Ebola Epidemic In West Africa
The long-running Ebola epidemic in Sierra Leone is all but over after nearly 13,500 cases and almost 4,000 deaths, those fighting the disease believe.
The last case in Sierra Leone was an eight-month-old child, who was hospitalized nearly two weeks ago and died four days later.
None of the 29 people who had contact with the child and were moved from the densely packed Freetown slum of Magazine Wharf to a voluntary quarantine facility have so far shown signs of illness.
Ebola – deaths and cases in the past 21 days
“We will wait to see if any of those high-risk people develop [Ebola] but if not, and even if they do, we have them safely out of the community. Our hope is that that is the last bit of this outbreak,” said Marshall Elliott, director of the UK government’s interagency taskforce, which is running the response with the Sierra Leone government and army.
An operation launched in June aimed at what seemed to be an intractable reservoir of disease among parts of the population of Kambia and Port Loko in the north of the country appears to have been a success.
There have been no cases in Kambia or Port Loko for well over a month, “which is really, really good”, said Elliott of Operation Northern Push. “It’s very hard for any of us who have worked on this for a long time to ever feel totally confident and relaxed because we have had surprises in the past. We remain vigilant.”
The west African epidemic was the largest ever outbreak of Ebola by a long way. The disease – first identified in 1976 – had only affected a few hundred people at any one time before. There have been almost 28,000 cases across west Africa since December 2013 and about 11,300 deaths.
At its peak last autumn, there were more than 700 cases a week, just in Sierra Leone, which meant the responders could do little more than collect bodies and urge families to report to the authorities anybody who was sick or dead.
Fear of being placed in an isolation unit with others who might have the disease deterred many from doing so – as did the adherence to cultural traditions that spread the contagion, involving care for the sick and burial rites including washing and kissing the body.
Sierra Leone is on the alert for cases crossing its northern border with Guinea, but that country is now doing better than expected and it is believed, said Elliott, that the successful vaccine trials made a big impact.
The vaccine proved to be 100% successful in protecting those who were given it. It was offered to all contacts of anybody diagnosed with Ebola. Among those who chose not to have it, some developed the disease.
The same vaccine is being given to health workers in a trial in Sierra Leone, but the Guinea trial will now be extended here too. “The president has signed off having the Guinea protocol for the vaccine here. It will still take a couple of weeks. The WHO [World Health Organization] are equipping themselves – setting themselves up to allow that to happen,” said Elliott.
“But hopefully actually we won’t need to. We do now genuinely feel we’re in a place where we may have seen the last of cases.”
Ebola – confirmed cases by week
At the weekend, Sierra Leone’s president, Ernest Bai Koroma, visited the Tonkolili district to celebrate the end of what Elliott said people hoped would be “the last ever big quarantine of this outbreak”. More than 500 people, the entire population of the village of Massesebe, were quarantined. It was triggered by a man who absconded from quarantine in Freetown, in order to visit his mother at the end of Ramadan. He fell ill and infected two other people there. But the village is now clear of the disease.
The last stages of the outbreak have been very hard work. The Northern Push in June was launched to try to re-energise those fighting the disease in the country’s most remote and traditional districts. “Getting them to end traditional burials [in which washing the body was a route of transmission of the virus] and accept that treatment was for their benefit was very difficult. People kept hiding themselves and going to traditional healers and doing unsafe burials,” said Elliott.
But house-to-house visits and sheer persistence appears to have paid off. The drop in cases in Port Loko and Kambia has also impacted on Freetown, because market traders and those looking for work in the city came by boat to the wharves and sometimes brought infection with them.
Success has been down to painstaking investigation with the help of many in the community, some of whom have survived Ebola or been in quarantine themselves and could allay some of the fear and suspicion among their neighbours. Surveillance teams have been able to obtain whole family chains, with the names and addresses of every person infected and their contacts.
Scientific developments have also helped. It is now possible to track spread of the virus through genetic sequencing. It was this that showed that the mother of the baby who died last week had been infected. She had hidden from the authorities and recovered at home, but transmitted Ebola to her baby daughter.