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Ebola: What Happened

COUNCIL ON FOREIGN RELATIONS  BY John Campbell
(Scroll down for Laurie Garett's essay "Ebola's Lessons.")

With a rapidly growing and urbanizing population, persistent poverty, and weak governance, Sub-Saharan Africa is likely to be the source of new epidemics that potentially could spread around the world. Understanding the disastrous response of African governments, international institutions, and donor governments to the Ebola epidemic is essential if history is not to be repeated yet again. That makes Laurie Garrett’s essay, “Ebola’s Lessons,” in the September/October 2015 issue of Foreign Affairs, essential reading.

The Ebola virus treatment center where four people are currently being treated is seen in Paynesville, Liberia, July 16, 2015. (Courtesy Reuters/James Giahyue)

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Community Knowledge, Attitudes, and Practices Regarding Ebola Virus Disease — Five Counties, Liberia, September–October, 2014

CDC  Morbid and Mortality Weekly Report   by Miwako Kobayashi, MD and others          July 10, 2015

To assess Ebola-related knowledge, attitudes, and practices (KAP) in the community, CDC epidemiologists who were deployed to the counties (field team), carried out a survey conducted by local trained interviewers. The survey was conducted in September and October 2014 in five counties in Liberia with varying cumulative incidence of Ebola cases. Survey results indicated several findings.

 First, basic awareness of Ebola was high across all surveyed populations (median correct responses = 16 of 17 questions on knowledge of Ebola transmission; range = 2–17). Second, knowledge and understanding of Ebola symptoms were incomplete (e.g., 61% of respondents said they would know if they had Ebola symptoms). Finally, certain fears about the disease were present: >90% of respondents indicated a fear of Ebola patients, >40% a fear of cured patients, and >50% a fear of treatment units (expressions of this last fear were greater in counties with lower Ebola incidence).

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Sierra Leone: Mothers Refuse to Vaccinate Children for Fear of Resurgent Ebola

BREITBART.COM  by Frances Martel                                             June 16, 2015

Doctors in Port Loko, a northwestern region of Sierra Leone outside Freetown, are reporting a significant drop in the number of mothers bringing their children to hospitals for routine vaccinations. The mothers, they say, fear exposing their children to a resurgent Ebola virus, and in keeping them from hospitals are risking triggering the spread of polio or measles.

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Readability of Ebola Information on Websites of Public Health Agencies, United States, United Kingdom, Canada, Australia, and Europe

CDC IED JOURNAL  by    Enrique Castro-Sánchez , Elpiniki Spanoudakis, and Alison H. Holmes    Volume 21, Number 7- July 2015                                          

 Public involvement in efforts to control the current Ebola virus disease epidemic requires understandable information. We reviewed the readability of Ebola information from public health agencies in non–Ebola-affected areas. A substantial proportion of citizens would have difficulty understanding existing information, which would potentially hinder effective health-seeking behaviors....

Several factors, including readability of information provided (8), can help reduce health literacy deficits...It is recommended that health information materials should be written at a level typically understandable by an 11-year-old person ... anxiety or panic attributed to a highly virulent infection, such as Ebola, might hinder comprehension of related information (11).

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Ebola spreads suspicion and rumours in Guinea

AFP                                                       June 7, 2015

Conakry, Guinea --The only possible place to encounter Ebola in Conakry is the main treatment unit, yet elsewhere in Guinea the virus is thriving in a febrile atmosphere of deep mistrust and swirling conspiracy theory....

It is in Guinea — the original epicentre but least-affected country — where the reaction to the fight against Ebola has been the most suspicious, however, manifesting itself in sporadic bloodshed.

Eight members of an outreach team in the southeastern town of Womey were killed by protesters who denied the existence of Ebola and denounced a “white conspiracy” in September last year.

Violence erupted last week in the country’s western provinces, where there are around 20 confirmed cases, with attacks targeting public institutions, ambulances and even health workers.

These examples of the “reluctance” of locals, to employ the official parlance, are igniting new transmission chains and so hampering efforts to stamp out the virus, say the authorities.

Read complete story.

http://gulfnews.com/news/africa/ebola-spreads-suspicion-and-rumours-in-guinea-1.1531265

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Liberia Burials Key in Ebola Fight

VOICE OF AMERICA by Joe DeCapua                                                   April 30, 2015

 The World Health Organization is set to declare Liberia Ebola free. It will make that declaration on May 9th if no new cases are reported. In a sign of how the situation has improved, the Liberian Red Cross has handed back responsibility for safe burials to the Ministry of Health.

A man is sprayed with disinfectant after he celebrated the memory of a loved one who died due to the Ebola virus at a newly built grave yard for Ebola virus victims in Monrovia, Liberia, Wednesday, March 11, 2015. Liberians held a church service Wednesday for families who lost members to Ebola to mark the country’s 99th celebration National Decoration Day, a holiday normally set aside for people to clean up and re-decorate the graves of their lost relatives. (AP Photo/Abbas Dulleh)

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Social Pathways for Ebola Virus Disease in Rural Sierra Leone, and Some Implications for Containment

PLOS     by Paul Richards and others                                                          April. 17,  2015                  
The current outbreak of Ebola Virus Disease in Upper West Africa is the largest ever recorded. Molecular evidence suggests spread has been almost exclusively through human-to-human contact.

 Social factors are thus clearly important to understand the epidemic and ways in which it might be stopped, but these factors have so far been little analyzed.

 The present paper focuses on Sierra Leone, and provides cross sectional data on the least understood part of the epidemic—the largely undocumented spread of Ebola in rural areas. Various forms of social networking in rural communities and their relevance for understanding pathways of transmission are described. Particular attention is paid to the relationship between marriage, funerals and land tenure.

 Funerals are known to be a high-risk factor for infection. It is suggested that more than a shift in awareness of risks will be needed to change local patterns of behavior, especially in regard to funerals, since these are central to the consolidation of community ties.

http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003567

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Conference Summary: Using Lessons Learned from Previous Ebola Outbreaks to Inform Current Risk Management

CENTER FOR DISEASES CONTROL by Dickmann P, Kitua A, Kaczmarek P, Lutwama J, Masumu J, Karimuribo E, et al             April 8,2015 

Summary of conference on lessons learned from Ebola crisis

"...A major conclusion was that infectious disease management will work only when it is established with and within the community and not directed against it. This lesson requires community engagement in formulating infection control measures, as well as implementation, dissemination, and promotion of these measures. Infection control procedures are generally perceived as intrusive and, as such, often interfere with local social, cultural, and religious practices.... Building on this process of finding the right, appropriate containment measures, communication and health promotion work best when they involve community and religious leaders, traditional healers, and other advocates.

National and cross-border Ebola outbreaks are a new development, and engagement with various communities has presented a particular challenge throughout the current outbreak. A key aspect of this engagement is to devise and elaborate solutions for infection control that are consistent with local realities and practices. International health and aid organizations must strive to work in concert with communities to find adequate infection-control solutions....

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Combatting Rumors About Ebola: SMS Done Right

When misinformation is a case of life or death, aid workers and communities need an ear to the ground

INTERNEWS   by  Anahi Ayala Iacucci                                                March 26, 2015

 What is now clear to healthcare organizations working on the ground in West Africa is that the Ebola epidemic has been driven as much by misinformation and rumors as by weaknesses in the health system. It is common sense that information is a critical element in combatting disease, particularly when contagion from common social practices, such as bathing the corpses of the deceased, were central to so much of the early spread of the disease. But in the context of a massive disease outbreak, when hundreds of international organizations and billions of dollars flood into a region whose fragile infrastructure has been damaged by years of civil war, information dissemination becomes a powerful challenge.

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The State of Vaccine Confidence

The Vaccine Confidence Project    2015
LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE 

Lead Authors:  Heidi Larson, PhD and Will Schulz, MPH
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