The Ebola virus causes serious symptoms, which are often fatal if not treated immediately. The disease first came to light in 1976 with two outbreaks in Africa. The recent 2014 outbreak in West Africa was the largest since its discovery in 1976. It took on pandemic status as it spread to multiple countries and continents. The countries most affected are those with the poorest public health systems, such as Guinea, Liberia, and Sierra Leone. On August 8, 2014, the WHO (World Health Organization) declared the West Africa outbreak a Public Health Emergency of International Concern under the International Health Regulations of 2005.
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The current Ebola virus disease (EVD) outbreak in West Africa is
the largest since the disease was first described in 1976. By the
end of March this year, it had caused more than 10 000 deaths, in-
cluding 495 among health care workers (HCWs).1,2 Twenty-four
patients with EVD have been admitted to hospitals in high-income
countries.3 The nurses who were infected while looking after Thomas
Duncan in Dallas, Texas, highlighted the risk of transmission of
EVD to HCWs, even in well resourced hospitals. HCWs in Australia
were quick to compare this with an outbreak of severe acute
respiratory syndrome (SARS) in a Toronto hospital in 2003, when a
single case led to an epidemic in which nearly half the cases
occurred in HCWs.4
“it is crucial that the decision-making process is transparent,
ethically and clinically rigorous, and acceptable to all
stakeholders”
The public response after a doctor who became infected while
treating patients with EVD in Africa returned to the United States,
and the ostracising of HCWs at the hospital where he was treated,
reflected community concerns about EVD.5 The unpredictable nature
of EVD, the infection of carers and the high case-fatality rate in
Africa have generated fear of the disease.
HCWs have raised concerns about appropriate clinical management of
patients with EVD and the need for a clear ethical framework to
guide decision making.6 While there are general management
guidelines for patients with EVD, including strict isolation,
appro- priate use of personal protective equipment (PPE) and prompt
correction of fluid and electrolyte loss, uncertainty surrounds
many aspects of care, includ- ing the extent to which supportive
care can be pro- vided and the circumstances under which it should
be discontinued.
Here, we focus on two ethical questions regarding the critical care
of patients with EVD in an Australian setting. The first is whether
it is ethically appropriate in some circumstances for HCWs to
decline to care for patients with EVD. The second question concerns
how treatment decisions should be made regarding limitation of
therapy for patients with EVD. Similar questions have been asked in
the context of other infec- tious diseases, including SARS, where
provision of care put HCWs at significant risk, and in the early
stages of the AIDS epidemic, when the risk to HCWs was
minimal.7,8
The current Ebola Virus Disease (EVD) outbreak in West Africa has
stimulated renewed interest in the development of treatment and
vaccines. As of February 18th 2015, 23,258 cases of EVD
have been reported in Nigeria, Senegal, Guinea, Liberia, Mali,
Sierra Leone, Spain, the United Kingdom and the United States of
America, with a total of 9,380 deaths [1]. Accordingly there is a
sense of urgency to develop therapies to curtail the epidemic. Four
critical processes need to be implemented for EVD clinical trials
in affected countries: 1) government collaboration in countries
that host EVD trials with study sponsors to ensure future access to
developed products; 2) collaboration between local researchers and
their Northern counterparts to ensure transfer of research
capacity; 3) development of competent local ethics committees; and
4) empowerment of community members to actively engage in research
design and implementation.
Stakeholder engagement in research helps to ensure prompt translation of research findings into policies and programmes. However, unlike most contemporary health research, EVD drug discovery needs to be conducted while the epidemic is ongoing. This brings a sense of urgency for EVD research protocol approval and study implementation, which may increase the likelihood of neglecting stakeholder engagement. This article highlights the merits of creating significant institutional relationships with the four key stakeholders – World Health Organization, national governments, researchers and community members - critical to the conduct of EVD trials, and discusses mechanisms to facilitate these engagement processes.
The Ebola communication crisis of 2014 generated widespread fear
and attention among Western news media, social media users, and
members of the United States (US) public. Health communicators need
more information on misinformation and the social media environment
during a fear-inducing disease outbreak to improve communication
practices. The purpose of this study was to describe the content of
Ebola-related tweets with a specific focus on misinformation,
political content, health related content, risk framing, and
rumors
Treatment centres and isolation zones were set up to reduce the spread of the virus and face-masks, gowns and gloves were used. Safe burial practices also helped to limit transmission of the virus, as did screening of passengers at international and domestic ports and airports
The following precautions can help prevent infection and spread of Ebola virus and Marburg virus.
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