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93 Days

If you haven't watched 93 Days by now, we suggest you do. This is your warning: the blog post has 'spoilers'. Netflix recently re-released the film so we thought it was only right that this week we bring you a blog post on Ebola virus. We're especially interested as it was a team of heroic black health professionals that were behind the exemplary response to the 2014 outbreak in Lagos, Nigeria.

Ebola virus disease, sometimes referred to as Ebola haemorrhagic fever, is a viral illness with sudden symptoms of fever, fatigue, muscle pain and headache noticed 2 to 21 days after infection. Fruit bats of the Pteropodidae family are thought to be natural Ebola virus hosts. The Ebola virus is introduced to the human population when in exposed to body fluids of said fruit bats or those of other infected animals such as chimpanzees, gorillas, forest antelopes (World Health Organisation, WHO). Ebola can then spread via direct human-human contact with the blood or body fluids of an infected individual. A diagnosis of Ebola is determined via various diagnostic methods (you can read more about these here).

Ebola’s first records are simultaneous outbreaks in Nzara, South Sudan and Yambuku, Republic of the Congo (DRC) in 1976. The virus has gained a reputation of high fatality with an average case fatality rate of 50%; however, some fatality rates have been as high as 90%.

Starting in December 2013 in Guinea, the 2013-2016 outbreak in Africa was considered the largest Ebola outbreak to date. Nigeria was the first country in western Africa to report an Ebola contamination during this outbreak in August 2014 (Index case: Patrick Sawyer)*. It is rumoured that Sawyer was known to have been exposed to the Ebola virus but 11 days prior to his travels but communication between government and health officials were lacking. In 93 Days, Sawyer is shown to be bought hospital after collapsing at Murtala Muhammed International Airport in Lagos, Nigeria. Nigerian health officials quickly recognised the symptoms and placed Sawyer under quarantine.

Dr Ameyo Adadevoh played a central role in combatting the 2014 outbreak by preventing Sawyer from leaving the hospital and placing them under quarantine. This action likely saved the lives of thousands by controlling the spread of the virus in Nigeria. The dedicated work of health and science professionals during this time is not to be forgotten.

By September 2014, the Nigeria Health Ministry reported that there were no known cases of Ebola in Nigeria. Nigerian officials used 'contact-tracing' to follow 529 contacts, each with a 21-day mandatory period of surveillance. It is a method used to identify people who have come in contact with the infected person. These quick, intense and large-scale operations have been acknowledged worldwide for their “world-class epidemiological detective work” (WHO). In total there are 8 reported deaths of Ebola in Nigeria (including Sawyer and Dr Adadevoh) and 20 confined cases: a 40% case fatality. Following successful containment, Nigeria then sent 600 volunteers to other countries, such as Sierra Leone and Liberia, to assist in the curbing the spread of the virus there as well. Nigeria’s method of contact-tracing was also adopted by other countries, such as the United States, when Ebola threats emerged.

In previous outbreaks, Ebola cases have been fought with rehydration and symptom-specific treatments to improve the chances of survival. However, in the current Ebola outbreak in Kivu (eastern DRC), the rVSV-ZEBOV vaccine is being used as a defence against ongoing infection. The rVSV-ZEBOV vaccine is an experimental vaccine against Ebola. Initial data indicates that the vaccine is effective at preventing infection; success rates are near 100% in trials when used in ring vaccination [1]. It is important to note that this was a sample group and numbers/effectiveness, in reality, are therefore unlikely to be as high.

So, what does this vaccine mean for countries facing Ebola outbreaks? As with the approval of many new vaccines, there may be some scepticism surrounding its deployment and place in this current day of medicine. However, with now manageable adverse effects of headache and fatigue, there is much hope for the rVSV-ZEBOV vaccine's future along with other vaccines being developed against the virus. Many science and health professionals are hopeful that one day, Ebola will be considered a thing of the past.

*For more information on the West African Ebola epidemic timeline

By Tomi Akingbade, Founder

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