Although there has been a dramatic waning of the illness in the region (even Guinea, where community involvement has been particularly problematic, has had no newly infected patients for three weeks), this is the second cluster of cases due to resurgence of Ebola in Liberia. On this occasion three members of one family have been involved at present, necessitating 149 individuals to be quarantined.
There are several reasons to suspect that this pattern of limited recurrence will continue for some time to come. Firstly, in all other outbreaks of Ebola in Africa, the disease has recurred. In fact as has been mentioned here before, this current outbreak of Ebola is not the first time that the virus has been identified in West Africa: a research team in 2014 showed that some blood samples from as far back as 2006 had been infected with the Ebola virus in Sierra Leone. The virus has actually been causing disease in West Africa for at least a decade; it’s just that no one knew.
Once Ebola is established in the bat population, it is possible that further animal to human transmission can occur by eating Ebola-infected meat, causing further outbreaks of the illness. More recent attention has been drawn to new infections that can occur following intimate contact with a ‘carrier’ of the disease. This method may have been responsible for
the first recurrence of Ebola in Liberia some weeks ago. Such ‘carriers’ could be patients who have recovered from Ebola, but still have the virus in their system. Recent research has suggested a more concerning possibility, however: there may be some individuals who can become infected with the virus but develop no symptoms – these individuals may be able to pass on the virus unwittingly.
Once a small outbreak of Ebola has occurred, community education and engagement are required to prevent the further transmission of the disease. During the earlier stages of the epidemic, cultural practices (such as performing local burial rites) aided the spread of Ebola. Such traditional practices have been successfully modified to make Ebola transmission much less likely, but when cultural beliefs are strongly held these practices can revert to riskier traditional forms.
There are also reasons to be optimistic for the control of Ebola in West Africa, however.
The WHO programme of increased testing has diagnosed many at an early stage of illness, preventing further transmission. The heightened community awareness of Ebola may be successful at avoiding infection in the first place, and facilitate early presentation when suspicious symptoms are experienced. Moreover, the on-going trial of a candidate Ebola vaccine has shown promising early results and if shown to be definitively effective, will have ramifications for the whole of Ebola-stricken Africa.
For those in business in the region, several important issues remain. As smaller Ebola recurrences are occurring at present, and may well continue, a degree of contingency planning is likely to be required. Although the case numbers may be low in the future, it is an understandable feature of Ebola that the fear surrounding the disease is considerable: effects on the country’s infrastructure, as well as on individual worker wellbeing and productivity, may be disproportionately large.
Written by Dr Simon Worrell BSc MBBS MRCP, Head of Medical Communications, Healix International.
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