With a total number of cases of more than 26,000 and deaths that reached 11, 000 as of May 2015, the 2014 Ebola outbreak is the largest Ebola epidemic in history since its discovery in 1976. It affected three West African countries, starting in Guinea, and then spreading to Liberia and Sierra Leone.
The difficulty to initially diagnose Ebola virus disease (EVD) stems mainly from the similarity of its symptoms in its early stage – which includes fever, headache and muscle pain – to influenza and malaria. People who were infected were often mistaken to be sick for other diseases, and had already passed the virus to their families and relatives by the time they were correctly diagnosed, contributing to its virulence.
The extent of the outbreak prompted the World Health Organization (WHO) to declare the Ebola epidemic in West Africa as an international health emergency, requiring coordinated response to stop its spread. The Center for Disease Control and Prevention (CDC), along with other U.S. government agencies, the WHO, and international partners continue their active efforts to respond to the Ebola outbreak in West Africa, in coordination with the local government of the Ebola-stricken countries.
Life After Ebola: How Guinea, Sierra Leone and Liberia are Coping
It has been over a year now since the Ebola outbreak began and progress is visible. As of May 9, 2015, the WHO declared the end of the Ebola outbreak in Liberia. This means that 42 days or two incubation periods have passed since the last Ebola patient was buried, a woman from greater Monrovia area who developed symptoms on March 20 and died on March 27; since then, no new cases were reported.
An official celebration was held in Liberia for this monumental achievement. Liberians celebrated in their streets as they danced, played drums, waved flags and posters with messages “Goodbye Ebola”.
In total, there were 10,604 cases and 4,769 deaths during the outbreak in Liberia. As the outbreak still continues over the country’s border, the local government is fully aware of the need to remain on high alert while public health authorities still maintain their active surveillance in Liberia to rapidly identify and act should new cases of Ebola occur.
In Sierra Leone, even though the Ebola outbreak is not yet over, early recovery efforts are being done to help the people and its communities return to their normal lives again. One of these early efforts includes the reopening of schools in Sierra Leone after Ebola forced their closure.
Other efforts aimed to rebuild the trust and confidence of people on their health systems and services by reactivating them, with specific focus on immunization, malaria, newborn and child health and maternal and reproductive health. When the outbreak began, Ebola-hit countries suspended all of their large-scale national mass immunization campaigns for diseases such as polio and measles. In May 2015, a maternal and child health week national campaign was held in Sierra Leone with the aim to immunize more than 1.5 million children under age 5. The children’s nutritional levels were also measured and deworming was done. HIV testing was also made available again for pregnant women and their partners.
Meanwhile in Guinea, as cases in the country started to decrease, Ebola cases were found to have shifted to its coastal areas. Accordingly, Guinea’s President declared a health emergency in five regions – the prefectures of Forecariah, Coyah, Dubreka, Boffa and Kindia – for 45 days period to address the situation.
The continuing outbreak in Guinea was believed to be due to community resistance. In contrast, in addition to making the response to Ebola a priority and the extensive support given by international organizations, community engagement was the third factor that brought the success in Liberia in stopping Ebola. Consequently, groups like Red Cross are aiding in the strengthening of community engagement in Guinea.
After battling with the deadly disease, the struggle is still on for some Ebola survivors months after their recovery, patients complain of side effects, including eye pain, redness and even blindness. A condition some doctors so called “post-Ebola syndrome”, survivors also complain of joint pains, hair and memory loss, and anxiety attacks. Sexual health effects like amenorrhea and the presence of the virus in the semen of men who recovered from Ebola are also some pressing concerns.
Reintegrating into their communities was also difficult for many Ebola survivors, as many of them are being shunned in the community in the fear of getting infected and are faced with the stigma brought by the disease.
Preventing the Spread of Ebola: CDC Safety Precautions
Due to the four Ebola cases in healthcare workers previously reported in The United States, including one dead and two imported cases, CDC and its partners are taking precautions to prevent additional Ebola cases in the U.S. CDC had issued a Warning Level 3 notice to avoid nonessential travel to Guinea and Sierra Leone because of the still continuing outbreaks in these two countries. However, with the declaration of the end of the Ebola outbreak in Liberia, CDC has downgraded the travel notice for Ebola in Liberia to Alert Level 2 notice, where travelers are recommended to practice enhanced precautions when traveling to the country.
For travelers who need to go to Guinea and Sierra Leone, CDC recommends the practice of careful hygiene by washing hands frequently with soap and water or using an alcohol-based hand sanitizer. CDC also recommends that travelers protect themselves by avoiding contact with the blood and body fluids, such as urine, saliva, sweat, feces, vomit, breast milk and semen of people with Ebola, the mode by which the disease is transmitted.
Although the natural reservoir host of Ebola virus remains unknown, researchers believe that fruit bats are the most likely choice. Moreover, Ebola does not only infect humans but also primates like monkeys, gorillas and chimpanzee. CDC therefore recommends avoiding contact or consumption of bats and primates.
If travelers develop fever or other symptoms of Ebola, such as severe headache, fatigue, muscle pain, vomiting, diarrhea, stomach pain or unexplained bleeding or bruising, seeking medical care immediately is advised.
Special recommendations are also given by CDC to healthcare workers in Guinea and Sierra Leone who are at risk to be exposed to people with Ebola. Wearing the recommended personal protective equipment, which includes face shield or goggles, medical mask, double gloves, waterproof gown or coveralls, and waterproof boots, and the use of proper infection control and decontamination measures are part of the special recommendations given by CDC.
The Race Against Ebola: Vaccines, Drugs and Other Therapies
So far, there is no FDA-approved vaccine or drug available for Ebola. Patients are treated symptomatically and are given basic interventions such as providing intravenous fluids, and maintaining oxygen status, blood pressure and electrolyte balance. However, experimental vaccines and drugs for Ebola are under development. Several candidate vaccines are already in various phases of clinical trials. Two front runners are about to enter phase II and III trials after these two vaccine candidates have been shown to be safe and well tolerated in humans in their phase I clinical trials.
One of these vaccine candidates is cAd3-ZEBOV, which is developed by GlaxoSmithKline, in collaboration with the US National Institute of Allergy and Infectious Diseases. It is based from a chimpanzee-derived adenovirus, genetically engineered to express glycoproteins from the Zaire ebolavirus. The other vaccine candidate is rVSV-ZEBOV, which is developed by NewLink Genetics and Mercks Vaccines USA, in collaboration with the Public Health Agency of Canada. This vaccine also uses a viral expression vector but is based on a livestock virus, the vesicular stomatitis virus, also genetically engineered to express glycoproteins from the Zaire ebolavirus.
Currently in phase I clinical trial, a two-dose vaccination approach for Ebola developed by Johnson & Johnson in association with Bavarian Nordic, uses two different vaccines, Ad26-EBOV and MVA-EBOV, for the first and second doses. Also in phase I trials is the recombinant protein Ebola vaccine candidate, based on the Guinea 2014 Ebola virus, developed by Novavax, a biotech company in the United States.
Clinical trials on a number of potential drugs are also underway. Favipiravir, an antiviral drug approved in Japan for the treatment of influenza, is still in its phase II trial; its preliminary results suggest that it might be helpful in Ebola patients who are in the early stages of the illness, but not in severe cases. Brincidofovir, an antiviral drug approved to treat CMV infections, is currently in its phase II trial being tested in Liberia, but has been stopped because of the declaration of Liberia as free from Ebola. ZMapp, a cocktail of three monoclonal antibodies with excellent activity against Ebola virus in animal models, had completed its phase I trials, and its phase II efficacy trial was initiated in February 2015.
Aside from vaccines and drugs being developed, a different approach against Ebola that is being tested in Guinea is through harnessing the antibodies present in the blood of patients who have recovered from Ebola and giving them to those who are infected. Studies done on the 1995 Ebola outbreak in Democratic Republic of Congo showed that seven out of eight people survived after given the therapy.
A year later, great efforts have been made to stop the Ebola outbreak. However, Ebola remains to be an enduring battle for people in Sierra Leone and Guinea. On the side of the quest for a vaccine and treatment for Ebola, there remain other concerns that need to be addressed. The need to build better health infrastructures in West Africa that are Ebola-ready is unmistakable. The physical aftereffects of surviving Ebola, particularly blindness, get in the way of survivors in resuming their normal lives. Nevertheless, the Ebola outbreak has taught the world one lesson – that with community engagement, with collective response and effort, and making the fight against emerging diseases such as Ebola a priority, the battle with Ebola can be won.