TMC PULSE

21 T M C » P U L S E | J U LY 2 0 1 8 Governments and philanthropic organizations around the world were forced to recognize the dev- astation that Ebola had unleashed. Those entities sped up develop- ment of the vaccine, Hotez said, so it could be used at the end of the outbreak. Officials administered the vaccine to people in close contact with the infected and they also gave it to those known to be in contact with the contacts through a method called the ring technique. More than 4,000 at-risk people received the vaccine. "I remember telling reporters, when this was used at the end of the big outbreak, 'if it saves one per- son's life, it was worth it,'" Geisbert recalled. The vaccine performed better than that: Not one person who received it contracted Ebola. But those numbers were bitter- sweet. On one hand, they proved that the vaccine was extremely effective. On the other, Hotez said, the outcome suggested "11,000 peo- ple died who didn't have to die." The success of the vaccine at the end of that outbreak gave officials the confidence to use rVSV-ZEBOV— at this point licensed to drugmaker Merck—at the onset of this spring's outbreak in the Democratic Republic of the Congo. McCormick, of UTHealth, said as long as health officials figure out how to maintain ample stocks of the vaccine and get it to rural areas, it might prevent Democratic Republic of the Congo something like the West Africa out- break from ever happening again. In late June, WHO officials said the current Ebola outbreak appeared to have stopped, though it would take until the end of July to officially confirm. Peter Salama, M.D., WHO deputy director-general for emer- gency preparedness and response, told Stat News that he believes the vaccination effort helped contain the outbreak. Geisbert's role in developing the vaccine is his third brush with Ebola-related fame. In 1989, he dis- covered the Reston virus, a species of Ebola, in monkeys that had been imported to a laboratory in the Washington, D.C. suburbs. The dis- covery set off a minor panic, given the lab's proximity to the nation's capital. The incident was chronicled in the Richard Preston bestseller, The Hot Zone. Geisbert snapped the photo of the virus that appears on the book cover. His expertise was crucial again in 2014 when a Liberian man in Dallas was diagnosed with Ebola, as were medical personnel who treated him. "I was on the phone with [then- Texas Governor] Rick Perry every other day," Geisbert said. But as Geisbert reflects on his years of work in dangerous condi- tions, he's hopeful. "What we do in the BSL4 [Biosafety Level 4] is dangerous," Geisbert said, referring to the type of lab where he works, which houses the world's most deadly, incurable diseases. "My wife runs my lab. The people in the lab are some of my closest friends. You're used to putting people you care about in harm's way." When he's in the lab, he often thinks about people in Africa and elsewhere who could be saved by his work. "They can't help that that's where they were born or that they're in this setting," Geisbert said. "You realize that could be your brother, your son, your wife." Ebola virus disease (EVD), formerly known as Ebola hemorrhagic fever, is a severe, often fatal illness in humans. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. The average EVD case fatality rate is around 50 percent. Case fatality rates have varied from 25 percent to 90 percent. The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests. The 2014–2016 outbreak in West Africa involved major urban areas as well as rural communities. Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, infection prevention and control practices, surveillance and contact tracing, a good laboratory service, safe and dignified burials and social mobilization. Early supportive care with rehydration, and symptomatic treatment improves survival. KEY FACTS ABOUT EBOLA Source: World Health Organization Credit: AP Photo/Sam Mednick

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