TORONTO – The struggle to control the world’s first recorded Ebola outbreak may hold clues as to how the raging epidemic of the disease in West Africa can be contained, say two men who led that 1976 effort.
Clear designation of responsibilities and authority, transparency and co-ordination of partners were essential to the campaign to stop that first outbreak, Dr. Joel Breman and Dr. Karl Johnson wrote in an article published online Wednesday by the New England Journal of Medicine.
That epidemic occurred at Zaire, now the Democratic Republic of Congo. During the outbreak, 318 people were known to have been infected and 280 of them died. The same subtype of Ebola — Ebola Zaire — is responsible for the current West African outbreak.
Breman and Johnson, who were with what is now the U.S. Centers for Disease Prevention and Control, were sent to Zaire to help extinguish the spread of what had been determined to be a new filovirus. Breman became the chief of surveillance, epidemiology and control, Johnson the scientific director of the International Commission for the Investigation and Control of Ebola Hemorrhagic Fever in Zaire.
In the article, the two talk about the challenges and what worked, mentioning door-to-door canvassing for undetected cases.
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They also report that some villages used a tool that was a holdover from the days of smallpox — they would isolate patients in huts outside of villages. A family member, sometimes someone who had survived the illness, was designated to bring the sick people food and medicine.
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Breman said the tactic was useful and could perhaps help in the current situation. In some of the worst affected places in this outbreak, there are far too few treatment beds available to handle all the cases. That means sick people are being cared for by their families, putting them at risk.
“We explained that it was a good idea and to do more of it,” Breman said in an interview.
Earlier this week, the World Health Organization raised concerns about the movement of Ebola cases in affected communities, noting that taxis may be playing an amplifying role in transmission of the virus.
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Multiple family members, sick and well, pile into taxis that take them from one treatment facility to another looking for an available bed. But there are none, the WHO said.
“When you start moving patients around, particularly when they get in an urban scenario, clambering for a hospital (bed), jumping in taxis … you’re going to contaminate the community,” Breman said.
“Local isolation is a public health response.”
Breman and Johnson said that in the current outbreak a top priority is to have enough staff do surveillance, find new cases and care for them and their contacts. That remains a problem: the International Society for Infectious Diseases put out an urgent call Wednesday for clinicians to volunteer for the containment effort.
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“Timely control will require convincing community leaders and health staff that isolation and rapid burial practices are mandatory; that patients can be cared for safely in improved local conditions; and that only trained, qualified, and properly equipped health staff should have patient contact,” Breman and Johnson wrote.
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On the Web:
The article and a slide show of pictures from the 1976 outbreak can be seen on the New England Journal’s website at http://www.nejm.org/doi/full/10.1056/NEJMp1410540
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