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Ebola: Still a long walk to safety in Africa

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Ebola: Still a long  walk to safety in Africa

The recent cases of the Ebola Virus Disease (EVD) in the Democratic Republic of the Congo raises questions about the containment of the disease in Africa. In this report, WALE ELEGBEDE writes on the need to safeguard the continent against another bout of EVD outbreak

 

Although the Ebola Virus Disease (EVD) first surfaced in two simultaneous outbreaks in Sudan and the then Zaire (now the Democratic Republic of Congo {DRC}) in 1976, the major outbreak that took the world by storm happened in 2014 and was mostly confined to the Sub-Saharan Africa.

 

In contrast to previous outbreaks, the 2014 EVD epidemic, which was first identified in Guinea, recorded an estimated 27,984 cases and 11,298 deaths.

 

From where it started in Guinea in December 2013 when an 18-month-old baby from a small village in Guinea was infected by bats, it extended to Sierra Leone, Liberia, Senegal, Nigeria, Mali, and also extended its spread to the United States (US) and Spain.

EVD, a rare and deadly disease, is a viral hemorrhagic fever of humans and other primates (monkeys, gorillas, and chimpanzees) caused by ebolaviruses. Fruit bats are believed to be the normal carrier in nature and are able to spread the virus without being affected by it.

 

Signs and symptoms typically start between two days and three weeks after contracting the virus with a fever, sore throat, muscular pain, and headaches. Vomiting, diarrhoea and rash usually follow, along with decreased function of the liver and kidneys. At this time, some people begin to bleed both internally and externally.

 

The disease has a high risk of death, killing between 25 and 90 per cent of those infected, with an average of about 50 per cent. This is often due to low blood pressure from fluid loss, and typically follows six to sixteen days after symptoms appear.

 

Human transmission of Ebola virus occurs when an individual with EVD transmits infected body fluids via direct contact with another human. Blood, urine, and semen have been identified as body fluids that can transmit the Ebola virus. The surface of a body can also serve to transmit Ebola virus even after death.

 

Spread may also occur from contact with items recently contaminated with bodily fluids. Semen or breast milk of a person after recovery from EVD may carry the virus for several weeks to months.

 

The 2014 experience

From the time Ebola was first recognised in 1976 until the horrible experience of 2014, the virus never managed to gain much ground. Previous outbreaks were located in such remote areas that the combination of fast action and the relative isolation of the communities allowed the outbreaks to remain contained.

 

Upon its outbreak in the more populous intersection of countries in West Africa, the disease ravaged many communities and left over 11,000 people dead.

In Nigeria, immediately the disease was imported to the country on July 20, 2014, after an infected Liberian arrived Lagos via aeroplane , the outbreak set off a wave of panic and consciousness.

 

The Liberian diplomat, Patrick Sawyer who became Nigeria’s first Ebola case died five days after, but not without infecting a total of 19 people, of whom seven died.

 

But during the period, handshake, hug and physical contact were at a premium. To even visit a hospital either as a patient or on a visit became a luxury. Everyone sees others as suspects and the level of compliance to rules of hygiene was at an all-time high.

Not only did many schools defer resumption, organisations devised new means of interaction. While religious gatherings were limited, social gatherings nearly came to a halt.

Thankfully, with a combination of efforts from individuals, governments and organisations, Nigeria was declared EVD-free on October 20, 2014.

 

The late Dr. Stella Ameyo Adadevoh, who raised a red flag when attending to the index patient at the First Consultant Hospital in Obalende, Lagos, was singularly hailed as the heroine for helping to ensure that a more devastating outbreak was avoided.

Just like Nigeria, Liberia, Guinea and Sierra Leone were certified free of the Ebola virus disease.

 

The 9th outbreak in the DRC

On May 8, 2018, the ninth outbreak of EVD was announced in the DRC and the battle to contain its spread from rural north-western DRC to urban centres and towns in the country commenced with high energy.

To avert the disaster of 2014, the United Nation (UN) and Doctors Without Frontiers (MSF) quickly countered the threat from the outbreak by making use of a new vaccine – quickly coordinated over an inoculation programme that began in the DRC city of Mbandaka, where around one million people live. They also applied another round of preventive vaccination in and around the town of Bikoro to the south, where the initial Ebola victims were identified.

 

But after all said and done, the outbreak which lasted for 77 days, had 55 cases and suffered 28 deaths. The DRC was certified free of the disease on July 24, 2018, by the World Health Organisation (WHO).

 

The new discovery in Sierra Leone

Just days after the end and timely containment of Ebola disease in DRC, a new strain of the deadly Ebola virus, Bombali Ebola was found in a bat in northern Sierra Leone and there are fears the virus could potentially spread to humans. Sierra Leone was one of three countries in West Africa to be struck by the devastating outbreak in 2014 and 2015. The country recorded 14,061 cases of infection and 3,955 deaths.

 

“The new strain has the potential to infect human cells, but it’s not known yet if it has been transmitted to people or can cause disease in humans.”

There is no evidence the virus has infected any humans so far.

 

Is Nigeria, Africa ready for another outbreak?

 

It’s clear from the lessons of the 2014 Ebola outbreak in West Africa that preparedness and response capacity of countries require significant investments to strengthen their health systems.

When this is not done, the countries become vulnerable to real and perceived threats to local, national and global outbreaks.

Personal preventive measures include proper hand washing, avoiding contact with the bodily fluids of individuals who are suspected of or confirmed to have Ebola, and avoiding the handling of bodies of persons who are suspected of or confirmed to have died from Ebola.

Speaking with New Telegraph on the issue, a Public Health Physician and Executive Secretary, Nigerian Academy of Science (NAS), Dr. Oladoyin Odubanjo, said it was not yet Uhuru for Africa as far as Ebola was concerned, stating that governments in the continent should step up their research base to curtail outbreaks.

He said, “It is not yet Uhuru in Africa and there is nothing like that yet. Bats alone are said to hold over one thousand viruses. Disease surveillance is a continuous thing and we are forever going to be monitoring.

 

You never go to bed as far as diseases is concerned. That is why you must have disease surveillance and response system that is responsive and effective.

 

“That is why we were concerned when people went back to bed after we conquered Ebola; you don’t do that. Ebola shouldn’t just have been a beginning and an end but a wake-up call that tells us that this is what can happen to you if you don’t have a functional health system all the time.”

 

On the efforts of donor agencies in alleviating the Ebola disease in Africa, he said, “Inasmuch as this is a global health issue, I don’t think the donor agencies should be doing what countries should be doing for themselves. The new Ebola vaccine appears to be the saving grace for preventing a major epidemic, at least for now. During the 2014 outbreak, the available treatment was limited to rehydration.

 

It was however believed that vaccination of those infected with the virus ensured the ending of the 2014-2016 outbreak.

In the Guinea trial, 5,837 people who had been in contact with someone who had the virus — or someone who had been in contact with the contact — got vaccinations. None of them became infected with the virus, according to a study published in ‘The Lancet’.

As it is, the EVD is just one door away since Africa is commonplace for consumption of ‘bushmeat’ including rats, bats, and monkeys, then there is the need for leaders in the continent to take the gauntlet of using the tools of technology and research to end this recurring disease.

The leadership should look inwards, create a common purse for the purpose and quit looking to the West for assistance.

Also, the people must inculcate preventive hygiene that will not accommodate the infection of the dreaded disease. Governments, public institutions, private organisations, schools, among others, must be on guard because a stitch in time saves nine.

 

As attention is being shifted to prevent another outbreak from turning to epidemics, those that fell sick with Ebola, but survived should not be ostracised. They should be cared for, there should be a comprehensive support for their recovery and well-being. Similarly, attention must not shift away from widows, widowers, orphans and other vulnerable populations who got hit by the outbreak.

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