The West Africa Ebola Virus Outbreak 2014

Ebola Virus Disease

This is a virus that affects the way blood clots. The blood clotting problems brought about by the virus causes the blood to leak from the body’s small blood vessels leading to internal bleeding.  When infected with the virus, the body also undergoes tissue damage and inflammation. The virus is spread when a person gets into contact with body fluids from an infected person; the fluids are sweat, blood, mucus, saliva, tears, faeces, vomit, urine, breast milk and semen. You can also be infected if you touch clothing or objects that have been in contact with body fluids from an infected person. The disease has the potential to spread very fast if swift infection control measures are not taken.

The 2014 Ebola Outbreak in West Africa

The initial case of this Ebola virus outbreak was recorded in December 2013 in a Guinea village where a 1 ½ year old boy is believed to have acquired the infection from bats (Danasekaran, Mani, & Annadurai, 2015). Thereafter, five more cases were reported with patients exhibiting fatal diarrhoea which led to issuance of a medical alert in 24 January 2014. Afterwards, the virus reached the capital city Conakry which resulted in Guinea’s Ministry of Health issuing an alert for a mysterious illness. After this, Pasteur Institute confirmed that the mysterious illness was Ebola which was a product of Zaire ebola virus (Danasekaran, Mani, & Annadurai, 2015). After 29 deaths and 49 confirmed cases, the World Health Organization declared the outbreak in March 23, 2014. 

As a result of a poor surveillance system coupled with poor public health infrastructure, it became difficult to contain the outbreak. Failure to contain the outbreak led to it spreading to neighbouring countries such as Sierra Leone where the first case was reported on May 26, 2014 and Liberia in March 2014. The virus spread from the countries rural areas to its three capital cities that were more densely populated which created a higher rate of transmission (World Vision, 2019). 

The situation continued to deteriorate in West Africa which led to the WHO declaring the situation as a Public Health Emergency of International Concern (PHEIC). A declaration like this is made on events that have the potential to spread internationally and those that need coordination at an international level. Before the epidemic was contained, it had spread to other countries that included Nigeria where the first case was confirmed on August 6, 2014, Italy on May 12, 2015, Spain on August 5, 2015, Mali on October 23, 2014, Senegal on August 29, 2014, the United States on September 30, 2014, and the United Kingdom on December 29, 2014 (World Vision, 2019). 

In august 2014, WHO declared the outbreak as an “international health concern” which was followed by Sierra Leone banning mass meetings and ordered all schools closed. In September 2014, the United States sent 3,000 military that set up 17 treatment points. The United Nations then declared the outbreak “a threat to international peace and security”.  Between September 19 and 21, there was a three-day lockdown in Sierra Leone to establish new infections and prevent the disease from spreading.  Health workers went from door to door in households to investigate any deaths that were not previously reported. They also reminded the people of the danger that is brought by traditional burials that involve coming into contact with a corpse. By the end of 2014, over 7,900 people had died from the disease with 8,997 infection reported. The disease was finally contained in May 2016 after 11,000 deaths and 28,000 infections (World Vision, 2019). 

Epidemiological Determinants and Risk Factors Associated with Ebola

History 

The first case of Ebola was reported in the Democratic Republic of Congo and Sudan in 1976. The virus is passed on to humans from wild animals, mostly apes, and quickly spreads through contact with infected bodily fluids. The natural host is thought to be the fruit bat although it is still unproven.  The Ebola virus exists in 6 species of which only four affect humans; Sudan ebolavirus, Tai Forest/Ebola Ivory Coast, Zaire ebolavirus, and Bundibugyo ebolavirus (Public Health England, 2016).

How it Spreads

The outbreak spread fast because of its spread in densely populated urban areas, increased movements across borders, and a conflict between primary infection control measures and established traditional and cultural practices among the affected communities.  It took the intervention of local leaders for the infection prevention measures to take effect. There was also a cautious implementation of policies at both the global and national level that helped prevent further spread of the virus putting an end to the outbreak (Public Health England, 2016).

Risk Factors

Whenever there is an outbreak, the first person to have the virus gets it from touching bodily fluids of an infected animal such as antelopes, gorillas, or chimpanzees; either dead or alive. In the outbreak that features in this paper, the first exposure was due to exposure to bats (Levy and Oboi, 2016). When a person gets into with any body fluid of the infected person, they get the virus. Infection can also be through contact with items that have been touched by an infected individual such as needles, utensils, or soiled clothing. Once infected, the victim takes a period of 2-21 days before they exhibit symptoms of the disease; during the incubation period, they cannot transmit the infection to another person. Transmission occurs after the infected person starts to exhibit symptoms of Ebola virus disease (Levy and Oboi, 2016). 

In some countries such as those in West Africa, the outbreak was fuelled by traditional interment practices where mourners get into direct contact with human corpses. The Ebola virus continues to live even after the death of the infected person. The burial ceremony of a traditional healer in Sierra Leone is suspected to have borne 365 new infections in March 2014.  Another factor that promotes spread of the virus is through sexual contact with someone who has recovered from the virus as the virus can still be in semen for several months after the individual has recovered (Danasekaran, Mani, & Annadurai, 2015).

People who live close to tropical rainforests in Africa are at a high risk of getting the virus from animals if they come into contact with an infected animal whether dead or alive. Family members of the infected individual are also a t a high risk of infection due to sharing of household items such as utensils, beddings, and clothing. Hospital staff who attend to the infected are have a risk of getting the disease as there are inefficient infection control measures (Danasekaran, Mani, & Annadurai, 2015). 

How an Ebola Virus Disease Outbreak would Impact the Community

If an outbreak of Ebola occurs in my community, it would be catastrophic. Since this area is densely populated, the virus would spread very fast. Most people would choose to stay at home and even children will not attend school. The outbreak would negatively affect business in the area as there would be no people to transact with.  The area would be declared a no go zone where no one can enter or leave the area to avoid spreading the virus to other areas. Most countries give travel advisories to their citizens against visiting the affected regions and also restrict entry of people from those regions into their boundaries (Stamm, 2015). 

The difficult part in an Ebola outbreak is in identifying the initial host or the person who brought the virus in the area. If for example the school nurse suspects that one of his students has the virus, the first thing would be to quarantine the student and inform relevant authorities of the same. The student’s family and anyone else the student would have been in contact with would also be put on quarantine to determine if they have the infection. Ebola places everyone at risk in the areas where it is found. Doctors and nurses are also at a high risk of contracting the virus as they handle the patient prior to establishing that the disease is in fact Ebola (Stamm, 2015). 

Reporting Protocol

When a health care provider or a laboratory suspects that a patient has Ebola, he should immediately notify the local health jurisdiction. The local health jurisdiction will then notify the Washington State Department of Health (DOH) Office of Communicable Disease Epidemiology (CDE). After reporting, the Local Health Jurisdiction Investigation has the responsibility to immediately employ infection control methods by first placing the patient under quarantine (Stamm, 2015).  They should also report all confirmed cases, potential cases, and those exposed to the virus to to CDE: 1-877-539-4344 or 206-418-5500.  The source of the infection should also be identified and any other person that might have been in contact with the patient. The Local Health Jurisdiction should also fill a case report form at https://www.doh.wa.gov/Portals/1/Documents/5100/420-128-ReportForm-Ebola.pdf  which goes into the Washington Disease Reporting System (WDRS).

Ebola Prevention Strategies

One way to prevent contracting the Ebola virus is to avoid visiting areas that have had outbreaks in the past. The CDC website has a list of countries that have had current epidemics; visit the website before you travel to know about the epidemics. In case you visit countries near these regions, do not consume bush meat. This is because the Ebola virus survives even when the host is dead; you can get the virus from the bush meat (World Vision, 2019). 

The second way to avoid Ebola is to regularly wash your hands with soap and water before you eat or drink. This practice not only helps in preventing Ebola, it also protects you from contracting many other infections. If you are a health worker, make sure that you wear protective gloves every time you are attending to a patient to avoid infection. You might be handling an Ebola patient without your knowledge and only come to discover it when it’s too late (World Vision, 2019).

References

Danasekaran, R., Mani, G., & Annadurai, K. (2015). West Africa Ebola outbreak 2014: the world′s largest Ebola outbreak so far. Menoufia Medical Journal, 0(0), 0. doi:10.4103/1110-2098.165830

Levy, B., & Odoi, A. (2017). Region level risk factors for the Ebola virus disease in West Africa. doi:10.7287/peerj.preprints.3021v1

Public Health England. (2016, August 19). Ebola: overview, history, origins and transmission. Retrieved from https://www.gov.uk/government/publications/ebola-origins-reservoirs-transmission-and-guidelines/ebola-overview-history-origins-and-transmission

Stamm, L. V. (2015). Ebola Virus Disease: Rapid Diagnosis and Timely Case Reporting are Critical to the Early Response for Outbreak Control. The American Journal of Tropical Medicine and Hygiene, 93(3), 438-440. doi:10.4269/ajtmh.15-0229

World Vision. (2019, August 1). 2014 Ebola virus outbreak: Facts, FAQs, and how to help. Retrieved from https://www.worldvision.org/health-news-stories/2014-ebola-virus-outbreak-facts