Kate Johnson

September 09, 2014

WASHINGTON, DC — "A perfect storm" of challenges came together to create the current outbreak of the virus in West Africa that is being called the worst Ebola outbreak in history, says an expert from the Centers for Disease Control and Prevention (CDC) in Atlanta.

Speaking here at the Interscience Conference on Antimicrobial Agents and Chemotherapy, Barbara Knust, DVM, MPH, an epidemiologist with CDC's Viral Special Pathogens Branch, said that "time-tested" public health measures that were used by the centers and other organizations in the more than 20 previous outbreaks of Ebola and Marburg hemorrhagic fever have still to be fully implemented in this outbreak and are not currently adequate.

"This outbreak occurred in a tri-national area with borders that are extraordinarily porous," she told Medscape Medical News. "There's a single ethnic tribe that is highly mobile and moving freely across borders. There are good roads — it doesn't take bush planes to get to the capital city — it takes a car and a couple of days of driving. And there's distrust of government in these countries that have had recent civil war."

Local populations are also resistant to aid workers and outbreak control measures and are often reluctant to practice good burial methods, performing ritual washing of infected corpses that have been shown to carry heavy viral loads even on the skin, she said.

International Response

Challenged by Thompson Ntuba, MD, a Cameroonian doctor at the meeting who called the international response to the outbreak slow and poor, Dr. Knust said, "Efforts that were made at the time, compared to previous outbreaks, should have been adequate, but I believe that the circumstances were such that it was able to move beyond what the initial resources could handle."

She added, "We really have to think about new strategies and bringing in a lot more resources than we've ever had to bring in before."

 
We really have to think about new strategies and bringing in a lot more resources than we've ever had to bring in before. Dr. Barbara Knust
 

With today's news that military personnel are being deployed to the region from both the United States as well as the United Kingdom, Dr. Ntuba told Medscape Medical News, "The US military is not going to produce vaccines and drugs." But he said, "if this response had happened at the start, we would have been able to contain it."

Dr. Knust noted, "It's always difficult to mobilize resources in a timely fashion and the international community is now moving quickly." But she pointed out that cultural barriers remain a major problem. "Engaging the community is a really important component — we call it social mobilization — but it can be slow to win trust."

The secondary effects of the outbreak are also causing what she called a humanitarian crisis, resulting in the collapse of local healthcare systems as well as civil unrest. "This means people are now dying of things that are not Ebola, such as diabetes or cholera — things that are potentially treatable."

Writing recently in the American Journal of Respiratory and Critical Care Medicine, Robert Fowler, MD, from the University of Toronto, Ontario, Canada, and his team described a similar scenario in the outbreak zone.

"The constellation of limited public health infrastructure, low levels of health literacy, few acute care and infection prevention and control resources, densely populated areas, a mobile population and a highly transmissible, lethal viral infection," they note, "have created a perfect storm underlying this outbreak."

54th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). Presented September 8, 2014.

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