Chủ Nhật, 7 tháng 12, 2014

Infectious Disease

Ebola: Can It End Next Summer?

Published: Nov 22, 2014

By Michael Smith, North American Correspondent, MedPage Today

The West African Ebola outbreak could be under control by next summer if local and international efforts to battle it continue to grow, according to the U.N. Secretary-General.

"If we continue to accelerate our response, we can contain and end the outbreak by the middle of next year," Ban Ki-moon told reporters after he and other U.N. leaders met in Washington, D.C., to discuss the situation.

But he cautioned that "results to date are uneven," with slowing rates of transmission in some places and increasing rates elsewhere in the three hardest-hit countries: Liberia, Guinea, and Sierra Leone.

Where aid efforts have been working, "we are seeing the bending of the current curve (and) this is quite encouraging. We are now able to see that our efforts are making differences."

But Ban said the U.N. estimates the response will have to strengthen by a factor of five in order to succeed, and he called for more international responders, more trained medical teams, and more volunteer health workers, especially in remote areas.

On the other side of the coin, Ban said it's also important to avoid travel bans, discrimination against healthcare workers, and other "steps that would isolate countries when they need help most."

The high-level meeting in Washington came as the World Health Organization reported that the global toll in the epidemic is now 15,351 confirmed, probable, and suspected cases in six affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain, and the U.S.) and two previously affected countries (Nigeria and Senegal) as of Nov. 18.

There have been 5,459 reported deaths since the outbreak began last December in Guinea.

Mali, which shares a 480-mile border with Guinea, had not had any cases of Ebola until late October, when a 2-year-old girl was brought from Guinea and died of the virus Oct. 24.

Although she was symptomatic while traveling, the case apparently did not lead to any others. All of her identified contacts are now past the 21-day incubation period without developing disease.

But an unrelated transmission chain -- also with roots in Guinea -- has now led to five cases, all fatal, in Mali, the WHO said Friday.

Ban said that cluster is "of great concern, of course," adding that WHO Director-General Margaret Chan, MD, accompanied by UNAIDS Executive Director Michel Sidibe, was to leave Friday for Mali to help develop the response.

The new cluster started with a 70-year-old religious leader from a border region in Guinea, who developed symptoms there and later traveled to the Malian capital of Bamako seeking care for kidney failure.

Ebola was not immediately recognized and the man appears to have infected a nurse, a doctor, and a friend before dying Oct. 27. Two contacts of the friend were also infected. All five of the infected people have since died.

Health officials in the two countries are now tracking about 500 possible contacts of the index case, Chan told reporters, in the hope they can forestall a wider outbreak.

Meanwhile, the agency has officially declared a separate outbreak over.

The outbreak, in the Democratic Republic of Congo, was reported Aug. 24 and was not related to the West Africa epidemic. It was localized to a remote area in the DRC's Equateur Province and caused 66 cases, including eight among healthcare workers.

As of Thursday, 42 days have passed -- twice the maximum incubation period for Ebola -- since the last case tested negative twice and was discharged from hospital. The WHO can declare the end of an Ebola outbreak in a country once 42 days have passed and no new cases have been detected.

A similar declaration will occur for Spain in 10 days, the agency noted -- 32 days have passed since a healthcare worker infected while caring for an Ebola patient in Madrid tested negative twice and was discharged from hospital.

The U.S., the only other country outside of Africa with home-diagnosed cases of Ebola, can be declared free of the virus Dec. 23 if no more cases appear.

That's 42 days after Craig Spencer, MD -- who contracted Ebola while treating patients in Guinea -- was discharged from New York's Bellevue Hospital on Nov. 11.

Comment