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Archived Comments for: Need of surveillance response systems to combat Ebola outbreaks and other emerging infectious diseases in African countries

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  1. New updates of Ebola from Dr. Anna, Medecins Sans Frontieres (MSF) China Chief Representative (Updated 31 July 2014)

    Xi Cheng, BioMed Central

    7 August 2014

    MAIN MESSAGES of Ebola:

    1. The epidemic is out of control. The epicentre of the epidemic has now shifted to Sierra Leone and increasingly, Liberia. The growing number of affected areas makes it difficult to care for patients and implement all the actions necessary to control the epidemic.

    2. The current response is entirely insufficient compared to the needs and there needs to be greater mobilisation on the ground. In Sierra Leone and Liberia: Critical gaps in all aspects of the response: medical care, training of health staff, infection control, contact tracing, epidemiological surveillance, alert and referral systems, community education and mobilisation. Organisations with the capacity to do community education / health promotion need to step up their activities. Communities remain fearful of this ‘new’ disease and do not trust health workers or facilities, which makes it extremely difficult to contain the epidemic. The WHO has the responsibility for coordinating the response to ensure all the necessary resources are mobilised quickly and the response is accelerated in order to assist the national governments in Guinea, Sierra Leone and Liberia to contain this epidemic. This needs to result in an immediate impact on the ground.

    3. The epidemic is causing an additional public health crisis. Many health facilities are closed or empty: people are not seeking care for regular illnesses for fear of being infected. Some health workers have been infected or have died. Many are therefore too afraid to come to work. The epidemic further strains weak health systems already trying to cope with existing health crises like malaria and maternal mortality.

    4. MSF has reached the limits of what we can do. MSF’s top priority is to provide care for patients infected with the virus and we have already deployed the maximum of our human resources to do that.


    The problem is not simply the high number of cases that are now appearing. It is mostly the fact that there are cases and hotspots spread out in so many locations in the three countries that it’s incredibly complicated to monitor and respond effectively. In principle, new treatment centres should be built in all the hotspots, with expert teams in each location, If you have a cluster of Ebola cases in one location, you have to:

    -       Set up treatment units

    -       Train care providers and all the support staff

    -       Have a contact tracing team that is actively following up all the people who have come into contact with an infected person

    -       Set up an epidemiological surveillance network

    -       Set up an effective alert system and referral service

    -       Do health promotion in the community

    -       Do infection control reinforcement in the local health facilities

    -       Do epidemiological investigation of the cases to understand the chain of transmission

    All of this requires a huge amount of manpower, even when there are just a few cases in one location. So when you multiply this set up to many locations at the same time, you run out of people. We are continuing to train people and doing all we can to provide care to as many people as possible. But it is not enough and we cannot do more. the WHO, health authorities and other organisations to scale up their response in order to assure all aspects of the response are implemented effectively over this now huge area.

    Competing interests

    None declared