The West African Ebola Virus Outbreak: Challenges and Response Efforts

West African Ebola Virus Epidemic

The outbreak began in Meliandou village within the prefecture of Gueckedou in southeastern Guinea, which borders both Sierra Leone and Liberia. Local leaders are key in facilitating community compliance with response measures including mandatory admission to hospitals for suspected cases and prohibiting movement of bodies between towns (common for cultural repatriation).

Effective contact tracing and monitoring have been central to containment efforts. Direct Relief has supported these efforts by providing personal protective equipment.

Guinea

In Guinea, one of the countries at the epicenter of this outbreak, weakened public health systems contributed to the rapid spread of Ebola. The disease quickly spread into the country’s neighboring Liberia and Sierra Leone, where a similar dynamic took hold.

The complex social and cultural factors that drive this crisis require a holistic approach to containment and recovery. This means incorporating local knowledge and culture into scientific advancements, such as the search for vaccines and treatments.

Across the region, World Vision staff trained influential local leaders—including Christian and Muslim clerics and traditional faith healers—to provide messages of Ebola awareness to their communities. Additionally, our teams provided training and materials for more than 800 community burial teams who performed 29,201 burials that prevent transmission while respecting families’ needs to mourn and preserve tradition. Our staff also assisted with tracing more than 175,000 contacts. This contact tracing is critical in understanding the chains of transmission and rapidly isolating contacts who become symptomatic.

Liberia

The outbreak began in Guinea in December 2013, and quickly spread to bordering Liberia and Sierra Leone. In these countries, weak surveillance systems and dysfunctional health care systems created an environment for rapid expansion of EVD. The outbreak was exacerbated by the fact that these three countries are still rebuilding their postwar capacities.

Health care workers face many challenges in these countries, including a lack of basic equipment and a shortage of trained personnel. This impedes their ability to prevent and control infectious diseases.

These challenges can be overcome with support for local leaders and by empowering community members. This includes training locals to conduct house-to-house search and contact tracing, as well as community education on Ebola prevention and control. This will help to reduce denials, mistrust and hostility to health care workers, especially foreigners. It will also increase the acceptability of bringing Ebola patients to isolation facilities. Combined with scientific advances in treatment and vaccines, this approach will have greater potential for addressing the current crisis.

Sierra Leone

By the time of the peak in the number of new cases in early January 2015, effective contact tracing had been established and chains of transmission were being interrupted [5].

The emergence of EVD in a densely populated urban area and complex interactions between infection control practices and prevailing cultural and traditional practices were key factors contributing to the scale of the outbreak. Engagement of local leaders in prevention programs and messaging, as well as careful policy implementation at the national and global level, led to the containment of the outbreak.

Molecular epidemiological evidence suggests that sustained human-to-human transmission in Sierra Leone was initiated by the index case from Meliandou village, in the prefecture of Gueckedou which borders both Guinea and Liberia. It is also believed that a second distinct viral lineage was reintroduced into the country from neighbouring Liberia. An MSF ETC was opened in Kailahun in June 2014 and, like many others at this stage of the epidemic, was soon overwhelmed. The government subsequently set up a Lassa fever isolation ward at Kenema District Hospital and increased the availability of PPE for health care workers (HCWs).

Nigeria

The epidemic was first detected in Nigeria on July 20, 2014, when a Liberian man infected with Ebola flew into Lagos and collapsed. He was initially diagnosed with malaria but Dr. Adadevoh suspected he had the disease. She did a rapid Ebola test and his result was positive.

In the three countries at the epicenter, cases rose rapidly in early 2015 but then began to fall. This was due to heightened medical response and efforts focusing on safe burials (requiring that bodies be retrieved from homes by teams wearing protective gear and buried in designated cemeteries).

Businesses suffered significant revenue losses during the outbreak, including lost market share and brand value. Many companies reported that meetings and projects were rescheduled and that contractual staff were reluctant to travel to Nigeria out of fear. Some companies also lost opportunities as customers stopped doing business with them altogether.

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