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Ebola Outbreak

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INTRODUCTION An epidemic of Ebola virus disease (EVD) is ongoing in West Africa. The outbreak began in Guinea in December 2013, but was not detected until March 2014, after which it spread to Liberia, Sierra Leone, Nigeria and Senegal. The outbreak is caused by the Zaire ebola virus, known simply as the Ebola virus (EBOV). It is the most severe outbreak of Ebola in terms of the number of human cases and deaths since the discovery of the virus in 1976, with the number of cases from the current outbreak now outnumbering the combined cases from all known previous outbreaks. Another outbreak in the Democratic Republic of Congo, which has killed 13 people as of 26 August 2014, is believed to be unrelated to the West African outbreak.

Initial outbreak in Guinea

Researchers believe that the first human case of the Ebola virus disease leading to the 2014 outbreak was a 2-year-old boy who died 6 December 2013 in the village of Meliandou, Guéckédou Prefecture, Guinea. His mother, 3-year-old sister and grandmother then became ill with symptoms consistent with Ebola infection and died. People infected by those victims spread the disease to other village.
On 19 March, the Ministry of Health acknowledged a local outbreak of an undetermined viral hemorrhagic fever; the outbreak, ongoing since February, had sickened at least 35 people and killed 23. Ebola was suspected, and samples had been sent to Senegal and France for disease identification. On 25 March, the World Health Organization (WHO) reported that the Ministry of Health of Guinea had reported an outbreak of Ebola virus disease in four southeastern districts: Guekedou, Macenta, Nzerekore and Kissidougou with suspected cases in the neighbouring countries of Liberia and Sierra Leone being investigated. In Guinea, a total of 86 suspected cases, including 59 deaths (case fatality ratio: 68.5%), had been reported as of 24 March. On 31 March, the US Center for Disease Control and Prevention (CDC) sent a five-person team to assist Guinea Ministry of Health and World Health Organization to lead an international response to the Ebola outbreak. On that date the WHO reported 112 suspected and confirmed cases including 70 deaths. Two cases were reported from Liberia of people who had recently travelled to Guinea, and suspected cases in Liberia and Sierra Leone were being investigated. On 30 April, Guinea's Ministry of Health reported 221 suspected and confirmed cases including 146 deaths. The cases included 25 health care workers with 16 deaths. By late May, the outbreak had spread to Conakry, Guinea's capital, a city of about two million inhabitants. On 28 May, the total cases reported had reached 281 with 186 deaths.

Complications in containment efforts

Difficulties faced in attempting to contain the outbreak include the outbreak's multiple locations across country borders, inadequate equipment provided for medical personnel, and lack of soap and water for hand-washing and disinfection. Containment efforts are further hindered because there is reluctance among country people to recognize the danger of infection related to person-to-person spread of disease, such as burial practices which include washing of the body of one that has died.

Extreme poverty A condition of dire poverty exists in many of the areas that have experienced a high incidence of infections. According to the director of an NGO in Guinea, "The poor living conditions and lack of water and sanitation in most districts of Conakry pose a serious risk that the epidemic escalates into a crisis. People do not think to wash their hands when they do not have enough water to drink."

Rumours and denial Denial in some affected countries has often made containment efforts difficult. Language barriers and the appearance of medical teams in protective suits has sometimes exaggerated fears of the virus. There are reports that some people believe that the disease is caused by sorcery and that doctors are killing patients. In late July, the former Liberian health minister, Peter Coleman, stated that "people don't seem to believe anything the government now says." Acting on a rumor that the virus was invented to conceal "cannibalistic rituals", demonstrations were staged outside of the main hospital treating Ebola patients in Kenema, Sierra Leone. The demonstrations were broken up by the police and resulted in the need to use armed guards at the hospital. In Liberia, a mob attacked an Ebola isolation centre stealing equipment and "freeing" patients while shouting "There's no Ebola".Red Cross staff was forced to suspend operations in southeast Guinea after they were threatened by a group of men armed with knives.

Healthcare workers Healthcare providers caring for Ebola patients and family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in direct contact with the blood or body fluids of sick patients. In some places affected by the current outbreak, care may be provided in clinics with limited resources (for example, no running water, no climate control, no floors, inadequate medical supplies), and workers could be in those areas for several hours with a number of Ebola infected patients. As of 11 August, healthcare workers have represented nearly 10 percent of the cases and fatalities, significantly impairing the ability to respond to the outbreak in a country which already faces a severe shortage of doctors. On 26 August, the WHO reported that more than 240 health care workers have developed Ebola in Guinea, Liberia, Nigeria, and Sierra Leone, and more than 120 have died. According to the WHO, the high proportion of infected medical staff can be explained by lack of the number of medical staff needed to manage such a large outbreak, shortages of protective equipment or improperly using what is available, and "the compassion that causes medical staff to work in isolation wards far beyond the number of hours recommended as safe.". Comparing the present Ebola outbreak to some in the past, the WHO notes that many of the most recent districts in which epidemics have occurred were in remote areas where the transmission had been easier to track and break. This outbreak is different in that large cities have been affected as well, where tracking has been difficult and medical staff may not suspect Ebola disease when they make a diagnosis. Several infectious diseases endemic to West Africa, such as malaria and typhoid fever, mimic the symptoms of Ebola disease, and doctors and nurses may see no need to take protective measures. Also, without recent past experience with the disease, people have become intensely fearful and have in some cases attacked medical staff, believing that they are the cause the disease. Furthermore, seeing so many die from the disease, some staff have been afraid to continue with their hospital work. The WHO reports that the loss of so many health workers has made it difficult for them to provide sufficient numbers of foreign medical staff. The African Union has launched an urgent initiative to recruit more health care workers from among its members. Among the fatalities is Samuel Brisbane, a former advisor to the Liberian Ministry of Health and Social Welfare whom British newspaper The Guardian described as "one of Liberia's most high-profile doctors." In July, leading Ebola doctor Sheik Umar Khan from Sierra Leone died in the outbreak, and another physician, Modupe Cole, a senior physician at the country`s main referral facility, died in August. On Wednesday 27 August Sierra Leonean presidential adviser Ibrahim Ben Kargbo announced the death of a third top doctor. Dr. Sahr Rogers working in Kenema has succumbed to the Ebola virus. Sierra Leone has two doctors per 100,000 people, and the death of another top doctor hampers their efforts to fight the disease.

Treatment No proven Ebola virus-specific treatment exists as of August 2014.\ Treatment is primarily supportive in nature and includes minimizing invasive procedures, balancing fluids and electrolytes to counter dehydration, administration of anticoagulants early in infection to prevent or control disseminated intravascular coagulation, administration of procoagulants late in infection to control bleeding, maintaining oxygen levels, pain management, and the use of medications to treat bacterial or fungal secondary infections. Early treatment may increase the chance of survival.

Economic Effects * Markets and shops are closing, due to travel restrictions, cordon sanitaire, or fear of human contact, leading to loss of income for producers and traders. * Movement of people away from affected areas has disturbed agricultural activities. * Tourism is directly impacted in affected countries. Other countries in Africa which are not directly affected by the virus have also reported adverse effects on tourismForeign mining companies have withdrawn non-essential personnel, deferred new investment, and cut back operations. * Many airlines have experienced reduced traffic. Some airlines have suspended flights to the area. * Forecasts of economic growth have been reduced. An initial World Bank-IMF assessment for Guinea projects a full percentage point fall in GDP growth from 4.5 percent to 3.5 percent. * The outbreak is straining the finances of governments, with Sierra Leone using Treasury bills to fund the fight against the virus * The U.N. Food and Agriculture Organisation (FAO) has warned that the outbreak could endanger harvest and food security in West Africa .

Suspects in India On Tuesday 27 August the Times of India reported that 112 Indian citizens and four Nepalese citizens had landed in Mumbai and Delhi from Liberia. Of the 17 who had arrived in Delhi, one had fever symptoms and had been quarantined at the Airport Health Organisation (APHO), an airport medical facility. Six others were screened for Ebola, and five passengers who arrived on routine flights from affected countries showing fever symptoms had also been quarantined. Earlier, it was reported that an isolation facility with 120 beds was being created in the Hindu Hriday Samrat Jogeshwari trauma care hospital by Brihanmumbai Municipal Corporation (BMC). As of 28 August, Health Ministry reported that 821 persons are being monitored and tracked for Ebola virus

Response by World Health Organization The World Health Organisation's (WHO) Regional Director for Africa, Luis Sambo, visited the affected countries from 21 to 25 July, meeting with political leaders, ministers of health, NGOs, and other agencies. He stressed the need to "promote behavioural change while respecting cultural practices." On 24 July, WHO's Director General met with agencies and donors in Geneva to facilitate an increase in funding and manpower to respond to the outbreak. WHO declared the outbreak an international public health emergency on 8 August, after a two-day teleconference of experts. On 11 August, they emphasised lack of supplies and capacity as one of the problems, while local awareness of the disease had increased. Revised guidelines on how to prevent the spread of the disease were released, updating guidelines from 2008.

On 28 August, the WHO said it is seeking $490 million in funding to fight the outbreak. They report that they "are on the ground establishing Ebola treatment centres and strengthening capacity for laboratory testing, contact tracing, social mobilization, safe burials, and non-Ebola health care" and "continue to monitor for reports of rumoured or suspected cases from countries around the world." Other than cases where individuals are suspected or have been confirmed of being infected with Ebola, or have had contact with cases of Ebola, the WHO does not recommend any travel or trade restrictions.

Conclusion After this outbreak of ebola and its effects, people should be more cautious about such disastrous outbreaks. Let’s hope that the cure is found soon and the effect of ebola on the world is to be minimized.

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