The medical world should not have been completely surprised when Ebola erupted in Liberia and surrounding countries more than a year ago, because there was evidence of its presence in the region as long ago as 1982, according to two Liberian health officials and a private expert who published an opinion piece in the New York Times today.
The three authors point out a 1982 article in Annals of Virology in which a trio of Germans reported finding Ebola antibodies in 26 of 433 Liberians (6%) who underwent testing for antibodies to Ebola, Marburg, and Lassa fever viruses.
The writers of the Times piece said they were "stunned" when they stumbled across the 1982 study in the course of drafting Liberia's recovery plan. The writers are Bernice Dahn, MD, MPH, chief medical officer of Liberia's Ministry of Health; Vera Mussah, MIPH, the ministry's director of county health services; and Cameron Nutt, Ebola response advisor for the nonprofit group Partners in Health.
The 1982 article calls the detection of the Ebola antibodies surprising and adds, "The results seem to indicate that Liberia has to be included in the Ebola and Marburg virus endemic zone. Therefore, the medical personnel in Liberian health centres should be aware of the possibility that they may come across active cases and thus be prepared to avoid nosocomial epidemics."
But the article also notes there was some doubt about the specificity of the indirect immunofluorescence test used to detect Ebola and Marburg antibodies in the serum samples, which were collected in 1978 and 1979.
The Times writers said the 1982 study was not the only one to report Ebola antibodies in Liberians. Three other studies in 1986 reported finding Ebola antibodies in 10.6%, 13.4%, and 14% of people sampled in northwestern Liberia. They also said other "forgotten reports" from the 1980s cited Ebola antibodies in residents of Sierra Leone and Guinea.
The writers said all those findings were essentially lost to Liberia, in part because none of the studies had any Liberian co-authors and because the reports were not easily accessed by people in the country.
"To our knowledge, no senior official now serving in Liberia's Ministry of Health had ever heard of the antibody studies' findings," the commentary says. "Nor had top officials in the international organizations so valiantly supporting the Ebola response in Liberia, including United Nations agencies and foreign medical teams."
If the virology findings had prompted efforts to prepare Liberia for Ebola, the outcome of the current epidemic might have been different, the three experts said. They concluded by asserting that the epidemic's legacy "must be a new architecture for global health delivery, with a strong focus on building local capacity to respond effectively to such crises."
Updates on numbers, NIH patient
In other developments, the latest Ebola numbers from the World Health Organization (WHO) today show close to 300 new cases and more than 100 deaths over the past few days.
The total of confirmed, probable, and suspected cases in Guinea, Liberia, and Sierra Leone has reached 25,516, with 10,573 deaths, the WHO said. The numbers indicate 288 new cases and 111 deaths since the previous update on Apr 2.
Also today, the condition of an American healthcare worker who contracted Ebola in Sierra Leone has improved from fair to good, the National Institutes of Health (NIH) reported. The worker is being treated at the NIH Clinical Center in Bethesda, Md.
The patient was admitted to the NIH facility in serious condition on Mar 13 after being evacuated from Sierra Leone. He or she was listed in critical condition on Mar 16 but was upgraded to serious condition 10 days later, according to previous NIH updates. The agency has not released any other details about the person.
Apr 7 Times commentary
April-June 1982 Annals of Virology paper
Apr 7 WHO Ebola statistics
Apr 7 NIH press release