The end of the epidemic ?

On 14 January 2016 Liberia was (once again) declared ebola-free by the World Health Organization. This meant that the end was almost in sight for the largest outbreak of ebola in history, as Sierra Leone was declared ebola-free on 7 November 2015, and Guinea on 29 December 2015. Unfortunately, on 15 January a new case of the disease was discovered in Sierra Leone. This means that the epidemic in West Africa is still not completely under control, but we hope that the end is in sight.

The 3 affected countries have now entered a 90-day period of enhanced surveillance, which will need to be maintained over a longer period in order to detect sporadic cases as quickly as possible and to take action to prevent new outbreaks.

The outbreak in West Africa, from December 2013 till January 2016, was the worst ebola outbreak ever reported, not only because of the high number of cases (28.637) and deaths (11.315), but also because the cases were so widely spread. Ebola outbreaks usually occur in remote rural areas. For the first time, however, the epidemic has also affected urban areas, which has led to the disease spreading like never before.

With more than 17,000 ebola survivors in the three affected countries, there is also a large population at risk of sporadic flare-ups or late complications, as we have seen during the past few months. The virus may persist for a long time in the human body, for instance in semen and ocular fluids, and as a result may cause new infections.

We also have to remain vigilant for occasional cases of other viral haemorrhagic fevers in travellers, such as Marburg virus disease, Lassa fever, Crimean-Congo haemorrhagic fever,…

What does this mean for health workers in Belgium ?

As the end of the epidemic is in sight, the risk of exposure to a patient infected with ebola in Belgium is extremely small, but still there. There is always a risk of new flare-ups, isolated cases or an epidemic caused by a new, similar virus.

That is why it is advisable to remain vigilant when dealing with travellers who are ill.

In particular, we would like to propose the following guidelines :

• Stay informed. Please consult this website, the website of the Institute of Tropical Medicine (ITM) and the website of the Scientific Institute of Public Health for epidemiological updates.
• Take a detailed case history of every patient returning from the tropics with a fever, giving special attention to travellers who came into contact with people who were ill, with bodies of the deceased, with bodily fluids and/or with dead animals.
• In case of doubt, apply a low threshold to treat the patient in droplet/contact isolation for the time being, and immediately consult a physician responsible for infectious disease control, a local infectiologist or the ITM physician on call. The three reference hospitals (the Leuven University Hospital, the Saint-Peter’s Hospital in Brussels and the Antwerp University Hospital) will remain prepared to treat patients with probable or proven viral haemorrhagic fever.