Background

The outbreak of Ebola virus disease in some parts of West Africa has been variously described as the largest, longest, most severe, and most complex and affecting multiple countries. The intensity and the immense devastation as witnessed by the rate of mortality and morbidity in the three most affected countries, Guinea, Liberia and Sierra Leone put almost all West Africa countries, especially those closer to the three countries into a state of anxiety and apprehension. As part of country-preparedness various countries activated their emergency response measures as well as developing and instituting new ones. Almost every country was concerned that an infected person from one of the affected countries would bring the infection to its country and therefore all countries sat alert and remained very vigilant especially to visitors entering their country from the most affected countries.  But with the Ebola cases in the most affected countries now tapering down, with incidence declining, most countries are thinking the worst may be over and are therefore either relaxing their emergency response measures or downgrading their activation markers. But if the epidemiology of the Ebola virus transmission, as has been occurring in the Central and Eastern African countries, is anything to go by then one would say that West African countries (those directly affected and those not directly affected) may be more at risk than ever before, risk from an infection with contact with an infected animal from within their own countries. In the Central and Eastern African countries Ebola Virus outbreak has always been sporadic, that is, it breaks out intermittently and at different places at different times and always through the natural known means of transmission which is through the direct contact with an infected animal from within ones’ own country. A direct contact with an infected animal can come about mainly through hunting, butchering and/or eating an infected animal such bats, non-human primates, duikers and the likes. This is even collaborated by some scientists at Oxford University who in a paper published in the journal “eLife” under the title “Mapping the zoonotic niche of Ebola virus disease in Africa” predicts that 22 countries, most of them in the West Africa, continue to stand the risk of experiencing Ebola virus outbreak from animals. This means that the countries concern, must as a matter of urgency and necessity, institute very effective proactive measures such as instituting what I call targeted and segmented efficient education to their populace and establishing a very safe and timely laboratory diagnoses to deal with possible Ebola virus outbreak should it occur.

Targeted and Segmented Efficient Education to the Populace

The first lesson we learn from the outbreak in Guinea, Liberia and Sierra Leone is that we are told one of the main reasons the Ebola virus outbreak getting out of hand in those countries was that of the peoples’ initial response and reaction. A reaction which was panic, anxiety, confusion, perplex and disbelieving and not willing to readily obey directives from the authorities. The people of those countries can be excused and forgiven because in their case it was unexpected and for that matter they were not prepared and also lacked adequate information. This unfortunately cannot be said of other West Africa countries, including Ghana, in the unlikely event of any future outbreak. This is because every West African country is now expected to know that the possibility of an Ebola virus breaking out in their country is quite high and even eminent. This means, their people need to be properly educated and well informed about what to do and how to behave in case of an outbreak. Considering, however, the socio-culture diversities of our people as well as the demographic differences I believe good education can be properly done by identifying the most-at-risk or more vulnerable group and given a specific targeted education. This is what I meant by “Targeted and Segmented Education”. For example, in the event of an outbreak occurring how should say the market traders and their customers behave? or say commercial transport drivers and other motorists and their passengers behave? So also students (both in residence and non-residence) and their authorities or others like hoteliers, security agencies, religious societies or organizations and even health care workers. In my opinion, I think we ought to break our society into segments and each segment given a specific targeted education. Through such means, I think, each person or group of persons in their daily activities would then know exactly what to do and how to behave in the event of any future Ebola virus outbreak and this I think would help to contain and minimize the impact any future Ebola virus outbreak will cause.

Author: Dr. Theophilus Ben Kwofie

Establishing a Very Safe and Timely Laboratory Diagnoses

Of equal importance is the ability to confirm in the laboratory all suspected cases in a timely manner. It is true that Ebola virus is a level–four pathogen and for that matter dangerous and therefore, it must necessarily be worked upon in a specialized laboratory, a Containment Level 4 facility. Even though such a facility does not exist in any of the West Africa countries, research institutes such as the Noguchi Memorial Institute in Accra has managed to establish an acceptable diagnostic facility in our country here and this is very commendable. But can institutes such as Noguchi alone be able to serve the nation should Ebola virus infection breaks out? NO, I don’t think so. I therefore think it is time for our health authorities to seriously consider equipping the laboratories of the bigger hospitals such as the Teaching, Regional, District and even major Private Hospitals to enable them SAFELY perform the laboratory diagnoses of Ebola Virus infection. I am of the strong opinion that another reason that fueled the outbreak in Guinea, Liberia and Sierra Leone is the mass isolation of anyone suspected of having Ebola virus infection. As we all may know diagnosing Ebola virus infection clinically in an individual who has been infected only a few days is difficult because early symptoms are nonspecific to the virus and are seen in other patients with diseases that occur much more frequently and are endemic in our sub-region. If, therefore, a person is suspected of having Ebola virus infection, then a laboratory tests must be done immediately and promptly otherwise we will end up exposing people whose cases weren’t Ebola virus infection to begin with to the infection through mass isolation. The question that may be asked is, “do I really think Ebola virus infection can be performed in the hospitals mentioned above?” My answer is emphatically YES. Yes we can properly train and equip the laboratories of the major hospitals as stated above to be able to handle this. My reasons are that, in Ghana for example, samples that are sent to Noguchi for analysis are collected or taken by personnel of the above described hospital laboratories who also process it before sending it to Noguchi. In addition, while waiting for Noguchi to come out with their report on the outcome of their investigation, sometimes taking more than a day, the personnel of these same hospitals and their laboratories are made to manage the suspected patients by performing other tests such as malaria, typhoid, hematology, biochemistry and other assays on the patient. This was at a time that there were no personal protective equipment (PPE) in the country and available to the laboratories concerned and therefore the personnel involved weren’t adequately protected against the Ebola virus. If, therefore, it is the danger of the virus and/or the safety of the personnel that we are concerned with then I am afraid the personnel who may have worked on the suspected patient would have already been exposed to the virus in an unprepared manner though this is not my reason. Now that PPEs are available in our country here and we are also told that isolation facilities are being established and perfected then it stands to reason that it should be possible to train and upgrade our hospital laboratories to be able to screen for the Ebola virus infection without danger. At any rate, I am of very strong opinion that diagnoses of any future outbreak of Ebola virus infection in any part of our world would be done with one of the many developed, but lying in wait, rapid assay equipment some of them are reported to take between five to thirty minutes to perform. The earlier, therefore, we prepare our hospitals to be able to undertake Ebola virus infection diagnoses the better it would for the efficient management of any future Ebola virus outbreak in our country.

Conclusion

So with this very timely laboratory diagnoses and targeted and segmented efficient education to the populace I believe we can, as country, contain any future Ebola virus outbreak if it does occur though my prayer is that it shouldn’t occur.

 

AUTHOR’S ADDRESS:

Department of Clinical Microbiology, School of Medical Sciences, College Health Science, Kwame Nkrumah University of Science and Technology, Kumasi, GHANA       

 

E-mail Address: tbenkwofie@yahoo.com