Why Is Guinea's Ebola Outbreak So Unusual?

Originally published on January 14, 2015 10:50 am

Doctors Without Borders has called the current outbreak of the Ebola virus in Guinea "unprecedented" — not because of the number of victims (so far at least 78 have died) but because the disease has traveled to various parts of the country. The widespread infection (which includes the capital city of Conakry) is at least unusual, the World Health Organization agrees, and presents more challenges than usual to the medical team seeking to contain the virus.

To learn more, we spoke with Esther Sterk, a tropical medicine adviser for Doctors Without Borders. She's been on the ground during past Ebola outbreaks in Africa and, from her base in Geneva, is helping coordinate efforts to quash this one. Sterk believes the infection may have spread more than usual because it's easy for people to travel from place to place in Guinea, including from the southern part of the country (where the first cases were reported) to the capital. The conversation has been edited for length and clarity.

How concerned are you about this outbreak?

We know from other outbreaks that epidemics can be stopped. And the principle is always the same: isolating suspected patients to prevent [them from giving] the disease to people around them. Also you follow the people who have been in close contact with patients with Ebola. So in the incubation period (which is 21 days), we follow them [tracking their contacts, and distributing information about prevention], because Ebola is [transmitted] by close contact with infected people. It's [spread via] body fluids, like the blood and the urine and the saliva, the stools — all body fluids are contagious.

What is also important is to inform the population about the disease. This is the first time Ebola is detected in Guinea, so the population and the medical staff don't know the disease. They need to be [told] how the disease is spread and how you can protect yourself, and what you need to do when you or somebody else has the symptoms (meaning that you have to go to an area where you can be isolated).

Any indication of how Ebola turned up in Guinea?

We have no clue. Researchers will definitely look into that.

How likely is it that it started with bats?

Between [human] outbreaks, the virus hides in certain animals. And it's thought that certain types of bats [are] possible reservoirs. In the areas where Ebola has occurred, the people eat bush meat — sometimes bats, monkeys ... that is a way the virus may be introduced into the population. So, the message in Guinea is: Don't eat bats; don't eat monkeys; don't touch sick or dead animals. People can infect themselves when they touch the fluids of an infected bat or a monkey [while] preparing the food, and also via [eating the] meat.

Is sexual activity another way that the virus spreads?

You can get infected by contact with all body fluids, so yes, also by sexual intercourse.

But people get [infected], and straightaway they get very sick. They start to [have] fever, and body pain; they start to vomit, they have diarrhea. So sexual intercourse is definitely not the main way of transmission.

I'd say more people get sick [via contact] with diarrhea and vomiting; for example, a man gets sick and his wife starts to clean up his diarrhea and his vomit, and she can get infected. So [it's] really caretakers of patients that get sick — or medical staff, if they are not respecting the precautions [for] an Ebola case.

Do you think there will be many more cases?

Ebola is not airborne, so not contagious like, for example, the flu. Now we know more or less which families are infected, so we are following them. The expectation is that if the people in the community are better informed about the disease, we can detect all possible cases of Ebola and [quarantine] them.

How long do you think it will take to contain this Ebola outbreak?

We will manage to contain this outbreak in a short amount of time, but it's difficult to say at the moment.

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We are tracking an outbreak of Ebola in West Africa and it appears to be getting worse. Ebola is one of the most lethal viruses on Earth and according to the international medical charity Doctors Without Borders, there have been 122 suspected cases and 78 deaths in Guinea. Two more cases have been confirmed in neighboring Liberia and other suspected cases have turned up in Sierra Leone.

The virus appears to be spreading in ways it hasn't in the past and some countries are shutting down border crossings and closing public markets to try to keep the disease at bay. NPR's Jason Beaubien reports.

JASON BEAUBIEN, BYLINE: Ebola outbreaks among humans usually are concentrated in rural parts of Central Africa. The disease doesn't tend to spread very far, in part, because it kills most of its victims before they can travel any great distance. But this time things are different. This is the first major outbreak outside of the Congo Basin. And rather than being focused in one village, it's spread across three countries.

In Guinea it's moved from the rural interior to the bustling capital on the coast. Tarik Jasarevic with the World Health Organization is part of an Ebola response team that's just flown in to the Guinean capital of Conakry.

TARIK JASAREVIC: It is a highly contagious disease. We don't have a vaccine. We don't have a specific treatment and fatality ratio is very high.

BEAUBIEN: The strain of Ebola that's raging in West Africa right now has had a fatality rate of up to 90 percent in the past. Physicians can't do much to save people who are already sick. Doctors Without Borders is concentrating on setting up isolation units, in part to care for the dying but also to get infected patients away from other potential victims.

The virus is not airborne. It can only pass from person to person through bodily fluids. Dr. Esther Sterk with Doctors Without Borders says this is why hospital workers and family members are at the highest risk.

DR. ESTHER STERK: For example, a man gets sick and then his wife starts to clean up his diarrhea and his vomit and she can get infected. And, for example, her sister comes to take care of the wife of the man. So this is how it normally spreads. It's really caretakers of a patient that get sick.

BEAUBIEN: Sterk has worked on four Ebola outbreaks over the last decade. She's now helping coordinate Doctors Without Borders response to the crisis from Geneva. Sterk says one of the biggest problems in the early days of the outbreak was that people in the region didn't know they were dealing with Ebola or even what Ebola is.

Guinea has launched widespread media campaigns telling people to not touch the bodily fluids of anyone who is sick. And to avoid traditional funeral practices that include cleaning corpses by hand. Sterk says by limiting transmission and isolating infected patients, she's confident this outbreak can be controlled.

STERK: We will manage to contain this outbreak (unintelligible) but when is a bit difficult to say at the moment.

BEAUBIEN: A team from the U.S. Centers for Disease Control and Prevention also landed in West Africa this week to try to help with that containment. Stuart Nichol, the head of the CDC's Viral Special Pathogens branch, says the death toll is expected to rise in the coming weeks, making this one of the bigger outbreaks. And he says this outbreak unfortunately shows that Ebola is far more widespread in Africa than previously thought.

STUART NICHOL: We think the reservoir for Ebola virus are bats. And so obviously bats are very mobile and so probably the distribution of the virus across Africa is probably broader than we currently know.

BEAUBIEN: In some places people eat bats. Other times people eat fruit that bats have been chewing on. And the virus then makes the leap from bats to humans. This current situation in West Africa suggests that even more Ebola outbreaks could occur in the future. Jason Beaubien, NPR News, Washington.


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