Wednesday, October 15, 2014

Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections — NEJM

It is ironic that the political forces who now sound the most strident and xenophobic alarms about Ebola virus are those which usually denounce "foreign aid".  Sen David Vitter (R-LA) voted against a bill to fund Ebola response because it was focused on Africa.   - gwc
Response to the Outbreak of Ebola Virus Disease in the DRC.VIDEO - response to the disease in Democratic Republic of the Congo

Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections — NEJM
by the WHO Ebola Response Team

"As of September 14, 2014, a total of 4507 confirmed and probable cases of Ebola virus disease (EVD), as well as 2296 deaths from the virus, had been reported from five countries in West Africa — Guinea, Liberia, Nigeria, Senegal, and Sierra Leone. In terms of reported morbidity and mortality, the current epidemic of EVD is far larger than all previous epidemics combined. The true numbers of cases and deaths are certainly higher.
There are numerous reports of symptomatic persons evading diagnosis and treatment, of laboratory diagnoses that have not been included in national databases, and of persons with suspected EVD who were buried without a diagnosis having been made.1
The epidemic began in Guinea during December 2013,2 and the World Health Organization (WHO) was officially notified of the rapidly evolving EVD outbreak on March 23, 2014. On August 8, the WHO declared the epidemic to be a “public health emergency of international concern.”3 By mid-September, 9 months after the first case occurred, the numbers of reported cases and deaths were still growing from week to week despite multinational and multisectoral efforts to control the spread of infection.1
The epidemic has now become so large that the three most-affected countries — Guinea, Liberia, and Sierra Leone — face enormous challenges in implementing control measures at the scale required to stop transmission and to provide clinical care for all persons with EVD. Because Ebola virus is spread mainly through contact with the body fluids of symptomatic patients, transmission can be stopped by a combination of early diagnosis, contact tracing, patient isolation and care, infection control, and safe burial.1
Before the current epidemic in West Africa, outbreaks of EVD in central Africa had been limited in size and geographic spread, typically affecting one to a few hundred persons, mostly in remote forested areas.4 The largest previous outbreak occurred in the districts of Gulu, Masindi, and Mbarara in Uganda.5 This outbreak, which generated 425 cases over the course of 3 months from October 2000 to January 2001,6 was controlled by rigorous application of interventions to minimize further transmission — delivered through the local health care system, with support from international partners.5,7,8
We now report on the clinical and epidemiologic characteristics of the epidemic in Guinea, Liberia, Nigeria, and Sierra Leone during the first 9 months of the epidemic (as of September, 14, Senegal had reported only a single case). We document trends in the epidemic thus far and project expected case numbers for the coming weeks if control measures are not enhanced."

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