Ebola deaths in Guinea put country in alert

A cidade de N’Zerekore foi a primeira a ter um surto da doença em meados de 2013. Na ocasião, os casos se espalharam rapidamente para outros países, como Libéria e Serra Leoa

The Guinean government confirmed in mid-February the existence of an Ebola epidemic in the southeast of the country. The first cases were recorded at the Gouecke subprefecture after the funeral of a nurse who died in late January in NZerekore. This is the first time that the disease has reappeared since the worst Ebola outbreak in the world, recorded in West Africa between 2013 and 2016. The proximity to the busy borders has hampered efforts to contain the virus. In total, the disease has killed at least 11,300 people, with most cases identified in Guinea, Liberia and Sierra Leone.

In November, the Democratic Republic of Congo (DRC) announced the end of a six-month epidemic, which totaled 130 cases and killed 55 people. The director of the World Health Organization (WHO) for Africa, Matshidiso Moeti, reported that the cases recorded in Guinea and the Democratic Republic of Congo have different origins. The WHO has carefully monitored new cases of Ebola since 2016, to prevent a new outbreak of the disease. Recently, the Democratic Republic of Congo (DRC) was considered to be in a state of emergency.

To learn more about the subject, the Communication Office of the Brazilian Society of Tropical Medicine (SBMT), interviewed Dr. Richard Reithinger, vice president of Global Health at RTI International, a non-profit research and global development institute.

Check the interview in full:

SBMT: Could you tell us about the current situation of Ebola in Guinea?

Dr. Richard Reithinger: On February 14, 2021, the Guinean Ministry of Health of Guinea informed the World Health Organization (WHO) of a cluster of 7 Ebola virus disease cases in the municipality (sub-préfecture) of Gouécké, which is located in the Nzérékoré Region in the south/south-eastern part of Guinea. The cases showed symptoms of diarrhea, vomiting and bleeding after attending the burial of a family relative. The first (“index”) case was a 51-year-old nurse, who presented at the health centre in Gouécké on January 18, 2021, and who was originally diagnosed with typhoid and malaria, and died 10 days later. Laboratory analyses are underway to identify the Ebola virus species and as of February 15, 2021, close to 200 contacts – people likely to have been exposed — have been identified.

Following the declaration of the Ebola outbreak, the Guinean Ministry of Health convened a crisis meeting, and the Ministry of Health, WHO, and Global Outbreak Alert and Response Network partners have initiated measures to control and prevent further spread of the outbreak. Multidisciplinary teams have been deployed to actively search and provide care for cases, trace and follow-up contacts, and sensitize health workers and communities on infection prevention and control.

In addition, WHO, coordinated the shipment of 11,000 Ebola vaccine doses, which recently arrived in Guinea. Vaccines will be administered to front line health care workers and others at greatest risk of having been or becoming exposed. Funds are currently being mobilized for a concerted response in Guinea and ensure that the outbreak is rapidly and effectively contained.

Given that Nzérékoré is the second-largest city in Guinea and is an important transportation hub to other parts of Guinea, as well as neighboring Liberia and Côte d’Ivoire, there is great concern about the exportation of Ebola cases across Guinea into the neighboring countries. At this point in time, none of the index case’s contacts are reported to have travelled to neighboring countries.

SBMT: New Ebola Outbreak creates unparalleled challenges during a pandemic. Which ones would you highlight?

Dr. Richard Reithinger: Guinea’s health systems are fragile and certainly the pandemic has put an additional stressor on these systems. However, compared to countries such as the United States or Brazil, the number of COVID-19 cases in Guinea has been limited, with approximately 15,000 cases and less than 100 deaths reported. While there are concerns with regards to COVID-19 diagnostic capabilities and, thus, under-reporting, the lower burden is likely due to other factors such as age (almost half of Guinea’s population is under 15 years of age) as well as the improved capability of the health system to manage emerging pandemic threats like COVID-19 following the substantial investments that were made during the 2013–2016 Ebola outbreak.

A concern of this new Ebola outbreak is that—just like in 2013–2016 and particularly if it spreads to other regions of the country—it will impact routine health service delivery if people perceive that it is not safe to attend health facilities. Services impacted could range from child immunizations to provision of antenatal care services to diagnosis and treatment of communicable diseases such as malaria, which—if impacted—could exacerbate the toll of these diseases/conditions.

SBMT: How to deal with the lack of funding, the lack of human resources, the lack of a strong and robust surveillance system to detect, isolate, test and treat new suspected cases to prevent further spread of the virus?

Dr. Richard Reithinger: It is true that Guinea’s health systems and that of its neighboring countries are fragile. However, the 2013–2016 Ebola outbreak led to substantial investments in the countries’ health systems, particularly in surveillance and outbreak response. Indeed, it can probably be said that the low burden of COVID-19 in Guinea, Liberia and Sierra Leone could be attributed to this investment. Moreover, the population has the experience of having gone through the past outbreak and is highly cognizant of the dangers that this new outbreak poses. Unlike 2013, the outbreak was notified early, and a response has been mobilized quickly.

Lastly, a game changer compared to 2013–2016, of course, is the availability of a vaccine, which should enable the Guinean Ministry of Health to contain the outbreak rapidly and effectively.

SBMT: The Ebola epidemic could be further complicated by coronavirus along and other humanitarian crises in Africa. What do you say about that?

Dr. Richard Reithinger: If contained rapidly and effectively, this new Ebola outbreak should not cause too much disruption to Guinea’s and West Africa’s health system or broader socio-economic fabric. Guinea’s and West Africa’s health priorities—ranging from vaccine preventable diseases; malaria; tuberculosis; to family planning; maternal and reproductive health; and nutrition—are much bigger than Ebola. Those services need continued substantial investment for these countries to thrive.

A bigger issue at hand is to ensure that COVID-19 vaccines are becoming available to low-income countries, like Guinea, so that the pandemic can be effectively curbed and that the socio-economic disruption that the pandemic has caused can be halted.

SBMT: Do you believe that one day it will be possible to break all transmission chains of the Ebola virus?

Dr. Richard Reithinger: Ebola virus is primarily transmitted by human-to-human contact with infected body fluids and corpses and causes severe and acute systemic disease with high mortality. While it can have substantial epidemic potential, as shown by the 2013–16 West African outbreak, one cannot forget that Ebola virus disease has a zoonotic origin—that is, the source of the outbreak in the human population is due to a spillover event from an animal reservoir, such as bats and bushmeat.

For example, in Brazil, you have Chagas disease and visceral leishmaniasis (kala-azar), both of which have domestic and wild animal reservoirs. Breaking all transmission chains of such zoonotic diseases would mean preventing spillover events or circulation of the virus in the animal reservoir—which is impossible.

SBMT: Would you like to add something that you consider important?

Dr. Richard Reithinger: Even amidst the Ebola outbreak, it is important to continue funding of and providing services to address diseases and issues around HIV, tuberculosis, malaria, reproductive health, and maternal and child health. Health officials in Guinea should also continue ongoing efforts to curb the spread of the COVID-19 pandemic. Given the quick response and actions already taken, the new Ebola outbreak should not cause too much disruption to Guinea’s and West Africa’s health system or broader socio-economic fabric.