Laidback Al
Well-known member
The International Ebola Emergency (August 20, 2014)
Sylvie Briand, M.D., Eric Bertherat, M.D., Paul Cox, B.A., Pierre Formenty, M.P.H., Marie-Paule Kieny, Ph.D., Joel K. Myhre, M.A., Cathy Roth, M.B., B.Chir., Nahoko Shindo, Ph.D., and Christopher Dye, D.Phil.
August 20, 2014DOI: 10.1056/NEJMp1409858
Excerpts
On August 8, 33 weeks into the longest, largest, and most widespread Ebola outbreak on record, the World Health Organization (WHO) declared the epidemic to be a Public Health Emergency of International Concern (PHEIC). . . .
A Public Health Emergency carries immediate consequences for all IHR signatories (see Box 1 in the Supplementary Appendix, available with the full text of this article at NEJM.org). For the four currently affected countries, the Emergency Committee made several recommendations. Heads of state should declare a national emergency, activate national disaster-management mechanisms, and establish emergency operations centers. There should be no international travel of infected persons or their contacts. In areas of intense transmission ? especially the border areas of Sierra Leone, Guinea, and Liberia ? the provision of clinical care to affected populations could be used as a basis for reducing people's movement. . . .
In late April, a dip in reported cases in Guinea gave hope that the epidemic was beginning to subside and could be confined largely to one country. That hope was abandoned as the number of confirmed cases in Liberia and Sierra Leone rose sharply during May. By August 16, the cumulative number of confirmed, probable, and suspected cases of EVD in the three worst-affected countries plus Nigeria was 2240, with 1229 deaths. The ratio of deaths to cases implies a case fatality rate of 55%. However, this estimate is approximate, since some cases and deaths (perhaps many) have been missed; in particular, contact tracing in Guinea during the initial period was far from adequate, allowing further opportunities for transmission. . . .
As yet, there is no persuasive evidence that the epidemic is under control. . . .
We do not yet have an Ebola vaccine or specific antiviral treatments (see Box 2 in the Supplementary Appendix), but evidence from the current and previous epidemics indicates that transmission can be interrupted by infection-control measures. The mode of transmission is well known: the chance of infection is high if there is direct contact with blood, secretions, organs, or other body fluids of infected persons. . . .
From previous epidemics it has been calculated that 1 primary human case generates only 1 to 3 secondary cases on average,3 as compared with 14 to 17 for measles in West Africa.4
These observations point to immediate priorities for control: early diagnosis with patient isolation, contact tracing, strict adherence to biosafety guidelines in laboratories, barrier nursing procedures and use of personal protective equipment by all health care workers, disinfection of contaminated objects and areas, and safe burials. . . .
These recommended control methods are, of course, more easily recited than implemented. Extraordinary resources are required by any health service confronted by Ebola; those in Guinea, Liberia, and Sierra Leone are severely stretched. Health services are understaffed. Essential personal protective equipment is in short supply. Capacities for laboratory diagnosis, clinical management, and surveillance are limited, and delays in diagnosis impede contact tracing. . .
This epidemic's unprecedented scale has been a surprise, but the response is now firmly under way. . . .
Monitoring of funds raised and disbursed, and of control measures implemented, is now intense. Above all, we are looking for a sustained decrease in incidence, from week to week and district by district, with no sign of further geographic spread. In the coming days and weeks, that will be our primary measure of success in preventing infections and saving lives.
link:http://www.nejm.org/doi/full/10.1056/NEJMp1409858?query=featured_infectious-disease
Sylvie Briand, M.D., Eric Bertherat, M.D., Paul Cox, B.A., Pierre Formenty, M.P.H., Marie-Paule Kieny, Ph.D., Joel K. Myhre, M.A., Cathy Roth, M.B., B.Chir., Nahoko Shindo, Ph.D., and Christopher Dye, D.Phil.
August 20, 2014DOI: 10.1056/NEJMp1409858
Excerpts
On August 8, 33 weeks into the longest, largest, and most widespread Ebola outbreak on record, the World Health Organization (WHO) declared the epidemic to be a Public Health Emergency of International Concern (PHEIC). . . .
A Public Health Emergency carries immediate consequences for all IHR signatories (see Box 1 in the Supplementary Appendix, available with the full text of this article at NEJM.org). For the four currently affected countries, the Emergency Committee made several recommendations. Heads of state should declare a national emergency, activate national disaster-management mechanisms, and establish emergency operations centers. There should be no international travel of infected persons or their contacts. In areas of intense transmission ? especially the border areas of Sierra Leone, Guinea, and Liberia ? the provision of clinical care to affected populations could be used as a basis for reducing people's movement. . . .
In late April, a dip in reported cases in Guinea gave hope that the epidemic was beginning to subside and could be confined largely to one country. That hope was abandoned as the number of confirmed cases in Liberia and Sierra Leone rose sharply during May. By August 16, the cumulative number of confirmed, probable, and suspected cases of EVD in the three worst-affected countries plus Nigeria was 2240, with 1229 deaths. The ratio of deaths to cases implies a case fatality rate of 55%. However, this estimate is approximate, since some cases and deaths (perhaps many) have been missed; in particular, contact tracing in Guinea during the initial period was far from adequate, allowing further opportunities for transmission. . . .
As yet, there is no persuasive evidence that the epidemic is under control. . . .
We do not yet have an Ebola vaccine or specific antiviral treatments (see Box 2 in the Supplementary Appendix), but evidence from the current and previous epidemics indicates that transmission can be interrupted by infection-control measures. The mode of transmission is well known: the chance of infection is high if there is direct contact with blood, secretions, organs, or other body fluids of infected persons. . . .
From previous epidemics it has been calculated that 1 primary human case generates only 1 to 3 secondary cases on average,3 as compared with 14 to 17 for measles in West Africa.4
These observations point to immediate priorities for control: early diagnosis with patient isolation, contact tracing, strict adherence to biosafety guidelines in laboratories, barrier nursing procedures and use of personal protective equipment by all health care workers, disinfection of contaminated objects and areas, and safe burials. . . .
These recommended control methods are, of course, more easily recited than implemented. Extraordinary resources are required by any health service confronted by Ebola; those in Guinea, Liberia, and Sierra Leone are severely stretched. Health services are understaffed. Essential personal protective equipment is in short supply. Capacities for laboratory diagnosis, clinical management, and surveillance are limited, and delays in diagnosis impede contact tracing. . .
This epidemic's unprecedented scale has been a surprise, but the response is now firmly under way. . . .
Monitoring of funds raised and disbursed, and of control measures implemented, is now intense. Above all, we are looking for a sustained decrease in incidence, from week to week and district by district, with no sign of further geographic spread. In the coming days and weeks, that will be our primary measure of success in preventing infections and saving lives.
link:http://www.nejm.org/doi/full/10.1056/NEJMp1409858?query=featured_infectious-disease