Outbreak in West Africa

The Ebola epidemic still 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. The organization operates eight Ebola case management centres (CMCs) across the region, providing approximately 650 beds in isolation, and one transit centre. Since the beginning of the outbreak, MSF has admitted more than 8,100 patients, among whom around 4,960 were confirmed as having Ebola. More than 2,300 patients have survived.

 

 

 

Our staff are fighting to save the lives of hundreds of patients and contain the Ebola outbreak in West Africa. But they can't operate without donations - please help by making a donation today.

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From the MSF Ebola crisis update, January 30, 2015:

Since the outbreak in West Africa was officially declared on March 22, 2014, it has claimed more than 8,600 lives in the region. The outbreak is the largest ever, and is currently affecting three countries in West Africa: Guinea, Liberia and Sierra Leone. Outbreaks in Mali, Nigeria and Senegal have been declared over. A separate outbreak in Democratic Republic of Congo has ended. 

During the last weeks, a downward trend of new cases has been reported in MSF Ebola management centres across the three affected countries, with 50 confirmed cases in its eight centres last week. While this is a promising development, the World Health Organization reported that only about half of new cases in both Guinea and Liberia are from known Ebola contacts, while in Sierra Leone there is no data available. There is almost no information sharing for tracing Ebola contacts between the three most-affected countries. Since a single new case is enough to reignite an outbreak, the level of vigilance should remain high in order not to jeopardise the progress made in stemming the epidemic.

MSF has been responding to the outbreak in West Africa since last March, and employs 302 international personnel and around 4,000 national locally hired staff in the region. 

 

How MSF treats Ebola patients: medical protocols

Follow the link below to read a Q&A with MSF public health specialist Dr. Armand Sprecher, who describes the clinical protocols MSF has used and adapted during its response to the West African Ebola outbreak:

 

 

Clinical trials for Ebola vaccines

Two of the three clinical trials for different treatments led by MSF and three research institutions have started, while the third should start soon at MSF sites in West Africa.  The French National Institute of Health and Medical Research (INSERM) is leading a trial for antiviral drug favipiravir at MSF’s facility in Guéckédou, Guinea. The University of Oxford leads, on behalf of the International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC), a Wellcome Trust-funded trial of the antiviral drug brincidofovir at Elwa3 in Monrovia. The inclusion of patients started on January 1, 2015. The inclusion of patients at this site has started. The Antwerp Institute of Tropical Medicine (ITM) will lead a trial of convalescent plasma therapy at MSF’s Donka Ebola centre in Conakry, Guinea.

 

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

 

 

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)

 

 

Fighting Ebola with music

Support for MSF's work in the fight against Ebola has included the efforts of some musicians from West Africa. In November, an all-star group of African recording artists released "Africa Stop Ebola," a charity single to raise awareness about the disease, announcing that all proceeds from the sale of the song in Europe were to be donated to MSF. 

 

In Liberia, meanwhile, a group known as the Talented Young Brothers recorded "Ebola is Real," a song written to help MSF conduct health promotion visits and to teach communities about how to reduce the threat of transmission of the Ebola virus.

 

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 more information about MSF's activities throughout the ongoing Ebola crisis in West Africa, please follow the links below: 

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