Ebola outbreak: How big is this threat

The outbreak of Ebola in West Africa is ongoing with more than 600  fatalities since February, it means it is the most severe outbreak of Ebola ever recorded, so would you say that the world should maybe pay more attention to this outbreak and, in general, what about the danger that the situation may deteriorate further or the virus may even hit bigger geographical area? Read few comments.

Derek GathererLecturer, Division of Biomedical and Life Sciences, Lancaster University

Yes, you are right, this outbreak is larger than anything that has been seen before.  Its size and the fact that we have cases in large capital cities like Monrovia and Conakry means it is definitely outside of our comfort zone in terms of knowing how to deal with it.

However, at the moment there are several positive signs: 1) as reported by the WHO, there has been a slowdown in the number of cases in Guinea, 2) The inter-ministerial meeting with the WHO in Accra on the 3rd July promised an increased budget and more international co-operation in controlling the disease, 3) about 70% of the cases are still in the Kissi Teng triangle (the area bounded by Gueckedou in Guinea, Foya in Liberia and Kailahun in Sierra Leone), which is a fairly restricted region in terms of its size.

Nevertheless there are also some negatives: 1) the fact that things are perhaps getting better in Guinea is contrasted with an increasing problem in Sierra Leone, 2) the traditional free movement of the Kissi Teng ethnic group across borders within their area may mean that the disease could spread back into Guinea from the other two countries, 3) previous reductions in disease numbers have been followed by sudden increases, 4) the illegal migrant route out of West Africa down the RN6 highway connecting Freetown (capital of Sierra Leone) and the migrant hub city of Agadez in Niger (from where the Saharan convoys leave heading north for Morocco and Tunisia), passes through both Gueckedou and Macenta, the epicentre of the current outbreak.

I think that spread down the illegal migrant route north is unlikely because 1) it is a long and hard journey and it would be difficult to make it all the way if you were suffering from Ebola, 2) we would see cases appearing in migrant hub cities, especially Agadez, and so far there are none.  Therefore the most likely route of entry to Europe is via air travel.  I am sure that the EU health authorities can cope with any air travellers who may arrive from affected areas with suspicious fevers.  It is important that the public realise that anybody returning from West Africa with a fever should seek medical advice immediately.

So, I see no current reason for alarm here in the EU.  In West Africa, there is still a big battle to be won.

Melissa Leach, Professor, Director, Institute of Development Studies

The outbreak is indeed very severe and is proving difficult to control because it is an entirely new disease in the region, and there is much public fear – both of the disease itself and also of seeking medical help. Building good community relations, working with traditional authorities, and seeking to understand local traditions around funerals, burial and caring for the sick, will be crucial to controlling the epidemic. Agencies are making strong efforts to engage with local communities and if this is done well, it should be possible to bring Ebola under control, as has happened in previous outbreaks in East and Central Africa. Authorities are on the alert and I do not think it likely that the virus will spread further in the region, or overseas. Researchers from the Dynamic Drivers of Disease in Africa Consortium (DDDAC) that I direct are currently working as part of the Ebola control efforts.

Daniel BauschHead, Virology and Emerging Infections Department, U.S. Naval Medical Research Unit No.6, Associate Professor, Department of Tropical Medicine, Tulane School of Public Health and Tropical Medicine

The outbreak is indeed continuing and we have a very serious situation here in Sierra Leone (from where I am currently writing). Spread to new regions of the presently afflicted countries (Guinea, Sierra Leone, and Liberia) and adjacent countries is possible. However, the World Health Organization, Ministries of Health of West African countries, and other partners are renewing and broadening the scale of the response efforts to gain control. We have certainly not seen the end yet, but the necessary structures to put an end to this are beginning to be put in place. The risk of spread to countries outside the region is low and, even if imported cases were to occur to countries outside of West Africa, the routine precautions taken and generally good healthcare infrastructure of most industrialized countries would make any sustained transmission from an imported case there very unlikely.

Ann Marie Kimball, Senior Program Officer, Epidemiology and Surveillance Global Health, Bill & Melinda Gates Foundation, Professor Emeritus, Epidemiology, University of Washington

This is a difficult question. In fact, it is one I posed routinely to my students when teaching at UW. The responses fell into two groups: 1) little risk. If it arrives in developed country settings hospital systems would limit the transmission. 2) High risk: given the long incubation period (up to 21 days) asymptomatic patients could become ill far from the epicenter and clinical recognition in hospital could lag.

What you are seeing is that where there is more mobility there is more of a challenge in limiting transmission.

Thomas GeisbertProfessor, Microbiology & Immunology, University of Texas, Medical Branch at Galveston

Yes, I think there should be considerable attention given to this outbreak as it is quite different than any previous outbreak not only in terms of it being the largest outbreak but also the broad geographical distribution of cases. Yes, one of the worst things that could happen is if the virus were to hit a large city and spread into larger populations.

David Sanders, Associate Professor of Biological Sciences, Purdue University

The world should be paying more attention to the outbreak and the breakdown of ecological barriers that leads to the spread of emerging diseases. We need to have a global perspective on these infectious agents, but our response should always be reasoned and based on science rather than panic.


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