Ebola outbreak declared over – Expert reaction

[UPDATE: Health officials in Sierra Leone have confirmed another death from Ebola, just hours after the World Health Organisation declared an end to the outbreak in West Africa – RNZ]

The World Health Organization (WHO) has declared the West African Ebola outbreak officially over.

EbolaThe WHO announcement is based in data which shows that for first time since the start of the epidemic two years ago the hardest-hit countries-Guinea, Liberia and Sierra Leone-have reported zero cases for at least 42 days.

“Detecting and breaking every chain of transmission has been a monumental achievement,” says Dr Margaret Chan, WHO Director-General. “So much was needed and so much was accomplished by national authorities, heroic health workers, civil society, local and international organizations and generous partners. But our work is not done and vigilance is necessary to prevent new outbreaks.”

Read more from the WHO.

The Ebola epidemic claimed the lives of more than 11 300 people and infected over 28 500.

Our colleagues at the UK SMC collected the following expert commentary.

Dr Peter Walsh, Lecturer in Primate Quantitative Ecology and researcher in emergent disease dynamics, University of Cambridge, said:

“It is not likely that a new emergence from the wildlife reservoir will occur, as the genetic data say pretty strongly that this has all been caused by one emergence event. However, some very convincing recent work has confirmed that Ebola can hide for many months in tissues that are protected from immune activity then re-emerge into the blood stream. Thus, it will not be surprising if more cases pop up.”

Prof Trudie Lang, Director of the Global Health Network, University of Oxford, said:

“This is an important event and excellent news for the countries affected however we must now make sure that we, as an international community, learn from this experience in order that we are better prepared next time.

“If we do not conduct research within an outbreak then we cannot learn how to halt the epidemic, how to manage the spread or treat those afflicted. This Ebola outbreak was remarkable in that we did manage to conduct clinical trials to see if vaccines and medicines could work on this virus. However the research response was still far too late, many months after it became an emergency and therefore we still do not have any treatments available for Ebola should it return.

“We need to make sure that conducting research is part of the immediate response and not thought about later only by doing this do we have a hope of finding treatments for these devastating diseases. There is a new outbreak in Brazil and other countries, called Zika virus, where there is a concern that it is causing head-related birth defects, but this is as yet unproven. Here we are working collaboratively with the international research community to get research studies set up much faster so we can learn about this disease and see if we can find a treatment. There will be another Ebola-like outbreak and we do need to be ready. We need to improve the capacity to undertake research in these regions, and this needs ongoing effort. We also need to work better together and for this the WHO need to take charge, and be supporting properly in doing so, in order that the humanitarian, research and global health security agencies can work together in the most impactful way possible to the benefit of the affected regions.”

Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, said:

“Today’s WHO announcement is welcome news but we must learn from Ebola’s devastating impact and ensure we are better prepared for infectious disease outbreaks. The world is still worryingly underprepared for potential future health threats and a change of mind-set is required to ensure we invest in research and development today to protect ourselves in years to come.”

Dr Nathalie MacDermott, Clinical Research Fellow, Imperial College London, said:

“It is great news that Liberia has once again been declared ‘Ebola free’ by the WHO and that for the first time in over two years all three heavily affected West African countries (Guinea, Liberia and Sierra Leone) have been declared free of Ebola transmission. This is an incredible achievement for all involved. However it is important that all three countries remain vigilant for possible further occurrences of infection. It is now known that the virus can persist in the bodily fluid of Ebola survivors for a significant period of time following their survival, and while the risk of transmission to others appears low the virus can be transmitted to close contacts, as demonstrated on several occasions in Liberia.

“With over 16,000 survivors in these three countries all health care workers must remain vigilant for re-emergence of infection within survivors and their close contacts to ensure rapid treatment of those affected and containment of any further clusters of infection. It is also imperative that we ensure survivors receive the medical and psychological support they require to come to terms with the disease they have suffered. A significant number continue to suffer ongoing physical problems from the disease such as chronic joint pain and eye problems, many of whom have gone blind as a result.

“Survivors also require support to re-integrate within their communities and re-establish their livelihoods, fear and stigma has contributed a significant burden to the ongoing struggles they face in obtaining work and being considered socially acceptable by their families and communities. Current figures indicate that there are over 22,800 children in Guinea, Sierra Leone and Liberia who have lost either one or both parents to Ebola, approximately 5700 have lost both parents. These children face significant uncertainty regarding the future. While many will have been placed with other family or community members and only a small number in orphanages, finances to care for them are in short supply. This means many children can no longer afford the fees to attend school, food insecurity is on the rise and children are subject to child labour to try and increase the household income to ensure adequate food. This is part of the legacy the West African Ebola epidemic has left, it is a part that we as the international community must not turn a blind eye to as Guinea, Liberia and Sierra Leone work to rebuild themselves following this costly epidemic.”

Prof John Edmunds, Dean of Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine (LSHTM), said:

“This is a very encouraging milestone, but we must remain vigilant as further sporadic cases can still occur. We also need to work hard now to help rebuild the affected communities, and make sure that we put systems in place to never let something like this happen again.”

Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:

“Great news – more than two years on, the world is finally Ebola-free and this is down to the hard work of the efforts of the people directly affected and those of the many volunteers who performed sterling work in the eventual international Ebola response. With more than 18,000 survivors in Africa and the known low risk of transmission long after the disease has been initially cleared, there is the chance of small flare ups. But the countries most affected are aware of these risks and hopefully the measures set in place to deal with these, if they happen, will prevent any future infections from spreading.

“But this outbreak was a wake-up call. The way that we lead our lives today.  Mass travel, development, habitat encroachment, largescale global trade and war and civil unrest mean that future outbreaks of deadly diseases like Ebola are inevitable. Whilst we can try to develop vaccines and treatments for some, it won’t be possible to mitigate against all threats with these types of intervention.

“We can’t simply think job done, move on. The world needs to unite and develop much more robust healthcare and surveillance systems in those parts of the world that need them most; only then can we be really prepared to deal with outbreaks in a more timely way. Let’s not forget, the reason that the recent Ebola outbreak was on such an unprecedented scale was that these surveillance and response systems initially failed.”

Dr Ed Wright, Senior Lecturer in the Department of Biomedical Sciences, University of Westminster, said:

“It is now apparent that a lethal combination of inaction and mistrust led to an infection of a 2 year old boy in rural Guinea becoming the index case in what has been described by many healthcare professionals and politicians as the biggest public health emergency the world has faced since HIV first surfaced in the mid-1980s. The outbreak of Ebola virus in West Africa, which has claimed over 7 times more lives than all previous outbreaks combined, is officially over but due to our better understand of the virus, especially how it can persist for up to 9 months in tucked away corners of the body, means that the countries at the epicentre of the outbreak are still in a state of heightened awareness with routine testing for the virus ongoing.

“There are many lessons to be learnt and changes to be made that will hopefully stop an outbreak occurring on this scale again, but for me, the most positive message to take from this outbreak is the dedication and courage of the staff who worked in the many Ebola treatment centres in Guinea, Sierra Leone and Liberia. At the end of 2014, when the number of cases was increasing almost exponentially and some scientists were forecasting it could rise to over 1 million by 2015, staff on the front line worked tirelessly in challenging condition to ensure only a fraction of the predicted number became infected.

“At the same time, great efforts were being made to develop devices capable of diagnosing infected individuals faster, effective treatments for people unfortunate enough to become infected and vaccines to prevent new cases. Even though some treatments did not live up to their early promise, two vaccines successfully underwent human trials in West African suggesting they would help limit the burden of Ebola virus in populations where future outbreaks occur.

“While it is inevitable that we will see further outbreaks of Ebola because we do not fully understand where the virus resides between outbreaks, what we have learnt as scientists and healthcare professionals over the last 25 months means they are unlikely to have the same impact.”

Dr Derek Gatherer, Lecturer in the Division of Biomedical and Life Sciences, Lancaster University, said:

“The sometimes unsteady progress of west Africa to the end of the Ebola outbreak continues with the good news that all three countries are now without active transmission chains.  Nevertheless, we need to continue to be vigilant for the return of Ebola via the sexual transmission route from male survivors.  This is a rare event, but as recent studies showed it can occur even several months after recovery.  Also, given the recent concern over Lassa fever in Nigeria, which can cause symptoms easy to confuse with Ebola, West African medical systems need to develop a robust and reliable protocol for differential diagnosis of haemorrhagic fevers and other severe fevers involving gastrointestinal symptoms.  Ebola cannot be allowed to fly under the medical radar again.”

Declared interests

Dr Peter Walsh: No conflicts of interest

Prof Trudie Lang: No conflicts of interest

Dr Seth Berkley:  No conflicts of interest to declare.

Dr Nathalie MacDermott: Funded by the Wellcome Trust and Imperial College Institute of Global Health Innovation to undertake a PhD in Ebola Virus Disease at Imperial College London. Figures courtesy of UNICEF country offices in Guinea, Liberia and Sierra Leone, December 2015.

Prof John Edmunds: No conflicts of interest

Prof Jonathan Ball: No conflicts of interest to declare

Dr Ed Wright: No conflicts of interest

Dr Derek Gatherer:  “Derek Gatherer is funded by Lancaster University to work on Ebola diagnostics and has been participating in the WHO/NIBSC diagnostic standards project”.