Ebola in Western Australia: fears and facts

Ebola virus causes haemorrhagic fever and has resulted in vast mortality in several epidemics. Most outbreaks have occurred in Africa but, due to international travel and commerce, it is not impossible that a case could occur in Australia. Few healthcare workers, let alone the public, have an understanding of Ebola. One can only imagine the panic and terror that a potential outbreak – with the accompanying, exaggerated media reports of an impending mass epidemic and death – could bring.This article provides information about Ebola and its containment. Should a potential Ebola case arise in Western Australia (WA), are there procedures in place to cope with this disease or would it lead to massive fatalities, as in previous epidemics? The authors have investigated and here outline the contingency plans and guidelines for Ebola.The authors found that, theoretically, WA could maintain and control public health in relation to this deadly virus. It is hoped, however, that it will never be necessary to put theory into practice.     

Considerations for use of Ebola vaccine during an emergency response

Vaccination against Ebola virus disease is a tool that may limit disease transmission and deaths in future outbreaks, integrated within traditional Ebola outbreak prevention and control measures. Although a licensed Ebolavirus vaccine (EV) is not yet available, the 2014–2016 West African Ebola outbreak has accelerated EV clinical trials and given public health authorities in Guinea, Liberia, and Sierra Leone experience with implementation of emergency ring vaccination. As evidence supporting the use of EV during an outbreak response has become available, public health authorities in at-risk countries are considering how to integrate EV into future emergency Ebola responses and for prevention in high-risk groups, such as healthcare workers and frontline workers (HCW/FLWs), even before an EV is licensed. This review provides an overview of Ebola epidemiology, immunology, and evidence to inform regional and country-level decisions regarding EV delivery during an emergency response and to at-risk populations before a licensed vaccine is available and beyond. Countries or regions planning to use EV will need to assess factors such as the likelihood of a future Ebolavirus outbreak, the most likely species to cause an outbreak, the availability of a safe and effective EV (unlicensed or licensed) for the affected population, capacity to implement Ebola vaccination in conjunction with standard Ebola outbreak control measures, and availability of minimum essential resources and regulatory requirements to implement emergency Ebola vaccination. Potential emergency vaccination strategies for consideration include ring or geographically targeted community vaccination, HCW/FLW vaccination, and mass vaccination. The development of guidelines and protocols for Ebola vaccination will help ensure that activities are standardized, evidence-based, and well-coordinated with overall Ebola outbreak response efforts in the future.     

Monitoring and Evaluating the Ebola Response Effort in Two Liberian Communities

Although credited with ultimately reducing incidence of Ebola Virus Disease (EVD) in West Africa, little is known about the amount and kind of Ebola response activities associated with reducing the incidence of EVD. Our team monitored Ebola response activities and associated effects in two rural counties in Liberia highly affected by Ebola. We used a participatory monitoring and evaluation system, and drew upon key informant interviews and document review, to systematically capture, code, characterize, and communicate patterns in Ebola response activities. We reviewed situation reports to obtain data on incidence of EVD over time. Results showed enhanced implementation of Ebola response activities corresponded with decreased incidence of EVD. The pattern of staggered implementation of activities and associated effects—replicated in both counties—is suggestive of the role of Ebola response activities in reducing EVD. Systematic monitoring of response activities to control disease outbreaks holds lessons for implementing and evaluating multi-sector, comprehensive community health efforts.     

Spreading Ebola Panic: Newspaper and Social Media Coverage of the 2014 Ebola Health Crisis

During times of hot crises, traditional news organizations have historically contributed to public fear and panic by emphasizing risks and uncertainties. The degree to which digital and social media platforms contribute to this panic is essential to consider in the new media landscape. This research examines news coverage of the 2014 Ebola crisis, exploring differences in presentation between newspaper coverage and news shared on the social news platform Reddit. Results suggest that news shared on Reddit amplified panic and uncertainty surrounding Ebola, while traditional newspaper coverage was significantly less likely to produce panic-inducing coverage.     

浙江省埃博拉出血热输入及本地传播风险评估

埃博拉出血热是由埃博拉病毒引起的一种发生于人类和非人灵长目动物（猴子、大猩猩和黑猩猩等）的急性传染病。2014年2月份以来,埃博拉出血热在西非国家大肆蔓延,并造成上千人死亡,8月8日世界卫生组织将其列为“国际关注的突发公共卫生事件”。本文通过专家会商法对浙江省埃博拉出血热输入传播风险开展快速评估,为各部门采取有效防控措施提供依据。     

埃博拉病毒病原学、宿主免疫反应及实验室诊断研究进展

目前埃博拉病毒已成为一种重要的威胁全球公共卫生的病原体和生物恐怖袭击的毒种之一,WHO将其列为潜在的生物战剂和对人类危害最严重的病毒之一,其病原学、宿主免疫反应及实验室诊断研究是病例早期发现、早期隔离、早期治疗的关键点。本文对其进行综述,为埃博拉病毒病的预防和控制提供参考。     

Evaluation of Early Warning,Alert and Response System for Ebola Virus Disease,Democratic Republic of the Congo, 2018–2020

The 10th and largest Ebola virus disease epidemic in the Democratic Republic of the Congo (DRC) was declared in North Kivu Province in August 2018 and ended in June 2020. We describe and evaluate an Early Warning, Alert and Response System (EWARS) implemented in the Beni health zone of DRC during August 5, 2018–June 30, 2020. During this period, 194,768 alerts were received, of which 30,728 (15.8%) were validated as suspected cases. From these, 801 confirmed and 3 probable cases were detected. EWARS showed an overall good performance: sensitivity and specificity >80%, nearly all (97%) of alerts investigated within 2 hours of notification, and good demographic representativeness. The average cost of the system was US $438/case detected and US $1.8/alert received. The system was stable, despite occasional disruptions caused by political insecurity. Our results demonstrate that EWARS was a cost-effective component of the Ebola surveillance strategy in this setting.     

Ebola and Its Control in Liberia, 2014–2015

The severe epidemic of Ebola virus disease in Liberia started in March 2014. On May 9, 2015, the World Health Organization declared Liberia free of Ebola, 42 days after safe burial of the last known case-patient. However, another 6 cases occurred during June–July; on September 3, 2015, the country was again declared free of Ebola. Liberia had by then reported 10,672 cases of Ebola and 4,808 deaths, 37.0% and 42.6%, respectively, of the 28,103 cases and 11,290 deaths reported from the 3 countries that were heavily affected at that time. Essential components of the response included government leadership and sense of urgency, coordinated international assistance, sound technical work, flexibility guided by epidemiologic data, transparency and effective communication, and efforts by communities themselves. Priorities after the epidemic include surveillance in case of resurgence, restoration of health services, infection control in healthcare settings, and strengthening of basic public health systems.     

Ebola in West Africa—CDC’s Role in Epidemic Detection,Control, and Prevention

Since Ebola virus disease was identified in West Africa on March 23, 2014, the Centers for Disease Control and Prevention (CDC) has undertaken the most intensive response in the agency’s history; >3,000 staff have been involved, including >1,200 deployed to West Africa for >50,000 person workdays. Efforts have included supporting incident management systems in affected countries; mobilizing partners; and strengthening laboratory, epidemiology, contact investigation, health care infection control, communication, and border screening in West Africa, Nigeria, Mali, Senegal, and the United States. All efforts were undertaken as part of national and global response activities with many partner organizations. CDC was able to support community, national, and international health and public health staff to prevent an even worse event. The Ebola virus disease epidemic highlights the need to strengthen national and international systems to detect, respond to, and prevent the spread of future health threats.     

Resultados y retos en salud pública ante la alerta por Ébola: una perspectiva desde Cataluña

The Ebola outbreak in Guinea Conakry was notified to the World Health Organization (WHO) in March 2014. It is the most complex Ebola outbreak to date, affecting Guinea Conakry as well as the surrounding countries and with a risk of the disease spreading outside Africa. For this reason, the World Health Organization declared this Ebola outbreak an international public health emergency in August 2014. The Public Health Agency of Catalonia, through the Spanish Alert and Emergencies Coordination Network, initiated public health actions in March 2014, developing a single protocol of action to be applied by all the health care providers in the whole Catalan territory, advice for travellers and voluntary workers arriving from affected countries and a weekly newsletter addressed to health professionals. At the same time, the Ebola Analysis and Monitoring Committee and the Ebola Scientific and Advisory Committee were established. More than 9600 professional health workers attended training sessions and informative sessions. From August 2014, the Catalan Epidemiological Surveillance Emergency Service (SUVEC) reported 117 suspected Ebola cases, of which only 3 met the epidemiological and clinical criteria leading to the activation of the action protocol. All 3 cases proved negative for Ebola. Also, 95 voluntary workers were monitored, 52% of whom were female and 74% had returned from Sierra Leone. Dealing with the suspected Ebola cases required a detailed advance preparation and planning, with a coordinated effort between the epidemiological and health-care network, and all the agents involved, as well as precise, realistic and appropriate risk communication. The prior screening of suspected Ebola cases by the SUVEC meant the immediate protocol was activated only in the cases that met the epidemiological and clinical criteria. This is a key point to be reinforced in any future international public health alerts.     

Reemerging Sudan ebola virus disease in Uganda, 2011

Two large outbreaks of Ebola hemorrhagic fever occurred in Uganda in 2000 and 2007. In May 2011, we identified a single case of Sudan Ebola virus disease in Luwero District. The establishment of a permanent in-country laboratory and cooperation between international public health entities facilitated rapid outbreak response and control activities.     

Community-Led Total Sanitation,Open Defecation Free Status,and Ebola Virus Disease in Lofa County,Liberia

The Ebola virus disease (EVD) epidemic entered Liberia through Lofa County in February 2014 and spread to two health districts where the nongovernmental organization Global Communities had been implementing community-led total sanitation (CLTS) since 2012. By December 2014 the county had 928 Ebola cases (422 of them confirmed) and 648 deaths. Before the epidemic, CLTS was triggered in 155 communities, and 98 communities were certified as Open Defecation Free (ODF). Using mixed quantitative and qualitative methods, we determined that no cases of EVD were found in ODF communities and in only one CLTS community that had not reached ODF status. No differences were found between EVD and non-EVD communities in tribe, religion, ethnic group, or major sources of Ebola information. Radio was the most common source of information for all communities, but health workers were the most trusted information sources. CLTS ODF communities attributed their avoidance of EVD to Water, Sanitation, and Hygiene behaviors, especially hand washing with soap and disposal of feces that they learned from CLTS prior to the epidemic. Communities that got EVD blamed their strong initial resistance to Ebola response messages on their distrust that Ebola was real and their reliance on friends and family for advice. A strong inverse correlation between EVD and CLTS with or without ODF emerged from the regression analysis (R = –.6).     

Community-based reports of morbidity,mortality, and health-seeking behaviours in four Monrovia communities during the West African Ebola epidemic

The goal of this study was to assess morbidity, mortality, and health-seeking behaviours during the 2014 Ebola outbreak in Monrovia, Liberia. This study examined commonly reported symptoms of illness, pre-clinical diagnostic practices, typical healthcare-seeking strategies, and health resources available to populations, in order to identify salient needs and gaps in healthcare that would inform local emergency response efforts. Semi-structured interviews were conducted with household members in four Monrovia neighbourhoods. Researchers used a multi-stage cluster approach to recruit participants. Within 555 households sampled, 505 individuals were reported sick (69%) or recently sick (38%) or deceased (7%). Common self-diagnoses included malaria, hypertension, influenza, typhoid, and Ebola. The most cited health-seeking strategy was to purchase medications from the private sector. Respondents also obtained healthcare from community members known to have medical experience. Findings suggest that non-formal healthcare systems played an important role in managing morbidity during the West African Ebola virus disease (EVD) outbreak. Lay community members engaged in complex assessments of health symptoms and sought biomedical care at rates perhaps higher than anticipated during the response. This study highlights how informal networks of healthcare providers can play an important role in preventing and curbing future emerging disease outbreaks.     

埃博拉出血热研究进展

埃博拉（Ebola）是一种十分罕见的病毒。1976年,在苏丹和刚果的埃博拉河地区被首次发现,而后因其先后在乌干达、刚果等非洲国家相继流行从而引起世界性的广泛关注。人类和灵长类动物由于感染埃博拉病毒可引发一种烈性传染病--埃博拉出血热,其死亡率高达50%~90%。埃博拉疫情已经构成了国际关注的突发公共卫生事件,被认为是世界上最凶猛的疾病之一,也是全球公共卫生面临的一大难题。中风、心肌梗塞、低血容量休克或多发性器官衰竭是埃博拉出血热的主要致死原因。本文从埃博拉出血热的流行特征、传播途径、免疫学发病机制及药物与疫苗研发等方面对近年来的有关研究进行了整理和综述。以期对埃博拉出血热的预防与治疗提供理论依据。     

The Merits of Malaria Diagnostics during an Ebola Virus Disease Outbreak

Malaria is a major public health concern in the countries affected by the Ebola virus disease epidemic in West Africa. We determined the feasibility of using molecular malaria diagnostics during an Ebola virus disease outbreak and report the incidence of Plasmodium spp. parasitemia in persons with suspected Ebola virus infection.     

Ebola in the Netherlands, 2014–2015: costs of preparedness and response

The recent epidemic of Ebola virus disease (EVD) resulted in countries worldwide to prepare for the possibility of having an EVD patient. In this study, we estimate the costs of Ebola preparedness and response borne by the Dutch health system. An activity-based costing method was used, in which the cost of staff time spent in preparedness and response activities was calculated based on a time-recording system and interviews with key professionals at the healthcare organizations involved. In addition, the organizations provided cost information on patient days of hospitalization, laboratory tests, personal protective equipment (PPE), as well as the additional cleaning and disinfection required. The estimated total costs averaged €12.6 million, ranging from €6.7 to €22.5 million. The main cost drivers were PPE expenditures and preparedness activities of personnel, especially those associated with ambulance services and hospitals. There were 13 possible cases clinically evaluated and one confirmed case admitted to hospital. The estimated total cost of EVD preparedness and response in the Netherlands was substantial. Future costs might be reduced and efficiency increased by designating one ambulance service for transportation and fewer hospitals for the assessment of possible patients with a highly infectious disease of high consequences.     

Race and the spatialisation of risk during the 2013–2016 West African Ebola epidemic

This paper examines the spatial navigation of risk by international health responders working in Ebola Treatment Centres (ETCs) during the West African Ebola epidemic. Drawing on Black studies and geographies it argues for a race-conscious analysis of spatial strategies of risk aversion in order to highlight the geographical, postcolonial and racial inequalities at the heart of the West African Ebola response. Based on interviews with international health responders to Liberia and Sierra Leone, it argues that the spatial organisation of ETCs perpetuated non-equivalence between Black and white lives and contributed to the normalisation of Black suffering and death.     

Infectious disease outbreak preparedness and response in Nigeria: history,limitations and recommendations for global health policy and practice

Effective disease outbreak response has historically been a challenging accomplishment for the Nigerian health system due to an array of hurdles not unique to Nigeria but also found in other African nations which share its large size and complexity. However, the efficiency of the response mounted against the Ebola Virus Disease (EVD) outbreak of 2014 proved that indeed, though challenging, proactive and effective outbreak response is not impossible. With over 20 public health emergencies and infectious disease outbreaks between 2016 and 2018 alone, Nigeria is one of only five members of the World Health Organization (WHO) African Region to report five or more public health events per annum. There are many lessons that can be drawn from Nigeria''s experience in handling outbreaks of infectious diseases. In this review, we discuss the history of emerging and re-emerging infectious disease outbreaks in Nigeria and explore the response strategies mounted towards each. We also highlight the significant successes and note-worthy limitations, which we have then utilized to proffer policy recommendations to strengthen the Nigerian public health emergency response systems.     

中美卫生检疫在埃博拉出血热防控中的比较

通过比较中美两国卫生检疫体制的不同和两国在埃博拉出血热疫情防控中的主要做法,分析两国卫生检疫的异同。本文主要讨论了中美两国在口岸筛查、指定口岸入境、援助疫情国以及感染病例回国隔离治疗等方面的差异,对于中国进一步做好卫生检疫工作提出了建设性的看法。提出了“积极支援疫情发生国”,“强化交通运输检疫和口岸检疫”,“稳步提升本国公共卫生水平”国际间传染病防控三原则。