Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control

Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridae family, has become one of the world's most feared pathogens. The virus induces acute fever and death, often associated with hemorrhagic symptoms in up to 90% of infected patients. The known sub-types of the virus are Zaire, Sudan, Taï Forest, Bundibugyo and Reston Ebola viruses. In the past, outbreaks were limited to the East and Central African tropical belt with the exception of Ebola Reston outbreaks that occurred in animal facilities in the Philippines, USA and Italy. The on-going outbreak in West Africa that is causing numerous deaths and severe socio-economic challenges has resulted in widespread anxiety globally. This panic may be attributed to the intense media interest, the rapid spread of the virus to other countries like United States and Spain, and moreover, to the absence of an approved treatment or vaccine. Informed by this widespread fear and anxiety, we analyzed the commonly used strategies to manage and control Ebola outbreaks and proposed new approaches that could improve epidemic management and control during future outbreaks. We based our recommendations on epidemic management practices employed during recent outbreaks in East, Central and West Africa, and synthesis of peer-reviewed publications as well as published "field" information from individuals and organizations recently involved in the management of Ebola epidemics. The current epidemic management approaches are largely "reactive", with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to "reactive" interventions, "pre-emptive" strategies also need to be instituted. We conclude that emphasizing both "reactive" and "pre-emptive" strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks.

The development of health-promoting hospitals using the Primary Care Award (PCA) standard in Muang District, Phitsanulok, Thailand

The purposes of this descriptive study were to : (1) determine the level of understanding of hospital personnel using the Primary Care Award (PCA) standard, and (2) determine the progress of implementation of the standard. The instruments used a questionnaire and a semi-structured interview form. The questionnaire was composed of three parts: the demographic data; the opinionaire focused on the implementation of the PCA and the roles of the stakeholders; and the evaluation of progress of implementing the PCA Standards. Respondents were hospital personnel working in each of the twenty four hospitals in Muang district, Phitsanulok province, Thailand. The results of the study revealed that the opinion of the hospital regarding the implementation of the PCA in all dimensions was high, however the actual implementation was at intermediate level. The Ministry of Public Health (MOPH) had high commitment towards the implementation of the PCA, while the provincial health office and the district health office had medium level of commitment. The participation of the local government and the village health volunteers were at the low level.