Question

1. a. The Ebola virus infected people in villages in central Africa decades ago, but it didn’t spread far.

            What was different about West Africa that led to the widespread outbreak in 2014?

b. Describe West Africa’s public health infrastructure

2. a. Which healthcare workers are responsible for breaking Ebola’s chain of infection

        b. How is the information these workers provide used to impact the spread of Ebola?

Answer 1

a.

The Western African Ebola virus epidemic (2013–2016) was the most widespread outbreak of Ebola virus disease (EVD) in history—causing major loss of life and socioeconomic disruption in the region, mainly in Guinea, Liberia, and Sierra Leone. The first cases were recorded in Guinea in December 2013; later, the disease spread to neighboring Liberia and Sierra Leone, with minor outbreaks occurring elsewhere. It caused significant mortality, with the case fatality rate reported which was initially considered, while the rate among hospitalized patients was 57–59%, the final numbers 28,616 people, including 11,310 deaths, for a case-fatality rate of 40%.] Small outbreaks occurred in Nigeria and Mali, and secondary infections of medical workers occurred in the United States and Spain. In addition, isolated cases were recorded in Senegal, the United Kingdom, and Italy. The number of cases peaked in October 2014 and then began to decline gradually, following the commitment of substantial international resources. As of 8 May 2016, the World Health Organization (WHO) and respective governments reported a total of 28,646 suspected cases and 11,323 deaths (39.5%), though the WHO believes that this substantially understates the magnitude of the outbreak.

On 8 August 2014, a Public Health Emergency of International Concern was declared and on 29 March 2016, the WHO terminated the Public Health Emergency of International Concern status of the outbreak.[27][28][29] Subsequent flare-ups occurred; the last was declared over on 9 June 2016, 42 days after the last case tested negative on 28 April 2016 in Monrovia.

The outbreak left about 17,000 survivors of the disease, many of whom report post-recovery symptoms termed post-Ebola syndrome, often severe enough to require medical care for months or even years. An additional cause for concern is the apparent ability of the virus to "hide" in a recovered survivor's body for an extended period of time and then become active months or years later, either in the same individual or in a sexual partner. In December 2016, the WHO announced that a two-year trial of the rVSV-ZEBOV vaccine appeared to offer protection from the variant of EBOV responsible for the Western Africa outbreak. The vaccine is considered to be effective and is the only prophylactic which offers protection; hence, 300,000 doses have been stockpiled. rVSV-ZEBOV received regulatory approval in 2019.

b.The status of the health infrastructure in the African Region ere has been limited focus on coordinating investment in health infrastructure across the Region. As a result, many countries have a variety of types, quality, and functionality of infrastructure making the assurance of eciency and equity dicult. Infrastructure, which encompasses the physical infrastructure, equipment, transport, and ICT requirements, needs coordinated planning, maintenance, and use for it to input into health system performance in a manner required to attain universal health coverage and SDGs. We assess the status of the health infrastructure in the region based on a health infrastructure score. is ideally would incorporate elements of availability, functionality, and readiness for the di­erent forms of infrastructure. However, the available information across countries relates to General readiness of facilities to provide essential services (presence of electricity, water, and other facilities needed to facilitate e­ective service provision) Availability of basic amenities needed for service provision Availability of basic equipment for general service provision Total density per 100 000 population: Total hospitals Total density per 100 000 population: Health posts Total density per 100 000 population: Health centers Total density per 100 000 population: District/ rural hospitals Hospital beds (per 10 000 population) e emerging health infrastructure score is based on averaging country normalized values for these variables – normalized from 0 to the highest value, to a range of 0 to 1. Countries are only included if they have information on more than one of these variables. When we compare the score across the di­erent countries of the African Region, we see there is a signcantly wide range from a high of 0.67 to 0.06 of the health infrastructure score. e highest score is seen in Guinea Bissau and is driven by high hospital density in the country.

a.

While that is a more technical and long-term project, there are also simple ways to effectively reduce the spread of infection, many of which are already part of hospitals’ and healthcare centers’ overall procedures. It is necessary for everyone in the healthcare system to follow these protocols, from doctors and nurses to environmental service technicians, facilities engineers, and administrators.

Keep in mind that if the reservoir cannot pass along the infection, or if the portal of entry/exit does not reach a new host, then the chain of infection is broken. That means the infection will be more difficult to contract and spread.

b.

Health-care workers should always take standard precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.

Health-care workers caring for patients with suspected or confirmed Ebola virus should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with EVD, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

Healthcare staff working with ANC or obstetric care should be informed about risks of persisting virus in pregnancy related fluids and encouraged to follow protocol for their own safety and the safety of the women they are caring for.

Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Ebola infection should be handled by trained staff and processed in suitably equipped laboratories.