The latest Ebola outbreak has hit the war-torn North Kivu province of the DRC (Democratic Republic of the Congo), and experts are struggling to contain it. Ebola outbreaks have captivated news media and audiences around the world since the devastating 2013 – 2016 West African Epidemic. However, most are still in the dark about what Ebola is, how it spreads and why it’s so rampant in Africa. Awareness was vital for the survivors of the West African Epidemic, and although new treatments are being developed, learning about Ebola remains a valuable tool for public health. Knowledge can help us fight not just the disease, but the fear and misconceptions that are often attached.
A Family of Viruses
People often talk about “The Ebola Virus” or just “Ebola”, but actually, there are 6 species within the “Ebolavirus” group, and some are more dangerous than others (see image below).
The Zaire species is the most dangerous and has been responsible for most of the major outbreaks. This is usually what people are referring to when they say, “Ebola virus.” All species – apart from Reston and Bombali – are known to cause disease in humans.
Ebola virus disease (EBV) is a truly horrific experience. It begins with a fever, eventually progressing to diarrhoea and vomiting, and finally death by shock or multiple organ failure. The case fatality rate of EBV is 50% on average; yes, that means one in two people who get the disease will die (WHO 2018). It is terrifyingly lethal, and if you want to avoid this disease, a good place to start is by understanding how it spreads.
Spreading like Wildfire
Ebola can “cross-over” into humans during spillover events which occur when the natural host population (fruit bats) encounters a new host population. Humans can become infected directly from fruit bats or through other infected jungle animals.
People are only infectious once symptoms have appeared, which usually happens 2 – 21 days after infection (this period where the person is infected, but not yet infectious is called the incubation period; it is when the virus is replicating inside the body). Ebola spreads from person-to-person through bodily fluids such as blood, urine, semen, and can get in through your eyes, nose, mouth or even just a cut on your skin.
The communities in west Africa tend to be close to the jungle, where fruit bats and other infected animals are likely to be found. That is one of the reasons why Ebola outbreaks are so common in this region.
Ebola Outbreaks Over Time
Since the first outbreaks of Ebola in 1976 there have been 22 major outbreaks, typically occurring in tropical regions of Sub-Saharan Africa. The most devastating outbreaks are shown in a timeline below.
The 2013 – 2016 West African Epidemic was likely the first time people living in developed countries heard about Ebola. This outbreak had more cases and deaths than all previous outbreaks combined, making it the most devastating Ebola outbreak in history.
Why is it so prevalent in Africa?
Guinea, Sierra Leone, and Liberia were at the center of the West African Outbreak in 2013-2016. This outbreak had spiralled out of control for several reasons:
- The number of deaths caused by Ebola in a short period of time has simply overwhelmed poverty-stricken areas, where the virus tends to hit; In the 2013 outbreak, the health infrastructure of some west African countries was extremely weak due to historical problems, such as extensive warfare. Not having proper protective gear and running out of clean gloves or needles was a common occurrence which explains why healthcare workers accounted for 10% of Ebola cases during this outbreak.
- In Africa, “bushmeat” is a traditional part of the diet, but also a potential source of infection from Ebola. During the 2013 – 2016 Ebola outbreak, consumption dropped from once every other day, to once a month. However, wealthier individuals living in more urban areas still ate bushmeat on a weekly basis.
- Traditional burial customs in some regions involved handling the still-contagious dead bodies with bare hands. The attempts of health workers to educate local communities about safety precautions was challenging due to low literacy rates and strong ties with burial traditions.
- Fear of Ebola led to a paucity of trained health workers to safely take care of patients and bodies. Many who served as healthcare workers put their lives at risk to save others, and in 2014 “Ebola Fighters” were selected as Time’s person of the year.
Hazard or Hype?
Terrifying news headlines appeared all over the United States during the West African Epidemic, many people feared that Ebola would spread to their own country. Was this ever a possibility, or was it just exaggeration by the media that led to xenophobia?
In the fall of 2014, 4 cases of Ebola were diagnosed in the U.S. These included a Liberian national, the two nurses that treated him, and a physician who had returned home from working in Guinea. They were quarantined, and those they had been in contact with were monitored for 21 days.
Ultimately, the availability of quarantine facilities, personal protective equipment, intensive care, and supportive treatment (e.g. rehydration) were instrumental in preventing the spread of disease in the U.S.
“The key to stopping the international spread of this disease is global vigilance” – Dr Isabelle Nuttall, Director, Global Capacities, Alert and Response, WHO
New Setting, New Problems
The current Ebola outbreak began on the 1st of August in the North Kivu province of the DRC. This time, we are faced with a new problem: vulnerable migrant populations and war.
North Kivu is currently in the middle of a military conflict, and ~20 active insurgent groups are making it difficult for healthcare workers to reach remote locations. Consequently, the sheer number of displaced refugees have made tracking the disease more complicated. As of the 22nd of August, there have been 103 cases and 61 deaths.
Hope remains however, in the form of an experimental Ebola vaccine (rVSV-ZEBOV). During the west African epidemic, the race began to develop a vaccine against Ebola. This vaccine made its way through clinical trials (proving to be both safe and effective) at an unprecedented speed. Although not currently licensed for commercial use, due to its substantial effectiveness an emergency stockpile has been established.
Following the success of this vaccine during the Equateur province outbreak in May, it is now being used in North Kivu. Both healthcare workers and contacts of infected patients are being vaccinated, a tactic known as ring vaccination. Hopefully, the availability of a vaccine – something that was missing during the west African epidemic – will keep this outbreak under control.
Let us know if you’d like to hear more about current outbreaks of disease around the world!
To learn more about Ebola:
- More on the Ebola Fighters, Time’s 2014 Person of the Year
- We Want You to Live – A prize-winning German film about the impossible choices people had to make during the Liberian Ebola outbreak
- The Story of Ebola – A cartoon video by the Global Health Media Project that emphasised the importance of preventative behaviour for winning the fight against Ebola