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Public health professionals may be confronted with unique ethical challenges in outbreak response situations. We conducted interviews with twenty-two public health professionals involved in responses to the 2014–2015 Ebola epidemic in Sierra Leone and Liberia to explore how they understood and experienced the ethical challenges involved in this work. The concerns covered in these interviews ranged dramatically, but three themes emerged as unique contributions from a subset of individuals integrally involved with the frontline response, who framed concerns about representation as key ethical issues. These included concerns regarding misrepresentations of West Africans as 'resistant' to the epidemic response, failures in material and information resources provided in the response, and representations of 'rationality' between responders and publics. Such concerns suggest that perspectives advanced in the critical public health literature in recent decades are circulating amongst public health professionals involved in outbreak response, although discord amongst respondents suggests the need for more deliberate efforts to reframe thinking about resistance, resources, and rationality in future public health outbreak responses. [ABSTRACT FROM AUTHOR]

During an Ebola outbreak, the WHO recommends that health professionals consider people as suspect cases (SCs) when they show key signs such as the sudden onset of high fever or specific symptoms after having had contact with a suspect or confirmed Ebola case. SCs should then get care, be isolated and be reported to health authorities until the Ebola virus disease is confirmed through a lab test. This exploratory study aims to understand this identification process in the field based on a qualitative analysis of the diagnosis and therapeutic itineraries of 19 SCs in Cote d'Ivoire and Senegal (2014-2015). Results indicate that the main criteria for SC identification at the field level were fever (understood broadly) and provenance from a highly affected country (applied indiscriminately). WHO criteria were not followed in at least 9 of the 19 cases. Several medical, social and cultural factors favour over-identification of people as SCs, including relativism in defining 'high fever', placism, humanitarian or securitarian bias, issues in categorising SC's contact cases, and the context of fear. To avoid undue categorisation and its possible harmful social effects, the WHO definition should be implemented more carefully in various contexts and with greater consideration for ethical issues, while prioritising diagnosis strategies with higher specificity. [ABSTRACT FROM AUTHOR]

Background: After the detection of an Ebola virus disease outbreak in west Africa in 2014, one of the elements of the response was to contact trace and isolate patients in specialised Ebola treatment units (ETUs) at onset of fever. We aimed to assess the economic feasibility of administering preventive malaria treatment to all contacts of patients with Ebola virus disease, to prevent the onset of febrile malaria and subsequent admission to ETUs.Methods: We used a decision tree model to analyse the costs of preventive malaria treatment (artemisinin-based combination treatment [ACT]) for all contacts of patients with Ebola virus disease (in terms of administration and averted ETU-stay costs) and benefits (in terms of averted ETU admissions) in west Africa, from a health-care provider perspective. The period of analyses was 1 year, which is roughly similar to the duration of the 2014-15 west Africa Ebola outbreak response. We calculated the intervention's cost per ETU admission averted (average cost-effectiveness ratio) by season (wet and dry), country (Liberia, Sierra Leone, and Guinea), and age of contact (<5 years, 5-14 years, and ≥15 years). We did sensitivity analyses to assess how results varied with malaria parasite prevalence (in children aged 2-10 years), daily cost of ETU stay (for Liberian malaria incidence levels), and compliance and effectiveness of preventive malaria treatment.Findings: Administration of ACTs to contacts of patients with Ebola virus disease was cost saving for contacts of all ages in Liberia, Sierra Leone, and Guinea, in both seasons, from a health-care provider perspective. In the wet season, preventive malaria treatment was estimated to reduce the probability of a contact being admitted to an ETU by a maximum of 36% (in Guinea, for contacts aged <5 years), and a minimum of 10% (in Guinea and Sierra Leone, for those aged ≥15 years). Assuming 85% compliance and taking into account the African population pyramid, the intervention is expected to be cost saving in contacts of all age groups in areas with malaria parasite prevalence in children aged 2-10 years as low as 10%. In Liberia during the wet season, malaria preventive treatment was cost saving even when average daily bed-stay costs were as low as US$5 for children younger than 5 years, $9 for those aged 5-14 years, and $22 for those aged 15 years or older.Interpretation: Administration of preventive malaria treatment to contacts of patients with Ebola virus disease should be considered by public health officials when addressing Ebola virus disease outbreaks in countries and seasons where malaria reaches high levels of transmission.Funding: Centers for Disease Control and Prevention. [ABSTRACT FROM AUTHOR]

Background By September 2014, an outbreak of Ebola viral disease (EVD) in West African countries had recorded over 2200 deaths. EVD, create fear and panic among patients, and other stakeholders, a risk factor for psychological distress, which could have public health implication for control of EVD. We determined factors associated with psychological distress among survivors and contacts of EVD and their relatives. Methods In a descriptive cross-sectional study, General Health Questionnaire was used to assess psychological distress and Oslo Social Support Scale was used to assess social support factors associated with psychological distress were determined using Chi 2 /odds ratio and adjusted odds ratio. Results Of the 117 participants, 78 (66.7%) were females. Most frequently occurring psychological distress were inability to concentrate (37.6%) and loss of sleep over worry (33.3%). Losing a relation to EVD outbreak (OR = 6.0, 95% CI: 1.2–32.9) was significantly associated with feeling unhappy or depressed while being a health worker was protective (OR = 0.4, 95% CI: 0.2–0.9). Adjusted odds ratio (AOR) showed losing a relation was a predictor of “feeling unhappy or depressed” (AOR = 5.7, 95% CI: 1.2–28.0) and inability to concentrate (AOR = 10.1, 95% CI: 1.7–60.7) while having no tertiary education remained protective (AOR = 0.2, 95% CI: 0.1–0.6). Conclusions Survivors and contacts of EVD and their relations develop psychological distress. Development of psychological distress was predicted by loss of family member. We recommended mental health specialists be part of case management teams. The teams managing EVD patients should be trained on recognition of common psychological distress. [ABSTRACT FROM AUTHOR]

The article reports on the cases of Ebola Virus Disease (EVD) in West Africa for 2015 including one-three cases of EVD each week since July, from Guinea or Sierra Leone, two confirmed cases in September, and no new cases in Liberia since July.

The article discusses the Ebola epidemic crisis as the death toll reaches to about 8,000. The West Africa suffers the most with nearly 20,081 patients, according to the World Health Organization (WHO), with most deaths in Liberia, Guinea and Sierra Leone. The visits to the affected area by various dignitaries including the U.S. President Barack Obama, UN Secretary General Ban Ki-Moon and French President Francois Hollande are also mentioned.