There have been several epidemics of Ebola since it was first described in1976, but all other outbreaks have affected Central African countries. West Africa’s lack of experience with the virus may partially explain the distrust often expressed towards healthcare workers in the field and the disbelief at attempts made to inform about the virus. In fact, fear and mistrust of medical professionals were said to be initial confounding features of the Ugandan Ebola epidemic in 2000 and other outbreaks in Central Africa. Following education programmes, however, attitudes and practices, including funeral traditions which aided transmission, were eventually changed, controlling the infection.
Some suggest that another factor which contributed to the scale of the current outbreak was the trans-national spread of Ebola that occurred in the initial four months, across the borders of Guinea, Sierra Leone and Liberia. This may have led to delays in the realisation that an epidemic was actually occurring. Added to this is the increasing ease of international travel, which has now fuelled the appearance of ‘imported’ cases – as has been seen in Nigeria and more recently, the USA.
Certainly many factors of the current Ebola crisis are similar to previous outbreaks, however.
This Ebola virus, a slight variant of the Zaire strain, is not more virulent than those identified in the previous outbreaks of the Democratic Republic of Congo and Gabon. The reproduction number (the number of newly infected patients resulting from one infected individual) is concerning but has been seen before. Moreover, all other outbreaks have occurred in resource-poor settings where medical help is limited. As mentioned, features such as local practices aiding transmission and mistrust of those seeking to help and educate, have been identified in earlier crises with Ebola and successfully changed, leading to the control of the virus.
Whilst not underplaying the severity of the current epidemic, which may still be at an early stage, the acknowledgement that not all aspects of the outbreak are unprecedented, may give a slight, cautious optimism for its eventual control. However, in the history of the disease the need for an international effort has never been greater and more urgent.
Written by Dr Simon Worrell BSc MBBS MRCP, Head of Medical Communications, Healix International.
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