Sierra Leone Telegraph: 17 May 2017
Three years ago the Ebola virus killed 10,000 people in West Africa. The latest outbreak in the Democratic Republic of Congo has so far claimed three lives. Jacqueline Weyer explains why swift and co-ordinated action is vital if the events of 2014 are to be avoided.
Three people have died and more than 125 are suspected to be infected with the Ebola virus in the Democratic Republic of Congo (DRC). The outbreak comes less than two years after the most deadly spread of the disease in West Africa. Jacqueline Weyer explains how the outbreak compares to those in the past.
Are there any links between this outbreak and the one that hit West Africa between 2014 and 2016?
There isn’t an expectation that a direct link will be found between the outbreak in West Africa and the one in the DRC. Sequencing data will reveal more information, most importantly the strain of the virus involved and how it relates to Ebola viruses reported in previous outbreaks.
The Ebola virus is known to occur in the DRC and outbreaks are not entirely unexpected. In fact the virus derives its name from the Ebola river in the northern Democratic Republic of Congo.
There have been more Ebola outbreaks in the DRC than in any other country. Over the past ten years there have been four: 2007, 2008-2009, 2012 and in 2014.
Nevertheless, whatever the virus or strain involved, outbreaks of viral hemorrhagic fever are always concerning. The unavailability of proven prophylaxis, effective treatment and high mortality rates are the reasons why these diseases are feared.
Outbreaks like this also often occur in areas that are impoverished. This poses particularly tough challenges in managing cases and containing an outbreak.
What is the difference between an outbreak and an epidemic? At which point will the outbreak become an epidemic?
The two terms actually have the same definition and are often used interchangeably. Both imply an increase in the number of cases of a disease occurring in a population at a specific time, or if there’s an expectation that the disease will spread.
The term “outbreak” is sometimes used when describing an event that happens suddenly and is limited in size and to a particular area. Epidemic, on the other hand, is used to describe a more profuse and dispersed disease event over time. But the line is grey.
What word is used is less important than the fact that outbreaks of viral hemorrhagic fever are always concerning.
What lessons have been learnt from previous outbreaks?
A swift response is critical to containing an outbreak. One major challenge in West Africa was the delay in recognising the outbreak. This meant that the disease was already spreading profusely which made it more complicated to contain the outbreak.
Containment efforts are complex and require many pieces of a puzzle to be put together to achieve success. This includes:
- supporting hospitals to limit transmission of the virus to health care workers while treating patients,
- engaging with communities so that they can understand the problem, and participate and support the containment efforts themselves,
- and active case tracing to identify potential contacts and new cases in order to ultimately interrupt the chain of transmission.
All these efforts have to be supported by adequate communication and logistics. The quicker all these actions can come together, the better the outcome of the containment effort.
Parts of the DRC are still plagued by violence. How would this exacerbate the current outbreak?
The violence in the country has had a massive impact on the availability of health care services. This is obviously a challenge and could hamper international efforts as relief workers and containment teams find it hard to reach the areas in need.
The good news is the country has experience in dealing with Ebola outbreaks, including some in country laboratory capacity for testing samples from suspected cases.
It’s still early days and much depends on how the situation unfolds in the DRC. But there are good examples of the challenges of delivering health care in conflict zones.
There are many initiatives and strategies for trying to ensure safe delivery of and access to health care in conflict zones by many governmental and non-governmental agencies around the world. The situations in Syria and South Sudan come to mind.
About the author
Jacqueline Weyer is a Senior Medical Scientist at the National Institute for Communicable Diseases, writing in theconversation.com