This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.

Subduing the Ebola Virus.

By Abubakar Danlami Balarabe | 03 Jun, 2015

As the Ebola viral disease epidemic is being conquered in West Africa, the greatest challenge is how to prevent the re-occurrence of the disease in West Africa or else where in the world. In veiw of this, you are hereby invited to the discussion and offer solutions, resource and suggestion on how to address this issue. I have this link below for a start. Thank you.

 http://www.who.int/csr/resources/publications/ebola/filovirus_infection_contr...

Attached resource:

Replies

 

Elizabeth Glaser Moderator Emeritus Replied at 3:58 AM, 4 Jun 2015

Abubakar , are you beginning a discussion here at GHDonline or is this an invite to one at WHO? Following your WHO link , I found the document but did not see any way to provide comments .

Well, can you hear me out on my idea?

Previously Ebola emerged every few years across central Africa, was contained, and then seeming disappeared. Since 2010 or 2011 , the gaps in time between outbreaks has gotten shorter and shorter to the point where there have been separate but concurrent outbreaks of Ebola Zaire in DRC, in central Africa, and across the region of West Africa during August -October 2014. And though resolving, the West African outbreak is still not over.

Some tests with high false positives pointed to the possibility of Ebola being in the region many years ago, long before this strain of Ebola could have been present. It has been said that because this information was not widely disseminated, that West African countries were not able to monitor and mobilize for this epidemic. But the fact is that the authors of those papers noted that high false positives made it almost impossible to determine if Ebola had been there , particularly since it could not be correlated with a pattern of illness or death that were typically associated with the most common (and deadly) type of Ebola. And the one type of Ebola that has been in West Africa, Ebola Tai Forest, with one confirmed and one suspect case, was well cited in the medical literature.

There was surveillance. Dr Khan and his team at Kenema Government Hospital in Sierra Leone had been collaborating for nearly a decade with US-based researchers to set up a comprehensive surveillance lab in emerging infectious diseases. Their lab began surveillance testing for Ebola, among other diseases , in March 2014, and made the first confirmation of Ebola in Sierra Leone in May 2014. But Dr Khan, his head nurse, his lab director, and many of their staff died fighting Ebola, because they did not have sufficient supplies of PPE, and frankly because the lives of ill and dying staff were not deemed to be worth the price of a dose of Zmapp. A lot of knowledge and expertise died with those good people.

We may not be able to be ready for Ebola, per se, but many at risk countries can practice for Ebola, through training staff to deal with different viral hemorrhagic fever endemic to the area, that of Lassa Fever. Lassa is present across a broad swathe of West Africa, and is seasonally present in those countries. Though the overall case fatality rate is low, it is responsible for between 250,000-500,000 cases of illness every year. Even with 1% mortality, that means there are between 2500-5000 deaths a year from Lassa fever in West Africa. Transmission of Lassa is similar to that of Ebola, and for those more severe cases ( with mortality as high as 30--40% ) staff are advised to wear PPE and use similar precautions as for Ebola. Like Ebola, pregnant women with Lassa have high mortality and very high rates of fetal demise.

There a a few facilities in West Africa with expertise in Lassa fever. Kenema Government Hospital was one, as was Phebe Hospital in Liberia.

Rather than making special, stand alone ETUs, might it make more sense to essentially cross train staff in Lassa Fever and Ebola, creating centers of Excellence in those at risk countries? In these centers, regular staff and nursing, medical, and laboratory tech students can be trained in IPC, Lass and Ebola care and prevent, and can provide consultation and additional resources when outbreaks occur.

If MOH in Lassa endemic countries had provided sufficient supplies of the proper PPE to deal with Lassa fever , and had enough staff with IPC expertise to provide round the clock care, as well as send trained staff to areas with high incidence, it would not have stopped the outbreak, but it might have lessened the overall impact and given a buffer to community teams to get started on their vital part of the equation.

In summary prevention and care for Lassa Fever outbreaks may be a reasonable model for Ebola; if a country does not have adequate supplies, trained hospital staff , community health teams, or logistics to deal with endemic Lassa Fever, then that country is unlikely to be prepared to deal with Ebola.

Abubakar Danlami Balarabe Replied at 8:39 PM, 4 Jun 2015

Dear Elizabeth,

Thank you for the observations. I actually want to start a discussion on the preventive aspect of the Ebola Viral Disease and I deliberately skipped the preamble and comparison with other hemorrhagic viral diseases such as, Lassa; Marburg; Dengue; etc. The focus here is on Ebola which is evidently most virulent, they have similarities in terms of management in hospital settings which is mainly barrier nursing, and as you pointed out with the necessry equipments and training. However, they have differences in the preventive strategies in the community. I happen to be from Northeastern Nigeria where the Lassa fever was first discovered in 1969 and which sadly, killed two Scottish nurses. Therefore, the need to maintain focus on Ebola is paramount to this discussion. Nonetheless, other hemorrhagic viral diseases can be kept in view for differentials. The aim is at the end of the discussion, participants can be well equipped with the preventive strategies at various levels of the disease transmission. I know you are among the 'Ebola war veterans', as such the discussion will certainly benefit immensely from your inputs and references. As for the link, it meant to kick start the discussion especially for students who want to join in. Thank you.

This Community is Archived.

This community is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.