Are we prepared for Ebola and other viral haemorrhagic fevers?

As the current Ebola virus outbreak reaches record numbers in West Africa, Australia is developing guidelines and protocols for dealing with suspected cases. We ask two important questions. Could a centralised approach to this process improve our response? And, would not the best preparation for Australia and other developed countries be to provide both resources and expertise to affected countries, applying the principle of enlightened self-interest? There has been significant experience in dealing with outbreaks of Ebola virus since the initial description of the virus and the first two outbreaks in 1976, although several features of the current outbreak are unusual. Prior to this outbreak, 2,387 cases had been reported in 28 separate outbreaks, with a case fatality risk (CFR) of 66.7 .1. Of the five species of Ebola virus, three (Zaire, Sudan and Bundibugyo) have been associated with significant human to human transmission, with the other two (Tai Forest and Reston) associated with limited or no human disease. The current outbreak has been caused by a new emergence of the Zaire species.2 Several factors have contributed to this outbreak being the largest described. By early September 2014, cases had been reported in multiple regions in five countries and for the first time involved large urban centres. Even before the dramatic spread of late August and early September, the World Health Organization (WHO) had designated this outbreak as a public health emergency of international concern.3 This designation has been used twice previously for the 2009 influenza H1N1 (Swine Flu) pandemic and the 2014 resurgence of polio. It has legal implications, invoking measures for disease prevention, surveillance, control and response under the 2005 International Health Regulations.