient management. Operationally, removing window-mounted nets is the most effective way to ensure safety targets are met; hybrid ventilation measures should be considered during low-wind conditions.