Ebola in West Africa — It’s Not Going Away

By Stan Deresinski, MD, FACP, FIDSA

Clinical Professor of Medicine, Stanford University, Hospital Epidemiologist, Editor of Infectious Disease Alert

SYNOPSIS: The current ongoing Ebola virus outbreak in West Africa is the largest ever recorded.

Sources: World Health Organization. Global Alert and Response. Ebola virus disease, West Africa – update. 24 June 2014. http://www.who.int/csr/don/2014_06_24_ebola/en/; Center for Disease Control and Prevention. MMWR Ebola viral disease outbreak – West Africa, 2014. http://1.usa.gov/1osPCv6

Outbreaks of Ebola virus infection usually are of relatively brief duration — this is not the case with the current outbreak in West Africa. As a consequence, 3 days after a similar warning was issued in Sierra Leone, the president of Liberia, Ellen Johnon Sirleaf, on June 28 announced on radio "Let this warning go out: Anyone found or reported to be holding suspected Ebola cases in homes or prayer houses can be prosecuted under the law of Liberia". The World Health Organization, calling it a sub-regional crisis stated that the outbreak in Guinea, Liberia and Sierra Leone is "the largest in terms of the number of cases and deaths, as well as the geographic spread of the disease."

The current Ebola outbreak is already the largest ever recorded. As of July 1, WHO reported 413 cases (293 confirmed, 88 probable, and 32 suspected) in Guinea and 239 (199 confirmed, 31 probable, 9 suspected) in Sierra Leone, as well as 107 cases (52 confirmed, 21 probable, 34 suspected) in Liberia. There have been 467 deaths among the total of 759 cases. The outbreak appeared to be waning in late April, but it then resurged.

WHO has concluded that 3 major factors account for the continuing outbreak:

• transmission within rural communities, together with traditional beliefs and cultural practices

• transmission in densely populated periurban areas of Conakry in Guinea and Monrovia in Liberia

• transmission across country borders.

CDC has indicated that the key elements in the control of Ebola outbreaks include:

• active case identification and isolation of patients from the community to prevent continued virus spread

• identifying contacts of ill or deceased persons and tracking the contacts daily for the entire incubation period of 21 days

• investigation of retrospective and current cases to document all historic and ongoing chains of virus transmission

• identifying deaths in the community and using safe burial practices

• daily reporting of cases.

Education of health-care workers regarding safe infection-control practices, including appropriate use of personal protective equipment, is essential to protect them and their patients because health-care–associated transmission has played a part in transmission during previous outbreaks. The geographically dispersed nature of the outbreak will also require regional cooperation, something that WHO is working to make happen by, among other things, convening a special meeting of Ministers of Health from the region.