Ebola Crisis: The
Emerging Threat
The Ebola 2014 Western Africa Outbreak
Current Western Africa Epidemic - Cases & Deaths
Origin of Current Ebola outbreak: Dec 2013
Location: The Forest region of Guinea.
The outbreak went unnoticed for 3 Months, by which time 50 unexplained deaths had occured in the area, and the scale of infection was increasing in Western Africa.
Why did the virus go unnoticed?
1) It was mistaken for Cholera or Malaria (which are very prevelent in this area) due to having similar initial symptoms.
2) Locals blamed unexplained deaths on witchcraft and evil.
3) Prior to the current outbreak, the an Ebola virus outbreak had never occured in Western Africa before.
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​Symptoms
Usually develop 2 to 21 days after being infected with the virus:
- fever
- headache
- joint and muscle pain
- sore throat
- intense muscle weakness.
Travel Advice
If you have any above symptoms within 21 days of returning from Western Africa, stay at home. Immediately phone 111 or 999, explain you have recently visited Western Africa.
Transmission - Can occur via:
- blood
- body fluids e.g saliva, feces, semen, breast milk, tears, blood
- infected organs
- consumption of bushmeat
- dead bodies
Learning from past outbreaks and mistakes
During the 1995 Ebola outbreak in Zaire (DRC), superstition and fear of the locals, as well as lack of resources, education, and well planned government, aided the spread of Ebola.
Exploring past outbreaks & learning from previous mistakes is important in order to tackle the 2014 Ebola crisis in Western Africa. Action needs to be taken at all levels: local, government and international to try and reduce the spread.
The main advice given to communities:
frequent hand washinng,
avoid physical contact
avoid crowded areas if have symptoms.
The Zaire 1995 outbeak suggested the importance of safe burials of the dead, as the Ebola virus can survive for several days outside dead skin.
Therefore, for the current Western Africa outbreak, a key target to reduce virus transmittion, from mourners touching bodies, is safe burials. As western african culture has more emphasis than subsharan african nations (previous outbreaks), on cleansing the body, trying to work with local communities to see the importance of adapting their cultural practices, is especially important to miniise the spread.
The rate of spread (as of Jan 2015):
Time taken for no. Confirmed case Suspected Country sick individuals case fatality fatality rate %
to double(days) rate (%) not confirmed
Guinea: 15.7 70.7 13
Liberia: 23.6 72.3 58
Sierra Leone: 30.2 69.0 35
The 2014/15 Western African crisis in Western Africa has shown that for future Ebola outbreaks, development of an ealy warning system with help at levels will be needed - international, national and regional.
Potential management of future outbreaks in the region will face challenges, such as: managment approach to disease, low-resources, knowledge gaps and operational barriers.
Ability to contain the virus and prevent transmission through education is key to future management stategies.
How Ebola is spread & what makes it so dangerous ?
Factors which have affected the spread of Ebola in 2014 epidemic
1) Poor response
The poor response was influenced by poor decisions of the WHO and governments of 3 main affected countries: Liberia,Guinea & Sierra Leone
Governments
a) The Governments lacked money, experience & resources to respond effectively. Guinea, Sierra Leone & Liberia are among the poorest countries.
b) Cases between countries were not properly followed up, leading to wider area of spread.
c) Only lab confirmed cases counted, but many died before tested = no. cases smaller than actual.
d) Guinea's government didn’t want foreign investors and businesses to pull out of country, so downplayed the epidemic.
Organisations
a) MSF are a minor company with previous Ebola outbreak experience
b) Previous Ebola cases occurred in a certain way and could be easily contained. The WHO left response to local ground level, however the local members had no previous Ebola outbreak experience.
c) Few ground level decicions were made, despite daily meetings.
d) The Main WHO coodrinator had no Ebola experiendce
Lack of response of western world
The World did not feel concerned with the intitial outbreak. However, as concerns of epidemic spread beyond Africa it captured the medias attention and became an important topic of concern. This prompted more aid and better co-ordination to take place.
2) New contries affected to past outbreaks
This Ebola outbreak is 1st documented outside Sub-Saharan Central Africa. Previously this strain of the virus has been found in only 3 Central African countries: Democratic Republic of the Congo (DRC), Republic of the Congo, and Gabon.
A lack of facilities, training and experience was available to cope with the epidemic. This resulted in significant crippling of the health sector, and concequently increased the impacts of other endemic diseases.
3) Cultural beliefs and practices
Burial practices
Traditional burial practices, involving washing and touching of the deceased, have been linked to 60% of Ebola cases in Guinea
Traditional medicine
Traditional healers have local knowledge, skills and practices in the local culture that have arisen from theories, beliefs, and experiences. They hold positions of influence and trust within the community and can influence locals thoughts on health messages.
4) Geographic location of the countries
The current Ebola strain in W. Africa thought to be transmitted from wildlife species to humanssthrough the ingestion of fruit that has been contaminated with infected fruit-bat saliva or feces.
Changing weather patterns influence forest fruit production and other resources. This could mean a wider foraging area will be used, thus presenting a greater risk to host species.
Land use change and deforestation have changed the distribution of species clusters. Increase contact between susceptible and infected hosts within and between species, as well as to humans.
This may intern affect climate change effects as contact probabilities can be altered by deforestation and land-use change, which may compound climatic effects and further cluster susceptible and infected hosts around more limited resources.
Environmeantal Factors
1) Average Temperature in W. Africa has increased in C20th and will continue to do so in the next ferw decades.
2) Concequently, understanding effects of climate change on the Ebola virus distribution is important. The effects of climate and weather on past outbreaks may be essential to anaylse to try and limit future spreads.
5) Existing diseases/health/social/political problems
Poor Medical Equiptment
Unsterilized medical equiptment & ack of resources aided transmission.
Social conditions
Population density - people/km sq (1960-2012):
223% Guinea 178% Sierra Leone 275% Liberia
Outbreak region population density has increased over C20th:
1) 1989 to 2004 - Armed conflict in West Africa, moving across borders among Liberia, Sierra Leone, Guinea, and Côte d’Ivoire. Mass refugee movements, displaced and vulnerable people.
2) Rural-urban migration has increased the proportion of people living in an urban environment, thus transmission is more likely.
3) Poverty, poor healthcare, poor housing infracstructure, education and high population density. These have increased the potential human-human transmission, possible contact with the virus and response to deal with the 2014 epidemic, thus contributing to its scale and duration.
Deforestation
Altration to human landscape by deforestation and urban land use has increased exposure to infected bats as they have to leave thier habitats and come into contct with humans.
a) Dec 2013 - Start of current outbreak in The Guinean forest. It is very biodiverse, containing an estimated 1/4 of all African mammalian fauna.
b) Cumulative forest loss estimated at around 85%
c) The landscape is dominated by forest-agricultural mosaics