Jul 21, 2018 Volume 392 Number 10143 p187-252 e4-e5
Ebola virus disease: 11,323 deaths later, how far have we come?
Joseph A Lewnard
…The data presented by the Ebola Outbreak Epidemiology Team indicate key areas of progress since the 2014 outbreak in west Africa. By contrast with a 5·0 day average time from illness onset to hospitalisation in that outbreak, and 4·7 days in an outbreak in the Democratic Republic of the Congo in the same year, the median time from illness onset to first hospitalisation was 1 day (range 0–10).2, 3, 4 Rapid case ascertainment and isolation narrows a crucial period of transmission risk within households and communities, and was facilitated by installation of Ebola virus disease treatment centres in Bikoro, Iboko, and Mbandaka by Médecins Sans Frontières mere days after the outbreak declaration.1 Modelling studies indicate that such timely mobilisation could have averted thousands of deaths from Ebola virus disease in west Africa,5, 6 many outside the doors of treatment centres that were already operating at capacity.
An efficacious, field-tested vaccine (rVSV-ZEBOV) is among the most important developments since 2014.7 Within 2 weeks of the outbreak declaration, more than 7500 doses were delivered to the Democratic Republic of the Congo for administration to primary and secondary contacts of cases. The authors report coverage among 496 of 504 vaccine-eligible contacts as of May 30, 2018;2 by June 16, 2920 contacts had been reached.1 On-the-ground vaccination teams—some operating in communities without electricity or telecommunications, and maintaining −70°C cold chains on the backs of motorcycles2, 8—have performed a heroic feat in this first use of the vaccine outside Guinea. Ongoing studies of clinical outcomes, immunological parameters, and adverse events among recipients will provide important data about vaccine safety and effectiveness…