One of the principle reasons why the 2014 epidemic was so much larger than any previously seen in Africa, was that the first cases occurred over the borders of several countries not known previously to have had Ebola. Furthermore, the cultural practices that facilitated the transmission of the virus, such as the ritual washing of the deceased that occurred during traditional burials, proved difficult to eradicate. Added to this was the distrust and fear of western aid workers, who were often blamed for the epidemic or for taking away sick loved ones, who never returned to their families. Such mistrust led to the late adoption of health advice and the failure of notifying healthcare workers when family members, especially children, became ill. All of these factors added together to fuel the epidemic, stoking the number of those affected, and those that died.
All of these obstructions to public health in West Africa, very understandable in the face of such a catastrophe, had been seen before and overcome during previous epidemics of Ebola in Central Africa, however. The present outbreak in the DRC is very unlikely to produce such case numbers as were seen in 2014, as the local population is sadly all too aware of Ebola and its historical solution: quarantine.
Some aspects of this outbreak are new, however.
Following criticisms of their response during the West African epidemic, the WHO and partners have responded impressively swiftly following the notification of a cluster of undiagnosed illnesses in a remote part of the DRC on the 9th May. In fact the very next day saw a multidisciplinary team, led by the DRC Ministry of Health, being sent into the affected region. In addition, the promising Ebola vaccine by Merck, rVSV-ZEBOV, has been given approval for use in the DRC. Although its abilities to stave-off Ebola infection need further clarification, the vaccine might be used in cases where the chain of infection is unclear; where contacts of an unexplained Ebola patient can be vaccinated to prevent further transmission. This is the so-called ‘ring’ strategy, where a ring of protected contacts surrounds an infected individual.
There are several logistical challenges involved with such a vaccination programme: contacts must be identified and inoculated swiftly before they do get infected with Ebola and the vaccine is given too late. Moreover the vaccine itself must be stored at minus 80 degrees C; at Congolese room temperature, the vaccine becomes useless after only one day.