- November 7: With the Ebola outbreak officially over in Sierra Leone, an MSF health specialist looks at remaining challenges
Doctors Without Borders/Médecins Sans Frontières (MSF)’s response to the largest Ebola outbreak in history began in March 2014.
Though Ebola has faded from the news headlines — and as of November 7, both Guinea and Sierra Leone have been declared Ebola-free — the epidemic in West Africa continues to claim lives. Currently, the main challenge comes from a weak surveillance monitoring system which is fragmented across the region. There were three confirmed new cases of Ebola in Guinea in the country in the week ending October 25 and 364 known contacts (141 high risk) are still being followed up across the country.
More than 11,000 people lost their lives to Ebola in West Africa since March 2014. Now the region also has an estimated 15,000 Ebola survivors, many of whom continue to face ongoing physical and mental health problems. The post-Ebola syndrome may include joint pain, chronic fatigue, hearing problems and eye problems. The eye conditions can potentially lead to blindness without prompt access to specialty care. In addition, survivors are at risk of stigmatization in their communities.
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MSF Ebola activity update, November 7, 2015:
MSF currently employs 75 international and 1,024 local staff in Guinea, Liberia and Sierra Leone, and has cared for 10,287 people, including 5,225 confirmed to be infected with Ebola since March 2014.
There were three new confirmed cases in the country in the week ending October 25. All three new cases are from the same household in the sub-prefecture of Kaliah, Forecariah, and are registered high-risk contacts linked to a case from the same area last week. The country also reported three cases the previous week. There are currently 364 contacts under follow-up in Guinea (an increase from 246 the previous week), 141 of whom are high-risk. An additional 233 contacts identified during the past 42 days remain untraced. Therefore there remains a near-term risk of further cases among both registered and untraced contacts.
On the occasion of the commemoration of the first year anniversary of the Ebola outbreak in Guinea, MSF and the prefectural authorities paid tribute to all those who fought against Ebola by unveiling a commemorative plaque and planting a mango tree.
After first being declared free of Ebola transmission on May 9, Liberia had six new cases confirmed at the end of June following the death of a 17-year-old boy. Liberia was again declared free of Ebola virus transmission in September, and has now entered a period of heightened surveillance.
Routine temperature checks continue unabated in health facilities in Liberia despite the end of the Ebola epidemic.
The last case to receive treatment for Ebola in Sierra Leone was confirmed free of the virus after a second consecutive negative test on September 25. The country was declared free of virus transmission on November 7, and it has entered into a period of enhanced surveillance.
MSF health promotion teams in Freetown, the capital of Sierra Leone, explain to members of the community how to prevent and recognize the symptoms of Ebola.
Pushed to the Limit and Beyond: MSF on the global response to the Ebola outbreak
In March 2015, Doctors Without Borders/Médecins Sans Frontières (MSF) released a critical analysis of the Ebola epidemic over the previous year, revealing the shortcomings of the global response to the crisis and warning that the outbreak, despite an overall decline in cases, is not yet over.
The report, Pushed to the Limit and Beyond, is based on interviews with dozens of MSF staff involved in the organization’s Ebola intervention. It describes MSF’s early warnings about cases of Ebola spreading in Guinea, the initial denial by governments of the affected countries, and the unprecedented steps that MSF was forced to take in the face of global inaction as the outbreak engulfed neighbouring states.
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:
Reine Lebel, a Canadian psychologist, talks about her work with Ebola patients.
How do MSF's Ebola treatment centres work? Click on the image below to visit an interactive guide. (Enlarge)
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.
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
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 thousands of people with the disease and helped to contain numerous life-threatening epidemics.
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 Uganda, Republic 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 characterized 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 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.”
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.
An Ebola outbreak is officially considered at an end once 42 days have elapsed without any new confirmed cases.
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.