Dixième épidémie d'Ebola en République Démocratique du Congo: défis majeurs relevés dans la prise en charge médicale / Tenth Ebola outbreak in Democratic Republic of the Congo: major challenges in health care management

Identifié depuis 1976, le filovirus Ebola est la cause d´une maladie caractérisée principalement par un syndrome grippale inaugural avec une fièvre quasi permanente suivi des signes digestifs: diarrhée, vomissement à la base de la déshydratation. La mort survient souvent dans un tableau de défaillance multi-viscérale (insuffisance hépatorénale, encéphalopathie voire, trouble de coagulation). Le taux de mortalité est compris entre 50 et 90%. Traditionnellement, les malades suspects et confirmés à Ebola étaient isolés dans des tentes pour un traitement essentiellement symptomatique avec utilisation fort limitée des actes invasifs. Les mesures de prévention n´étaient faites que de respect des mesures d´hygiène. Chez les personnels soignants, le taux de contamination était de 76% lors de la première épidémie de Yambuku. Au fil du temps, des mesures de prise en charge se sont améliorées par l´utilisation du vaccin, une réanimation appropriée, traitement spécifique au filovirus et l´utilisation des CUBE (chambre d´urgence biosécurisée pour epidémie).

Identified in 1976, Ebola virus, a member of the Filoviridae family (filovirus), can cause a disease mainly characterized by inaugural influenza-like syndrome with almost permanent fever followed by gastrointestinal symptoms, such as diarrhea, vomiting causing dehydration. Death often occurs as a result of multi-system organ failure (hepatorenal failure, encephalopathy or even blood clotting disorders). Mortality rate is between 50 and 90%. Traditionally, patients with suspected and diagnosed Ebola were isolated in tents for essentially symptomatic treatment with very limited use of invasive procedures. Prevention consisted of measures aimed at respecting hygiene. Among caregivers,infection rate was 76% during the first Yambuku outbreak. Over time, management measures have been improved by the use of the vaccine, appropriate resuscitation techniques, specific treatment for filovirus and the use of BECUO (Biosecure Emergency Care Unit for Outbreaks).

Association between treatment with oral third-generation cephalosporin antibiotics and mortality outcomes in Ebola virus disease: a multinational retrospective cohort study.

OBJECTIVE: To evaluate the association between oral third-generation cephalosporin antibiotic treatment and mortality in Ebola virus disease (EVD). METHODS: This retrospective cohort studied EVD-infected patients admitted to five Ebola Treatment Units in Sierra Leone and Liberia during 2014-15. Empiric treatment with cefixime 400 mg once daily for five days was the clinical protocol; however, due to resource variability, only a subset of patients received treatment. Data on sociodemographics, clinical characteristics, malaria status and Ebola viral loads were collected. The primary outcome was mortality compared between cases treated with cefixime within 48 h of admission to those not treated within 48 h. Propensity scores were derived using clinical covariates. Mortality between treated and untreated cases was compared using propensity-matched conditional logistic regression and bootstrapped log-linear regression analyses to calculate an odds ratio (OR) and relative risk (RR), respectively, with associated 95% confidence intervals (CI). RESULTS: Of 424 cases analysed, 360 (84.9%) met the cefixime treatment definition. The mean age was 30.5 years and 40.3% were male. Median cefixime treatment duration was 4 days (IQR: 3, 5). Among cefixime-treated patients, mortality was 54.7% (95% CI: 49.6-59.8%) vs. 73.4% (95% CI: 61.5-82.7%) in untreated patients. In conditional logistic regression, mortality likelihood was significantly lower among cases receiving cefixime (OR = 0.48, 95% CI: 0.32-0.71; P = 0.01). In the bootstrap analysis, a non-significant risk reduction was found with cefixime treatment (RR = 0.82, 95% CI: 0.64-1.16, P = 0.11). CONCLUSION: Early oral cefixime may be associated with reduced mortality in EVD and warrants further investigation.

OBJECTIF: Evaluer l'association entre le traitement antibiotique oral avec des céphalosporine de troisième génération et la mortalité dans la maladie au virus Ebola (MVE). MÉTHODES: Cette étude de cohorte rétrospective a été menée chez des patients infectés par la maladie au virus Ebola admis dans cinq unités de traitement Ebola en Sierra Leone et au Libéria en 2014-2015. Le traitement empirique avec Cefixime 400 mg une fois par jour pendant cinq jours était le protocole clinique. Cependant, en raison de la variabilité des ressources, seul un sous-ensemble de patients a reçu un traitement. Des données sur la sociodémographie, les caractéristiques cliniques, le statut du paludisme et les charges virales d'Ebola ont été collectées. Le critère principal était la mortalité comparée entre les cas traités au céfixime dans les 48 heures suivant l'admission et ceux non traités dans les 48 heures. Les scores de propension ont été dérivés à l'aide de covariables cliniques. La mortalité entre les cas traités et non traités a été comparée à l'aide d'analyses de régression logistique conditionnelle et de régression log-linéaire bootstrapées pour calculer respectivement un rapport de cotes (OR) et un risque relatif (RR), avec des intervalles de confiance (IC) à 95% associés. RÉSULTATS: Sur 424 cas analysés, 360 (84,9%) répondaient à la définition du traitement au céfixime. L'âge moyen était de 30,5 ans et 40,3% étaient des hommes. La durée médiane du traitement par le céfixime était de 4 jours (IQR: 3, 5). Parmi les patients traités au Cefixime, la mortalité était de 54,7% (IC95%: 49,6 à 59,8%) vs 73,4% (IC95%: 61,5 à 82,7%) chez les patients non traités. Dans la régression logistique conditionnelle, la probabilité de mortalité était significativement plus faible parmi les cas recevant du céfixime (OR = 0,48 ; IC95%: 0,32 à 0,71; P = 0,01). Dans l'analyse bootstrap, une réduction du risque non significative a été trouvée avec le traitement au céfixime (RR = 0,82, IC95%: 0,64 à 1,16 ; P = 0,11). CONCLUSION: Le céfixime par voie orale rapide peut être associé à une mortalité réduite dans la MVE et mérite une investigation plus approfondie.

[The Causes of Harm: Ethnography of Representations of the Emergence during the 9th Ebola Outbreak in DRC (Equateur Province, 8 May-24 July 2018)]. / Les causes du mal : ethnographie des représentations de l'émergence de la 9e épidémie d'Ebola en RDC (province de l'Équateur, 8 mai-24 juillet 2018).

The article focuses on describing the different causal models of misfortune and their social constructions in the context of the Ebola virus disease which emerged in Equateur Province, Democratic Republic of Congo, in May 2018. Based on a corpus of qualitative data collected during three weeks of fieldwork, this article details the explanatory models relating to the chains of contamination and their hybridization between biomedical models and sorcery and/or political logic. By also addressing the impacts of discourse on the animal origin of the virus, this article contributes to an analysis of the gap between the different understandings and responses to the epidemic phenomenon and the scale of the response.

Cet article s'attache à décrire les différents modèles de causalité du malheur et leurs constructions sociales suite à l'émergence de la neuvième épidémie de la maladie à virus Ebola dans la province de l'Équateur, en République démocratique du Congo en mai 2018. Fondé sur un corpus de données qualitatives collecté lors de trois semaines de terrain, l'article détaille les modèles explicatifs ayant trait aux chaînes de contaminations et leur hybridation entre modèle biomédical et logique mystique et/ou politique. En traitant également de la réception du discours scientifique sur l'origine animale du virus, cet article contribue à une analyse du fossé existant entre les différentes compréhensions et réactions locales et biomédicales face au phénomène épidémique et à l'ampleur de la riposte.

Critical evaluation of the appetite test for children with severe acute malnutrition.

OBJECTIVES: The appetite test is used to risk stratify for children with severe acute malnutrition (SAM) in inpatient or outpatient care. The test is recommended in guidelines despite lack of evidence. We evaluated its ability to identify children at risk of a poor treatment outcome. METHODS: We conducted an observational study of children diagnosed with SAM at three health facilities in Ethiopia. The appetite test was done independently, and the result did not affect decisions about hospitalisation and clinical care. Data were analysed using mixed linear and logistic regression models. RESULTS: Appetite was tested in 298 (89%) of 334 children enrolled; 56 (19%) passed. Children failing the appetite test had a 6.6% higher weight gain per day (95% CI: 2.6, 10.8) adjusted for type of treatment, oedema, duration of follow-up and age than children passing the test. We found medical complications in 179 (54%) children. Medical complications were associated with blood markers of metabolic disturbance. Children with medical complications tended to have lower weight gain than those without complications (3.5%, 95% CI: -0.25, 7.0). Neither the appetite test nor medical complications were correlated with bacteraemia or treatment failure. CONCLUSIONS: Our findings question the use of the appetite test to identify children who need inpatient care. An assessment of medical complications alone could be a useful risk indicator but needs to be evaluated in other settings.

OBJECTIF: Le test de l'appétit est utilisé pour stratifier les risques chez les enfants souffrant de malnutrition aiguë sévère (MAS) en soins hospitaliers ou ambulatoires. Le test est recommandé dans les directives malgré le manque d'évidence. Nous avons évalué sa capacité à identifier les enfants à risque de mauvais résultats de traitement. MÉTHODES: Nous avons mené une étude observationnelle chez des enfants diagnostiqués avec une MAS dans trois établissements de santé en Ethiopie. Le test de l'appétit a été effectué indépendamment et le résultat n'a pas affecté les décisions d'hospitalisation et de soins cliniques. Les données ont été analysées à l'aide de modèles de régression linéaire et logistique mixtes. RÉSULTATS: : L'appétit a été testé chez 298 (89%) des 334 enfants inscrits; 56 (19%) ont réussi le test. Les enfants qui échouaient au test de l'appétit avaient un gain de poids de 6,6% plus élevé par jour (IC95%: 2,6 à 10,8) ajusté pour le type de traitement, l'œdème, la durée du suivi et l'âge que les enfants réussissant le test. Nous avons trouvé des complications médicales chez 179 (54%) enfants. Des complications médicales ont été associées à des marqueurs sanguins de troubles métaboliques. Les enfants souffrant de complications médicales avaient tendance à avoir un gain de poids plus faible que ceux sans complications (3,5% ; IC95%: -0,25 à 7,0). Ni le test de l'appétit ni les complications médicales ne corrélaient avec une bactériémie ou à un échec du traitement CONCLUSION: Nos résultats remettent en question l'utilisation du test de l'appétit pour identifier les enfants qui ont besoin de soins hospitaliers. Une évaluation des complications médicales à elle seule pourrait être un indicateur de risque utile, mais doit être évaluée dans d'autres contextes MOTS-CLÉS: malnutrition aiguë sévère, appétit, gestionnaire de communauté, évaluation des risques, aliments thérapeutiques.

Caracterización clínico epidemiológica de pacientes con ébola en un centro de tratamiento de Sierra Leona / Clinical-epidemiological characterization of Ebola disease in patients at a treatment center in Sierra Leone

Introducción: La enfermedad del ébola se dio a conocer por primera vez en 1976, con una letalidad muy elevada en todos los brotes detectados. Objetivo: Caracterizar clínica y epidemiológicamente a los pacientes portadores de la enfermedad por el virus del Ébola. Métodos: Se realizó un estudio observacional, descriptivo y transversal en 424 pacientes ingresados en un centro de tratamiento de ébola en la República de Sierra Leona, África occidental, con el diagnóstico confirmado mediante la técnica de reacción en cadena de la polimerasa para virus Ébola, durante el período de noviembre de 2014 hasta marzo de 2015. Resultados: Se muestra que el grupo etario más afectado fue el de 25 a 34 con un 25,9 por ciento. La mayor letalidad se presentó en los pacientes con más de 65 años de edad con un 44,4 por ciento. El síntoma que prevaleció fue la fiebre para un 61,8 por ciento, y el hipo se presentó en el 88,8 por ciento de los fallecidos. Conclusión: Se concluye que la enfermedad no tuvo distinción significativa con el sexo. La mayor letalidad se presentó en las edades geriátricas. Los síntomas más frecuentes fueron la fiebre, diarrea y el decaimiento. El hipo fue el signo que más se presentó en los pacientes que fallecieron(AU)

Introduction: Ebola disease was first reported in 1976 with a very high lethality in all outbreaks. Objective: To clinically and epidemiologically characterize the patients carriers of Ebola virus disease. Methods: we conducted an observational, descriptive and cross-sectional study in 424 patients admitted to an Ebola Treatment Center in the Republic of Sierra Leone, West Africa from November 2014 to March 2015. The polymerase chain reaction technique for Ebola virus confirmed the diagnosis. Medical records provided all data. Results: The age group most affected was 25 to 34 (25.9 percent). The highest lethality occurred in those over 65 years of age (44.4 percent ). Fever was the prevailing symptom (61.8 percent) and hiccups occurred in 88.8 percent of the deceased. Conclusion: Clinical manifestations were variable, although fever was the main symptom. Hiccup was a sign of poor prognosis when associated with a higher percentage of mortality. Lethality was high(AU)

Environmental temperature and case fatality of patients with Ebola virus disease in Sierra Leone and Liberia, 2014-2015: a retrospective cohort study.

OBJECTIVE: Fluid loss during Ebola virus disease (EVD) infections from gastrointestinal dysfunction leads to volume depletion. It is possible that high environmental temperatures may exacerbate volume depletion or interfere with the provision of medical care by providers in full personal protective equipment. We investigated the effect of environmental temperature on case fatality. METHODS: The International Medical Corps (IMC) operated five Ebola Treatment Units (ETUs) in Liberia and Sierra Leone during the 2014-2016 epidemic. Demographic and outcomes variables for 465 patients with EVD were sourced from a de-identified, quality-checked clinical database collected by IMC. Daily environmental temperature data for Liberia and Sierra Leone were collected from a publicly available database (Weather Underground). Mean daily environmental temperatures were averaged across each patient's ETU stay and environmental temperature thresholds were determined. Multiple logistic regression was utilised, with forward variable selection and threshold for entry of P < 0.1. Statistical significance was defined as P < 0.05. The following variables were analysed as potential confounders: age, sex, ETU, length of ETU operation and date of treatment. RESULTS: Case fatality was 57.6% among patients diagnosed with EVD. Analysis of case fatality across environmental temperature quintiles indicated a threshold effect; the optimal threshold for average environmental temperature during a patient's ETU stay was determined empirically to be 27.4 °C (81.3 °F). Case fatality was significantly greater for patients with average environmental temperatures above the threshold (70.4%) vs. below (52.0%) (P < 0.001). In multiple regression, patients with average environmental temperature above the threshold during their ETU stay were significantly more likely to die than patients below the threshold (aOR = 2.5, 95% CI 1.6-3.8, P < 0.001). This trend was observed only among patients treated in white tent ETUs, and not in ETUs with aluminium roofs. DISCUSSION: These findings suggest that an average environmental temperature above 27.4 °C (81.3 °F) during patients' ETU stay is associated with greater risk of death among patients with EVD. Further studies should investigate this effect. These results have potential implications for reducing case fatality through improved ETU construction or other temperature control methods within ETUs during future outbreaks.

French guidelines for the outpatient management of Ebola virus disease: Applicability by family physicians.

BACKGROUND: During the last alarming Ebola Virus Disease (EVD) outbreak, the French Ministry of Health developed guidelines for the outpatient management of EVD. We aimed to assess family physicians' (FP) knowledge of EVD, to assess their working conditions, and to collect their opinion about the applicability of these guidelines in France. METHODS: Cross-sectional quantitative study (telephone or email) performed (November 2014-June 2015) during the EVD outbreak. Relevant results were further analyzed with a qualitative study (interviews) based on grounded theory (June-September 2016), after the end of the EVD outbreak. RESULTS: Thirty-three FPs out of 100contacted answered our survey (response rate: 33%). We interviewed five FPs. Their knowledge of EVD was good. Information sent by post, especially from the national medical association, was considered the best means of information and was preferred to emails. Compliance with guidelines was based on their ease of understanding and application (common sense). The main difficulty in applying these guidelines was the unusual recommended equipment that seemed unnecessary as the management of these patients was based on their interview (anamnesis) and isolation without examination. EVD had little impact on the FPs' practice, they only trained their secretaries to screen for suspected EVD patients and refer them to the mobile emergency unit. CONCLUSION: FPs had good knowledge of EVD and guidelines. This seemed important to prevent the outbreak in France as they were ready to cope with such a situation, thanks to guidelines they could easily adjust to their practice.

Ebola virus disease: Biological and diagnostic evolution from 2014 to 2017.

The Ebola virus disease outbreak observed in West Africa from March 2014 to June 2016 has led to many fundamental and applied research works. Knowledge of this virus has substantially increased. Treatment of many patients in epidemic countries and a few imported cases in developed countries led to developing new diagnostic methods and to adapt laboratory organization and biosafety precautions to perform conventional biological analyses. Clinical and biological monitoring of patients infected with Ebola virus disease helped to determine severity criteria and bad prognosis markers. It also contributed to showing the possibility of viral sanctuaries in patients and the risk of transmission after recovery. After a summary of recent knowledge of environmental and clinical viral persistence, we aimed to present new diagnostic methods and other biological tests that led to highlighting the pathophysiological consequences of Ebola virus disease and its prognostic markers. We also aimed to describe our lab experience in the care of Ebola virus-infected patients, especially technical and logistical changes between 2014 and 2017.

Bioética e investigación: análisis de caso de la epidemia por el virus ébola en 2014

La epidemia por el virus Ébola, en África occidental (2014), ha suscitado una serie de interrogantes éticos en torno a las medidas de salud pública para su contención, el uso de medicamentos experimentales y el desarrollo de vacunas contra esta enfermedad. El presente trabajo explora algunas de estas preguntas desde la perspectiva de la ética en investigación biomédica. La epidemia por el virus Ébola es un modelo de estudio adecuado para abordar esfuerzos multilaterales en investigación, así como para analizar aspectos antropológicos en salud pública y determinantes sociales, económicos y políticos en salud a nivel global.

The Ebola virus epidemic in West Africa (2014) has raised some ethical questions surrounding public health measures for its containment, the use of experimental drugs and the development of vaccines against this disease. This paper explores some of these issues from the perspective of ethics in biomedical research. Ebola virus epidemic is a suitable study model to address multilateral efforts in research as well as to analyze anthropological aspects of public health and social, economic and political determinants of global health.

A epidemia pelo vírus Ebola, na África Ocidental (2014), tem levantado uma série de questões éticas em torno às medidas de saúde pública para a sua contenção, o uso de medicamentos experimentais e o desenvolvimento de vacinas contra esta doença. Este artigo explora algumas destas questões a partir da perspectiva da ética na pesquisa biomédica. A epidemia pelo vírus Ebola é um modelo de estudo adequado para abordar esforços multilaterais em pesquisa, como também para analisar aspectos antropológicos em saúde pública e determinantes sociais, econômicos e políticos em saúde a nível global.

International health threats and global early warning and response mechanisms.

The global community continues to incur the high costs of crisis mitigation and emergency response to outbreaks of emerging infectious diseases, such as those caused by the H5N1 highly pathogenic avian influenza virus, Ebola virus, Nipah virus, Zika virus or the Middle East respiratory syndrome coronavirus. These viruses are particularly dangerous in regions associated with poor development indicators and high vulnerability. The drivers of these disease crises include failures in the way that animal diseases are detected and reported and failures in the way in which disease response is implemented by animal health and public health systems. In addition, the lack of a coordinated response hampers disease control efforts. A comprehensive approach for disease prevention, detection and response, however, requires a coordinated and joint effort among governments, communities, donors and international networks to invest effectively in prevention systems that can identify early signals of the emergence, spillover and spread of animal pathogens at the local level. These signals include trade bans, market closures, civil unrest, heavy rains and droughts associated with climate change, and livestock intensification or changes in consumer behaviour. The global community needs to increase its investment in early warning and detection systems that can provide information that enables action to be taken at the national, regional and global levels in the event of an outbreak of a transboundary animal disease (TAD). Like any preventive measure, an early warning system requires financial resources, but these are insignificant when compared to the losses that are avoided. Building a global early warning and effective response system for outbreaks is value for money, as the benefits far outweigh the costs. The goal of the Food and Agriculture Organization of the United Nations (FAO) is to end hunger and poverty, which is a challenging and complex task. Building global capacity to prepare for and respond to TADs is an important element of the FAO's strategic objective to increase the resilience of livelihoods to threats and crises. Each year, livestock, and the people who rely upon them for their livelihoods, are confronted with animal disease and crises. They can strike suddenly, causing obvious illness and death, or emerge insidiously and become well established before becoming apparent. Animal disease emergencies threaten the production of, and access to, food; consequently, one of the FAO's missions is to help countries to prepare for and respond to animal health disasters.

La communauté mondiale continue à supporter le coût élevé de l'atténuation des crises ainsi que des réponses apportées en urgence aux foyers de maladies infectieuses émergentes, par exemple les infections dues au virus H5N1 de l'influenza aviaire hautement pathogène, au virus Ebola, au virus Nipah, au virus Zika ou au coronavirus responsable du syndrome respiratoire du Moyen-Orient. Ces virus sont particulièrement dangereux dans les régions les plus vulnérables et dont les indicateurs de développement sont bas. Les défaillances dans la détection et la notification des maladies animales jouent un rôle déterminant dans ces crises sanitaires, de même que l'incapacité des systèmes de santé animale et publique à mettre en œuvre une réponse sanitaire appropriée. En outre, l'absence de coordination dans les réponses apportées affaiblit les efforts pour lutter contre les maladies. La mise en place d'une méthode de prévention, de détection et de réponse intégrée face aux maladies exige que les gouvernements, les communautés, les donateurs et les réseaux internationaux associent leurs efforts et se concertent afin d'investir efficacement dans des systèmes de prévention capables de détecter à l'échelle locale les tout premiers signes d'émergence d'un agent pathogène chez les animaux, de sa transmission à d'autres espèces et de sa propagation. Parmi ces signes révélateurs on peut citer certaines interdictions d'importer, mais aussi la fermeture des marchés, l'existence de troubles civils, les changements climatiques tels que de fortes précipitations ou une sécheresse prolongée et la modification de certaines tendances en production animale ou du comportement des consommateurs. La communauté mondiale doit investir davantage dans des systèmes d'alerte précoce et de détection afin d'obtenir l'information nécessaire pour prendre des mesures appropriées, à l'échelle nationale, régional et mondiale, en cas d'apparition d'une maladie animale transfrontalière. Comme toute mesure de prévention, les systèmes d'alerte précoce doivent être correctement financés, mais cet effort est insignifiant lorsqu'on le compare aux pertes qu'il permet d'éviter. La création d'un système mondial d'alerte précoce et de réponse en cas de foyers constitue un investissement rentable, qui génère des bénéfices bien supérieurs à ses coûts. L'Organisation des Nations Unies pour l'alimentation et l'agriculture (FAO) a pour objectif de mettre un terme à la faim et à la pauvreté dans le monde, ce qui constitue une tâche complexe et difficile. Le renforcement des capacités mondiales de préparation et de réponse en cas de maladies animales transfrontalières est un aspect important des objectifs stratégiques de la FAO visant à accroître la résilience des moyens d'existence face aux crises et aux menaces. Chaque année, le cheptel domestique et les personnes qui en tirent leur subsistance sont confrontés à des maladies animales et à des crises sanitaires. Celles-ci peuvent se déchaîner brutalement et présenter un tableau clair de morbidité et de mortalité, ou bien émerger de manière insidieuse et se propager avant l'apparition de signes manifestes. Puisque la production et l'accès aux denrées alimentaires sont menacés par les catastrophes sanitaires dues aux maladies animales, l'une des missions de la FAO consiste à aider les pays à répondre à ces catastrophes et à s'y préparer.

La comunidad mundial sigue soportando los elevados costos de las actividades de atenuación de crisis y de respuesta de emergencia ante brotes de enfermedades infecciosas emergentes como los causados por el virus de la influenza aviar altamente patógena H5N1, el del Ébola, el Nipah, el Zika o el coronavirus del síndrome respiratorio de Oriente Medio. Estos virus resultan especialmente peligrosos en regiones que presentan indicadores de desarrollo mediocres y un elevado nivel de vulnerabilidad. Entre los factores que subyacen a estas crisis sanitarias están las deficiencias en la forma de detectar y comunicar estas enfermedades y la inadecuada aplicación de medidas de respuesta por parte de los sistemas de salud pública y sanidad animal. Por añadidura, la ausencia de una respuesta coordinada lastra también las actividades de lucha. Un trabajo integral de prevención y detección de enfermedades y de respuesta a ellas exige sin embargo un esfuerzo coordinado y conjunto de gobiernos, poblaciones, donantes y redes internacionales para invertir eficazmente en sistemas de prevención que sirvan para detectar las señales precoces de aparición, extensión y propagación de patógenos animales a nivel local, señales como prohibiciones comerciales, cierres de mercados, desórdenes civiles, cambios climáticos como lluvias o sequías intensas o modificación de la dinámica de producción ganadera o los patrones de consumo. La comunidad mundial debe invertir en mayor medida en sistemas de alerta y detección rápidas que aporten información que pueda traducirse en acciones de ámbito nacional, regional y mundial en caso de brote de una enfermedad animal transfronteriza. Como toda medida de carácter preventivo, un sistema de alerta rápida requiere recursos económicos, pero su cuantía resulta insignificante en comparación con las pérdidas que se evitan. La construcción de un sistema mundial de alerta rápida y respuesta eficaz en caso de brote ofrece gran rentabilidad, por cuanto los beneficios superan holgadamente los costos. La Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO) persigue el objetivo de poner fin al hambre y la pobreza, empresa harto difícil y compleja. Dotar al mundo de la capacidad de preparación y respuesta ante enfermedades animales transfronterizas es un elemento importante del objetivo estratégico de la FAO de lograr que los medios de sustento gocen de mayor resiliencia ante crisis y amenazas. Cada año, los rebaños de animales domésticos y las personas que dependen de ellos para vivir hacen frente a enfermedades y crisis zoosanitarias, que pueden golpear de forma súbita y extender abiertamente la enfermedad y la muerte o, por el contrario, surgir insidiosamente y arraigar antes de que su presencia resulte patente. Las emergencias zoosanitarias hacen peligrar la producción de alimentos y el acceso a ellos. Una de las misiones de la FAO, por consiguiente, es la de ayudar a los países a prepararse para episodios de catástrofe zoosanitaria y a responder a este tipo de eventos cuando se produzcan.

A brief history of biological weapons programmes and the use of animal pathogens as biological warfare agents.

Any one of thousands of different microorganisms that affect the health and safety of the world's populations of humans, animals and plants could potentially be weaponised; that is undergo research and development whose aim is to create species or strains that could serve as deadly payloads for spray systems, bombs, rockets or missiles. However, many historical studies of warfare have made it clear that only a few species of bacteria and viruses have been weaponised. As is made clear in this paper, of the pathogens weaponised in the 20th century by Japan, the Union of Soviet Socialist Republics (USSR), the United States and Iraq, most were zoonotic pathogens. If a nation or terrorist group were to acquire biological weapons in the future, it is most likely that their payload would be a zoonotic pathogen.

Chacun des milliers de microorganismes différents qui affectent la santé et la sécurité des populations humaines, animales et végétales de la planète peut être transformé en arme biologique, c'est-à-dire faire l'objet de procédures de recherche et développement visant à mettre au point des espèces ou souches destinées à charger des systèmes d'épandage, des bombes, des roquettes ou des missiles à puissance létale. Néanmoins, de nombreuses études historiques sur les armements démontrent que le nombre de bactéries et de virus effectivement militarisés est limité. L'auteur explique que la plupart des agents pathogènes militarisés au cours du xxe siècle par le Japon, l'Union des Républiques soviétiques socialistes (URSS), les États-Unis et l'Irak étaient de nature zoonotique. Si une nation ou un groupe terroriste devait acquérir des armes biologiques à l'avenir, la charge utilisée serait probablement constituée d'agents pathogènes zoonotiques.

En potencia, cualquiera de los miles de microorganismos distintos que afectan a la salud y seguridad de las poblaciones mundiales de humanos, animales o plantas puede ser convertido en un arma, o dicho de otro modo: servir de objeto de investigación y experimentación con el propósito de crear especies o cepas que puedan constituir la carga mortífera de sistemas de vaporización, bombas, cohetes o misiles. Con todo, numerosos estudios de historia de la guerra dejan patente que solo unas pocas especies de virus y bacterias han sido efectivamente transformadas en armas. Como deja claro el autor, la mayoría de los patógenos que en el siglo xx convirtieron en arma el Japón, la Unión de Repúblicas Socialistas Soviéticas (URSS), los Estados Unidos y el Iraq eran zoonóticos. Si en el futuro una nación o un grupo terrorista hubiera de procurarse armas biológicas, lo más probable es que estas estuvieran cargadas con un patógeno zoonótico.

Linking animal diseases and social instability.

Social instability occurs as a consequence of war, civil strife or natural disasters such as earthquakes, floods and droughts. Animal diseases, including zoonoses, can be both a precursor to social instability and a result of social instability. Coping mechanisms, such as sound policies, trust in government, and robust infrastructure break down at times of civil instability. Such breakdowns often lead to a decline in both public health and the food and agricultural livestock base, thus creating a vicious cycle that involves inadequate nutrition, threatened livelihoods, and fewer opportunities for safe trade. This article is principally a discussion of a theoretical nature on the dynamics between animal diseases and social instability. Based on their experience of working for the Food and Agriculture Organization of the United Nations (FAO), the authors provide numerous examples of the connection between the two, mostly in countries that have fragile environments and are experiencing protracted crises. Disease has a direct and immediate effect on a community, but, in addition, if the community is not able to recover from the impact of a disease on their health and livelihoods, the consequences of an outbreak can persist even after the disease is no longer present. Stability, therefore, depends on a variety of factors, including the ability of a community to overcome the effects of a disease outbreak or other destabilising event. The FAO approach to helping families and communities to cope with the destabilizing effects of animal diseases is to build resilience, particularly amongst the most vulnerable households. This requires individuals and governments to gain a better understanding of what drives disease at the interface between human and animal health. In addition, it requires governments to invest in social protection programmes, establish a long-term risk reduction strategy that decreases vulnerability, and improve the sustainability of safe agricultural and marketing practices.

L'instabilité sociale est généralement une conséquence des conflits armés, des guerres civiles ou des catastrophes naturelles telles que tremblements de terre, inondations ou sécheresse. Les maladies animales, zoonoses incluses, sont des signes précurseurs de l'instabilité sociale, mais aussi son résultat. En période d'instabilité sociale, les mécanismes d'adaptation aux crises liés notamment à des politiques judicieuses, à la confiance dans l'action du gouvernement et à des infrastructures solides s'effondrent. Ces défaillances entraînent souvent un déclin à la fois de la santé publique et des ressources essentielles de l'agriculture et de l'élevage, créant ainsi un cercle vicieux caractérisé par une nutrition inadéquate, des moyens d'existence menacés et des possibilités raréfiées d'accéder à des marchés sûrs. L'essentiel de cet article est consacré à l'analyse théorique de la dynamique des liens entre les maladies animales et l'instabilité sociale. À partir de l'expérience acquise en travaillant pour l'Organisation des Nations Unies pour l'alimentation et l'agriculture (FAO), les auteurs donnent de nombreux exemples de ces liens, qui concernent pour la plupart des pays dont l'environnement est fragilisé ou qui sont exposés à des crises prolongées. Toute maladie a un effet direct et immédiat sur la communauté atteinte ; or, dans les situations où une communauté n'est pas en capacité de se relever après avoir subi cet impact ni d'assurer un retour à la situation antérieure en matière de santé et de moyens de subsistance, les conséquences d'un foyer persistent bien au-delà de la durée de la maladie. Par conséquent, la stabilité dépend de facteurs variés, dont l'aptitude d'une communauté à surmonter les effets d'un foyer ou d'autres événements déstabilisants. La méthode suivie par la FAO pour aider les familles et les communautés à faire face aux effets déstabilisants des maladies animales consiste à renforcer leur capacité de résilience, en particulier dans les foyers les plus vulnérables. Cela suppose que les individus et les gouvernements améliorent leur connaissance des facteurs propices à l'apparition des maladies à l'interface entre la santé humaine et animale. En outre, cela suppose que les gouvernements investissent dans des programmes de protection sociale, qu'ils mettent en place une stratégie de réduction des risques sur le long terme qui limite les vulnérabilités et qu'ils œuvrent pour une meilleure durabilité des pratiques agricoles et commerciales exemptes de risques.

La inestabilidad social es producto de guerras, disturbios civiles o catástrofes naturales como terremotos, inundaciones o sequías. Las enfermedades animales, comprendidas las zoonosis, pueden ser un precursor o un resultado de la inestabilidad social. En condiciones de inestabilidad civil se agrietan los mecanismos de un país para hacer frente a esas enfermedades (tales como políticas sólidas, confianza en los poderes públicos e infraestructuras robustas), lo que suele traducirse en un deterioro de la salud pública y de la cabaña ganadera en que reposan la alimentación y la agricultura, generándose así un círculo vicioso que trae consigo una nutrición deficiente, pone en peligro los medios de sustento y dificulta un comercio seguro. Los autores examinan básicamente los aspectos teóricos de la dinámica que conecta entre sí las enfermedades animales y la inestabilidad social. Recurriendo a su experiencia de trabajo para la Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO), ofrecen numerosos ejemplos de la relación existente entre ambos fenómenos, sobre todo en países que presentan un medio ambiente fragilizado y sufren crisis prolongadas. La enfermedad repercute directa e inmediatamente en la población, pero además, si esta no puede recuperarse de los efectos de una enfermedad sobre su estado sanitario y sus medios de vida, las consecuencias de un brote pueden dejarse sentir hasta mucho después de que la enfermedad haya desaparecido. La estabilidad depende por lo tanto de diversos factores, en particular la capacidad de las comunidades para superar los efectos de un brote infeccioso u otros episodios que las hayan desestabilizado. Desde la FAO se trata de ayudar a las familias y comunidades a lidiar con los efectos desestabilizadores de las enfermedades animales generando resiliencia, especialmente en las familias más vulnerables. Para ello es menester que tanto individuos como poderes públicos conozcan mejor los factores que hacen que una enfermedad se manifieste en la interfaz de la salud humana con la sanidad animal. Es preciso, además, que las administraciones inviertan en programas de protección social, instituyan una estrategia a largo plazo de reducción del riesgo, que redunde en una menor vulnerabilidad, e instauren procedimientos agrícolas y de comercialización más sostenibles.

Quantifying the risk of nosocomial infection within Ebola Holding Units: a retrospective cohort study of negative patients discharged from five Ebola Holding Units in Western Area, Sierra Leone.

OBJECTIVES: A central pillar in the response to the 2014 Ebola virus disease (EVD) epidemic in Sierra Leone was the role of Ebola Holding Units (EHUs). These units isolated patients meeting a suspect case definition, tested them for EVD, initiated appropriate early treatment and discharged negative patients to onward inpatient care or home. Positive patients were referred to Ebola Treatment Centres. We aimed to estimate the risk of nosocomial transmission within these EHUs. METHODS: We followed up a cohort of 543 patients discharged with a negative EVD test from five EHUs in the Western Area, Sierra Leone, and examined all line-listed subsequent EVD tests from any facility in the Western Area to see whether the patient was retested within 30 days, matching by name, age and address. We defined possible readmissions as having the same name and age but uncertain address, and confirmed readmissions where name, age and address matched. RESULTS: We found a positive readmission rate of 3.3% (18 cases), which included 1.5% confirmed readmissions (8 cases) and 1.8% possible readmissions (10 cases). This is lower than rates previously reported. We cannot ascertain whether EVD was acquired within the EHUs or from re-exposure in the community. No demographic or clinical variables were identified as risk factors for positive readmission, likely due to our small sample size. CONCLUSIONS: These findings support the EHU model as a safe method for isolation of suspect EVD patients and their role in limiting the spread of EVD.

Fear on the networks: analyzing the 2014 Ebola outbreak / El temor en las redes: Análisis del brote de ébola del 2014 / Temor nas redes: uma análise do surto de Ebola de 2014

ABSTRACT During the 2014 Ebola outbreak, information spread via multiple platforms, including social networks and Internet search engines. This report analyzes Twitter tweets, Facebook posts, and Google trends, as well as several other Internet resources, from March - November 2014. Understanding the types of discussions, social behaviors, feelings expressed, and information shared during the Ebola outbreak can help health organizations improve communication interventions and avert misinformation and panic during health emergencies. In all, 6 422 170 tweets, 83 Facebook posts, and Google search trends were integrated with 63 chronological Ebola-related events. Events that prompted a surge in tweets using #ebola were related to new cases of infection or the entry of the disease into a new geographic area. Most tweets were re-tweets of information provided by news agencies and official health organizations. Events related to new infections and deaths seemed to correlate with an increase of words that express fear. Google results concurred with Twitter and Facebook. Data from social media activity can be used to form hypotheses about how the public responds to and behaves during public health events, prompting health organizations to adopt new strategies for communications interventions. Furthermore, a spike in activity around a topic can be used as a surveillance technique to signal to health authorities that an outbreak may be underway. It is also recommended that news agencies, which engage with the public most often, consider content review by health experts as part of their health communications process.(AU)

RESUMEN Durante el brote de ébola del 2014, se difundió información por medio de varias plataformas, entre ellas las redes sociales y los motores de búsqueda de Internet. En este informe se analizan los tuits en Twitter, los mensajes publicados en Facebook y las tendencias de búsqueda en Google, así como varios recursos más en Internet, en el período comprendido entre marzo y noviembre del 2014. La comprensión de los tipos de conversaciones, el comportamiento social, los sentimientos expresados y la información transmitida durante el brote de ébola puede ayudar a las organizaciones de salud a mejorar sus intervenciones en materia de comunicación y evitar la información incorrecta y el pánico que se pueden propagar durante las emergencias de salud. En total, se integraron 6 422 170 tuits, 83 mensajes de Facebook y las tendencias de búsqueda en Google con 63 eventos cronológicos relacionados con ébola. Los eventos que dieron lugar a un incremento de los tuits con la etiqueta #ebola estaban relacionados con nuevos casos de infección o la entrada de la enfermedad en una nueva zona geográfica. La mayor parte de los tuits eran reenvíos de información suministrada por las agencias de noticias y las organizaciones de salud oficiales. Los eventos relacionados con nuevas infecciones y defunciones parecían guardar correlación con un aumento del uso de palabras que expresaban temor. Los resultados de Google coincidían con Twitter y Facebook. Se pueden emplear datos provenientes de la actividad de las redes sociales para formar hipótesis sobre el modo en que el público responde a los eventos de salud pública y en que se comporta durante ellos, e incitar a las organizaciones de salud a que adopten nuevas estrategias para las intervenciones en materia de comunicación. Además, se pueden usar los aumentos de la actividad en torno a un tema como técnica de vigilancia para señalar a las autoridades de salud que es posible que haya un brote. Se recomienda también que las agencias de noticias, que interactúan con el público con más frecuencia, consideren la posibilidad de contar con expertos en salud para examinar los contenidos en el marco de su proceso de comunicación para la salud.(AU)

RESUMO No transcurso do surto de Ebola de 2014, a informação se espalhou por diversas plataformas como as redes sociais e os mecanismos de busca da internet. Este artigo examina as mensagens no Twitter, postagens no Facebook e tendências no Google e outras mídias digitais no período de março a novembro de 2014. Entender as formas de discussões, comportamentos sociais, sentimentos expressos e informações partilhadas no decorrer do surto de Ebola pode contribuir para melhorar as intervenções em comunicação por parte das organizações de saúde e evitar a desinformação e o pânico em situações de emergência em saúde. Ao todo, 6.422.170 mensagens no Twitter, 83 postagens no Facebook e tendências de busca no Google foram correlacionadas a 63 eventos cronológicos relativos ao surto de Ebola. Os eventos que suscitaram um aumento no número de mensagens no Twitter com o hashtag #ebola foram a ocorrência de novos casos de infecção ou o surgimento da doença em outras áreas geográficas. Grande parte da atividade no Twitter consistiu no reenvio de mensagens com informações fornecidas pelas agências de notícias e organizações oficiais de saúde. Os eventos relacionados a novas infecções e mortes aparentemente se correlacionaram ao uso de um maior número de palavras que expressam temor. Os resultados do Google coincidiram com os do Twitter e Facebook. A análise da atividade nas mídias sociais permite formular hipóteses sobre a reação e o comportamento do público em situações de risco em saúde pública, motivando o uso de novas estratégias de comunicação por parte das organizações de saúde. Um pico de atividade em torno de um assunto pode ser um recurso de vigilância usado pelas autoridades sanitárias para sinalizar a possível ocorrência de um surto. Também se recomenda às agências de notícias, por estarem em contato constante com o público, integrar a análise do conteúdo por especialistas em saúde ao processo de comunicação de assuntos em saúde.(AU)

[Motivations and emotional experiences of the first hospital multidisciplinary team trained to care for people with Ebola in Andalusia, Spain (2014-2016)]. / Motivaciones y experiencias emocionales del primer equipo multidisciplinario hospitalario entrenado para atender casos de Ébola en Andalucía (2014-2016).

OBJECTIVE: The Hospital Universitario Virgen del Rocío (HUVR) of Seville was chosen as the reference Andalusian site to treat possible cases of Ebola. After the health alert (WHO, 2014), a voluntary group of healthcare and non-healthcare professionals was set up, which, after being trained, treated a possible case. In this light, the aim is to understand the motivations and emotional experiences of this group and to identify the facilitators of and obstacles to its operation. METHOD: Qualitative, interpretative and phenomenological study. Observation unit: professional team of the HUVR trained to treat Ebola cases. Analysis units: teamwork, motivations and emotions. Three interviews with key informants were conducted, as well as three discussion groups involving 23 of the 60 team members (2014-2016). A content analysis of the motivations, emotions and elements affecting the team's operation was conducted with QSRNUDISTVivo10. VALIDITY: data sources, techniques and disciplinary perspectives were triangulated. The results were presented to the team, which duly agreed with the findings. RESULTS: Training, professional responsibility, professional self-esteem, risk appetite or loyalty to the leader stood out as motivations to voluntarily join the team. Emotional experiences evolved from fear and stress to self-pressure control, while essential elements for the team's operation were found to be calmness and confidence based on training and teamwork. Family, source department, resources, communication media and emotional management were facilitators of or obstacles to the team's success. CONCLUSION: An understanding of the key motivational and influential factors may be important in the management of effective and successful multidisciplinary teams during health alerts.

[New viral risks in blood transfusion by 2016]. / Nouveaux risques viraux en transfusion sanguine à l'horizon 2016.

Viral safety remains a major concern in transfusion of blood products. Over years, the control measures applied to blood products were made more and more sophisticated; however, the number of infectious agents, and notably of viruses, that can be transmitted by transfusion is increasing continuously. The aim of this review paper is to actualize that published in the same journal by the same authors in 2011 with more details on some of actual vs virtual viral threats that were identified recently in the field of blood transfusion. The main subjects that are covered successively concern the transmission via transfusion of hepatitis E virus, the frequency of transfusion transmitted arboviruses, transfusion at the time of the Ebola epidemics in West Africa, the debated role of Marseillevirus (giant viruses infecting amoebae and suspected to infect human blood latently), and, finally, the recent report of the identification in blood donors of a new member of the Flaviviridae family. The addition of these new viral risks to those already identified-partially controlled or not-pleads for the urgent need to move forward to considering inactivation of infectious agents in blood products.

Manifestaciones hematológicas, etiopatogenia y exámenes de laboratorio en la enfermedad por virus Ébola / Hematologic manifestations, pathogenesis and laboratory tests in Ebola virus disease

La enfermedad por el virus del Ébola es una dolencia con frecuencia fatal, causada por una de las cinco cepas altamente contagiosas de este virus que afecta, tanto a animales como a seres humanos, cuya tasa de letalidad puede llegar al 90 por ciento. Desde su detección se han producido varios brotes, incluido el último en abril de 2014. Una de las manifestaciones más importantes es el síndrome hemorrágico que suele darse en las últimas etapas de la enfermedad, cuadro que no ocurre en todos los pacientes afectados. Se describen las principales manifestaciones hematológicas presentes en esta entidad, así como algunos aspectos de su etiopatogenia y exámenes de laboratorio útiles en el manejo de estos pacientes(AU)

Ebola virus disease is an often-fatal infection caused by one of the five strains of the Ebola virus that affects both animals and humans. The fatality rate can reach 90 percent and since its detection, there have been several outbreaks, including the last in April 2014. One of the most important manifestations is the hemorrhagic syndrome which usually occurs in the late stages of the disease, condition that is not present in all affected patients. Major hematologic manifestations in this entity, as well as some aspects of its pathogenesis and useful laboratory tests in the management of these patients are described(AU)

Manifestaciones hematológicas, etiopatogenia y exámenes de laboratorio en la enfermedad por virus Ébola / Hematologic manifestations, pathogenesis and laboratory tests in Ebola virus disease

La enfermedad por el virus del Ébola es una dolencia con frecuencia fatal, causada por una de las cinco cepas altamente contagiosas de este virus que afecta, tanto a animales como a seres humanos, cuya tasa de letalidad puede llegar al 90 por ciento. Desde su detección se han producido varios brotes, incluido el último en abril de 2014. Una de las manifestaciones más importantes es el síndrome hemorrágico que suele darse en las últimas etapas de la enfermedad, cuadro que no ocurre en todos los pacientes afectados. Se describen las principales manifestaciones hematológicas presentes en esta entidad, así como algunos aspectos de su etiopatogenia y exámenes de laboratorio útiles en el manejo de estos pacientes(AU)

Ebola virus disease is an often-fatal infection caused by one of the five strains of the Ebola virus that affects both animals and humans. The fatality rate can reach 90 percent and since its detection, there have been several outbreaks, including the last in April 2014. One of the most important manifestations is the hemorrhagic syndrome which usually occurs in the late stages of the disease, condition that is not present in all affected patients. Major hematologic manifestations in this entity, as well as some aspects of its pathogenesis and useful laboratory tests in the management of these patients are described(AU)

[Mobile laboratories for rapid deployment and their contribution to the containment of emerging diseases in Sub-Saharan Africa, illustrated by the example of Ebola virus disease]. / Laboratoires mobiles et leur contribution dans l'endiguement de pathologies émergentes en Afrique subsaharienne illustrée par l'exemple de la maladie à virus Ebola.

The Ebola virus, which became a global health concern in 2014, is an example of an emerging pathogen. Ebola virus disease can only be diagnosed in biosafety level 3 and 4 laboratories, which provide the security required to avoid exposure of both the staff and the environment to the pathogen. These laboratories are often far from the site of outbreaks, which may occur in rural areas or border regions (when the disease is imported from a neighboring country). Rapidly deployable laboratory units can bring the diagnosis closer to the outbreak site and thus significantly shorten the time to delivery of results, thus facilitating epidemic containment. Here we report our experience from the first months of implementation in Mali of a mobile laboratory unit of the same type as the European mobile labs and we describe the workflow in the laboratory as well as the training of its Malian staff. Based on our experience and the reports of other projects, we propose a framework in which these mobile laboratory units can strengthen epidemiological surveillance and contribute to containing outbreaks of emerging diseases in sub-Saharan Africa.

Ébola: Un riesgo para la población en un mundo globalizado / EBOLA: a risk for the population in a global world

La enfermedad por virus Ebola fue identificada por primera vez como una epidemia mortal en Nzara en el sur de Sudán y en Yambuku en el norte de la República Democrática del Congo (RDC, antes Zaire) en 1976. Desde entonces, las epidemias por Ebola han sido reportadas en otros países de África Central, en dos períodos distintos, con una brecha aproximada de quince años de silencio. Recientemente se han reportado brotes en Guinea, Liberia, Nigeria y Sierra Leona que están generando preocupación mundial debido a que su propagación por contacto directo con una amplia variedad de fluidos corporales de un individuo infectado como sangre o secreciones (saliva, sudor, vómitos) y con objetos (como agujas) contaminados con secreciones infectantes coloca en riesgo a familiares y amigos que atienden a personas enfermas y especialmente al personal en establecimientos de salud, debido a que generalmente no disponen de equipos de bioseguridad, ni de adecuadas medidas de limpieza y eliminación de instrumentos para protegerse, se desconoce cómo las personas se infectan con el virus Ebola, existen medidas de prevención primaria, pero no hay ninguna vacuna disponible. Debido a la alta letalidad y a la posible dispersión y aparición de casos en otros continentes, el objetivo de la presente revisión está dirigido a describir las características clínico epidemiológicas de Ebola para actualizar el conocimiento de la enfermedad tanto en el personal de salud como en la población general y promover la toma de medidas de prevención para evitar su propagación.

Ebola virus disease was first identified in 1976 in Nzara southern Sudan, and in northern Yambuku in the Democratic Republic of Congo (DRC, formerly Zaire). Since then, Ebola epidemics have been reported in other countries in Central Africa, in two different periods, with an approximate gap of fifteen years of silence. Recent outbreaks have been reported in Guinea, Liberia, Nigeria and Sierra Leone, that are generating global concern due to its spread by direct contact with a wide variety of bodily fluids from an infected person as blood or secretions (saliva, sweat, vomit) and objects (such as needles) contaminated with infectious secretions, which pose a risk to family and friends caring for sick people and especially the staff in health facilities, because generally they lack equipment or adequate biosecurity measures for cleaning and disposing instruments for their protection. Currently, it is unknown how people become infected with the Ebola virus; there are measures for primary prevention, but there is no vaccine available. Due to the high case-fatality rates and possible spread and occurrence of cases in other continents, the aim of this review is aimed at describing the clinical and epidemiological characteristics of Ebola in order to update the knowledge about this disease in both health workers and the general population and promote the adoption of measures to prevent and avoid its spread.