Strong international support is still needed to bolster the remaining portions of West Africa's Ebola response, such as treatment units and putting contact tracing teams in place, a top World Health Organization (WHO) official said today, warning against a false sense of optimism and complacency.
Bruce Aylward, MD, MPH, the WHO's assistant director-general in charge of Ebola outbreak response, told reporters in Geneva today that Ebola transmission in West Africa is still intense enough to pose a threat of international spread and though response efforts are making a difference—especially more treatment beds and safer burials—behaviors play a key role. He said one badly done burial, for example, could spark another spike in cases.
Caution balances message of progress
At the end of September when the United Nations Mission for Ebola Emergency Response (UNMEER) launched and case numbers were rising exponentially, the WHO and its partners set an aggressive Dec 1 target for 70% of sick people to be isolated in treatment centers and for 70% of Ebola victim bodies to be buried safety. Though overall the countries didn't meet the targets, "the big picture is that we're in a different place than we were 60 days ago," Aylward said.
One piece of good news is that all three countries have exceeded the 70% goal for safe burials, following the doubling of safe burial teams, which are now at 202, he said. Also, two countries—Guinea and Liberia—have exceeded the 70% for Ebola patient treatment and isolation. Aylward said Ebola treatment beds have also doubled over the past 60 days, which has played a key role in edging the countries toward that goal.
Managing escalating Ebola activity in western Sierra Leone remains one of the big challenges, he said, as does putting treatment units in the areas where they're needed, given the expanding geographic range of the disease.
Aylward said the political will and investments are there for the response, but he said the most alarming thing he's heard is that things are "on track" and he warned against using the word "optimism" when gauging outbreak trends.
"There's no room for optimism when dealing with Ebola," he said. Unlike other diseases, the response demands getting Ebola to zero cases, which won't happen without 100% safe burials, 100% patients treated and isolated, and broad, aggressive case finding and contact tracing efforts in every district, he added.
The response is shifting from being hunted by the virus to hunting the virus and shutting down all chains of transmission, Aylward said.
Opportunities for response
The recent slowdown in cases offers new opportunities for responders and scientists, according to a Nov 26 editorial in the journal Nature. Nature editors added, however, that the surge in cases in Sierra Leone is a reminder that Ebola remains a major threat.
The exact reasons for the lull in cases in Guinea and Liberia are unclear, but are probably related to response efforts gaining steam and Africans coming to terms with the disease and blocking its main routes of transmission, such as by reducing traditional burial practices, the editors said. The slowing of cases in some areas offers a reprieve to health workers and scientists and "is an opportunity to regroup, to consolidate gains, and to go all the more on the offensive," the editorial said.
Global groups should heed the advice of Doctors without Borders, which has said a more flexible Ebola response is needed, given the shifting epidemiology of the disease, the Nature editors wrote.
They also said the slowdown creates some precious time for testing drugs and vaccines, though they pointed out that the focus on countermeasures has turned the spotlight and resources away from simpler interventions such as rehydration and electrolyte control that could have had an immediate impact.
Outbreak response updates
No new Ebola cases have been detected in Mali over the last few days, keeping its total at 8 cases, 6 of them fatal, the country's president, Boubacar Keita, said on Nov 29, according to an update today from UNMEER. It said 285 people are being monitored, and so far none have shown any signs of the disease.
UNMEER also said today that five transit centers designed to isolate up to 12 suspected Ebola cases pending transfer to treatment units have opened in different cities in Guinea, with five more to be open by Dec 5.
In Liberia, an expedited review of lab locations requested by the US Centers for Disease Control and Prevention has prompted a reshuffling of labs, with a new one to be deployed to Sinoe County.
Meanwhile in Sierra Leone, the first Ebola treatment center opened in Makeni. The $300,000 unit was built by Addax Bioenergy Ltd as part of its contribution to the Ebola response, UNMEER said.
In a Nov 28 report, UNMEER said a recent meeting in Monrovia on payment of wages for Ebola workers found that one of the main challenges was a lack of a centralized government list of workers, so the next step will be gathering all the information needed for a centralized national database. A similar meeting in Guinea identified the same problem, and officials agreed that a response-worker database is needed to track payments.
In Liberia, global partners are setting up 15 community care centers in different hot spots, the UNMEER said, and in Guinea construction on four more ETUs is under way, with the capacity to treat 190 patients. The locations are Nzerekore, Coya, Beyla, and Kerouane.
Other developments
- A rapid diagnostic test for Ebola will be tested in coming weeks in the Ebola treatment center in Conakry, Wellcome Trust, one of the joint funders, reported on Nov 28. The 15-minute test is six times faster than other tests that are currently used. The trial will be led by a team from the Pasteur Institute in Dakar, Senegal. The new test involves a "mobile suitcase laboratory" designed for low-resource settings. It includes a solar panel, a power pack, reagents that can be used and transported at room temperature, and a results reader the size of a small laptop.
- The Italian nongovernmental organization Emergency expects to launch a trial of the antiarrhythmia drug amiodaraone for treating Ebola in Sierra Leone, according to a Nov 27 British Medical Journal (BMJ) report. The trial will be conducted at a hospital built recently by the United Kingdom to be run by Emergency. Roberto Satolli, coordinator of the trial, told BMJ that preclinical studies have shown the drug to be a potent filovirus inhibitor, and because the drug's safety profile is known based on its use for many decades, it appears to be a good candidate for a phase 3 trial.
- The WHO on Nov 26 released a set of key messages for counseling men who have survived Ebola. It said it does not recommend isolating men whose blood has tested negative for the disease. India recently quarantined a man who arrived in the country after recovering from Ebola in Liberia after traces of the virus were found in his semen. Based on limited studies, it said men who have recovered should be aware that seminal fluid may be infectious as long as 3 months after symptom onset and that they should take precautions during that time, including good personal hygiene after masturbation and, if abstaining from sex isn't possible, use of condoms. The agency noted, though, that sexual transmission of Ebola has not been documented.
- To assist health providers in West Africa, the WHO recently issued a guide for delivering obstetric and newborn care in Ebola outbreak settings. The 5-page guide details interventions for lowering delivery and postpartum risks for mothers and newborns and steps for minimizing health worker exposure to blood and body fluids that could transmit Ebola.
See also:
Dec 1 WHO press briefing transcript
Nov 26 Nature editorial
Dec 1 UNMEER report
Nov 28 UNMEER report
Nov 27 BMJ report
Nov 28 Wellcome Trust press release
Nov 26 WHO statement on Ebola virus in semen
