#Ebola and Twitter: lessons learned

Background: Twitter plays a role in information distribution during emergencies, and it is widely used by public health organisations during public health crises. Twitter has facilitated transmission of both accurate information and misinformation during the West African Ebola outbreak. Study objective: To investigate the ways in which Twitter was used during the West African Ebola outbreak by the general Twitter population as well as by the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) in order to better inform future efforts to harness the public health potential of Twitter. Methods: The full historic Twitter dataset of over 60 million Ebola tweets from December 2013 to May 2015 was analysed using a platform for machine data analysis (Splunk Enterprise 6.3.0). In addition to descriptive statistics of Twitter use and engagement, content analysis was conducted to categorise Twitter accounts and tweets of interest. Main results: The temporal tweet frequency distribution corresponded with key Ebola news events with a substantial proportion of tweets coming from West Africa. News, humour, Twitter celebrities’, and celebrities’ accounts achieved the highest level of engagement with the general Twitter population. The WHO and CDC also ranked high in engagement levels. Both the WHO and CDC actively used Twitter to communicate with the Twitter public. However, their strategies at disseminating public health information and guidance varied. Conclusion: Twitter activity during the Ebola outbreak was more likely to coincide with news events rather than disease dynamics. Twitter provides a unique opportunity for public health organisations to listen to their audience and to share scientifically accurate information. Public health organisations could do more to engage with the Twitter population during the West African Ebola outbreak. Such organisations may benefit from employing humorous and emotional content and/or collaborating with accounts with a high level of Twitter engagement.