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EBOLA
NEW: Senegal: 1 case
Congo: 13 dead
Guinea: 430 dead
Liberia: 694 dead
Nigeria: 6 dead
Sierra Leone: 422 dead
Total: 1552 dead
Copyright © 2014 Elsevier Ltd All rights reserved.
The Lancet, Early Online Publication, 29 August 2014
doi:10.1016/S0140-6736(14)61343-X
Cite or Link Using DOI
Is respiratory protection appropriate
in the Ebola response?
Jose M Martin-Moreno a,
Gilberto Llinás a,
Juan Martínez Hernández bWe write to express our concern about one aspect of the response to the
current epidemic of Ebola that has, so far, received little attention,
1 lacks
an evidence base, and might be counterproductive.
The primary mode of transmission of Ebola virus is through contact with
infected patients’ secretions (such as blood, vomit, or faeces) directly and
indirectly (for example, from contaminated needles). This transmission
occurs via close family contact or in health-care settings, particularly when
placing orotracheal intubation or when caring for a patient who is vomiting
or bleeding. Ebola is rarely transmitted via an airborne route.
2 Although
these routes of transmission are well known,
3,
4 most agencies, including
governmental agencies responsible for repatriating western patients, apply
infection-control measures appropriate for airborne diseases.
Excessive precautions could offer reassurance to those responding to
Ebola, yet complete respiratory protection is expensive, uncomfortable,
and unaffordable for countries that are the most affected. Worse, such an
approach
suggests that the only defence is individual protective
equipment, which is inaccessible to the general population.
Moreover, the image of workers with spectacular protective clothing might
contribute to the panic in some communities. If this leads people to flee
affected areas it could increase the spread of infection.
It also reinforces the view that some lives are more valuable than others,
already engendered by decisions about the use of experimental
Ebola drug ZMapp.5
We contend that the systematic application of precautionary measures that
protect health-care personnel and others from direct contact (ie, gloves
and waterproof smocks, goggles, masks, and individual rooms or wards in
the hospital) are sufficient to manage most patients (who do not
experience haemorrhage or vomiting). In fact, goggles and masks might
not even be necessary to speak with conscious patients, as long as a
distance of 1—2 metres is maintained (the maximum distance that
infectious droplets might reach). Exceptional precautions, such as
pressurised suits with oxygen tanks, should be reserved for interventions
that generate aerosols (invasive explorations or intubations), specific
situations (eg, massive haemorrhage), or in laboratories where the virus is
cultivated. They are unnecessary in the settings where the virus is most
rampant.
In western Africa now there is a need for rational and efficient use of
protective equipment. This can only be achieved by communicating a
consistent message that the disease is essentially transmitted through
direct contact.
In control of infectious diseases, more is not necessarily better and, very
often, the simplest answer is the best.
We declare no competing interests.
References
1 Roddy P, Weatherill D, Jeffs B, et al. The Médecins Sans Frontières
intervention in the Marburg hemorrhagic fever epidemic, Uige, Angola,
2005. II. Lessons learned in the community. J Infect Dis 2007; 196:
S162-67.
PubMed
2 Alimonti J, Leung A, Jones S, et al. Evaluation of transmission risks
associated with in vivo replication of several high containment pathogens
in a biosafety level 4 laboratory. Sci Rep 2014; 4: 5824.
PubMed
3 CDC. Ebola hemorrhagic fever information packet. Atlanta, GA: Centers
for Disease Control and Prevention, 2009.
http://www.cdc.gov/vhf/ebola
/pdf/fact-sheet.pdf. (accessed Aug 27, 2014)
4 WHO. Interim infection prevention and control guidance for care of
patients with suspected or confirmed filovirus haemorrhagic fever in
health-care settings, with focus on Ebola. Geneva: World Health
Organization, 2014.
http://www.who.int/csr/resources/who-ipc-guidance-
ebolafinal-09082014.pdf. (accessed Aug 27, 2014)
5 Brady O. Scale up the supply of experimental Ebola drugs. Nature 2014;
512: 233.
PubMed
a Department of Preventive Medicine and Public Health, University of
Valencia, 46010 Valencia, Spain
b Preventive Medicine and Public Health Service, Hospital La Paz-Carlos III,
Madrid, Spain