Aspects épidémiologiques de la maladie à virus Ebola en Guinée (décembre 2013–avril 2016)

Abstract

Ebola Zaire species variant Makona between its emergence in December 2013 and April 2016, resulted in an epidemic of Guinea importance and unprecedented gravity with 3814 reported cases of which 3358 were confirmed (88.0%) and 2544 were died (66.7%). The epidemic has evolved in phases: a silent phase without identification of all fatal cases until February 2014; a first outbreak from March 2014, when the alarm is raised and the virus detected, which lasted until July 2014; a second increase, which was the most intense, from August 2014 to January 2015 focused primarily on the forest Guinea; and a final increase from February 2015 centered on lower Guinea and the capital Conakry. Adapting strategies in 2015 (initiative "Zero Ebola in 60 days" active case search and suspicious deaths and awareness of active prefectures, microbanding the last affected communities and raking around these localities) and ring vaccination of contacts around confirmed cases has allowed to gradually control the main outbreak in October 2015. But a survivor was originally resurgence in forest areas between March and April 2016 with 10 cases including 8 deaths. The epidemic has particularly affected the forest Guinea region (44% and 48% of Guinean cases and deaths), elderly women (≥ 50 years), and health professionals (211 cases including 115 deaths); however, almost one-third of the patients (32.6%) was not provided supportive care in the Ebola centers. The epidemic is currently marked by the resurgence of small foci, from excreting subjects cured of the virus who have been controlled so far successfully. The survivors are the subject of special attention. It is necessary to learn lessons from the response to better prepare for the future, to improve knowledge about the natural history of the Ebola virus disease, and to rethink communication in this regard with the public and its leaders.

Unsafe Burials: Challenge to Controlling Local Ebola Outbreaks in Guinea 2015–2016

“…As of April 2016, delayed reporting of suspect cases and unsafe burials continued to be a major contributor to the transmission of Ebola virus in Guinea despite previous efforts made by local and international responders [4,7]. A previous report described the largest documented transmission of Ebola virus from delayed case reporting and unsafe burials in Guinea from December, 2014-January 2015 [11].…”

“…Collaboration and trust from the population, respect of local customs and religious practices, accommodation of cultural preferences to the extent that they do not endanger the living, and involvement of the population in resolving the challenges of incompatible cultural and public health practices are essential for the interventions to succeed. These social and cultural factors have been shown to be very effective in other studies to improve awareness among groups that might be resistant to Ebola intervention efforts [4,[14][15]. Involvement of community leaders in the planning and implementation of these interventions and community acceptance of safe burial practices which could be culturally sensitive is critical for the successful management and prevention of future Ebola outbreaks.…”

“…As of June10, 2016, Ebola virus disease (EVD) has killed over 11,000 persons in Guinea, Liberia, and Sierra Leone [3]. In Guinea alone, it has affected over 3,800 persons and reportedly killed 2,544 persons [4]. Guinea was declared Ebola free in December 2015 by WHO, however, resurgence of EVD in Guinea during FebruaryApril 2016 underscored the need for improved training on prompt case reporting and safe burials of corpses infected with Ebola.…”

“…However, as of June 2016, seven documented clusters have occurred following control of the epidemic; rapid and coordinated efforts controlled all occurrences. The recent resurgence of EVD in Guinea has been linked to possible sexual transmission of the virus in the semen of a male survivor [4,8]. This resurgence coupled with delayed case reporting and increased viral transmission through unsafe burials remains a challenge for controlling Ebola outbreaks.…”

Qu’apprend-t-on de nouveau des épidémies émergentes ?

“…Rappelons les faits concernant l'alerte initiale en Guinée. Les autorités sanitaires lancèrent l'alerte nationale le 13 mars 2014, plus de deux mois après le décès du cas index, le 23 décembre 2013, un enfant de 18 mois du village de Méliandou dans la préfecture de Guéckédou en Guinée forestière [13][14][15]. L'alerte internationale fut ensuite rapidement lancée le 23 mars 2014 après la confirmation biologique.…”