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HICprevent

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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Update: Ebola Crashes Celebration of Epidemic End

January 14th, 2016

By Gary Evans, Senior Staff Writer

A day after it was declared vanquished, Ebola returned with a new fatal case in Sierra Leone. That means follow-up of possible contacts is underway as we return to the laborious leg work of eradicating the persistent virus.

The World Health Organization said Jan. 14 that all known chains of transmission of Ebola have been stopped, but warned that “flare-ups [are] expected and that strong surveillance and response systems will be critical in the months to come.” The immediate flare up was more like a firecracker going off before you can throw it, but with Ebola why should we expect anything else?

The historic outbreak is thought to have begun two years ago in a small village in Guinea when a 2-year-old boy playing in a hollow, bat-infested tree became the index case. Fruit bats inhabited the tree until it caught fire some time later, issuing a “rain of bats” the locals said. Culling bats with a voracious appetite for insects is not considered an option on a continent where half a million people die annually of mosquito-borne malaria. In any case, researchers are finding that fruit bats apparently carry Ebola only intermittently, so coexisting with the mammals seems the best course of action.

The end of the outbreak came in Liberia, which was first declared free of Ebola transmission in May 2015, but the virus was re-introduced twice since then, with the latest infections in November. The Jan. 14 announcement came 42 days (two 21-day incubation cycles of the virus) after the last confirmed patient in Liberia tested negative for the disease two times. This is the first time since the start of the epidemic two years ago that all three of the hardest-hit countries — Guinea, Liberia and Sierra Leone — have reported zero cases for at least 42 days.

The Ebola epidemic infected 28,500 people and forever altered the perception of the virus in the infectious disease world. Heretofore considered a non-pandemic threat by many because it killed its victims faster than they could transmit it, this Ebola outbreak showed a capacity to persist and spread internationally that ensures the virus will never be underestimated again. The best monument to the hundreds of care givers that died trying to stop it would be the development and broad distribution of an effective vaccine. That and other public health measures and improved surveillance systems could ensure that a large, susceptible human population is never again at its mercy.