Outbreak in West Africa

The Ebola epidemic currently sweeping through West Africa has proven to be the most devastating single outbreak of the disease in history. Médecins Sans Frontières/Doctors Without Borders (MSF) has been working to contain the outbreak since reports of its spread first appeared. However, the organization has warned that it had reached the limits of what its teams can do, and has called for a coordinated international effort to help fight the epidemic.

 

LIVE NOW: Stopping Ebola: MSF’s experience on the front lines of a historic epidemic. Watch the webcast and join the discussion.

 

 

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From the MSF Ebola crisis update, October 30, 2014:

Since the outbreak in West Africa was officially declared on March 22, it has claimed 4,919 lives. The outbreak is currently affecting three countries in West Africa: Guinea, LiberiaSierra Leone and Mali. On October 24, the first case of Ebola was confirmed in Mali, and that person has died. The World Health Organization (WHO) has declared an official end to the epidemic in  Senegal and Nigeria because there have been no active cases for 42 days. One person in the United States is currently being treated for Ebola, and one has died. One person in Spain and two people in the USA have recovered. An outbreak unrelated to the one in West Africa is taking place in Democratic Republic of Congo

Following announcements made in the last weeks, deployment of international aid is slowly taking place in the three main countries affected. However, there is little indication that current efforts to increase capacity to isolate and take care of suspected and confirmed Ebola cases will address needs sufficiently.

MSF teams in West Africa are still seeing critical gaps in all aspects of the response, including medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education and mobilization.

MSF has been responding to the outbreak since March, and currently has a total of 3,347 staff working in Guinea, Liberia and Sierra Leone, treating a rapidly increasing number of patients. Since the response began, 23 MSF staff members have been infected with Ebola, eight of whom have recovered. The vast majority of these infections were found to have occurred in the community.

 

Get the latest updates on Ebola from MSF

For the most recent information from MSF about the ongoing Ebola crisis, please follow the links below: 

Read other recent updates

 

Eyewitness: Ebola

Reine Lebel, a Canadian psychologist, talks about her work with Ebola patients. 

 

MSF and Ebola in the news media

MSF has been at the forefront of efforts to contain the disease since the outbreak began. To see the latest media coverage, visit our weekly scrapbook of news reports about MSF and Ebola.

 

 

Tim Jagatic

Profile: Tim Jagatic - A Canadian reflects on his second mission to West Africa

Tim Jagatic is a Windsor, Ontario-based doctor who traveled to Guinea last April with Médecins Sans Frontières/Doctors Without Borders (MSF) to help control the Ebola epidemic. In July he returned to the frontlines, this time to Sierra Leone, where the virus has spread.

Read More

 

 

MSF on the ground

Updated October 30, 2014

MSF currently has 3,347 staff working on Ebola in Guinea, Liberia and Sierra Leone, treating a rapidly increasing number of patients. 

Guinea

Conakry

  • MSF is running a 85-bed Ebola management centre in Donka hospital.  
  • MSF is training Ministry of Health staff inside the facility so they can be deployed by the Ministry of Health to facilities in other parts of the country.
  • Location of new case management centre (CMC) confirmed in Koloma, Conakry. Site is being cleared prior to construction.
Guéckédou
  • MSF is running a 85-bed Ebola management centre.
  • MSF has opened a new 35-bed transit centre in Macenta, from where patients are transferred to Guéckédou.
  • MSF is training Ministry of Health staff so they can be deployed elsewhere in the country.
  • The team is carrying out investigation and health promotion activities in the area.
  • MSF is constructing a new case-management centre in Macenta with the Red Cross, and a transit centre in Forécariah for the Ministry of Health. 

Sierra Leone

Kailahun

  • MSF is running a 96-bed Ebola management centre that maintains almost full capacity.
  • MSF has trained around 750 community health workers to spread health promotion messages about Ebola in their communities and ensure they know what to do if there is someone with symptoms of Ebola
  • MSF is providing psychological support to patients and their relatives
  • Survival rate is above 40 per cent. 
  • MSF is providing social mobilization and sensitization training to communities in the districts including the Public Health Units

Bo

  • MSF has opened a 35-bed Ebola management centre in Bo. As a result, the transit centre operated near MSF’s hospital in Gondama was closed.
  • MSF suspended emergency pediatric and maternal services in Gondama on October 16; MSF had been running the hospital since 2003.
  • The Norwegian staff member who was diagnosed with Ebola has recovered and been discharged.
  • Operations are ongoing and teams are seeing a small but consistent number of patients.

Liberia

Monrovia
  • MSF is running a 250-bed Ebola management centre known as ELWA3.
  • MSF has restarted a campaign for community health promoters to go door to door, raising awareness about how Ebola is transmitted and how to avoid infection. Eight hundred home protection and disinfection kits were distributed on the first day. Survival rate is above 40%.
  • Anti-malaria kits are now being distributed to 300,000 people in densely populated areas of Monrovia.
 
Foya
  • MSF is running a 40-bed Ebola management centre.
  • MSF is providing psychological support to patients and their relatives. 
  • MSF is running several outreach activities, such as health promotion, safe burial practices, and an ambulance service. Outreach activities are being carried out south of Foya, where most cases come from, as well as to the east and south of the nearby town of Voinjama, where a team is now based. 
  • MSF is training health staff, especially health promoters for community education.

 

Mali

  • On October 23, the first case of Ebola was confirmed in Mali. The WHO, CDC and the Ministry of Health in Mali are responding. An MSF team arrived in Mali this week to reinforce MSF’s regular mission and provide technical support to the Ministry of Health.

 

Uganda

  • There has been a confirmed case of Marburg fever in Uganda. MSF has helped reinforce local capacities for the treatment of confirmed cases (ward rehabilitation, staff training), and is currently involved in the reinforcement of infection control capacities (contact tracing, follow-up and management of suspect cases, isolation capacities in primary health structures). No new cases of the disease have been declared in the last 21 days.

 

Interactive Guide to an Ebola High Risk Zone

How do MSF's Ebola treatment centres work? Click on the image below to visit an interactive guide. (Enlarge)

 

Ebola in the Democratic Republic of Congo

The current outbreak of Ebola  in Democratic Republic of Congo is unrelated to the one in West Africa. Around 60 MSF staff have been deployed to Lokolia and Boende in response to the outbreak, and teams are running two treatment centres, one with 24 beds and the other with 10 beds. With no reported new cases since early October, the MSF teams in Lokolia and Boende have activated exit plans for the coming weeks.  

 

 

 

Ebola: the basics

Ebola refers to several strains of the same virus, first identified in humans in 1976 in Sudan and Democratic Republic of Congo (DRC), along the Ebola River. Ebola viruses produce devastating illnesses, most often leading to death. They cause hemorrhagic fevers, which lead to internal and external bleeding, similar to Marburg fever, which results from a related virus.  There is no treatment and no vaccine.

Certain species of bats living in the tropical forests of Central and West Africa are thought to be Ebola’s natural reservoir. While they carry viruses, they show no symptoms and appear to contaminate large monkeys and humans through their droppings or bites. Humans can also catch the virus after contact with infected animals, dead or living, or from other infected persons.

Before the most recent epidemic in West Africa, the most recent outbreaks killed several dozen people in Uganda and DRC in 2012. Although it is very dangerous, Ebola remains rare. Before 2014, approximately 2,200 cases had been recorded following the discovery of the virus in 1976. Of those, 1,500 were fatal. However, sporadic cases and, even epidemics are known to have gone undetected in the past because they occurred in remote areas where people lacked access to medical care. The 2014 West African epidemic has already been responsible for more deaths than all previous outbreaks put together.

 

Dr. Esther Sterk specializes in tropical diseases at Médecins Sans Frontières (MSF). She has worked on many missions, including several Ebola epidemics in Uganda and DRC, most recently in summer 2012.

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What are Ebola’s distinctive features?

This is a rare disease. Epidemics are limited, but they create panic every time because Ebola is fatal in 25 to 90 per cent of cases. After an incubation period of two to 21 days, the virus causes a raging fever, headaches, muscle pain, conjunctivitis and general weakness. The next phase involves vomiting, diarrhea and, sometimes, a rash. The virus spreads in the blood and paralyzes the immune system. It is particularly formidable because the body does not detect these viruses right away. When the organism does respond, it is often too late. By then, the viruses have created blood clots, which block vital organs and cause major hemorrhages. Patients may have heavy bleeding, including from the nose or via their urine.  

The disease is transmitted by contact with the fluids of infected people or animals, such as urine, sweat, blood or mother’s milk. Family members and healthcare workers treating patients are at great risk of infection. The high mortality rate and bleeding are so frightening that healthcare workers often flee, abandoning patients.

Funeral traditions in which family members wash the body of the deceased are also a major means of transmission in African communities.

 

How does MSF respond to Ebola epidemics, given that there is no treatment?

Although there is no cure for this disease, we can reduce its very high mortality by addressing the symptoms. This includes administering a drip to patients who have become dehydrated from diarrhea and by confirming that they do not have a different disease, such as malaria or a bacterial infection like typhoid. Vitamins and pain medication can also be useful. When the person loses consciousness and bleeds copiously, there is no hope.  At that point, we ease the patient’s pain and stay with him until the end.

Once the first case is confirmed by a blood test, every person who cares for an infected patient must wear a hazardous materials ('hazmat') suit, gloves, a mask and protective goggles and exercise extreme caution when administering treatment. Decontamination chambers are generally installed between the isolated patients and the external environment. To confine the epidemic, it is critical to trace the entire transmission chain. All individuals who have had contact with patients who may be contaminated are monitored and isolated at the first sign of infection.  The affected communities must also be informed about the illness and the precautions to be taken to limit risks of contamination. Basic hygiene – such as washing one’s hands – can significantly reduce the risk of transmission.

In recent years, MSF has been involved in nearly every Ebola epidemic.

 

What are the prospects for the fight against Ebola?

Although several countries are interested in it in connection with protecting against bacteriological warfare or bioterrorism, the research is limited. The small number of epidemics and patients restricts the investigations. To develop vaccines, you need a sufficient number of volunteers. Research is also underway on the origin of the virus and on bats, Ebola’s likely natural reservoir.

In recent years, MSF has been involved in nearly every Ebola epidemic. Other organizations have also been present, but we can provide our experience in treating cases. Considerable materiel is often required to isolate patients and prevent contamination among healthcare workers. We are also trying to improve our response to these epidemics. That is the key to success. You’ve got to act as quickly as possible as soon as the first case is confirmed. The challenge is that Ebola occurs in isolated areas and it takes time to identify the disease and alert the health authorities. In addition, the early symptoms resemble those of malaria. We are training healthcare workers so that they can respond quickly.

 

The Boy Who Tricked Ebola

Mamadee is an eleven-year-old patient in Liberia who survived Ebola

 

Ebola: Medical information

If contracted, Ebola is one of the world’s most deadly diseases. It is a highly infectious virus that can kill up to 90 percent of the people who catch it, causing terror among infected communities.

Médecins Sans Frontières/Doctors Without Borders (MSF) has treated hundreds of people with the disease and helped to contain numerous life-threatening epidemics.  

It is estimated there have been over 1,800 cases of Ebola, with nearly 1,300 deaths.

The Ebola virus was first associated with an outbreak of 318 cases of a haemorrhagic disease in Zaire (now the Democratic Republic of Congo) in 1976. Of the 318 cases, 280 died — and died quickly. That same year, 284 people in Sudan also became infected with the virus, killing 156.

The Ebola virus is made up of five species: Bundibugyo, Ivory Coast, Reston, Sudan and Zaire, named after their places of origin. Four of these five have caused disease in humans. While the Reston virus can infect humans, no illnesses or deaths have been reported.

MSF has treated hundreds of people affected by Ebola in UgandaRepublic of Congo, the Democratic Republic of Congo (DRC), Sudan, Gabon and Guinea.In 2007, MSF entirely contained an epidemic of Ebola in Uganda.

Causes of Ebola

Ebola can be caught from both humans and animals. It is transmitted through close contact with blood, secretions, or other bodily fluids.

Healthcare workers have frequently been infected while treating Ebola patients. This has occurred through close contact without the use of gloves, masks or protective goggles.

In areas of Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found dead or ill in the rainforest.

Burials where mourners have direct contact with the deceased can also transmit the virus, whereas transmission through infected semen can occur up to seven weeks after clinical recovery.

Symptoms of Ebola

Early on, symptoms are non-specific, making it difficult to diagnose.

The disease is often characterised by the sudden onset of fever, feeling weak, muscle pain, headaches and a sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function and, in some cases, internal and external bleeding.

Symptoms can appear from two to 21 days after exposure. Some patients may go on to experience rashes, red eyes, hiccups, chest pains, difficulty breathing and swallowing.

Diagnosing Ebola

Diagnosing Ebola is difficult because the early symptoms, such as red eyes and rashes, are common.

Ebola infections can only be diagnosed definitively in the laboratory by five different tests.

Such tests are an extreme biohazard risk and should be conducted under maximum biological containment conditions. A number of human-to-human transmissions have occurred due to a lack of protective clothing. 

“Health workers are particularly susceptible to catching it so, along with treating patients, one of our main priorities is training health staff to reduce the risk of them catching the disease whilst caring for patients,” said Henry Gray, MSF’s emergency coordinator, during an outbreak of Ebola in Uganda in 2012.

“We have to put in place extremely rigorous safety procedures to ensure that no health workers are exposed to the virus – through contaminated material from patients or medical waste infected with Ebola.”

Treating Ebola

No specific treatment or vaccine is yet available for Ebola.

Standard treatment for Ebola is limited to supportive therapy. This consists of hydrating the patient, maintaining their oxygen status and blood pressure and treating them for any complicating infections.

Despite the difficulty of diagnosing Ebola in its early stages, those who display its symptoms should be isolated and public health professionals notified. Supportive therapy can continue with proper protective clothing until samples from the patient are tested to confirm infection.

MSF contained an outbreak of Ebola in Uganda in 2012 by placing a control area around the treatment centre.

An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.

Make a donation to Médecins Sans Frontières/Doctors Without Borders (MSF)

 

MSF updates

For the most recent information from MSF about the ongoing Ebola crisis in West Africa, please follow the links below: 

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