An extraordinary event and an international emergency is how the World Health Organization (WHO) has described the outbreak of Ebola in four West African countries. The current epidemic, which began in Guinea in December 2013, now involves transmission in Guinea, Liberia, Nigeria, and Sierra Leone. With the number of deaths already passing 1,000 by mid-August, this is currently the largest Ebola outbreak ever recorded, said the WHO.

In response to the outbreak, a number of unaffected countries have made a range of travel related advice or recommendations. The WHO has said that the possible consequences of further international spread of the killer disease are particularly serious in view of the virulence of the virus and weak health systems in the currently affected countries. The coordinated international response is deemed essential to stop and reverse the international spread of Ebola, said the WHO. Ebola has no licensed vaccine or treatment and is one of the most virulent viral diseases known to humankind, leaving death in its wake.

The affected African countries are particularly vulnerable to Ebola as their health systems are fragile with significant deficits in human, financial and material resources, resulting in compromised ability to mount an adequate Ebola control response and inexperience in dealing with Ebola outbreaks, said the WHO. Misperceptions of the disease, including how the virus is spread, are other major challenges.

The virus, originally discovered on the continent, has now spread to different parts of the world, according to the latest medical reports by the WHO and the U.S. Centers for Disease Control and Prevention (CDC).

Advanced laboratories

As the deadly Ebola virus continues to sweep across West Africa, Kenyan advanced medical facilities are being used to tackle the lethal disease. Kenya has five level four laboratories suitable for dealing with the virus. This is according to Dr. Kevin De Cock, Director of the Center for Global Health at CDC, who spoke to ChinAfrica from Liberia, where the Ebola situation is grave. Level four laboratories are the most advanced of their kind.

"Level four laboratories have the capacity to store viruses and other pathogens of all ailments in safe modes. From HIV, Marburg virus, Ebola and other diseases, the labs have the capacity to diagnose the pathogens more effectively compared to other labs of lower levels," he said.

"Kenya, Egypt and South Africa are the only countries on the continent with such high level laboratories," said De Cock.

Suspected Ebola disease specimens have been brought to Kenya from other regions, especially West Africa, for testing, due to the advanced lab facilities in the East African country. The disease, according to De Cock, has been spreading at alarming levels since it was first discovered in Africa in 1976.

The level four labs are very advanced but there are few in the developed world. This is because of ethical issues, such as fear that bio-terrorists can hijack them. The United States only has less than seven of them, according to the National Institute of Health, while the United Kingdom has only three.

In West Africa, where the Ebola virus has spread significantly, the most advanced labs are level three, severely hampering their capacity to combat the disease.

"Nigeria and other countries in West Africa that have been affected by Ebola are continuously sending specimens to Kenya for testing. Kenyan labs can easily handle the Ebola virus once confirmed at the highest security standards. That is because level four labs are the most advanced in the world," said De Cock.

The Canadian and U.S. governments, CDC and the University of Manitoba fund these advanced medical labs in Kenya. The Kenyan Government has also contributed a portion of the funds.

East Africa is now taking preventive measures such as using travel bans and quarantining suspected Ebola carriers, while at the same time accepting pathogen specimens for diagnosis from people suspected to have the disease. The specimens are then stored for future use in research and other scientific studies.

Banned flights

From August 19, Kenya slapped a temporary ban on the entry of passengers from and through Ebola affected West African countries as the disease continues to spread. It had already set up a 20-bed Ebola isolation unit at the Kenyatta National Hospital in April. 

Uganda and Nigeria on the other hand are testing most passengers who arrive at its ports of entry.

De Cock, an epidemiologist and a virologist by profession and a former director of the WHO and CDC Kenya, said the need to find both an effective vaccine and a cure for Ebola is very important as the disease, if ignored by authorities, has the potential to be a worse epidemic than HIV in the first decades when it first emerged almost 40 years ago.

"Even till today, HIV is a threat, since there is no reliable vaccine and the current drugs that treat HIV are increasingly becoming resistant to the virus. But compared to Ebola, so far a lot has been achieved globally. We, as experts, do see Ebola terrorizing the whole globe if we just rely on ineffective preventive measures such as global travel bans," said De Cock.

Untested vaccine - ethical dilemma

De Cock recently spent time traveling around the world monitoring the status of the disease and said an emergency global Ebola conference took place in Geneva in early August.

He said the only drug that is being used to treat Ebola to date is known as ZMapp. Developed by American researchers, it is more of an experimental drug. However, it has so far shown promising results. But he said its efficacy is just the tip of the iceberg as scientific research on a vaccine and cure is still far from conclusive.

A WHO panel of experts concluded that in the circumstances of the current Ebola outbreak it is ethical to offer unproven interventions with as of yet unknown efficacy and adverse effects, as potential treatment or prevention.

In Africa, vaccine initiatives have taken place in West Africa, mostly Nigeria. The United States and the United Kingdom are also working on various initiatives.

Kenya's Health Cabinet Secretary, James Macharia, confirmed that the country would set up additional isolation facilities.

"Kenya is at a huge threat of catching Ebola. We have had a few cases in recent years so we can't take any risks. We are working closely with transport authorities to make sure Ebola does not enter Kenya. The last thing we want is to ban or restrict flights. If that will be the case, then we will have to suspend flights until the situation calms down. It is a serious global problem and decisions have to be made jointly by countries," he said.

"We are also purchasing items to equip our hospitals as we tackle Ebola," said Macharia at a recent Nairobi news conference.

Germano Mwabu, Professor of Economics at the University of Nairobi, said the situation with Ebola, particularly in Kenya, could affect the economy, especially tourism.

"If the disease gets out of control and there is a big possibility it can, then there will be economic consequences for the country. Already Western countries have put travel bans on Kenya as terrorism takes center stage. So further international bans will hurt the tourism sector," he said.

"Also on the other hand if people continue to get sick and die, then the workforce will be less and cost companies financial losses as there would be no one to do the work. Fighting Ebola needs team work," Mwabu told ChinAfrica.

Macharia confirmed that the government would be setting up a health task force to tackle epidemic diseases such as Ebola.

"You are looking at a global problem - Ebola is real. We are looking at a disease that has the potential to wipe out the human race if it is not contained, not just in East Africa, but also globally. So countries [working] through the WHO have to work as a team," said Macharia.

He said Kenya would also launch vaccine initiatives on the deadly disease, probably before the end of the year.

Health insurance

Health Insurance companies are now on high alert and many are counting losses on payouts in case of an outbreak in the East African region. Economists and doctors estimate that many could incur great losses, further affecting the health sector.

"In my private clinic, a lot of medical services payments are from health insurance companies. Most patients do not pay cash, but they pay from their health cover. I get about 1,000 patients visiting my facility each month. They risk running out of cash and that may be a worry but not for now," said Dr. Evan Abwao, a Nairobi-based private doctor.

He also said that some companies may collapse if they don't prepare well, but feels the country's medical fraternity is however confident they are ready to deal with an outbreak.

Dr. Shanaz Shariff, Kenya's Director of Public Health, said based on availability of funds, a vaccine initiative on Ebola could begin this year in Kenya.

"We do expect to work with partners such as the CDC. There is great hope in the initiative taking place before December, but it will depend on a lot of issues such as finance. We do expect a few vaccine collaborations as we have held talks with different partners," said Shariff. CA

(Reporting from Kenya)

Ebola Key Facts

» Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.

» EVD outbreaks have a case fatality rate of up to 90%.

» EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.

» The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.

» Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.

» Severely ill patients require intensive supportive care. No licensed specific treatment or vaccine is available for use in people or animals.

» Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo.

» EVD is often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function.

(Source: WHO)

Ebola Air Travel Transmission Low

On August 14, the World Health Organization (WHO) reiterated its position that the risk of transmission of the Ebola virus disease during air travel remains low. Ebola is not airborne and can only be transmitted by direct contact with the body fluids of a person who is sick with the disease. On the small chance that someone on the plane is sick with Ebola, the likelihood of other passengers and crew having contact with their body fluids is low. The WHO is therefore advising against travel bans to and from affected countries.

(Source: WHO)

AU Calls for Continental and Global Action

The African Union (AU) Commission has commended the ongoing continental and global efforts to turn the tide against the Ebola outbreak in Guinea, Sierra Leone and Liberia. The current epidemic is the biggest and most complex that the West African region has experienced since the first human outbreak occurred in 1976.

"The response to the Ebola outbreak needs concerted continental and global action to address the epidemic which poses a threat to global health and development," said Dr. Nkosazana Dlamini Zuma, Chairperson of the AU Commission.

In a statement, the AU said cases have since been recorded in the Federal Republic of Nigeria. There is a possibility that the outbreak may spread to other countries in West Africa and beyond if effective measures including community engagement are not put in place. Various mechanisms will need to be put in place to ensure that African countries are prepared to deal with the threat.

Efforts by the AU Commission to mobilize member states, partners and the international community to complement the efforts of the affected countries, especially in replenishing the African Public Health Emergency Fund, are underway, said the statement. More resources are needed to meet the needs on the ground including the deployment of several hundred medical personnel in affected countries to ease the strain on overstretched treatment facilities.

The AU said various actions that are needed to stop the epidemic include strengthening surveillance systems and community education. The Ebola outbreak has further provided the impetus to urgently speed up the establishment of the African Center for Disease Control and Prevention for early detection, preparedness and response, said the statement.