The world has moved on from Ebola, what does that mean for West Africa?

Now that the West African Ebola epidemic is over, what does that mean for the residents of Liberia, Guinea, and Sierra Leone? Is it back to life as usual, but with everyone on constant lookout for more Ebola cases? Are there special health considerations necessary for Ebola survivors?

The WHO developed a three phase framework for tackling the Ebola epidemic. Phase 1 was the rapid scale up of treatment facilities, safe burial practices and behavior change. Phase 2 involved the enhanced capacities for case finding, contact tracing and community engagement. Phase 3 builds on these two phases and expands that to include vaccines, diagnostics and survivor health to achieve a “resilient zero”.

It is important to remember that Ebola flare-ups are likely to continue across the three affected countries of Guinea, Liberia and Sierra Leone. Liberia experienced two flare-ups since they were first declared Ebola-free (42 days, twice the 21 day incubation period, without a new case). Sierra Leone also has a flare-up of one case since being declared Ebola-free. But effectively containing the flare-ups can prevent another epidemic.

Geographical distribution of new and total confirmed cases

Ebola case reports as of 14-02-2016. Courtesy WHO.

So what is the WHO and other partners working on to ensure that the affected countries achieve and maintain a “resilient zero”? Phase 3 has two objectives: to accurately define and rapidly interrupt all remaining transmission chains; and to identify, manage and respond to the consequences of residual Ebola risks.

It seems like Objective 1: to accurately define and rapidly interrupt all remaining transmission chains, is going well. Each of the three affected countries has at least one rapid-response team which is deployed once a confirmed case has been detected. Symptomatic cases are identified through regular surveillance and contacts are rapidly identified for monitoring. The surveillance programs ensure that everyone, alive or deceased, that have or had symptoms of Ebola are tested. These teams provide a rapid response so the cases don’t result in additional cases, effectively ending the Ebola transmission chain before it even gets started.  Response strengthening at the national and sub-national level will continue throughout 2016.

Objective 2: to identify, manage and respond to the consequences of residual Ebola risks, is also going well. The Ministries of Health for Liberia, Sierra Leone and Guinea with the WHO and other partners have plan to deliver comprehensive packages of essential services to safeguard the health of the more than 10,000 people who have survived Ebola. This involves viral persistence studies to see how long Ebola survives in semen of male survivors as well as semen screenings and counselling services for male survivors. This way men can understand which precautions to take to prevent the spread of Ebola to their sexual partners. Specialized eye exams  are also being provided to some survivors in Sierra Leone as eye problems have been shown to be a common complication in Ebola survivors.

Although Guinea, Liberia and Sierra Leone experienced the Ebola epidemic, they aren’t the only countries in West Africa that need to be concerned about Ebola flare-up cases. The WHO and partners are working to expand Ebola preparedness activities to neighboring highest priority counties- Cote d’Ivoire, Guinea-Bissau, Mali and Senegal. These activities ensure that countries are ready to effectively and safely detect, investigate and report potential Ebola viral disease cases, and to mount an effective response.

Ebola preparedness activities will invariably lead to overall health systems strengthening for the affected countries as well as the targeted priority countries, once Ebola preparedness criteria has been met. If there is one benefit that comes out of the Ebola epidemic, it’s the increased focus on health systems strengthening that will provide health benefits for many years to come.

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