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The last five years have seen an increase in the number of documented cases of Ebola, a deadly and macabre viral disease, thanks to widespread (and ongoing) outbreaks that ravaged Africa and even spread in from other parts of the world. But a new study released Thursday suggests that the waves of misery and death that we record every time we discover the Ebola virus are just the tip of the iceberg – at least half of the epidemics of its 40-year recurrence could to have gone unnoticed.
Researchers at the University of Cambridge examined data from the largest Ebola outbreak ever: nearly 30,000 cases were reported and 11,000 deaths between 2013 and 2014, mostly concentrated in Africa. # 39; West. They were particularly interested in how secondary infections during the outbreak spread beyond the initial case of an animal, usually a bat, transmitting the disease to a person. They used the data to create a model of the cases expected since 1976, when the first-ever Ebola patients were reported. Then they compared the model to the actual documented Ebola balance sheet.
Based on this comparison, they estimated that about half of all overflow events – a case of animal infecting a person with Ebola, which could then have turned into an epidemic more important – have not been reported during all this time.
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"Although the total number of evidence in this area is still limited, the main result of this study – [Ebola] epidemics are not detected – is consistent under many different sets of assumptions, "wrote the authors in their article published Thursday in PLOS Neglected Diseases.
As frightening as it may seem, it is worthwhile to put it in a broader context. Prior to the 2013 outbreak, most outbreaks of Ebola had been very minimal. And missing cases are particularly likely to be "dead ends," to quote the authors, as it would be easier for a doctor to never hear and document. Thus, even with the most generous assumptions used in the study, hidden homes could represent between 100 and 300 cases in total over a period of 43 years.
In addition, according to the authors, some factors could significantly increase the number of overflow events beyond what they had planned. If, over the years, some strains of Ebola in the wild were less contagious or nauseating than usual, for example, more people might have been carrying the disease without knowing it.
More than an accurate estimate of the number of Ebola cases, the study is meant to show that we have not put in place an effective system to detect these outbreaks in general. And the more hidden outbreaks, the greater the risk that one of them will turn into something more monstrous and more difficult to fight.
"There is a clear need to improve outbreak detection and rapid response, and investments in these areas are among the most effective ways to reduce the number of deaths" from the Ebola virus, the authors wrote.
This is a hard lesson that is timely. Last week, the World Health Organization announced that the current Ebola epidemic outbreak in the Democratic Republic of Congo has become international, with at least three cases in the neighboring country, Uganda. The 10-month-old epidemic is already the second-highest ever, with just over 2,000 confirmed or probable cases and nearly 1,400 deaths.
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