Annals of African Medicine
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LETTER TO THE EDITOR
Year : 2015  |  Volume : 14  |  Issue : 4  |  Page : 200-201  

Insights from the Ebola virus disease outbreak


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India

Date of Web Publication16-Oct-2015

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd Floor, Ammapettai Village, Thiruporur- Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1596-3519.150098

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How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Insights from the Ebola virus disease outbreak. Ann Afr Med 2015;14:200-1

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Insights from the Ebola virus disease outbreak. Ann Afr Med [serial online] 2015 [cited 2020 Sep 27];14:200-1. Available from: http://www.annalsafrmed.org/text.asp?2015/14/4/200/150098

Sir, The 2014 outbreak of Ebola virus disease (EVD) has been declared as an international public health emergency.[1] Since its origin in March 2014 in Guinea, almost 15,935 cases of EVD (confirmed, probable and suspect) have been reported till the end of November 2014 in eight of the affected nations (viz. Guinea, Liberia, Mali, Sierra Leone, Nigeria, Senegal, Spain, and United States of America).[2],[3] Moreover, the worrisome factor is the ability of Ebola virus to claim the lives of a significant number of affected persons (viz. almost 5700 deaths have been reported), without sparing the health care professionals.[3],[4] Although, time and again multiple outbreaks/epidemics of infectious origin have been reported in the past, this current outbreak of Ebola virus was not expected to result in such a catastrophe (owing to moderately long incubation period, absence of airborne transmission and noninfectious asymptomatic patients).[5],[6] This was also presumed since almost 20 such EVD outbreaks have been reported till date (first outbreak in 1976), and all of them were successfully contained without any significant loss of human life (viz. the caseload and death rate of current outbreak has already exceeded the estimates of all previous 20 outbreaks combined).[3],[5] Now, the question arises if the public health authorities and the health professionals are dealing with a known enemy, then what went wrong that they failed to contain the same?[1],[4],[6] The retrospective analysis of the outbreak provided valuable insights on how a common disease agent with a limited infectivity could maneuver the existing weaknesses in the public health care delivery system.[7] It was concluded that a wide range of factors such as lack of preparedness;[8] delayed initial response;[8] poverty;[9] shortcomings in the public health infrastructure (viz. limited number of laboratories well-equipped with diagnostic facilities, no isolation wards, human resource constraints, untrained health care personnel, shortage in logistics – personal protective equipments, etc.);[2],[4],[9] absence of clear roles and responsibilities of different cadres of health workers;[6] inadequate contact tracing;[9],[10] inability of the government authorities to involve community in their initiatives;[11] no trust of people in the public health sector;[4],[6] minimal awareness of the people about the different aspects of the disease (viz. reservoir species, mode of transmission of disease, clinical features, preventive measures, high-risk behavior which should be avoided, etc.);[10] traditional and ritual practices;[12] development of a sense of fear among the masses and thus they refrained themselves from availing the services of public health sector (instead approached traditional healers);[9],[12] no regulation on the movement of the people across the land borders (hot zone) in the affected adjoining nations;[6],[9] hot and humid environment in the affected regions, thus decreasing the work efficiency of staff;[9] empty-handed clinicians (no drug and no vaccine);[13] and dearth of research in the field;[9],[13] allowed the disease to grow to epidemic proportions. Thus, the 2014 Ebola epidemic has highlighted the growing socioeconomic disparities in the world, where the richer sections of society access the best medical care and poor people are left to die.[9],[14] It further revealed that the existence of an effective public health care delivery system and involvement of the community is a must to successfully counter any such outbreak in the future.[4],[9],[10] The outbreak even exposed the wide gaps that are persisting in the research arena – as even after passage of 4 decades the health professionals have no effective drug or vaccine, which can be employed on a mass scale in affected nations for the benefit of people.[10],[13],[14] In addition, it has been realized that by not adhering to the basic preventive strategies (viz. use of personal protective equipment, maintaining hand hygiene, use of disinfectants, etc.), the disease eventually involved multiple districts, states, and countries.[8],[10],[15] Finally, the EVD outbreak emphasizes the need of development of an action plan (in unaffected nations), timely support from international agencies/countries, and contribution from the researchers to deny further expansion of the disease.[1],[4],[7],[16] In conclusion, the 2014 outbreak of EVD has proved to be an eye-opener for the health professionals who advocate "health for all" and "millennium development goals," despite not achieving the basic health care services on a universal platform. The need of the hour is tofirst strengthen primary health care services so that future such outbreaks can be averted, and lives of thousands of people can be saved in years to come.

 
   References Top

1.
Briand S, Bertherat E, Cox P, Formenty P, Kieny MP, Myhre JK, et al. The international Ebola emergency. N Engl J Med 2014;371:1180-3.  Back to cited text no. 1
    
2.
Baize S, Pannetier D, Oestereich L, Rieger T, Koivogui L, Magassouba N, et al. Emergence of Zaire Ebola virus disease in Guinea. N Engl J Med 2014;371:1418-25.  Back to cited text no. 2
    
3.
World Health Organization. Ebola Response Roadmap Situation Report; 26 November, 2014. Available from: http://www.who.int/csr/disease/ebola/situation-reports/en/?m=20141126. [Last accessed on 2014 Nov 30].  Back to cited text no. 3
    
4.
Frieden TR, Damon I, Bell BP, Kenyon T, Nichol S. Ebola 2014 – New challenges, new global response and responsibility. N Engl J Med 2014;371:1177-80.  Back to cited text no. 4
    
5.
Centers for Disease Control and Prevention. Outbreaks Chronology: Ebola Virus Disease. Atlanta: CDC; 2014. Available from: http://www.cdc.gov/vhf/Ebola/outbreaks/history/chronology.html. [Last accessed on 2014 Oct 28].  Back to cited text no. 5
    
6.
World Health Organization. Ebola in West Africa: Heading for Catastrophe? 2014. Available from: http://www.who.int/csr/disease/Ebola/Ebola-6-months/west-africa/en/. [Last accessed on 2014 Oct 30].  Back to cited text no. 6
    
7.
World Health Organization. What this – The Largest Ebola Outbreak in History – Tells the World: Deadly Pathogens Exploit Weak Health Systems; 2014. Available from: http://www.who.int/csr/disease/Ebola/Ebola-6-months/lessons/en/. [Last accessed on 2014 Nov 20].  Back to cited text no. 7
    
8.
Hwang ES. Preparedness for prevention of Ebola virus disease. J Korean Med Sci 2014;29:1185.  Back to cited text no. 8
    
9.
Chan M. Ebola virus disease in West Africa – No early end to the outbreak. N Engl J Med 2014;371:1183-5.  Back to cited text no. 9
    
10.
World Health Organization. Ebola Virus Disease – Fact Sheet No. 103; 2014. Available from: http://www.who.int/mediacentre/factsheets/fs103/en/. [Last accessed on 2014 Nov 19].  Back to cited text no. 10
    
11.
Bah SM, Aljoudi AS. Taking a religious perspective to contain Ebola. Lancet 2014;384:951.  Back to cited text no. 11
    
12.
World Health Organization. Sierra Leone: A Traditional Healer and a Funeral. Available from: http://www.who.int/csr/disease/Ebola/Ebola-6-months/sierra-leone/en/. [Last accessed on 2014 Nov 19].  Back to cited text no. 12
    
13.
Marzi A, Feldmann H. Ebola virus vaccines: An overview of current approaches. Expert Rev Vaccines 2014;13:521-31.  Back to cited text no. 13
    
14.
Fauci AS. Ebola – Underscoring the global disparities in health care resources. N Engl J Med 2014;371:1084-6.  Back to cited text no. 14
    
15.
World Health Organization. Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-care Settings, with Focus on Ebola. Geneva: WHO Press; 2014.  Back to cited text no. 15
    
16.
Green A. WHO and partners launch Ebola response plan. Lancet 2014;384:481.  Back to cited text no. 16
    




 

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