• ebola
• crisis
• malaria
• Force health protection

Dear Sir

We have read with interest the article by Bricknell et al1 previously published in this journal and we would like to continue this debate by reporting the French Defense Medical Service (DMS) experience in a similar position in Guinea and the role of Force Health Protection (FHP).

France deployed a treatment centre dedicated to healthcare workers (HCW) infected by Ebola virus (Centre de Traitement des Soignants—CTS), from January to July 2015, on the Guinean air force base in Conakry. About 400 French servicemen were deployed for missions ranging from 1 to 4 months duration, during which 60% (n=246) worked in the hazardous area (red zone). A specific procedure was implemented to monitor servicemen's temperature twice daily using an infrared thermometer. According to the procedure, any servicemen presenting with Ebola virus disease (EVD) suspicion should be hospitalised in a dedicated isolation area to undergo PCR diagnosis, after an epidemiological and clinical assessment.

To prevent this highly stressful situation, preventive measures were established. HCWs were trained for biosecurity before their deployment in the CTS and a procedure put in place in case of a viral exposure incident which relied on assessment of the contamination risk by a trained infectiologist for each notified event. As fever is the main symptom in EVD, prevention of malaria and gastrointestinal (GI) diseases were priorities, as identified by UK DMS in Sierra Leone; we also identified poisonous snakebites and reactive stress as significant prevention targets.

Besides the ready availability of malaria chemoprophylaxis (doxycycline), training sessions were organised regarding vector control measures centred on individual protection (eg, the use of repellents, long-lasting bed nets and preimpregnated military uniforms). Additionally, elimination and treatment of vector breeding sites along with installation of Mosquito Magnet were implemented. No cases of malaria were reported in Guinea or after return to France within the servicemen deployed.

To prevent GI diseases, the catering was provided by a local company selected by the French military veterinarian and only bottled water was provided. Two diarrhoea epidemic episodes occurred after meals in restaurants outside of the CTS, in Conakry.

The CTS staff were offered psychological support during the mission due to the stressful context (the high fatality rate of the disease), the physical constraints (personal protective equipment and extreme heat) and the living conditions. No medical evacuation for psychological reason was needed.

The CTS was surrounded by lush vegetation creating good conditions for many lethal snakes such as the boomslang (Dispholidus typus) and black mamba (Dendroaspis polylepis). To dissuade these animals, rodent control was set up inside and around the CTS, in association with Margosa, a snake repellent. No snakebites were reported during the CTS duty period. All CTS servicemen returning to France after deployment underwent the national monitoring procedure for 21 days; no cases of EVD have been reported.2

To conclude, as raised by Bricknell et al, all the prevention measures implemented show that FHP is essential to preserve operational capabilities and the field public health experts have to be mobilised throughout the mission, from the planning till the end.