The Ebola epidemic still affecting West Africa has proven to be the most devastating single outbreak of the disease in history. Médecins Sans Frontières/Doctors Without Borders (MSF)’s West Africa Ebola response started in March 2014, and includes activities in Guinea, Liberia, Mali and Sierra Leone. MSF currently employs 185 international and around 1,150 locally hired national staff in the region.
On March 23, 2015, MSF released Pushed to the Limit and Beyond: A Year Into the Largest Ever Ebola Outbreak, a report looking at the global response to the West African Ebola epidemic.
- Ebola Is Not Finished Yet: An MSF nurse in Sierra Leone on why she won't give up until the disease is defeated (VIDEO)
- It's too early to declare victory in fight against Ebola: MSF Canada's Stephen Cornish
- Pushed to the Limit and Beyond: MSF on the global Ebola response one year into the deadliest outbreak in history
- 'Ebola is not over until there are zero cases:' MSF's Dr. Joanne Liu on the challenge that remains in West Africa
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MSF Ebola activity update, May 7, 2015:
March 23, 2015, marked the one-year anniversary of the World Health Organization's confirmation that an outbreak of Ebola had started in the West African country of Guinea. At the time of the announcement, MSF was already on the ground in the region, helping to respond to the crisis. Since then, MSF's activities have included:
- 9,446 patients admitted to MSF Ebola management centres
- 5,168 patients confirmed with Ebola
- 2,449 patients recovered from Ebola in MSF centres
The number of cases in Guinea keeps fluctuating, although it has significantly fallen. The situation in some others prefectures remains concerning, especially in Forecariah. The high level of stigmatization and reticence, particularly towards recovered patients, is still a problem.
WHO should declare Liberia Ebola-free on May 9. MSF welcomes that Liberia has had no cases of Ebola for 42 days and applaud the efforts of the Liberian people in achieving this. But with the outbreak still ongoing in neighbouring Guinea and Sierra Leone, we cannot say that Ebola is over just yet. Vigilance against re-emergence is key and close surveillance is crucial.
Liberia’s already weak public health system has been seriously damaged by the epidemic, with many hospitals shut down. As health facilities begin to reopen, infection control will be crucial to help restore public confidence in the health system.
The case load in Sierra Leone has stabilized to an average of ten people per week, with the majority of cases found in the Western Area and in the region of Kambia, at the border with Guinea. Today, MSF teams are focusing on outreach activities, surveillance and health promotion amongst others. In collaboration with national authorities, teams are also starting to identify other health needs in the country.
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:
MSF involvement in clinical trials
MSF is currently actively involved in three different studies in Guinea, focusing on three different aspects of the medical response: diagnosis, prevention and treatment.
Vaccination Trial: Since March 7, MSF has launched a clinical trial for the rVSV-EBOV vaccine in partnership with WHO. This clinical trial aims to verify the safety and effectiveness of the vaccine against Ebola. It consists of two arms: a ring vaccination arm, which means that contacts of a confirmed patient will be vaccinated; and the vaccination of Ebola front-line workers (such as doctors, nurses, ambulance drivers, staff involved in contact tracing, and individuals responsible for burials). WHO is responsible for the ring vaccination. MSF focuses on the front-line workers and aims at enrolling 1,200 volunteers.
Convalescent Plasma Trial: The clinical trial for convalescent plasma began in February in partnership with the Tropical Medicine Institute in Antwerp. Plasma from volunteering recovered patients is given to Ebola patients, expecting to boost their immune response. The study aims at enrolling 120 patients.
GeneXpert Trial: MSF has just started assessing the feasibility of using the GeneXpert technology (already used to test multi-drug-resistant tuberculosis) to improve blood-testing Ebola in terms of logistics and timing.
For the most recent information from MSF about the ongoing Ebola crisis, please follow the links below:
- Clinical trials show experimental Ebola drug can produce positive effect for some patients
- 'No one should slip through the cracks’: An MSF epidemiologist on why tracing Ebola patients is essential
- Is Ebola a death sentence for pregnant women? Meet Adama, a survivor in Sierra Leone (story and video)
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.
- VIDEO: MSF Canada's Stephen Cornish tells The Globe and Mail why the Canadian government should open treatment centres in Ebola outbreak areas
- Stephen Cornish discusses Canada's and the world's response to Ebola on CBC's Power and Politics
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.
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.
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 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 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 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 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.
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.
For more information about MSF's activities throughout the ongoing Ebola crisis in West Africa, please follow the links below:
- Ebola: MSF halts experimental drug trial underway in Liberia
- Decline in Ebola cases is encouraging, but critical gaps remain says MSF
- Liberia: Trial of possible Ebola drug begins at MSF treatment centre in Monrovia
- Liberia: Ebola outbreak contained in Lofa County, MSF hands over activities
- Ebola fighters are TIME's person of the year for 2014
- International response to Ebola continues to be slow, risks becoming a 'double failure' says MSF
- Sierra Leone: 1.5 million people receive malaria drugs in a country ravaged by Ebola
- 'The medics counts on us': An MSF hygienist from Sierra Leone on his role in the fight against Ebola
- Webcast: Stopping Ebola: MSF’s experience on the front lines of a historic epidemic
- Ebola in Liberia: Malaria must be treated as well
- FAQ: The Top Ten Questions About Ebola
- EBOLA TIMELINE: As of November 2014
- Mali: MSF expands activities to fight Ebola outbreak after new case detected
- MSF teams withdraw as Ebola outbreak in DRC comes under control
- MSF Canada develops online Ebola briefing tool to train health workers
- First trials for Ebola treatments to start at MSF sites in December
- Aid must adapt to new phase of outbreak in Liberia after recent progress
- MSF responds to Health Canada's guidelines regarding health workers returning from Ebola contexts
- Webcast: Stopping Ebola: MSF’s experience on the front lines of a historic epidemic
- Ebola in Liberia: Malaria must be treated as well
- FAQ on MSF's Ebola response and protocols
- Press Release: Quarantine can undermine efforts to curb Ebola epidemic
- MSF urges immediate action on treatment and vaccines for front-line workers
- Press Release: MSF staff member in U.S. hospital receiving treatment for Ebola
- 'Pa, I am well': My son is MSF's 1,000th Ebola survivor in West Africa
- MSF calls for new treatments and vaccines to help bring outbreak under control
- A new spike in Ebola cases in Guinea pushes Conakry treatment centre to the limit
- Inside Monrovia's 'Hotel Tent', where Ebola's orphans wait for someone to take them home
- DRC: MSF teams withdraw as Ebola outbreak comes under control
- MSF Ebola teams in Democratic Republic of Congo treating cases despite difficult conditions
- MSF operating two Ebola treatment centres in Democratic Republic of Congo
- Press Release: Norwegian MSF staff member infected with Ebola (October 6, 2014)
- Sept. 25, 2014: MSF International President Dr. Joanne Liu addresses the UN General Assembly on Ebola
- 'My friend across the fence': A story of survival at an MSF Ebola treatment centre
- 'Somebody had to do it': An MSF worker in Liberia on turning people away from an overwhelmed Ebola treatment centre
- MSF International President Dr. Joanne Liu addresses the UN member states on Ebola, September 16: "The response remains totally, and lethally, inadequate"
- The Boy Who Tricked Ebola
- MSF International President Dr. Joanne Liu addresses the UN member states on Ebola, September 2: 'You have a political and humanitarian responsibility'
- Press release: MSF denounces international inaction, calls for states with bio-disaster response resources to deploy them immediately
- Op-Ed: The failure of the international response to Ebola
- Ebola: MSF sends specialists and materials to Democratic Republic of Congo
- MSF deeply saddened by the deaths of Guinean, Liberian and Sierra Leonean colleagues
- An MSF doctor discusses experimental Ebola treatments
- Ebola in West Africa: An MSF operational update
- Op-Ed by Stephen Cornish: Ebola Outbreak Calls for Global Response
- Crisis Update: MSF increases its efforts as Ebola outbreak continues to spread
- Canadian doctor Tim Jagatic on his second mission to Ebola-stricken West Africa
- Crisis Update: Race against time to control Ebola outbreak in Sierra Leone
- Press Release: 'The epidemic is out of control'
- Field News: Two MSF doctors discuss the outbreak in West Africa
- Crisis Update: Ebola epidemic in Guinea
- Interview with a Canadian MSF psychologist in Guinea