Ebola Virus Disease in West Africa — The First 9 Months

The n e w e ng l a n d j o u r na l of m e dic i n e c or r e sp ondence Ebola Virus Disease in West Africa — The First 9 Months To the Editor: The World Health Organization (WHO) Ebola Response Team (Oct. 16 issue) 1 predicted that the current Ebola epidemic would claim a dreadful 20,000 combined cases by early November 2014, assuming no change in the con- trol measures applied in West Africa. The threat that Ebola poses to national public health and social, economic, and security foundations may worsen if a secondary epidemic eventually ex- plodes in the region. Since June 2014, nearby Ghana has been affected by a serious cholera epidemic that was responsible for 12,622 cases as of September 6. 2 Current cholera and Ebola zones are separated by Ivory Coast, a frequent crossing point for commuters traversing West Africa. To effectively control cholera epidemics, specialized treatment centers, access to potable water, sani- tation, and community hygiene awareness are critical. However, in Ebola-affected areas, quaran- tine units are overwhelmed, many health facili- ties are dysfunctional after the desertion by staff members who fear viral contamination, and it has become increasingly dangerous to conduct awareness campaigns owing to violence against health and humanitarian workers accused of this week’s letters 188 Ebola Virus Disease in West Africa — The First 9 Months 189 Goal-Directed Resuscitation in Septic Shock 191 Malpractice Reform and Emergency Department Care 193 Physiological Approach to Acid–Base Disturbances 196 Inefficacy of Platelet Transfusion to Reverse Ticagrelor spreading Ebola. Likewise, neglecting to rapidly control this cholera epidemic in Ghana could have unpredictable yet potentially devastating consequences. Stanislas Rebaudet, M.D., Ph.D. Assistance Publique–Hopitaux de Marseille Marseille, France Sandra Moore, M.S., M.P.H. Renaud Piarroux, M.D., Ph.D. Aix–Marseille University Marseille, France renaud.piarroux@ap-hm.fr No potential conflict of interest relevant to this letter was re- ported. 1. WHO Ebola Response Team. Ebola virus disease in West Africa — the first 9 months of the epidemic and forward projec- tions. N Engl J Med 2014;371:1481-95. 2. Cholera outbreak in the West and Central Africa: regional update, 2014 (week 35). New York: UNICEF (http://www.unicef .org/cholera/files/Cholera_regional_update_W35_2014_West_ and_Central_Africa.pdf). DOI: 10.1056/NEJMc1413884 To the Editor: The WHO Ebola Response Team describes the epidemiology of Ebola virus dis- ease (EVD) in West Africa using anonymized pa- tient-level data generated from EVD surveillance in multiple countries. These data document the demographic profile of patients with EVD, their risk factors, and the course of their illness. We regret that the WHO neither makes this data set publicly available nor provides an interface to ex- tract customized tabulations. Such data sharing could accelerate the discovery of key factors in the epidemic and could yield insight into the eco- nomic and demographic drivers of the outbreak. It would also permit a better assessment of pos- sible control scenarios. Current models of EVD transmission 1,2 are parameterized with the use of outdated data from much smaller Central Afri- can outbreaks, which limits their applicability to West Africa. Some patient-level data sets collect- n engl j med 372;2 nejm.org january 8, 2015 The New England Journal of Medicine Downloaded from nejm.org at UC SHARED JOURNAL COLLECTION on January 11, 2015. For personal use only. No other uses without permission.