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Sierra Leone: MSF-OCB supported research on Ebola

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Source: Médecins Sans Frontières
Country: Guinea, Liberia, Sierra Leone

INTRODUCTION

Outbreaks of Ebola virus were first discovered in the 1970’s in various central African countries, however, the West Africa outbreak that started in December 2013 has been the largest and most devastating to date.

There are five different types of Ebola virus and the West African outbreak was caused by the Zaire species, which is known to have a very high mortality rate. As of February 2016, 28,603 people have been infected and 11,301 patients died in the three most affected countries of Sierra Leone, Guinea and Liberia. A limited number of additional cases were reported in Nigeria, Mali, the United States of America, Senegal, the United Kingdom, Spain and Italy due to the repatriation of infected citizens by medical evacuation and persons entering countries well and then becoming sick from the virus causing further spread among close contacts.

The epidemic can be divided into four phases (1). The first phase was from December 2013 to March 2014, during which the first infections occurred in a remote region of Guinea. The inadequate health infrastructure present and the first time appearance of the virus in this region resulted in cases presenting unrecognised and therefore spread occurred undetected. The second phase from March to July 2014 heralded the confirmed spread of Ebola to the neighbouring countries of Liberia and Sierra Leone. At this time, Médecins Sans Frontières (MSF) had multiple teams on the ground responding to the escalating crisis (2) and were vocal about the need for both national and international assistance (3). During this phase hundreds of healthcare workers became infected and died from the virus.

The third phase of the outbreak from August to December 2014 saw an exponential rise in the number of cases across the three most affected countries, including for the first time outbreaks in major urban settings. Overstretched MSF Ebola treatment centres (ETC) were forced to turn away cases. On August 8th, the Director-General of the World Health Organization (WHO) declared the Ebola outbreak a public health emergency of international concern. The fourth phase, from December 2014 to January 2016 was characterized by decreasing numbers of new cases. This was achieved through a combination of community, national and international efforts. A number of trials for new vaccines and treatments started during this phase.

MSF in close collaboration with other actors such as the WHO and Ministry of Health (MoH), has been detecting and controlling Ebola outbreaks for decades in various African countries and uses six pillars for its approach:
- Isolation of cases and supportive medical and mental health care in dedicated ETC’s - Contact tracing - Awareness raising in the community
- A functioning surveillance and alert system
- Safe burials and house spraying
- Maintaining healthcare for non-Ebola patients

These six pillars have brought previous outbreaks under control relatively quickly. The size and spread of the recent West African outbreak made it difficult for all these six control measures to be implemented quickly and as a result the virus spread.

Prior to this outbreak, the volume of scientific research available on Ebola was limited. MSF ETC’s admitted over 5,200 confirmed Ebola cases, of which almost 2,500 have been cured (MSF Ebola crisis information update #19). No other national, international or non-governmental organisation has cared for more patients with Ebola than MSF.

This placed MSF in the unique position of being able to use its data and experience to answer scientific questions about Ebola and how it spreads. The main objective of MSF has always been to provide medical care to those in need and this was never jeopardised by research needs.
The type of research MSF was involved in varied. Some research used routine patient data that was collected in the ETC’s as part of standard care to answer questions such as which factors increased a patient’s chances of survival?

Other research required the collection of very specific information in order to assess for example if a trial vaccine prevented new cases of Ebola. Anthropological research required going out into the communities and asking people what they thought of Ebola and the efforts to control it.

MSF carried out research in a number of areas including epidemiology (describing the disease and its spread), vulnerable patient groups, clinical trials for new treatments, community views of Ebola, operational issues and effects of the outbreak on general healthcare. These areas of research closely reflect the six pillars of Ebola control mentioned earlier. This document aims to summarise the key findings of this research, and identify lessons learnt and knowledge gaps.


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