Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control

Abstract

Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridae family, has become one of the world's most feared pathogens. The virus induces acute fever and death, often associated with hemorrhagic symptoms in up to 90% of infected patients. The known sub-types of the virus are Zaire, Sudan, Taï Forest, Bundibugyo and Reston Ebola viruses. In the past, outbreaks were limited to the East and Central African tropical belt with the exception of Ebola Reston outbreaks that occurred in animal facilities in the Philippines, USA and Italy. The on-going outbreak in West Africa that is causing numerous deaths and severe socio-economic challenges has resulted in widespread anxiety globally. This panic may be attributed to the intense media interest, the rapid spread of the virus to other countries like United States and Spain, and moreover, to the absence of an approved treatment or vaccine. Informed by this widespread fear and anxiety, we analyzed the commonly used strategies to manage and control Ebola outbreaks and proposed new approaches that could improve epidemic management and control during future outbreaks. We based our recommendations on epidemic management practices employed during recent outbreaks in East, Central and West Africa, and synthesis of peer-reviewed publications as well as published "field" information from individuals and organizations recently involved in the management of Ebola epidemics. The current epidemic management approaches are largely "reactive", with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to "reactive" interventions, "pre-emptive" strategies also need to be instituted. We conclude that emphasizing both "reactive" and "pre-emptive" strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks.

Lessons about Causes and Management of an Ebola Outbreak

“…1,[13][14][15] The shortage of equipment, facilities, and skilled personnel in the endemic areas limited the supportive care that should have been provided to the general population in this emergency situation as it was delivered to infected health care personnel who were expatriated to resource-rich settings in Europe and North America. 9 This view is reinforced by other facts. Structures for the management and treatment of EVD, and the laboratories for clinical and molecular analysis seem to have been more effective in Guinea where the outbreak was better controlled compared to other affected countries.…”

“…9,17 Liberia, Sierra Leone and Guinea are among the 20 countries with the lowest index of human development, with more than 50% of the population living below the poverty line. 11 Previous EVD outbreaks were limited in size and geographic distribution because most of them began and ended in rural areas unlike the 2014 Ebola epidemic which reached the urban areas in West Africa.…”

“…1 The epidemic was controlled only when international, logistic and economic efforts were provided and a multidisciplinary international collaboration was performed. 9 …”

“…9,21 In the next paragraphs, we explain the principal steps for an effective strategy to face Ebola in the future. However, it is diffi cult for the countries in at-risk zone to improve their health systems to a standard similar to that of high income countries without considerable donor support and international assistance to create the necessary infrastructure for patient care, prompt diagnosis, training, and the technology required for reporting an epidemic.…”

“…Many lessons were drawn and learnt from this epidemic and from assessment of the world's preparedness to handle it. 9 In this review, we tried to summarize these lessons and to present the principal keys and requirements for an effective Ebola outbreak management approach.…”