Ebola virus epidemic in Guinea

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Ebola virus epidemic in Guinea
Guinea - Location Map (2013) - GIN - UNOCHA.svg
A map of Guinea where the Ebola virus outbreak began
Cases contracted in Guinea3,806 (as of 25 October 2015) [1]
Deaths2,535

An epidemic of Ebola virus disease in Guinea from 2013 to 2016 represented the first-ever outbreak of Ebola in a West African country. Previous outbreaks had been confined to several countries in Sub-Saharan Africa. [2]

Contents

The epidemic, which began with the death of a two-year-old boy, was part of a larger Ebola virus epidemic in West Africa which spread through Guinea and the neighboring countries of Liberia and Sierra Leone, with minor outbreaks occurring in Senegal, Nigeria, and Mali. In December 2015, Guinea was declared free of Ebola transmission by the U.N. World Health Organization, [3] however further cases continued to be reported from March 2016. [4] The country was again declared as Ebola-free in June 2016. [5]

Epidemiology

Researchers from the Robert Koch Institute believe that the index case was a one or two-year-old boy who lived in the remote village of Meliandou, Guéckédou located in the Nzérékoré Region of Guinea. Researchers believe that the boy was said to have contracted the virus while he was playing near a tree that was a roosting place for Angolan free-tailed bats infected with the virus. [6] Dr. Fabian Leendertz, an epidemiologist who was part of the investigative team, said Ebola virus is transmitted to humans either through contact with larger wildlife or by direct contact with bats. The boy, later identified as Emile Ouamouno, fell ill on 2 December 2013 and died four days later. [7] [8] [9] The boy's sister fell ill next, followed by his mother and grandmother. [10] [11] It is believed the Ebola virus later spread to the villages of Dandou Pombo and Dawa, both in Guéckédou, by the midwife who attended the boy. From Dawa village the virus spread to Guéckédou Baladou District and Guéckédou Farako District, and on to Macenta and Kissidougou. [10] [11]

Although Ebola represents a major public health issue in sub-Saharan Africa, no cases had ever been reported in West Africa and the early cases were diagnosed as other diseases more common to the area such as Lassa fever, another hemorrhagic fever similar to Ebola. Thus, it was not until March 2014 that the outbreak was recognized as Ebola. The Ministry of Health of Guinea notified the World Health Organization (WHO), and on 23 March the WHO announced an outbreak of Ebola virus disease in Guinea with a total of 49 cases as of that date. [12] [13] [14] [15] By late May, the outbreak had spread to Conakry, Guinea's capital, a city of about two million inhabitants. [16]

Containment efforts

Quarantines and travel restrictions

Location of Guinea LocationGuinea.svg
Location of Guinea

In August, Guinea's President Alpha Conde declared a national health emergency due to the outbreak. He stated efforts to control the spread of the Ebola virus would include forbidding Ebola patients from leaving their homes, border control, travel restrictions, and hospitalization for individuals suspected to be infected until cleared by laboratory results. He also banned the transporting of the dead between towns. [17]

Good disease tracing was important to prevent the outbreak from spreading. Previous Ebola outbreaks had occurred in remote areas making containment easier; the West African outbreak struck in an area that lies at the centre of both a highly-mobile and densely populated region which made tracking more difficult: "This time, the virus is traveling effortlessly across borders by plane, car and foot, shifting from forests to cities and springing up in clusters far from any previously known infections. Border closures, flight bans and mass quarantines have been ineffective." Peter Piot, who co-discovered Ebola, said Ebola "isn't striking in a 'linear fashion' this time. It's hopping around, especially in Liberia, Guinea and Sierra Leone". [18]

Fear of healthcare workers and clinics

Medecins Sans Frontieres staff dressed in protective clothing Preparing to enter Ebola treatment unit (3).jpg
Médecins Sans Frontières staff dressed in protective clothing

Containment was also difficult due to fear of healthcare workers. Infected people and those that they were in contact with evaded surveillance, moving at will and hiding their illnesses while they infected others in turn. Entire villages, stricken by fear, closed themselves off, giving the disease an opportunity to strike in another area. It was reported that in some areas it was believed that health workers were purposely spreading the disease to the people, while others believed that the disease did not exist. Riots broke out in the regional capital, Nzérékoré, when rumors were spread that people were being contaminated when health workers were spraying a market area to decontaminate it. [19]

In May, the number of Ebola cases appeared to be decreasing and Médecins Sans Frontières (MSF) closed a treatment facility in the Macenta region because the outbreak of Ebola there appeared to have been resolved. At the time it was thought that the new cases were caused by people returning from Liberia or from Sierra Leone; however it was later suggested that villagers had become fearful and were hiding cases rather than reporting them. Seeing workers wearing the required protection outfits worn by health workers and taking those suspected of having Ebola or of being contacts to the treatment center (perhaps never to be seen again), refusing the usual burial rituals when a patient died, and other actions taken by the unfamiliar individuals that had come to their remote areas, had led to rumors of organ harvesting and government and tribal plots. According to a September news report, "Many Guineans say local and foreign healthcare workers are part of a conspiracy which either deliberately introduced the outbreak, or invented it as a means of luring Africans to clinics to harvest their blood and organs." [20] As described in another news article, "The health workers don’t look like any people you’ve ever seen. They perform stiffly and slowly, and then they disappear into the tent where your mother or brother may be, and everything that happens inside is left to your imagination. Villagers began to whisper to one another—They’re harvesting our organs; they’re taking our limbs". [21] Moreover, due to fear, many people were avoiding hospital treatment for any ailment and were self-treating with over the counter drugs from a pharmacy. [20]

On 18 September, eight members of a health care team were murdered by local villagers in the town of Womey near Nzérékoré. The team consisted of Guinean health and government officials accompanied by journalists, who had been distributing Ebola information and doing disinfection work. They were attacked with machetes and clubs, and their bodies were found in a septic tank. The dead included three journalists and four volunteers. [22] [23] [24]

Outbreak progression

October 2014

The reported weekly cases of Ebola in Guinea as listed on Wikipedia's 2014 Ebola Virus in West Africa timeline of reported cases and deaths; some values are interpolated. West Africa Ebola 2014 9 Reported Cases per Week Guinea.png
The reported weekly cases of Ebola in Guinea as listed on Wikipedia's 2014 Ebola Virus in West Africa timeline of reported cases and deaths; some values are interpolated.

The governor of Conakry, Soriba Sorel Camara, prohibited all cultural events for the holiday of Tabaski in a decree of 2 October 2014. [25] [26]

In the WHO Situation Report of 8 October, it was reported, that the transmission of Ebola was persistently high with approximately 100 new confirmed cases in the first week of October. The first cases were reported in the district of Lola. [27] Médecins Sans Frontières reported a massive spike in the number of new cases in the capital city of Conakry. One facility admitted 22 patients in a single day (6 October), 18 of them coming from Coyah region, 50 kilometres (31 miles) east of Conakry. [28]

On 19 October, Guinea reported two new districts with Ebola cases. The Kankan district, on the border with the Côte d'Ivoire and a major trade route to Mali, confirmed one case. Kankan also borders the district of Kerouane in this country, one of the areas with the most intense virus transmissions. The Faranah district to the north of the border area of Koinadugu in Sierra Leone also reported a confirmed case. Koinadugu was one of the last Ebola-free regions in that country. According to a WHO report, this new development highlights the need for increased surveillance of cross border traffic in an effort to contain the disease to the three most affected countries. [29]

On 23 October, Saccoba Keita, the head of Guinea's Ebola mission, announced the government has started compensating the families of health care workers who died after contracting the virus. At that time, 42 health care workers had died, including doctors, nurses, drivers, and porters. The compensation totals $10,000 (£6,200) and is to be paid as a lump sum. [30]

November 2014

In mid-November, the WHO reported that while intense transmission persists and cases and deaths continue to be under-reported, there is some evidence that case incidence is no longer increasing nationally in Guinea. They report that case numbers in some districts have been fluctuating, but they remain consistently high. New case numbers have been declining in the outbreak's point of origin, Gueckedou, but transmission continues to be high in Macenta. Of a total of 34 districts in Guinea, 10 remain unaffected by Ebola, contrasting with Liberia and Sierra Leone, where every district has been affected. [31]

On 20 November, the local Red Cross in Kankan Prefecture sent blood samples via a courier when the taxi he was traveling in was stopped by robbers. The bandits made off with the cooler bag containing the blood samples. The Guinea authorities made a public appeal for the return of the blood samples. The robbery occurred near the town of Kissidougou. [32]

December 2014

On 14 December the WHO stated that 17 districts reported new confirmed or suspected cases in this week. Guinea reported 2,416 cases with 1,525 deaths on this date. Only 10 out of the 34 districts have not reported cases. Conakry reported 18 new cases in this week. The northern district of Siguiri is of particular concern, as it borders Mali and reported 4 new probable cases. [33]

Free of Ebola transmission

The country was declared free of Ebola transmission on 29 December 2015, 42 days after the last Ebola patient tested negative for a second time. [34] Guinea was subsequently in a 90-day period of heightened surveillance according to the U.N. World Health Organization which also offered assistance [3] - with funding from the agency's donors.

New cases March 2016

On 17 March 2016, the government of Guinea reported 2 people had tested positive for Ebola virus in Korokpara. [4] It was also reported that they were from a village where members of one family had died recently from vomiting (and diarrhoea). [35] On 19 March, it was reported that another individual died due to the virus, at the treatment centre in Nzerekore. [36] The country's government quarantined an area around the home where the cases took place. This region of Guinea is where the first case was registered in December 2013, at the beginning of the Ebola outbreak. [37] On 22 March, it was reported that medical authorities in Guinea have quarantined 816 people as possibly having had contact with the prior cases (more than one hundred individuals were considered high risk [38] ); [39] on the same day Liberia ordered its border with Guinea closed. [40] Macenta prefecture, 200 kilometers from Korokpara, registered the fifth fatality due to the Ebola virus disease in Guinea. [41] On 29 March it was reported that about 1000 contacts had been identified (142 as high risk), [42] and on 30 March 3 more confirmed cases were reported from the sub-prefecture of Koropara in Guinea. [43] On 1 April it was reported that possible contacts, which number in the hundreds, had been vaccinated with an experimental vaccine, in a "ring vaccination" approach. [44]

On 5 April it was reported that there were nine new cases of Ebola since the virus resurfaced. Of these nine cases eight have died. [45] After a 42-day waiting period, the WHO declared the country free of Ebola on 1 June. [5]

Vaccines

After a trial run of an experimental Ebola vaccine involving 11,000 people in Guinea, Merck, the vaccine's manufacturer, announced it was found to be “highly protective” against the virus. [46] This confirmed the results of a study published in 2015 that awarded the vaccine 100 percent effectiveness after tests on 4000 people in Guinea who had been in close contact with Ebola patients. [46] However, a study sponsored by the National Institutes of Health, the Food and Drug Administration and the U.S. Department of Health and Human Services, and conducted by researchers from the U.S. National Academy of Medicine, called the vaccine's effectiveness in preventing Ebola infections into question. [47] In particular, the authors criticized the methodology of the patient trail, and argued that the protection provided by the vaccine may be lower than officially announced. [47]

The WHO approved the vaccine for use in the ongoing Ebola outbreak on 29 May 2017. [48] [49]

It was announced in May 2017 that the Gamaleya Research Institute of Epidemiology and Microbiology in Russia would deliver 1000 doses of an independently produced vaccine to Guinea for testing. According to a Xinhua report, it is the only officially authorized and approved Ebola vaccine for clinical use to date. [50]

Works derived from the Ebola crisis

See also

Related Research Articles

<span class="mw-page-title-main">Guinée forestière</span> Forested region of Guinea

Guinée forestière is a forested mountainous region in southeastern Guinea, extending into northeastern Sierra Leone. It is one of four natural regions into which Guinea is divided and covers 23% of the country. It includes all of the Nzérékoré administrative region, and shares a border with Sierra Leone and Liberia. Its rocky topology contains several mountain ranges and has an average elevation of 460m. Forested Guinea contains important areas of biological diversity such as the UNESCO World Heritage site Mount Nimba Strict Nature Reserve and biosphere reserve Ziama Massif. The Guéckédou prefectures also recorded the initial case of the 2014 Ebola outbreak in Meliandou, a rural village. The virus subsequently spread to urban areas and neighbouring countries Sierra Leone and Liberia.

Macenta is one of fourteen cities in the country of Guinea, West Africa, in the south of the country. It is the capital of the Macenta Prefecture, the Nzérékoré Region situated in the southeastern border of the country.

<span class="mw-page-title-main">Guéckédou</span> Sub-prefecture and town in Nzérékoré Region, Guinea

Guéckédou or Guékédou is a town in southern Guinea near the Sierra Leone and Liberian borders. It had a population of 79,140 but has grown in the 21st century due to refugees fleeing the Second Liberian Civil War and the Sierra Leone Civil War.

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Meliandou is a village in Guéckédou Prefecture, in the Nzérékoré Region of southern Guinea. Medical researchers believe that the village was the location of the first known case of Ebola virus disease in the epidemic in West Africa. The patient zero of Ebola was a two-year-old boy who died in 2013. The boy's pregnant mother, sister, and grandmother also became ill with symptoms consistent with Ebola infection and died. People infected by those victims later spread the disease to other villages.

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<span class="mw-page-title-main">Ebola virus cases in the United States</span>

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<span class="mw-page-title-main">Responses to the West African Ebola virus epidemic</span>

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<span class="mw-page-title-main">West African Ebola virus epidemic timeline</span>

This article covers the timeline of the 2014 Ebola virus epidemic in West Africa and its outbreaks elsewhere. Flag icons denote the first announcements of confirmed cases by the respective nation-states, their first deaths, and their first secondary transmissions, as well as relevant sessions and announcements of agencies such as the World Health Organization (WHO), the U.S. Centers for Disease Control (CDC), and NGOs such as Doctors Without Borders; medical evacuations, visa restrictions, border closures, quarantines, court rulings, and possible cases of zoonosis are also included.

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The following lists events that happened during 2014 in Sierra Leone.

The Womey massacre was a deadly attack on and murder of eight members of a team of healthcare workers, journalists, and government officials who were affiliated with the conflict resolution non-profit Search for Common Ground and WHO in mid-September 2014, traveled to the village of Womey in Guinea's southwest region to educate the local population during the West African Ebola virus epidemic outbreak. The team had come to warn the village about dangers of the Ebola virus disease. By 24 September 2014, Ebola disease was reported to have killed over 600 people in Guinea during previous months.

<span class="mw-page-title-main">Ebola in Nigeria</span>

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<span class="mw-page-title-main">West African Ebola virus epidemic timeline of reported cases and deaths</span>

In March 2014, the World Health Organization (WHO) reported a major Ebola outbreak in Guinea, a western African nation, the disease then rapidly spread to the neighboring countries of Liberia and Sierra Leone with smaller outbreaks occurring in Senegal, Nigeria, and Mali; the resulting West African Ebola virus epidemic is the largest Ebola outbreak ever documented.

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References

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  2. ↑ "Ebola virus disease Fact sheet No. 103". World Health Organization. September 2014.
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  5. 1 2 "End of Ebola transmission in Guinea" . Retrieved 9 June 2016.
  6. ↑ von Csefalvay, Chris (2023), "Host-vector and multihost systems", Computational Modeling of Infectious Disease, Elsevier, pp. 121–149, doi:10.1016/b978-0-32-395389-4.00013-x, ISBN   978-0-323-95389-4 , retrieved 2 March 2023
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  46. 1 2 "Ebola Vaccine Protects Against Deadly Virus". Bloomberg.com. 23 December 2016. Retrieved 13 July 2017.
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