Vulnerability, hysteria and fear - conquering Ebola virus.

Since the current International Health Regulations were implemented in 2007, the World Health Organization has declared only three events to be public health emergencies of international concern: the 2009 H1N1 infl uenza pandemic, the recent resurgence of polio and, now, the Ebola virus disease (EVD) outbreak in West Africa.1 The species circulating in West Africa, Zaire ebolavirus, carries the highest mortality of the fi ve known species of the genus Ebolavirus.2 Symptoms of EVD include fever, myalgia, severe diarrhoea and vomiting and, in some instances, internal and external haemorrhaging. Beyond the medical emergency, affected communities face signifi cant disruption to their lives and livelihoods. Impacts documented in the current outbreak include stigmatising of people who are suffering from or have recovered from the disease, and food insecurity due to quarantined villages being unable to plant or harvest produce. Ebola virus is transmitted via direct contact with blood, other bodily fl uids or contaminated fomites.3 Spillover from animals into humans typically occurs through hunting, butchering and consumption of bushmeat (especially primates), as well as possible transmission from bats.4 Human-to-human transmission follows when people care for patients or infected family members or participate in traditional burial practices.5 Health care workers who have close contact with patients in the absence of strict infection control measures are at signifi cant risk. The fi rst known outbreak of EVD occurred simultaneously in the Democratic Republic of Congo and Sudan in 1976, culminating in over 600 cases and a case-fatality rate (based on identifi ed cases) in excess of 70%. Since then, several outbreaks have been identifi ed in humans and other primates in Central and East Africa.4 The current EVD outbreak in West Africa, where outbreaks have not previously been identifi ed, is the largest recorded. In this outbreak, early cases of EVD went unrecognised as health care workers not familiar with the disease assumed it to be Lassa or yellow fever (both endemic in the region) or malaria. Recent serosurveys suggest that Ebola virus, either Zaire ebolavirus or Bundibugyo ebolavirus, may have been circulating in Sierra Leone as early as 2006.6 What led to the spread of the virus so far west is uncertain. Possibilities include transmission by bats, transportation, an infected traveller, or handling and consumption of bushmeat.2 In an unprecedented development, the WHO has endorsed the use of experimental drugs in the current outbreak, although these are in short supply.7 Hence, control efforts are focused on patient isolation, infection control practice and communication of risk reduction messages in affected communities. Anthropologists have been deployed to provide culturally appropriate responses through better understanding of local customs and perceptions. For instance, in the 2000 Uganda outbreak, isolation areas were initially surrounded with opaque tarpaulins to protect patient privacy, with deceased patients being immediately placed in bags and disposed of rapidly. From the local perspective, ill people would disappear into the isolation units, never to be seen again, and family members were denied the right to grieve according to tradition. Adapting to this information, medical teams removed the tarpaulins so that family members could see their relatives and escort their bodies to the burial grounds.8 Outside West Africa, there are concerns that the virus will spread via an infected traveller arriving at an international airport. Australia is well prepared for such a possibility. The Australian Government Department of Health provides extensive guidance for the public, health care professionals and laboratories, and risk assessment guidelines and management Sources of information on Ebola virus disease from Australian federal and state health departments