During this unprecedented epidemic that has hit Africa West “much has been learned and what we propose in the future will be quite different,” told AFP Michel Van Herp MSF. “The next outbreak should be less dramatic,” he predicted. One that broke out in December 2013 in Guinea before touching Liberia and Sierra Leone has made more than 11,300 dead.

“For the people in contact with the sick at home, it will propose either a vaccine or a pill because some refuse vaccination,” added the epidemiologist, Ebola specialist, based in Belgium. And “it will be a great achievement if the vaccine is available” for health workers who have paid a heavy Ebola (over 500 dead).

One of the vaccines, the Merck is advanced (Canadian VSV-EBOV developed by the US laboratory), said Professor Jean-François Delfraissy, coordinator of the fight against Ebola for France.

However, it has only been tested on subjects in contact with infected people, and not in the general population. For his part, Dr. Stephen Kennedy, principal in charge of a test in Liberia on two vaccines, the Merck and the GSK (GlaxoSmithKline), believes they have “promising effects.”

The Most products or vaccine trials have been conducted to completion, if not ready on time when the epidemic was in full swing.

The care of patients was improved. Mortality was reduced by 70% to 40%, says Prof. Delfraissy citing in particular the absence, at first, systematic patient infusion. The intravenous drip set, to ensure proper hydration and prevent kidney failure, increases the chances of survival.

Next time, promising treatments may be proposed again as the Japanese antiviral, the favipiravir (Avigan the Fuji Film) in tablet form, which was the most widely used and zmapp (antibody cocktail).

Experimental molecule Gilead GS-5734, and injection with a length of long life (in the body) is also a track to dig. The Scottish nurse, who made a serious relapse with encephalitis late 2015, after being declared cured, who had received it, survived.

The favipiravir, very well tolerated, will likely be in the future, in combination with another treatment. It has already been tested with zmapp but on a limited number of patients.

Changes survivors

Furthermore, MSF has found that a drug against malaria containing amodiaquine reduced mortality 31% in one of its centers in Liberia.

For Dr. Iza Ciglenecki, co-signatory of the study on this drug, “it is urgent to conduct tests” to confirm its effectiveness against Ebola.

Finally, the track transfusion of convalescent serum or blood, despite recent disappointing results, is not abandoned.

The monitoring of survivors is also crucial, whether sequelae (damage to the eyes …) or the persistence of the virus in their body, especially the sperm, because of the proven possibility of sexual transmission. The epidemic has indeed revealed that Man could be a virus reservoir.

For sperm, the risk does not appear solid, but remains unclear, according to Van Herp. In Guinea, where there are nearly 1,300 survivors, a group, which will be followed for two years, is being set up and could reach 800 participants in late March.

“Basically, over a third have virus sequences in sperm three months after being considered cured, then this down but in some patients nine months was found the virus after, “says Dr. Delfraissy, considering a treatment trial in this area.

surveillance and warning systems Some in West Africa to break the chain of transmission of the virus must also be set up. “Further research in the field of vaccines, therapeutics and animal virus reservoir and human remains essential”, sums up specialist

Ebola. Portrait of a [19459019killervirus]

Causing fever, severe vomiting and diarrhea, Ebola which WHO is expected to announce Thursday the end of the epidemic in West Africa, has more than 11,000 dead in two years and prompted the Fear globally because of its dangerousness

– HOW MANY VICTIMS

Part of the south of Guinea in December 2013, the epidemic of “Ebola virus disease” made in least 11 315 deaths per 28 637 reported cases, according to a report from the World Health Organization (WHO)

Victims have concentrated more than 99% in three neighboring countries. Guinea (more than 2,500 dead ), Sierra Leone (more than 3,900 dead) and Liberia (over 4,800 deaths), undervalued according to WHO balance sheets

– WHERE DOES THE VIRUS

Historically? Ebola was first demonstrated in Central Africa. This virus Filoviridae family (filovirus) is named after a river in northern Democratic Republic of Congo (formerly Zaire) where it was first identified in 1976. Five distinct types of Ebola virus have since been listed: Zaire, Sudan, Bundibugyo, Reston, Tai Forest. The virus causing the epidemic in West Africa Zaire species of

– HOW IS IT

The virus circulates among bats? fruit-eating, considered the natural host of Ebola, they do not develop the disease. Other mammals such as apes, antelopes and porcupines can carry it and transmit it to humans.

During an outbreak, Ebola is transmitted between humans through direct and close contact. A healthy person is contaminated by “bodily fluids” of a sick person: blood, vomit, feces, etc. Unlike the flu, this virus can not be transmitted by air. Also Ebola is it less contagious than many other viral diseases

But this virus is formidable because of his “case fatality rate” very high. On average it kills half the people it reaches, according to WHO.

– WHAT SYMPTOMS

After an incubation period of 2-21 days (average around five days), Ebola is characterized by a sudden fever, with intense weakness, muscle and joint pain, headache and sore throat.

This phase is often followed by vomiting, diarrhea, rash, failure of the kidneys and liver. In some cases, occur internal or external bleeding

– HOW TO PROTECT

The instructions are based on simple but rigorous preventive measures (hand washing, disinfection solutions with hydro -alcooliques …), as well as monitoring of symptoms, including fever.

It is recommended to stay away from sick or dead bodies within several meters, for caregivers .?, wearing gloves and masks

– WHAT SEQUELAE

Sequels were frequently observed in survivors: arthritis, vision problems, eye inflammation, and hearing disorders .

– IS POSSIBLE TREATMENTS

Several tests were conducted with experimental treatments and vaccines during the epidemic in West Africa

Among these treatments. include the favipiravir (Avigan), antiviral developed against the flu by a subsidiary of the Japanese group FujiFilm or zmapp (result of a US-Canadian collaboration), cocktail of three monoclonal antibodies gave an experimental basis in some patients. The administration of antimalarial amodiaquine-artesunate has helped significantly reduce mortality, according to a study in a treatment center Doctors without Borders (MSF) in Liberia.

Hope could also come from vaccines. Guinea tested on more than 4,000 people, the VSV-EBOV developed by the Public Health Agency of Canada with US NewLink Genetics Laboratories and Merck, proved 100% effective, according to a study published in July. Other candidate vaccines were also tested, particularly the one developed by the British firm GSK with the American Institute of Allergy and Infectious Diseases (NIAID).