[Ebola Virus Disease Outbreak Response in West Africa]

The largest ever outbreak of Ebola virus disease has been spreading in West Africa. The authors were deployed to Liberia and Sierra Leone as short-term consultants for the World Health Organization. Our mission was to ensure clinical management and infection prevention and control priorities in frontline treatment centres. This paper describes how the disease is spread, its symptoms and progression, measures currently taken to ensure both infection control and the best possible care, and the significance of infections among health care workers. We adopted an approach which is detailed in the WHO Clinical Management of Patients with Viral Haemorrhagic Fever. Areas within the treatment centres were divided into either a "hot zone" or a "cold zone". Patients were interviewed, and those patients who met the criteria for suspected, probable or confirmed cases were moved to hot zones. All health care workers wore personal protective equipment when entering a hot zone and washed hands with a hypochlorite solution after each patient encounter. Among the problems which we encountered was a fundamental mismatch in the numbers of patients and nurses. The nurses often had to work alone in hot zones in protective equipment which limited physical movement and blurred vision. These factors contributed to fatigue due to prolonged outbreak response and may have resulted in infections among the nursing staff. In conclusion, we present the current situation in West Africa in regard to the recent outbreak of Ebola virus disease, specifically the clinical picture based on our observation. We further propose steps to be taken to handle the patient care safely and effectively. We hope our experience will contribute to national discussions on how to respond to the Ebola virus disease.