Ebola Update

WHO issues Ebola Response Roadmap to stop transmission of virus

WHO issues Ebola Response Roadmap to stop transmission of virus The World Health Organisation (WHO) has issued an Ebola Response Roadmap with the goal to stop Ebola transmission in affected countries within 6-9 months and prevent international spread.

The WHO notes that the 2014 Ebola Virus Disease (EVD, or “Ebola”) outbreak “continues to evolve in alarming ways, with the severely affected countries, Guinea, Liberia, and Sierra Leone, struggling to control the escalating outbreak against a backdrop of severely compromised health systems, significant deficits in capacity, and rampant fear.”

To accelerate actions on Ebola in West Africa, a Ministerial meeting was convened in July in Accra, Ghana, and an operations coordination centre established in Conakry, Guinea. The escalating scale, duration and mortality of the outbreak led the Governments of Guinea, Liberia, and Sierra Leone and WHO to launch an initial Ebola Virus Disease Outbreak Response Plan on 31 July 2014, which outlined the main pillars for action based on the situation at that time and an initial estimate of resource requirements. Since then the outbreak has been further complicated by spread to Lagos, Nigeria.

In August 2014, an Emergency Committee was convened by the Director-General of WHO under the International Health Regulations (2005) [IHR 2005], which informed the Director-General’s decision on 8 August 2014 to declare the Ebola outbreak a Public Health Emergency of International Concern and issue several Temporary Recommendations to reduce the risk of international spread.

As of 27 August 2014, the cumulative number of Ebola cases in the affected countries stands at more than 3000, with over 1400 deaths, making this the largest Ebola outbreak ever recorded, despite significant gaps in reporting in some intense transmission areas. An unprecedented number of health care workers have also been infected and died due to this outbreak.

The WHO warns that although national authorities in the affected countries have been working with WHO and partners to scale-up control measures, the Ebola “outbreak remains grave and transmission is still increasing in a substantial number of localities, aggravating fragile social, political and economic conditions in the sub-region and posing increasingly serious global health security challenges and risks”

The Roadmap outlines a number of objectives including: 1. To achieve full geographic coverage with complementary Ebola response activities in countries with widespread and intense transmission 2. To ensure emergency and immediate application of comprehensive Ebola response interventions in countries with an initial case(s) or with localized transmission 3. To strengthen preparedness of all countries to rapidly detect and respond to an Ebola exposure, especially those sharing land borders with an intense transmission area and those with international transportation hubs “Fundamental to the Roadmap is the strengthening of laboratory, human resource, and response capacities, all of which are on the critical pathway for short- and long-term EVD control, as well as strengthening of the public health infrastructure against future threats. Some areas require particularly urgent action, such as infection control training,” the WHO said.

Outbreak underestimated

The WHO issued a statement on 22 August stating that the Ebola outbreak had been significantly underestimated. The magnitude of the Ebola outbreak, especially in Liberia and Sierra Leone, has been underestimated for a number of reasons, the WHO said.

Many families hide infected loved ones in their homes. As Ebola has no cure, some believe infected loved ones will be more comfortable dying at home. Others deny that a patient has Ebola and believe that care in an isolation ward – viewed as an incubator of the disease – will lead to infection and certain death.

Most fear the stigma and social rejection that come to patients and families when a diagnosis of Ebola is confirmed. These are fast-moving outbreaks, creating challenges for the many international partners providing support.

Quantities of staff, supplies, and equipment, including personal protective equipment, cannot keep up with the need. Hospital and diagnostic capacities have been overwhelmed. Many treatment centres and general clinics have closed.

Fear keeps patients out and causes medical staff to flee. In rural villages, corpses are buried without notifying health officials and with no investigation of the cause of death. In some instances, epidemiologists have travelled to villages and counted the number of fresh graves as a crude indicator of suspected cases.

In parts of Liberia, a phenomenon is occurring that has never before been seen in an Ebola outbreak. As soon as a new treatment facility is opened, it is immediately filled with patients, many of whom were not previously identified.

This phenomenon strongly suggests the existence of an invisible caseload of patients who are not being detected by the surveillance system. An additional problem is the existence of numerous “shadow-zones”.

These are villages with rumours of cases and deaths, with a strong suspicion of Ebola as the cause, that cannot be investigated because of community resistance or lack of adequate staff and vehicles.

Middle East response

The Saudi government in April announced that it had stopped issuing pilgrimage visas for travellers from the three affected West African countries. Dubai-based Emirates Airline, in the first week of August, became the first major international carrier to suspend service to Guinea due to the outbreak.

 Date of upload: 16th Sep 2014


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