The Ebola virus is one of the rarest and deadliest diseases found to man. It affects both humans and other animals such as primates including monkeys, gorillas and chimpanzees. It has been found in ill or dead fruit bats, forest antelope and porcupines in the rainforest among other areas. It is a member of the Filoviridae family. It is in the genus Ebolavirus and order Mononegavirales. Formerly known as Ebola hemorrhagic fever, it is known to kill up to 90 percent of people who are infected (Leroy, E.M, et. al, 2011).
It has a filamentous structure that is assembled in an envelope virus with particles containing negative-sense, single stranded RNA whose genomes are packaged inside a helical nucleocapsid. Ebola virus spreads through direct contact with bodily fluids such as blood, secretions, or organs of a person or animal who is currently infected with or has died from the disease. Initially it was thought that people got infected through contact with an infected animal and then passed on the virus from person to person. As the virus enters the immune system and organs it causes the levels of blood clotting cells to drop drastically, ultimately leading to severe and uncontrollable bleeding. Symptoms of Ebola Virus Disease (EVD) include fever, muscle pain, fatigue, severe headache, weakness, vomiting, diarrhea, abdominal pain and unexplained hemorrhage. Symptoms such as these may appear anywhere from 2 to 21 days after contact with the virus, usually an average of 8 to 10 days. The virus cannot be spread when a person does not show any signs or symptoms of being infected.
Ebola itself is not as contagious as other more common viruses such as measles or influenza. Getting the virus can happen in a number of ways. When a person makes contact with the infected bodily fluids or objects which are contaminated, the virus can break through the skin or mucous membranes in the eyes, nose and mouth. In early epidemics of the virus, the reuse of nonsterile injection equipment was responsible for health-care associated transmissions (The first confirmed, 2015). Another way to acquire the virus is through direct contact with fruit bats or primates who have the disease. The practice of food contaminated with bat feces is also thought to contribute to the spread. In addition, the disease can be transmitted sexually. More research has to be done on the prevalence of transmissible Ebola virus in semen over certain periods of time. All survivors of the disease need to test twice negatively to ensure safe sex practices among those affected. Airborne transmission has been show to affect nonhuman primates however there is no evidence of infection via inhalation in humans. The natural reservoir of the virus and the mode of transmission to humans is not yet confirmed. There has been successful infection in bats and rodents when doing laboratory testing of reservoir competence, but successful infection to plants and arthropods has not been done yet. Some studied have shown that survivors have antibodies in the blood that can be detected up to ten years after recovery.
Patients are usually more infectious in the later stages of the disease whose symptoms include diarrhea, vomiting and hemorrhages. This is because the amount of virus in the blood increases during the course of the illness. A phenomenon of the disease known as super-spreading is when there is a disproportionate number of individuals known as super spreaders who infect a large number of secondary individuals. These secondary cases are relative to an average infectious individual and mathematically are given by the offspring distribution of the virus. The offspring distribution is the probability that any one infected individual generates a certain amount of secondary cases along with the average new number of infections. Super spreading of the disease was found to be responsible for approximately 61% of infections during the 2014 epidemic (Lau, 2017). Another recognizable contributor linked to 300 cases was a funeral for a traditional healer in Sierra Leone in 2015 (The first confirmed, 2015). Being able to quantify super spreading is an important part in predicting future epidemics. Ebola virus is rare and usually imported by travelers from affected areas or by scientists working on materials and animals with the virus.
The five distinct species of Ebola virus have been isolated mainly from African countries. They include Zaire ebolavirus, Sudan ebolavirus, Tai Forest ebolavirus, Bundibugyo ebolavirus, and Reston ebolavirus which originated from the Philippines. The differences between the species is caused by the varying severity of the symptoms. Zaire ebolavirus and Sudan ebolavirus are known for their virulence compared to the other species.
The first cases of the virus infection were reported in Zaire. Zaire ebolavirus, the most common species of Ebola virus, was first isolated in 1976 during an outbreak in northern Zaire now known as the Democratic Republic of Congo or DRC. There was an 88% fatality rate with a total of 280 deaths out of the 318 cases. This strain has the highest fatality rates and is responsible for the outbreak that started in West Africa in 2014. The World Health Organization deems an outbreak when a country has no new case report for 42 days all the while having proper surveillance and proper diagnostic capability in the area (If the active, 2014).
The outbreak in 2014, which was reported first in March of that year was the largest outbreak since the discovery of the virus. The fatality rate during this outbreak was 64.3% in hospital admissions, 31.5% in treatment centers in Africa and 20% in patients taken care outside of West Africa. The virus was 97% similar to the first known Ebola virus that originated in 1976 according to genetic sequencing (CDC Laboratories, 2015). This outbreak had over 11,000 deaths in a total of 28,000 cases. The most recent outbreak was August of this year in the DRC. Previous to this on December 4th 2018, 271 deaths were confirmed out of a total of 458 cases in the DRC. The current outbreak is the tenth identified one to happen in the DRC to date.
Sudan ebolavirus was first isolated in 1976 as well during an outbreak in southern Sudan. It has an identical syndrome to Zaire ebolavirus only with a lower number of deaths with a fatality rate of 53-65%. The largest outbreak of this virus occurred in 2000 in Uganda with a total of 425 cases (Leroy et al., 2011). Tai Forest ebolavirus has only been documented in one case in 1994. A Swiss researcher found out about the disease while performing an autopsy on a chimpanzee. Bundibugyo ebolavirus was discovered in 2007 during a single outbreak in western Uganda. Reston ebolavirus was first isolated in Reston, Virginia in 1989. It was found to be imported through Cynomolgus monkeys from the Philippines. Workers that were exposed to infected animals had no symptoms even though they had positive blood serum.
Since the discovery of the virus in 1976, the Ebola outbreaks in West Africa, which began in southeastern Guinea under a rural setting began to spread to urban areas. The first two outbreaks were of fatal hemorrhagic fever and occurred in various parts of Central Africa, Zaire and South Sudan (CDC Laboratories, 2015). During the first outbreak nurses in the Yambuku mission hospital used five syringes for 300 to 600 patients daily. This improper nursing technique was the source for much of the early transmission of the disease. Initially, public health officials assumed outbreaks were coming from a single event associated with someone who was infected and traveling between multiple areas. Only later did scientists discover that the outbreaks came from two separate genetically distinct viruses. After this, scientists stated that the virus came from two different sources and spread independently of one another to the people populating those specific areas. Interestingly enough, viral and epidemiological data suggest that the Ebola virus was around way before the first reported cases (Emergence of Ebola, 2018).
In 1989 when Reston ebolavirus was discovered, the third strain of Ebola, it was in research monkeys imported from the Philippines into the United States. This was a key turning point in seeing that Ebola was no longer confined to Africa but existed in Asia as well. The few people who were infected with this strain never developed hemorrhagic fever. By 1994, when the Cote d’lvoire outbreak occurred, scientists and researchers had a better understanding of how the virus spread and made an effort to reduce transmission. This was done by using proper techniques for syringes, using disposable equipment, and wearing gloves masks and gowns.
Now in 1995, when another Zaire outbreak happened in the Democratic Republic of Congo the local community was well educated as well as the hospital staff. There was the right amount of equipment present to be able to deal with the outbreak as well. Important to note that by 1995, healthcare practitioners and personnel were trained on disease reporting and patient case identification which significantly increased keeping records of Ebola virus.
In 2014, the largest ever recorded epidemic in West Africa with 25,826 cases and 10,704 deaths was reported by April 12, 2015 primarily in Guinea, Liberia and Sierra Leone. This changed the direction vaccines for this disease were headed. Before the outbreaks were controlled by isolating symptomatic individuals, looking at who they were in contact with, cremating them during burial and changing various practices. Now, more social efforts have been put into place such as media campaigns, educational programs, and religious programs as well (Mukpo, 2014). A multitude of factors play into the growth of the virus such as emerging populations and interactions with wildlife.
Since Ebola was rare when it first began, not many vaccine companies saw it profitable to take on the task of creating one. Development for a vaccine against the disease came in the late 1970s but the efforts were not enough to have any significant results. Now in 2014, previous tests on animals were fast tracked to Phase 1 clinical trials. Currently there is a global registry listing several Ebola vaccine trials in progress involving human subjects. Since the 2014 outbreak was due to Zaire ebolavirus, all the current vaccines being designed are for that strain. If it works, it will be likely we can apply similar principles to creating vaccines for the other strains of the virus as well. The two best vaccines to date are a GSK chimpanzee adenovirus vector vaccine and a Merck/New Link Genetics recombinant vaccine. They are both currently being tested in Phase 2 trials in Liberia for those at risk of contracting the disease (Ebola virus disease, 2018). More Phase 2 and 3 trials are being planned but in general scientists have had a harder time developing treatment for a viral disease rather than bacterial. Viruses have fewer targets for treatment unlike bacteria which have many. In addition, the Ebola virus evolves quickly so developing a vaccine today does not necessarily mean it will work a year or two from now.
The high death rate makes it difficult to work on the virus and there are only a few laboratories that you are allowed to do testing in, specifically biosafety level 4 facilities, the highest level of protection (Rettner, 2014). Some potential treatments show promise in animals specifically with the way the virus replicates. There was a reduction in the healthcare workers who accounted for those infected from the 1995 outbreak which was 25%, to the 2014 outbreak which healthcare workers represented only 3.9%. In 2014-2015 the majority of transmission was between family members, a total of 74% (Baseler, 2017).
At this point, changes in the prevention and control of Ebola Virus Disease have to be made. In regards to the political economy model of the disease, the current top to bottom approach is not working in preventing the disease from spreading, meaning we must turn to another alternative. The top to bottom method is when health institutions and populations wait for the disease to be present in individuals before they begin treatment. Since this disease is quite contagious if the proper precautions are not taken, waiting is not productive. The bottom to top approach is aggressively preventing the disease. A community and individual ownership of the disease is vital in being able to prevent it in those highly affected countries. We should not be waiting until we have high death tolls to start taking this epidemic seriously; unfortunately, what a majority of the Liberian government did in the outbreak of 2014 (Obilade, 2015).
The government of Liberia allocated resources to secondary villages affected by Ebola. This resulted in a loss of political support for areas that were hit first and an increase in votes from those swing villages and secondary hit areas. Consequently, the citizens of the country were able to decided who their vote would go to and this directly impacted the government and their role in prevention of the Ebola virus. Overall, foreign aid came late to the countries that were first affected by Ebola in 2014 and this greatly devastated their populations. It is obvious that a better tactic needs to implemented for the next outbreak and this will only be done with bottom to top processing.
The resources of these countries need to be mobilized to prepare for future devastation of Ebola and precautions need to be taken right away. Some ways to do this in highly affected areas is have individuals take their temperature twice a day to look for early symptoms. A reduction in the amount of time spent outside will help with the risk of getting infected. Cleaning and wiping down the house inside will help as well. Schools should use their platform to emphasize personal hygiene and create an environment where students are able to be educated on Ebola. Not only students but adults need to take individual ownership of their health education. Training and retraining of health care workers will improve the community knowledge on infectious disease control. Communities should take the initiative to identify, isolate and report incidences as well (Fast, 2015).
Overall, the political economic model of Ebola is highly manipulated by the government and the people voting on those positions (Mukpo, 2014). It is difficult to get international cooperation because of the low number of people affected by this disease in those countries. However, if a change is wanted the whole world needs to move to a bottom to top approach of prevention of Ebola virus. This can be accomplished with the help of a medical anthropologist in looking at specifically the social and biological factors that are currently influencing the spread of this disease. With a more precise outlook combined with data showing promising numbers of the spread of this disease decreasing, medical anthropologists could change the whole outlook on the Ebola virus.
When looking at how the disease distribution and health disparity will change throughout time and the use of government health care resources, it can offer an important insight into changing the nature of this disease once and for all. We need to start implementing serious prevention and actually put money into researching how to stop the occurring epidemic of the Ebola virus before it takes the lives of those who have the opportunity to get well and healthy. Feeling compelled to help victims who have already been infected is not a step in the right direction. The political economic model shows that foreign resources are not enough. Unfortunately, those are the resources which have been a majority of what has been used to fight the epidemic. Hopefully with medical anthropologists on board, they will be able to help understand the interrelationships that affect this disease and globalize truly helpful efforts.
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