The tail of the epidemic and the challenge of tracing the very last Ebola case

EUROSURVEILLANCE  by  K. Kaasik-Aaslav and  D. Coulombier                                   March 26, 2015

Upon entering what seems to be the tail of the epidemic and, as in any such moment, the ‘Ebola endgame’ strategy requires adaptation to the heterogeneity of the epidemiological situation. The tools for EVD control need to be fine-tuned and the commitment from the teams supporting local authorities in affected countries needs to be sustained.

While the pressure on clinical and laboratory expertise gradually decreases, the demand shifts towards field epidemiologists to assist local public health experts and support community workers to engage in active surveillance and to monitor remaining transmission chains in affected communities.

The priority at this stage of the epidemic is the early detection of possible re-emergence of transmission, in relation with importation of cases from areas still experiencing active transmission. Other contributing factors to re-emergence of transmission could be delayed secondary transmission, as suspected recently through sexual contact in Liberia and Macenta, Guinea or new primary zoonotic transmission from the animal reservoir given the long duration of the present outbreak [11,12]. However, no conclusive evidence is available for sexual transmission of the disease by convalescent EVD-negative individuals [13]. Moreover, no new primary zoonotic transmission has been documented in the affected countries.

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