Transmission of Ebola within the health system (8)

5 May, 2019

Dear David Gisselquist and HIFA colleagues,

David, you said: "Evidence people avoiding health facilities helped to stop bola outbreaks. Until recently, scholarly discussions have been clear on this issue. For example, (a) In 2005, Susan Fisher-Hoch described DRC's (Zaire's) 1976 outbreak (p 129 in ): 'Most of the cases became infected in the hospital, and the local community, despite their poverty and lack of education, quickly figured this out and abandoned the hospital, effectively terminating the outbreak.'"

I think we should be cautious about reference to historical accounts. The preceding sentence to the aboove quote notes: 'In Yambuku [the site of the 1976 outbreak], the prenatal clinic served many women but had limited equipment (needles and specula), which was constantly reused without adequate sterilization.'

It would be interesting to know whether re-use of needles (and gloves and other equipment) continues to be a major issue in DR Congo, in addition to other basic hygiene measures by healthcare providers.

Meanwhile, we await clarification from WHO about the details of Dr Michael J Ryan's (WHO Assistant Director-General, Emergency Preparedness and Response) statement: "If we look at the intense outbreak we had in Beni City... we estimate that 80-85% of the transmission in that outbreak was occurring inside the health system."

Without such clarification, there is a risk that such statements can be interpreted to condone or even promote avoidance of health facilities by the public, which is the opposite of current public health advice.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: