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 Table of Contents  
LETTER TO EDITOR
Year : 2016  |  Volume : 7  |  Issue : 1  |  Page : 1

Ebola-free Liberia: Scrutinizing the efforts of public health sector and international agencies


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Chennai, Tamil Nadu, India

Date of Submission11-May-2015
Date of Acceptance25-Jun-2015
Date of Web Publication11-Jan-2016

Correspondence Address:
Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, 3rd Floor, Ammapettai Village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2008-7802.173789

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How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Ebola-free Liberia: Scrutinizing the efforts of public health sector and international agencies. Int J Prev Med 2016;7:1

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Ebola-free Liberia: Scrutinizing the efforts of public health sector and international agencies. Int J Prev Med [serial online] 2016 [cited 2020 Aug 5];7:1. Available from: http://www.ijpvmjournal.net/text.asp?2016/7/1/1/173789

Dear Editor,

The 2014-2015 outbreak of Ebola virus disease has been acknowledged as a global health priority, not only because of the number of cases, but also because of the prolonged duration for which it persisted, the number of nations affected, and associated high case-fatality rate. [1] In fact, since its emergence in March 2014 to mid-June 2015, almost 27,341 cases and 11,184 associated deaths have been reported among the 10 affected nations worldwide. [2] However, in Liberia alone, 4716 (42.8%) number of deaths have been reported (case-fatality rate - 44.6%), which is highest among all the involved countries, and is even the second leading nation with regard to the total number of cases (10,564), next only to Sierra Leone. [2],[3]

On the May 9, 2015, Liberia was declared free of Ebola transmission by the World Health Organization (WHO), because of no detection of any laboratory-confirmed cases since last 6 weeks, with the last confirmed case being buried on March 28, 2015. [4] Although, the start of the outbreak in Liberia was misleading, with the scarce number of cases being reported in March-May 2014, and not an alarming trend even in June (when compared with Guinea and Sierra Leone), the scenario became very serious in August and September 2014 (as 300-400 new cases were being reported each week). [4]

In these couple of months, day-to-day lives of people were significantly affected as no vacant beds were available in the treatment centers, patients started to succumb within the hospital premises, corpses were not buried for days together, most of the flights were cancelled, shortage of food supply, and fuel was widely seen, the major proportion of institutions, including health facilities were closed, and a sense of fear and uncertainty prevailed among families and communities. [4],[5] However, the health professionals continued to exercise their duties even in periods when there was a scarcity of personal protective equipment, and in the process around 375 health workers were infected, of whom 189 died. [4] Anyway, in response to the concerted efforts by the WHO in the form of establishing the treatment center, the outbreak began to subside in late October, with case-fatality rates remarkably reduced, and since late March this year no cases were reported. [4],[5],[6]

The critical review of the efforts made in Liberia in response to an Ebola outbreak highlighted the role of multiple factors which eventually enabled the nation to defeat the disease. These factors include strong leadership and clear vision by the policy maker by declaring the disease as a public health priority to all the concerned departments; active involvement of the stakeholders (viz., village heads, religious leaders, women associations, youth groups, etc.) of the community by developing a sense of need among them; increasing the level of faith and neutralizing any rumors about the disease among the local people - by building see-through walls in treatment centers so that people can watch the proceeding or developing mechanism to respond promptly to transport calls or by sensitizing the health professionals to build confidence among local residents; strengthening of the treatment facilities (by creating medical units, treatment centers, logistics support) and laboratory network by establishing five dedicated Ebola laboratories; courageous attitude of the local volunteers; enormous support from the international community (viz., monetary assistance, human resources - deployment of foreign medical teams, etc.); and well-coordinated national and international response. [4],[6],[7],[8]

Even though, Liberia has been declared Ebola-free, nevertheless, the Government of Liberia should remain on high alert and continue their surveillance and contact tracing activities, as the Ebola outbreak still persist in neighboring Guinea and Sierra Leone, and there is a potential risk of re-emergence of the disease across the borders. [4],[5] Further, there is a significant need to strengthen the other health care services (like maternal and child health including immunization), as all of them took a back seat, while the outbreak of Ebola was ongoing in the nation. [9]

To conclude, achievement of the Ebola-free status by Liberia is a remarkable achievement for the local people, public health sector, and the international agencies which have assisted the nation in conquering all the existing challenges, and finally interrupting the endemic transmission of the disease. This accomplishment represents only half a battle won and should serve as a learning lesson for other Ebola affected nations to work in an effective manner to completely eliminate the disease completely from the West-Africa.

 
  References Top

1.
Arwady MA, Bawo L, Hunter JC, Massaquoi M, Matanock A, Dahn B, et al. Evolution of Ebola virus disease from exotic infection to global health priority, Liberia, mid-2014. Emerg Infect Dis 2015;21:578-84.  Back to cited text no. 1
[PUBMED]    
2.
World Health Organization. Ebola Situation Report - 17 June, 2015; 2015. Available from: http://www.apps.who.int/ebola/current-situation/ebola-situation-report-17-june-2015. [Last accessed on 2015 Jun 20].  Back to cited text no. 2
    
3.
Helleringer S, Noymer A. Magnitude of Ebola relative to other causes of death in Liberia, Sierra Leone, and Guinea. Lancet Glob Health 2015;3:e255-6.  Back to cited text no. 3
    
4.
World Health Organization. The Ebola Outbreak in Liberia is Over; 2015. Available from: http://www.who.int/mediacentre/news/statements/2015/liberia-ends-ebola/en/. [Last accessed on 2015 May 11].  Back to cited text no. 4
    
5.
Chan M. Ebola virus disease in West Africa - No early end to the outbreak. N Engl J Med 2014;371:1183-5.  Back to cited text no. 5
    
6.
Reed P, Giberson S. The Monrovia medical unit: Caring for Ebola health care workers in Liberia. Disaster Med Public Health Prep 2015;9:1-2.  Back to cited text no. 6
[PUBMED]    
7.
Abramowitz SA, McLean KE, McKune SL, Bardosh KL, Fallah M, Monger J, et al. Correction: Community-centered responses to Ebola in Urban Liberia: The View from Below. PLoS Negl Trop Dis 2015;9:e0003767.  Back to cited text no. 7
[PUBMED]    
8.
World Health Organization. WHO strategic response plan 2015: West Africa Ebola outbreak. Geneva: WHO Press; 2015.  Back to cited text no. 8
    
9.
Takahashi S, Metcalf CJ, Ferrari MJ, Moss WJ, Truelove SA, Tatem AJ, et al. Reduced vaccination and the risk of measles and other childhood infections post-Ebola. Science 2015;347:1240-2.  Back to cited text no. 9
    



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