Global History of Health - Teaching Notes on Ebola (08/13/2014)

Edit Mode is: ONON•HST 301: Global History of Health (2014 Fall) 2014Fall-T-HST301-SSH301-

ASB301-87024-88306-88305 Ebola

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Success: The 2014 Ebola Epidemic - News Reports edited.

Ebola

Websites and Blogs for Keeping Up-to-Date

Enabled: Statistics TrackingWe are inundated with news nowadays. This folder has links (which you may wishto bookmark) to websites and blogs that are reliable sources of science andmedical information. Some things you always want to look for: that they aredirectly linking to science and medical journals; that they are directly citingrepresentatives of authoritative institutions (WHO, CDC, etc.); that commentatorshave some "street cred": that they've lived and worked in the areas beingdiscussed or have some other personal life experience that makes their voice"authoritative."

Note: if you have any language capabilities beyond English, you should definitelyalso be reading news sources from elsewhere beyond Anglophone countries. Ifyou haven't already used the alternate news sources available on Google, click thislink, https://support.google.com/news/answer/40237?hl=en, to see alternatelanguage versions of Google News.

The 2014 Ebola Epidemic - News Reports

Enabled: Statistics TrackingThis folder gathers together news accounts of the 2014 Ebola outbreak, frominitial reports in March 2014 up to the present day. (Most recent articles appearat the top.) Even scanning the titles is sufficient to watch the narratives about thedisease. Look for the following "inflection points":

December 2013: outbreak begins in Guéckédou, Guinea (this first knownfatality, a 2-year-old boy, was not identified as possibly an Ebola deathuntil March)first published reports in March; WHO issues its first communiqué on theoutbreak on 23 Marchnotices of spread beyond national bordersnotices of the vulnerability of healthcare workers

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April 16: Blaize et al. publish their report in the New England Journal ofMedicine arguing that the outbreak in West Africa is caused by a hithertoundocumented clade of the Zaire strain of the Ebola virus; they trace theoutbreak to a 2-year-old boy who died of the disease in early December2013July 20: transmission by air travel (specifically to Lagos, Nigeria, the largestcity in Africa); this individual--a Liberian-American, Patrick Sawyer, diesJuly 25July 27: death of leading Sierra Leone doctorAugust 1: it is announced that a Liberian in Morocco has died of Ebola,raising the possibility of spread in that country, too [it is later announcedthat the individual died of a heart attack, not Ebola]August 2: transfer of 1st of American health workers to Emory UniversityHospitalAugust 4: deployment of troops in Liberia to help contain spreadAugust 4: 1st statement that epidemic has peaked (this, 3 days after WHODirector General declared it "out of control")August 4: Nigerian doctor who tended to Ebola-stricken traveler hashimself now taken illAugust 5: announcement that the two American missionaries evacuatedfrom Liberia were given an experimental drug derived from tobaccoAugust 5: British Airways announces that it is suspending flights to SierraLeone and LiberiaAugust 5: 3 leading global health experts, including Peter Piot, aco-discoverer of Ebola, call for access to experimental drugs for all Africansafflicted by the diseaseAugust 6-7: WHO holds emergency meeting in Geneva to discuss situationwith EbolaAugust 6: death announced of nurse who cared for Patrick Sawyer in LagosAugust 6: the CDC goes to Level 1 alert, its highest level, freeing uppersonnel to focus on the Ebola outbreakAugust 8: the WHO declares the West African Ebola outbreak aninternational public health emergency, its highest level of alertAugust 8: Nigeria President, Goodluck Jonathan, declares a national stateof emergencyAugust 9: Liberian President Ellen Johnson Sirleaf apologizes tohealthworkers for the high fatalities among their peersweekend of August 9-10: Liberia and Guinea, but also distant Zambia(central southern Africa) close their bordersAugust 12: WHO ethics panel approves use of experimental drugs for Ebolapatients in AfricaAugust 12: Spanish priest, who was evacuated from Liberia back to Madrid,and given the same experimental drug as the Americans Brantly andWritebol, diesAugust 12: 3rd person dies in Nigerian outbreak, Jatto Asihu Abdulqudir,who had contact in Lagos with the Liberian-American, Patrick Sawyer

Ebola https://myasucourses.asu.edu/webapps/blackboard/content/listC...

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Ebola - narratives of discovery Enabled: Statistics TrackingPostedhere aresome ofthe originalaccountsof thediscoveryof theEbola virusin 1976. Includedhere alsoare twodocumentaryfilms, bothhaving todo with thesecondlargestoutbreak,in Zaire(nowDemocraticRepublic ofCongo) in1995,whichinfected317people, ofwhom 245died. (Tomyknowledge,no filmfootageexists ofthe original1976outbreak.)

Current Research on Ebola

Again, this won't pretend to be exhaustive, but I'll be collecting here some ofthe main recent scientific studies on Ebola: its origins, transmission, clinicalmanifestations, and epidemiology. You might wish to start with theFeldmann and Geisbert review in The Lancet in 2011 for an overview of mostof the basic medical science and epidemiology.


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Ebola Extra Credit option

Enabled: Statistics TrackingWe will be incorporating discussion of the on-going Ebola outbreak inWest Africa into lecture, at least as long as it remains a major item in thenews. It will also be an occasional topic in our daily quizzes, though ourmain focus will remain on our eight paradigmatic diseases (as outlined inthe syllabus).

However, Ebola and related filoviral diseases are clearly not going to bedisappearing from the public health landscape any time soon even if thepresent outbreak is brought swiftly under control. For those of you whowish to invest more time in getting to know the origins, epidemiology,clinical science, or anthropology of this disease, you may choose to doan Extra Credit research paper. You have absolute latitude in choosingyour topic, but you must clear it with me prior to embarking on the mainresearch and writing. And remember that I will be insisting that you takea historical approach, meaning that you are watching some element ofthis story change over time. Finally, I will insist that at least 50% of thesources you use come from non-U.S., non-European sites. This is toensure that you are capturing the voices and perspectives of Africans,who are most immediately threatened by the disease. The detailedinstructions will be posted here by early September.


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ASB301-87024-88306-88305 Ebola Websites and Blogs for Keeping Up-to-Date

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Websites and Blogs for Keeping Up-to-Date

AllAfrica.com

AllAfrica.com is an aggregator of news reports from several dozen different newsoutlets all across Africa. This is one of the best places to find news that isn'talready tailor-made for a western audience. Put "Ebola" in the search box to findrelevant articles.

CDC webpage for Ebola Hemorrhagic Fever

Enabled: Statistics TrackingThis includes lots of very helpful background information, including: a list ofprevious outbreaks going back to the original discovery of the disease in 1976. The CDC (remember that this stands for Centers for Disease Control andPrevention) also publishes the MMWR, Morbidity and Mortality Weekly Report. Thisreports not simply on disease events here in the U.S., but also those around theworld that might potentially threaten the U.S. Here's the main URL: http://www.cdc.gov/mmwr/. And here's the link to the specific Ebola page: http://www.cdc.gov/vhf/ebola/.

WHO Global Alert and Response page for Ebola

Enabled: Statistics TrackingThis includes a FAQs page: http://www.who.int/csr/disease/ebola/faq-ebola/en/. And here's the direct link to the frequently updated "OutbreakNews" page: http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news.html.

2014 West Africa Ebola Outbreak - Wikipedia entry

Wikipedia has now become a major resource for tracking developing stories ofinternational significance. It is open to universal editing, of course, so I would not


Websites and Blogs for Keeping Up-to-Date https://myasucourses.asu.edu/webapps/blackboard/content/listC...

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recommend relying on it for any official information. But it will likely prove ahandy resource for keeping up with the major developments. (Posted07/30/2014)

New York Times - What You Need to Know About the EbolaOutbreak

Even if you don't have a subscription to the New York Times, this page can beconsulted to stay apprised of basic scientific information on the disease and thedevelopments in the 2014 West African outbreak.

CIDRAP: Center for Infectious Disease Research and Policy

From CIDRAP's blurb: "The Center for Infectious Disease Research andPolicy (CIDRAP; "SID-wrap") is a global leader in addressing public healthpreparedness and emerging infectious disease response. Founded in 2001,CIDRAP is part of the Academic Health Center at the University of Minnesota."

African Geography

Enabled: Statistics TrackingThis map quiz is an excellent way to make sure you're as on top of Africangeography as you will need to be for this course. It's free and you can take it asoften as you like.

Pro-MED Mail

Pro-MED Mail is the police scanner for infectious disease specialists. It issponsored by the International Society for Infectious Diseases. If you want tolisten in to news reports of disease outbreaks as they come in from around theworld (often before official governmental announcements will be made), this is theplace to be. (This is not the place to be if you tend toward paranoia orhypochondria.)

Mens et Manus: Updated Ebola Charts

These are handsomely produced graphics that give a good summary of theunfolding outbreak. (Added 08/07/2014)


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Médecins sans Frontières (Doctors Without Borders)

8 August 2014

“Declaring Ebola an international public healthemergency shows how seriously WHO is taking thecurrent outbreak; but statements won’t save lives.”Bart Janssens, MSF Director of Operations

“Declaring Ebola an international public health emergency showshow seriously WHO is taking the current outbreak; butstatements won’t save lives,” says Dr Bart Janssens, MSF Directorof Operations. “Now we need this statement to translate intoimmediate action on the ground. For weeks, MSF has beenrepeating that a massive medical, epidemiological and publichealth response is desperately needed to saves lives and reversethe course of the epidemic. Lives are being lost because theresponse is too slow.”“Countries possessing necessary capacities must immediatelydispatch available infectious disease experts and disaster reliefassets to the region. It is clear the epidemic will not becontained without a massive deployment on the ground fromthese states.”“In concrete terms, all of the following need to be radicallyscaled up: medical care, training of health staff, infectioncontrol, contact tracing, epidemiological surveillance, alert andreferral systems, community mobilisation and education.”“MSF currently has 66 international and 610 national staffresponding to the crisis in the three affected countries. All

Médecins sans Frontières (Doctors Without Borders), a medical relief group, andSamaritan's Purse, a Christian charity, were the main international contributors tothe Ebola outbreak prior to the WHO's August 8 announcement of a PHEIC. MSFposts updates of its activities on its website.

In response to the WHO statement on August 8, MSF made its ownannouncement, here in full:

Ebola: Official MSF response to the WHO declaringEbola an international public health emergency

Share


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our Ebola experts are mobilized, we simply cannot do more.”


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ASB301-87024-88306-88305 Ebola The 2014 Ebola Epidemic - News Reports

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The 2014 Ebola Epidemic - News Reports

"Using a Tactic Unseen in a Century, Countries Cordon Off Ebola-Racked Areas" - New York Times (08/13/2014)

"The Ebola outbreak in West Africa is so out of control that governments therehave revived a disease-fighting tactic not used in nearly a century: the “cordonsanitaire,” in which a line is drawn around the infected area and no one is allowedout.

"Cordons, common in the medieval era of the Black Death, have not been seensince the border between Poland and Russia was closed in 1918 to stop typhusfrom spreading west. They have the potential to become brutal and inhumane.Centuries ago, in their most extreme form, everyone within the boundaries wasleft to die or survive, until the outbreak ended. . . .

“It seems like a reflexive movement by the governments to show that they’redoing something, and since they have armies more elaborate than their healthcare systems, they use the army,” said Dr. William Schaffner, the head ofpreventive medicine at Vanderbilt University’s medical school."

"ECOWAS official dies of Ebola in Lagos" - The Cable (Nigeria)(08/12/2014)

Jatto Asihu Abdulqudir, a functionary for the Economic Community of WestAfrican States (ECOWAS) Commission, dies in Lagos of Ebola. He had representedthe Commission in dealing with Patrick Sawyer, the Liberian-American who hadcollapsed on July 20 at the Lagos airport, and subsequently died on July 25.

"The other Ebola debate: What about existing drugs?" -ScienceInsider (08/12/2014)


The 2014 Ebola Epidemic - News Reports https://myasucourses.asu.edu/webapps/blackboard/content/listC...

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On the same day that a WHO panel approved the use of experimental (but nearlyunobtainable) new drugs for Ebola, there appears this piece documenting adebate among scientists and clinicians about the possible use of statins (normallyprescribed for high cholesterol) to control the wild immune response thatcharacterizes a lethal Ebola infection.

"Ethical considerations for use of unregistered interventions forEbola virus disease (EVD)" - WHO (08/12/2014)

Enabled: Statistics TrackingFormal statement of the panel that convened on 11 August 2014 to debate theethics of giving experimental drugs to Ebola victims.

"Ebola: Spanish missionary dies of disease after being flown toMadrid" - The Guardian (08/12/2014)

Enabled: Statistics TrackingReporting on the death of the Spanish priest, Miguel Pajares, 75. "Doctors said hewas weakened and feverish, but in a stable condition. He was taken to Madrid'sCarlos III hospital, where he was due to receive the experimental treatmentZMapp. A spokesperson from the hospital said he had died on Tuesday morning,but would not confirm whether he had received the treatment."

"Ebola: Nigeria confirms new case in Lagos" - The Guardian(08/11/2014)

As of Monday, 11 August 2014, there are now 10 confirmed cases of Ebola inNigeria, all stemming from Liberian-American Patrick Sawyer, who collapsed atthe Lagos airport upon arriving from Liberia on 20 July. He died 25 July, puttingthe window of infection for these other victims all within that time period. Onenurse who attendend Sawyer has already died.

"Ivory Coast imposes travel restrictions as Ebola fears spread" -Reuters (08/11/2014)

"Ivory Coast, the economic powerhouse of French-speaking West Africa, onMonday banned air travelers from the three countries worst-hit by the Ebolaoutbreak and ordered its flagship carrier Air Cote d'Ivoire to cease flights to and


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from them."

Among other information provided here: "As the disease spreads, the weaknessof West African healthcare systems has been exposed. Liberia, where thedisease is spreading fastest, has only 51 qualified doctors while Sierra Leonehas just 136, according to political risk research company DaMina Advisors."

"Responding to Ebola" - Project Syndicate (08/11/2014)

This opinion piece by Jeffrey D. Sachs, a global economist, does a good job inexplaining why we need a general "global health" perspective in approaching even(currently) localized outbreaks like the current Ebola epidemic in West Africa

(1) most new epidemic diseases are zoonoses, meaning that new ones willkeep arising as we continue to push into new ecosystems and as climatechange scrambles what we have come to think of as stable ecologicalbalances(2) once a new disease presents itself, global spread is almost certain giventhe hyper-connected world we live in where just a few hours' flight canspread a bug across several continents(3) "Third, the poor are the first to suffer and the worst affected." This is anitemization of all the ways poverty--basic lack of resources--contributes todisease acquisition and disease amplification.(4) This makes the assertion that however sophisticated our responses tonew disease, our response will always be lagging, either in discovery ordelivery of benefits. "There is no ultimate victory, only a constant armsrace between humanity and disease-causing agents."

"DoD Establishes Ebola Task Force" - Global BioDefense (08/11/2014)

The U.S. Department of Defense establishes an Ebola task force, signalling themounting concern that this outbreak is threatening political stability in WestAfrica and may have wider ramifications.

"Nigeria Struggles to Cope With Ebola Outbreak" - New YorkTimes (08/11/2014)

This has some background information on Patrick Sawyer, the Liberian-Americanwho fell ill and died in Lagos, Nigeria, in July after tending to his sister in Liberia,who also died of Ebola.


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"Ebola restrictions affect food supply" - IOL News (08/11/2014)

"West Africa is counting the cost of measures to contain the deadly Ebolaepidemic, as unprecedented restrictions cause food shortages, transport snarlsand soaring prices, sparking fears people could die of hunger."

"Can you get Ebola through the air? Here's what the science says"- Vox (08/10/2014)

Discusses a 2012 study that documented (limited) transmission of a strain ofEbola from pigs to monkeys. Makes the point that such a scenario is unlikely tohappen among humans because the virus affects human and primate bodiesdifferently than pigs.

"Ebola May Pose Little Threat to U.S., but It Looms Large onTwitter" - New York Times (08/10/2014)

Enabled: Statistics Tracking"Why do people feel compelled to post and rebroadcast jokes, rumors and dreadof a distant disease that public health officials say is extremely unlikely to poseserious risk on this side of the Atlantic Ocean?

"The science behind how and why ideas spread on social media is a growing areaof research. At the most basic level, marketing experts say, people tend to sharestories that stir their deepest feelings, whether positive or negative."

Quoting Pamela Rutledge, a psychologist and director of the Media PsychologyResearch Center in Corona del Mar, CA: “Twitter panics, such as we’re seeing withEbola, are a reflection of people trying to get information, sharing information— even if it’s inaccurate — because being part of the conversation is lessthreatening than being out of the ‘know’. ”

"How Owensboro tobacco grew a possible miracle drug to treatEbola" - Kentucky.com (08/09/2014)

More background on the genesis of the tobacco-grown drug that wasadministered to the healthcare workers from Samaritan's Purse and, mostrecently, the Spanish priest who was repatriated to Spain after he, too, contractedEbola in Liberia.


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"Ebola outbreak: High death toll among health worker firstresponders" - CBC News (08/09/2014)

"Liberia's President Ellen Johnson Sirleaf apologized on Saturday for the highdeath toll among the country's healthcare workers who have fought an Ebolaoutbreak, which has killed nearly 1,000 people in three countries.

"'If we haven't done enough so far, I have come to apologize to you,' she toldhundreds of health workers who gathered at Monrovia's City Hall for a meetingwith her government."

"Tracing Ebola’s Breakout to an African 2-Year-Old" - New YorkTimes (08/09/2014)

In a John Snow or Typhoid Mary-type mode, this piece in the New York Timestraces the entire West African outbreak to a single 2-year-old child who becameill in December 2013.

However, this would not pass muster as an epidemiological analysis because itassumes rather than proves that all subsequent cases are human-to-humantransmissions. The central question is always this: how did the little boy getsick? Are we looking at one single bat bite that sparked this whole epidemic?That's possible, but this piece--written in too definitive a style--shuts downspeculation much too early.

"The awful ethical questions at the center of the Ebolaemergency” - Vox (08/08/2014)

This useful essay walks you through several of the key ethical questions that mustbe addressed, now that we have learned that a trial Ebola treatment has beenadministered to two Americans who contracted Ebola in Liberia. 1)Is it okay toskip the drug testing pathway in a crisis? 2) Why did Americans get anexperimental drug while hundreds of Africans die of Ebola? 3) What if the Eboladrug doesn't work? 4) Who should fund access to Ebola medicines?

This is surely the beginning of what will be a long debate.


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"WHO Statement on the Meeting of the International HealthRegulations Emergency Committee Regarding the 2014 EbolaOutbreak in West Africa" - WHO (08/08/2014)

This formal declaration of a "Public Health Emergency of International Concern(PHEIC)" is the highest level of alert the WHO can declare.

"Inside the Flying Quarantine Ward Used to Transport EbolaPatients" - Wired.com (08/08/2014)

Describes the specially designed plane that brought American healthcare workersKent Brantly and Nancy Writebol back to the U.S. in early August.

"Q&A: American Virus Expert in Africa’s Ebola Zone: ‘This is LikeWar’" - National Geographic (08/08/2014)

Enabled: Statistics TrackingAn on-the-ground interview with a virologist in Sierra Leone:

"Q: What can be done to bring Ebola under control?

A: The only thing that is going to change the course of this epidemic isactual epidemiology. We need to stop the disease from being transmitted. You'rea positive case: Who did you have contact with? Who did those people havecontact with? Do we have a motorcycle or truck we can send out to interview thatperson? Will the person be willing to be interviewed? Or have they already run offto seek treatment or to another city?"

"WHO declares Ebola outbreak an international public healthemergency" - The Guardian (08/08/2014)

Enabled: Statistics TrackingThis news will appear on hundreds of news outlets. Here's the link to the WHO'soriginal announcement. The WHO has declared emergencies only twice in recentyears - swine flu in 2009 and polio in May of 2014. (I can explain in class why thisis an extraordinary measure of WHO's increasing international authority.)

Reading through some of these individual reports in outlets that are doing theirown investigative reporting has some value, such as this bit in The Guardian'saccount: "The charity Save the Children, which said it was scaling up itsoperations in the region, warned that medical services in the affected countries


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were already overwhelmed. Rob MacGillivray, its regional humanitarian director,said that even before the outbreak there was less than one doctor for every33,000 people in Sierra Leone and Liberia."

"Ebola Experts Warn of an African 'Apocalypse'" - Daily Beast(08/07/2014)

The Daily Beast is not normally a news outlet I would go to for public healthinformation, but this reports on a meeting held in Washington today at which CDCDirector Thomas Frieden as well as Ken Isaacs, the Vice President of Program andGovernment Relations for Samaritan’s Purse, spoke. Isaacs is reported as saying"We believe that these numbers [1,711 diagnoses and 932 deaths] represent just25-50 percent of what is happening.”

Another important point made when discussing the need to educate the localpopulace in Liberia: the 14-year civil war, which only recently ended, has left awhole generation of children and young adults virtually illiterate.

"Fighting Fear, Fatigue on the Front Lines of Ebola" - WebMD(08/07/2014)

“'They’re wearing the protective gear, but most people have never worn it before.' And the working conditions are unpredictable. 'You can’t control when someoneis going to vomit on you. You can’t control working a 90-hour week,' he says. It’sthis 'perfect storm' of conditions, Fair says, that’s made the outbreak sohazardous for health care workers."

"Ebola Cases Mix With Malaria Amid ‘Slow-Motion Disaster’" -Bloomberg News (08/07/2014)

Okay, here, at last, we get some epidemiological insight into this unfoldingepidemic. One of the precepts we'll be learning this semester about a "GlobalHistory of Health" approach is that we must always be nimble enough to considermore than one disease at a time, since that's what human populations are oftendealing with. The parts of West Africa that have been affected by Ebola alreadyhad endemic problems with malaria (and yellow fever and many other thingsbesides). One of the immediate problems in diagnosis is that the clinician (andthe patient) is more apt to think of these more common diseases uponpresentation than Ebola, thus delaying appropriate interventions or precautions.

This news piece makes the particular point that the rainy season is coming onsoon, meaning more mosquitos, meaning more malaria.


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"Ebola Therapy From an Obscure Biotech Firm Is Hurried Along" -New York Times (08/06/2014)

Enabled: Statistics TrackingThis has some useful background information on the manufacture of theexperimental Ebola drug, ZMapp: "ZMapp uses an approach called passiveimmunotherapy. Instead of having a vaccine stimulate the immune system tomake antibodies that attack the virus, passive immunotherapy simply supplies theantibodies to the patients. For some infectious diseases, these antibodies areextracted from the blood of patients who have survived the infection andpresumably have effective antibodies.

"ZMapp instead consists of antibodies that are made by exposing mice to a keyEbola protein and harvesting their antibodies. Those antibodies are thengenetically modified to make them more like human antibodies and therefore lesslikely to provoke an immune reaction if injected into people.

"The gene for each antibody is then introduced into the leaves of tobacco plantsusing a system developed by Icon Genetics, a German company. The leaves thenproduce the antibody."

President Sirleaf's announcement of a State of Emergency inLiberia - 08/06/2014

President Ellen Johnson Sirleaf of Liberia declares a state of emergency in Liberia,saying that normal public health laws are no longer adequate to contain thedevolving situation. This is the original text of her statement.

"Why do two white Americans get the Ebola serum whilehundreds of Africans die?" - Washington Post (08/06/2014)

The author of this piece about the new ethical stakes that have been raised is thedirector of the Division of Medical Ethics at NYU Langone Medical Center’sDepartment of Population Health. "The reasons for different treatment are partlyabout logistics, partly about economics and, partly about a lack of any standardpolicy for giving out untested drugs in emergencies."


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"CDC issues highest-level alert for Ebola" - USA Today (08/06/2014)

While the WHO is meeting in Geneva to decide whether to declare a public healthemergency, the CDC moves ahead declaring a Level 1 alert, which puts most of itspersonnel onto the Ebola case to help contain the epidemic. This is only the 3rdtime in its history that the CDC has made this move. (Previous instances were inthe aftermath of Hurricane Katrina in 2005 and in the 2009 flu outbreak.)

"Africa Experts: Give new US Ebola drug to Africans" - Al-Jazeera(08/06/2014)

Enabled: Statistics Tracking"Three of the world's leading Ebola specialists [Peter Piot, David Heymann, andJeremy Farrar] have called for experimental drugs and vaccines to be offered topeople in West Africa, where a vast outbreak of the deadly disease is raging inthree countries." The manufacturer, however, said very little of the drug is yetavailable.

Peter Piot is currently the director of the London School of Hygiene and TropicalMedicine; he was a co-discoverer of Ebola in 1976 and a leader in the campaignagainst HIV/AIDS for more than 3 decades thereafter. Heymann is the director ofthe Chatham House Centre on Global Health Security, and Farrar is the Director ofthe Wellcome Trust, the biggest private funder of health research in the U.K. Thestatement, originally published in the Wall Street Journal, can be found here onthe Wellcome Trust's website (with no paywall): http://blog.wellcome.ac.uk/2014/08/06/experimental-medicine-in-a-time-of-ebola/.

In another notice of the letter, it is noted that "The decision to offer [the Americanworkers] the experimental treatment — while dozens of African doctors andnurses have perished — has provoked outrage, feeding into African perceptionsof Western insensitivity and arrogance, with a deep sense of mistrust and betrayalstill lingering over the exploitation and abuses of the colonial era." See thisaccount in the Los Angeles Times.

"Ebola Virus Inflicts Deadly Toll on African Health Workers" - WallStreet Journal (08/06/2014)

"[M]edical staff at the very heart of West Africa's fight against Ebola--many ofthem poorly equipped, low paid and insufficiently prepared--are becoming someof its most immediate victims. In Liberia, 15% of those who have died from thevirus were doctors or nurses who contracted it at work, government recordsshow. In Sierra Leone, where the disease has killed at least 572 people, 50 of


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those were hospital workers, government data there show."

"Nigerian nurse dies of Ebola as death toll jumps to 932" - USAToday (08/06/2014)

This is the worst possible news that could come out of Nigeria right now: thecaretakers who treated the Liberian-American man who died in Lagos, Nigeria, onJuly 25 are now themselves proving to be infected. Besides this nurse who hasdied, five other Nigerian healthworkers have now been diagnosed with thedisease.

"Suspected Ebola victim dies in Saudi Arabia" - BBC News (08/06/2014)

"A Saudi man who was being treated for Ebola-like symptoms has died at ahospital in Jeddah, Saudi Arabia's health ministry says." This also has some usefulbackground information, such as this: "Earlier this year, Saudi Arabia stoppedissuing visas to Muslims from several West African countries, amid concerns thatvisiting pilgrims [coming to Saudi Arabia on the Hajj] could spread the disease."

According to initial reports coming out of Saudi Arabia on 9 August, the testsare coming back negative for Ebola.

"Concerned about Ebola? You’re worrying about the wrongdisease" - The Guardian (08/06/2014)

A little calm reflection amidst the hype this week. The gist:

A deadly disease is set to hit the shores of the US, UK and much of the rest ofthe northern hemisphere in the coming months. It will swamp our hospitals,lay millions low and by this time next year between 250,000 and 500,000worldwide will be dead, thousands of them in the US and Britain.

Despite the best efforts of the medical profession, there’s no reliable cure,and no available vaccine offers effective protection for longer than a fewmonths at a time.

If you’ve been paying attention to recent, terrifying headlines, you mayassume the illness is the Ebola virus. Instead, the above description refers toseasonal flu – not swine or bird flu, but regular garden variety influenza.


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Our fears about illness often bear little relation to our chances of fallingvictim to it, a phenomenon not helped by media coverage, which tendstowards the novel and lurid rather than the particularly dangerous.

"WHO to convene emergency meeting on Ebola" - Xinhua (08/06/2014)

First news of the WHO meeting to be held 6-7 August comes from the Chinesenews agency, Xinhua. The world is on alert.

"World Bank pledges $200m to contain Ebola" - Al-Jazeera(08/05/2014)

$200 million is twice the amount that the WHO just dedicated to Ebola on July31st.

"The Ebola Outbreak: 'A Dress Rehearsal For The Next Big One'" -NPR blog (08/05/2014)

An interview with author David Quammen, author of Spillover (2010), whichexamines the role of zoonotic diseases.

"Nigerian Official Says 7 More Show Ebola Symptoms" - ABC News(via AP) (08/05/2014)

"A total of eight people in Nigeria who were in direct contact with a man who flewto Lagos and died of Ebola now have symptoms of the dreaded and deadlydisease and have been placed into quarantine, a Nigerian health official saidTuesday."

"BA suspends flights to Liberia and Sierra Leone" - BBC News(08/05/2014)

This news that one of the largest international carriers, British Airways, issuspending all flights to Liberia and Sierra Leone shows the domino economic


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effects that come with epidemic outbreaks. "BA said in a statement: 'We havetemporarily suspended our flights to and from Liberia and Sierra Leone until 31August 2014 due to the deteriorating public health situation in both countries.

"'The safety of our customers, crew and ground teams is always our top priorityand we will keep the routes under constant review in the coming weeks.'"

"Ebola Drug Made From Tobacco Plant Saves U.S. Aid Workers" -Bloomberg News (08/05/2014)

Enabled: Statistics TrackingThis will go down as one of the great ironies of history if this drug proveseffective: "A tiny San Diego-based company provided an experimental Ebolatreatment for two Americans infected with the deadly virus in Liberia. Thebiotechnology drug, produced with tobacco plants, appears to be working."

On the role of ASU's Charles Arntzen in the development of the drug, click here.

"US government had role in experimental Ebola treatment given to2 American aid workers" - US News and World Report (08/04/2014)

"The experimental treatment the U.S. aid workers are getting is called ZMapp andis made by Mapp Biopharmaceutical Inc. of San Diego. It is aimed at boosting theimmune system's efforts to fight off Ebola and is made from antibodies producedby lab animals exposed to parts of the virus."

"Patient at Mount Sinai Has Ebola-Like Symptoms, Hospital Says"- New York Times (08/04/2014)

Enabled: Statistics TrackingFirst reports out of New York of a possible Ebola case in New York City. Awaitingconfirmation from tests. Update on August 6: the results were negative.

"Qatar taking precautions to protect against deadly Ebola virus" -Doha News (08/04/2014)

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This piece signals the ways in which the wider world is beginning to brace for thepossible impact of Ebola outside of West Africa. As always, note the connections: "Qatar is home to thousands of West African expats, and the recent opening of its$15.5 billion Hamad International Airport has prompted a wave of worry fromsome residents."

"The economics of Ebola, or why there's no cure" - Los AngelesTimes (08/04/2014)

So here's the argument in its basic form: "The current outbreak of Ebolanumbered 1,323 cases and 729 deaths. An outbreak on that scale . . . isn'tthreatening enough to grab the attention of pharmaceutical R&D departments.That doesn't necessarily make Big Pharma the villain of the piece, since it's hard toargue that a rare disease that erupts sporadically should be a higher priority than,say, malaria, which strikes 220 million people a year and kills 660,000."

"Nigeria confirms doctor as 2nd Ebola case" - Washington Post(08/04/2014)

Enabled: Statistics TrackingThe other shoe has dropped. As would be expected, a health worker whoadministered to the sick American air traveller who collapsed at the Lagos,Nigeria, airport (and subsequently died) has himself taken ill. Now we watch andwait to see how this new phase of the epidemic plays out in Lagos, Africa's largestcity. This will get worse before it gets better.

"Contagion Screenwriter: Ebola Isn’t the Pandemic. Fear Is" - Time(08/04/2014)

Enabled: Statistics TrackingThis piece is important, because it gives us an important cultural reference pointto assess our own reaction. Scott Z. Burns was the screenwriter for the 2011movie Contagion, which in my opinion is the best (fictitious!) depiction of what atrue pandemic would look like in the modern world. We always have to use ourimaginations to think in a global framework. But it is critical that we keep ourimaginations tethered to concrete information and not let them run wild. Although ASU has a subscription to Time, it doesn't seem to have regular accessto pieces posted online, so I have downloaded the whole essay and posted it here.


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"Troops deploy in Sierra Leone, Liberia to try to stop Ebolaspread" - Reuters (08/04/2014)

"Terrorists could use Ebola to create dirty bomb to kill largenumbers in the UK, says Cambridge University disease expert" -Daily Mail (08/03/2014)

Okay, we're getting into official paranoid-hysteria mode here. If you actually readthrough the article, you'll see that there is absolutely not a shred of evidence thatanybody is or has yet tried to "weaponize" Ebola. In fact, aside from one off-handcomment by the Cambridge scientist (who seems to have wanted to cash in on his0.15 nanoseconds of fame), the bulk of the article says absolutely nothing aboutterrorists. This is "yellow journalism" at its worst. But unfortunately, epidemicsituations feed on frenzy.

"Sunday Show Round Up: CDC downplays threat of Ebola outbreakon U.S. soil as American patient arrives in Atlanta" - WashingtonFree Beacon (08/03/2014)

Enabled: Statistics TrackingQuoting Thomas Frieden, head of the CDC, who went on all the U.S. Sunday talkshows on 3 August 2014, on what needs to be done to control the current Ebolaoutbreak: “Really, the tried and true public health mechanisms work. You find thepatients. You isolate them. You find out who their contacts were. You trace thecontacts. You track them everyday for 21 days. If they get fever you start thatprocess again. You make sure there’s good infection control and you educate thecommunity in Africa about safe burial practices. When you do those simple things,Ebola stops.”

"U.S. doctor quarantines himself at home after treating Ebolapatients in Liberia" - Q13Fox.com (08/03/2014)

Buried in the news this weekend about the return of physician Kent Brantly to theU.S. and his care at Emory University Hospital is this report of another U.S.physician who returned home from Liberia and self-quarantined himself to makesure he did not transmit Ebola (if he acquired it) to anyone else.


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"Liberian Dies in Morocco of Ebola - Internal Affairs MinisterDiscloses" - AllAfrica (Heritage, 08/01/2014)

Enabled: Statistics TrackingThis one nearly slipped under the radar: it is reported by the Liberianminister a Liberian has died of Ebola in Morocco. Like the case of theLiberian-American who died in Nigeria in July, therefore, this case wouldshow the disease moving well outside any geographically confined area. However, it was later reported that this individual died of a heart attack,not Ebola: from ProMED-mail: "He tested negative; it was a heart attack, seein French: http://www.aufaitmaroc.com/maroc/societe/2014/7/31/une-crise--cardiaque-et-non-ebola_220832.html#.U-Du2Gd02Cg, courtesy ofProMED subscriber Giuseppe Michieli. - Mod.JW]"

"Ebola outbreak: end of epidemic could be in sight, saysscientist" - The Telegraph (08/01/2014)

The one note of optimism on an otherwise bleak day of news: "Chris Witty, aDFID advisor and Professor of Public and International health at the LondonSchool of Hygiene and Tropical Medicine, said Guinea had already seen theworst of the outbreak and cases were now beginning to decrease. || Althoughthe number of infections is continuing to rise in Sierra Leone and Liberia, ProfWitty said the situation was likely to peak soon and then the epidemic wouldbegin to decline."

"What we need to fight Ebola" - The Washington Post (08/01/2014)

This op-ed piece was written by Michael T. Osterholm, the director of theCenter for Infectious Disease Research and Policy (CIDRAP) at the Universityof Minnesota. This analysis is spot on in explaining why this Ebola outbreakis so different from all the others that have been recognized since the diseasewas first discovered in 1976: "What’s different about this outbreak? TheEbola virus hasn’t changed; Africa has changed. First, residents of theaffected countries — Guinea, Liberia and Sierra Leone — travel much fartherand have many more contacts than they did in previous decades. Followingup on all contacts who live a few miles from a case is much easier thantracking down people who may live far away. With modern transportation,family members may travel hundreds of miles to be with sick loved ones. Andmore of this outbreak area, in West Africa, is urbanized than where many ofthe previous outbreaks occurred in Central Africa, so the virus spreadsfaster."


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"Tekmira shares skyrocket as Ebola outbreak intensifies inAfrica" - Reuters Canada (08/01/2014)

Lest we forget that there's always a profit to be made in a crisis. "Sharesof Canada's Tekmira Pharmaceutical Corp TKMR.O TKM.TO, which hasambitions of producing the first treatment for the deadly Ebola virus,have skyrocketed as the worst-ever outbreak of the virus intensified inWest Africa. || While human tests of the company's treatment,TKM-Ebola, were put on hold last month due to safety concerns,investors scrambled to buy its stock, sending shares up 1.5 percent to$13 in midday Nasdaq trading, and up more than 50 percent over thepast fortnight."

"Obama says Ebola outbreak must be taken seriously, UStaking precautions for US-Africa summit" - US News andWorld Report (08/01/2014)

This U.S.-African summit, scheduled to take place in Washington nextweek, had been planned many months ago. Representatives of SierraLeone and Liberia have already cancelled plans to attend.

"'Training for this': Atlanta hospital ready for opportunityto treat Ebola patients" - CNN (08/01/2014)

Enabled: Statistics TrackingCNN is based in Atlanta, so expect to see lots of local coverage of theEbola victims evacuated to Atlanta from this news outlet. This storyrecounts advance preparations for the arrival of the Ebola patients tothis, one of only four such centers in the country equipped to providecomplete isolation of infectious patients. "The isolation unit was created12 years ago in conjunction with experts from the U.S. Centers forDisease Control and Prevention, which is based down the street. Itfeatures "special air handling," strict protocols on everything andeveryone who goes in and out of a patient's room, and other measures toensure that any potential dangers are contained."


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"Ebola patient coming to U.S. as aid workers' healthworsens" - Reuters (08/01/2014)

Enabled: Statistics TrackingReuters reports that one of the two American aid workers who havebecome infected with Ebola will be transferred to Emory UniversityHospital in Atlanta for treatment. The move is being facilitated bythe CDC, also based in Atlanta. "Reynolds [CDC spokesperson] saidthe CDC was not aware of any Ebola patient ever being treated in theUnited States, but five people in the past decade have entered thecountry with either Lassa Fever or Marburg Fever, hemorrhagicfevers similar to Ebola."

This piece also notes that other news outlets are saying that twoAmerican patients are coming, presumably physician Kent Brantlyand missionary Nancy Writebol, both of whom work for the medicalcharity, Samaritan's Purse. Moreover, the report notes that "CDCDirector Dr. Thomas Frieden said in a conference call thattransferring gravely ill patients has the potential to do more harmthan good." [Context: remember that Frieden was at the center ofthe firestorm in July about the accidental shipments of potentiallylethal anthrax and flu strains from CDC labs. And July was alsowhen the vials of smallpox were found in an NIH/FDA lab inBethesda, MD.] So this sounds like there is already increasingtension among members of the U.S. public health wing aboutappropriate course of action. This is a turning point in the story, nomatter the outcome.

"W.H.O. Says Outbreak of Ebola Virus Is OutpacingControl Efforts" - New York Times (08/01/2014)

Dr. Margaret Chan, WHO Director General, met on Friday, August 1,with the leaders of the three most affected countries: Guinea,Liberia and Sierra Leone. The meeting, which took place in Conakry,the capital of Guinea, announced the introduction of a $100 millionplan to deploy hundreds more medical professionals in the field totry to stem the epidemic's spread. Here's the link to Chan's officialaddress: statement of Margaret Chan, WHO Director General, on 1August 2014.

"Nations Intensify Efforts to Suppress Ebola Outbreakin West Africa" - NY Times (07/31/2014)

The increasing anxiety is apparent in this report from July 31, 2014:


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WHO "said the death toll had risen to 729 from 672, after57 more people died during a four-day period betweenJuly 24 and 27 in Guinea, Liberia, Sierra Leone andNigeria, Africa’s most populous nation. In the sameperiod, 122 new cases were detected, bringing the totalof confirmed and probably infected patients to 1,323."CDC

"Liberia shuts schools as Ebola spreads, PeaceCorps leaves three countries" - Reuters (07/30/2014)

As with the cancellation of flights in the previous days, thisnews on 30 July 2014 is a significant sign of increasing panic inthe several West African countries facing the Ebola epidemic. "Liberia will close schools and consider quarantining somecommunities, it said on Wednesday, rolling out the toughestmeasures yet imposed by a West African government to halt theworst outbreak on record of the deadly Ebola virus. 'This is amajor public health emergency. It's fierce, deadly and many ofour countrymen are dying and we need to act to stop thespread'." The evacuation of Peace Corps volunteers is perhapsthe more serious development, since it signals to local peoplethat westerners themselves no longer have confidence in thelocal health infrastructure. The full citation is: David Lewis andEmma Farge, "Liberia shuts schools as Ebola spreads, PeaceCorps leaves three countries," Reuters, 07/30/2014,http://www.reuters.com/article/2014/07/31/us-health-ebola-idUSKBN0FZ2P120140731.

"Faced with challenging Ebola outbreak, medicalworkers use education to combat fear" - PBSNewsHour (07/28/2014)

Enabled: Statistics TrackingThis links to a video.

"Ebola outbreak: Asky bans flights in West Africa" -BBC News (7/29/2014)


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Again, we're watching the point of transition from localizedepidemic to potential pandemic. Because of the apparentimportation of Ebola into Nigeria because of a passenger ona plane, the possibility of further spread via plane travel isbecoming concrete. ASKY, the West African airline, hascancelled flights to Sierra Leone and Liberia, citing itsconcern for the safety of its passengers and staff. ASKY'sdecision follows that of Nigeria's largest airline, Arik Air,which did the same several days ago.

"Ebola outbreak: Nigeria begins screening fordeadly virus" - CBC News (07/26/2014)

"Nigerian health authorities are racing to stop the spread ofEbola after a man brought the deadly and highly contagiousdisease by plane to Lagos, Africa's largest city with 21million people. . . . Officials in the country of Togo, wherethe sick man's flight had a stopover, also went on high alertafter learning Ebola could possibly have spread to a fifthcountry."

"Ebola center in Sierra Leona under guard afterprotest march" - Reuters (07/26/2014)

This is the saddest news yet coming out of the spreadingEbola epidemic in West Africa: public hysteria is rising dueto the uncontrolled disease, which is threatening to turn adisease catastrophe into a political catastrophe. "Policewere guarding an Ebola treatment center in Sierra Leone onSaturday, the day after thousands marched on the clinicfollowing allegations by a former nurse the deadly virus wasinvented to conceal "cannibalistic rituals" there."

"Nigeria: Government Confirms a Death FromEbola" - New York Times(07/25/2014)

Now add Nigeria to the list of West African countriesinvolved in the current Ebola outbreak, the largest one everseen. The Nigerian official died within a day of returninghome from a conference in Lagos. So it is likely that thedisease has already penetrated into the Nigerian population


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and for some reason has escaped attention thus far. The number of countries with Ebola cases has nowrisen to four: Sierra Leone, Liberia, Guinea, andNigeria.

"Chief Ebola doctor in Sierra Leone hascontracted the deadly disease himself" -The Independent (07/23/2014)

This is a grave turn of events in what is already anincreasingly calamitous epidemic in West Africa. TheSierra Leone doctor, Sheik Umar Khan, a 39-year-oldvirologist, had already been involved in the treatmentof about 100 Ebola patients. That even full protectivegear and strict decontamination practices did notprotect bodes ill for the ability of clinical containmentof the disease, which is primarily circulating betweenpatients and those with whom they have close contact,including health providers.

"West Africa Ebola outbreak total tops1,000" - CIDRAP (07/21/2014)

The latest news on the West African Ebola outbreakfrom CIDRAP (Center for Infectious Disease Researchand Policy).

"Ebola cases in West Africa reach 964,deaths top 600" - CIDRAP (07/15/2014)

The potential threats to health of highly infectiousorganisms here in the States these past two weeks haslargely occluded a still unfolding nightmare in WestAfrica. This only keeps getting worse. CIDRAP, by theway, stands for "Center for Infectious Disease Researchand Policy." This is a good news site to follow.

"Ebola Outbreak: 25 More Deaths Confirmed


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in West Africa" - BBC News (07/08/2014)

Enabled: Statistics TrackingThe stunning spread of Ebola fever into West Africacontinues, with 25 more deaths confirmed sinceearly July, bringing the total number of deathssince the outbreak began in March 2014 to over500. This is the largest known outbreak of Ebola(which was first identified in 1976), both in termsof geographic spread and number of deaths.

"Ebola outbreak spreads as toll reaches337" - Al-Jazeera (06/19/2014)

The full citation is: "Ebola outbreak spreads as tollreaches 337," Al Jazeera, 06/19/2014.

"Ebola in Guinea – people, patterns, andpuzzles" - Lancet Global Health Blog(04/03/2014)

Enabled: Statistics TrackingThis is a valuable piece that gets beyond the "scarydisease" narrative and tries to ask the underlyingsocial and cultural questions that are the hallmarkof what we're doing in this course. No humaninfectious disease comes out of nowhere: theseliving organisms were living somewhere elsebefore they got into human bodies. So where wasthat? And what has changed to allow access tohuman bodies that didn't exist before? (Leachactually muses where Ebola hasn't been morewidespread that previously imagined, and simplywas never noticed before because it kills mostlypoor, rural people.) The full citation is: MelissaLeach, "Ebola in Guinea – people, patterns, andpuzzles," The Lancet Global Health Blog,04/03/2014, accessed 06/20/2014.


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"Why Anthropologists Join An EbolaOutbreak Team" - NPR (04/02/2014)

Enabled: Statistics TrackingThis is a piece that appeared on NPR and itgets at the heart of why training in globalhealth now encompasses many specialtiesbeyond the doctors and nurses we normallythink of as "first responders" in a health crisis. (posted 04/03/2014)

"WHO: Death Toll In Guinea EbolaOutbreak Mounts To 80" - RTT News(04/02/2014)

Enabled: Statistics TrackingNews of a new Ebola hemorrhagic feveroutbreak broke in late March 2014. For thefirst time, the disease appeared in far WestAfrica, including Guinea and Sierra Leone.

"The Ebola virus first appeared in 1976 in twosimultaneous outbreaks in Sudan andDemocratic Republic of the Congo (DRC) and itdoes not normally cause a large number ofcases - the largest outbreaks were ofapproximately 400 cases. However, with notreatment and no cure, it has a very highfatality rate of up to 90 percent." (posted04/02/2014)

Guinea Minister of Health, InitialDeclaration of Outbreak (in French) -03/21/2014

Guinea Minister of Health (2014-03-21)."Épidémie de la fièvre virale hémorragique enGuinée: Déclaration du Ministre de la santé"[Epidemic of viral hemorrhagic fever in Guinea:Declaration of the Minister of Health] (inFrench). L'Express Guinee. Retrieved2014-08-09.


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ASB301-87024-88306-88305 Ebola Ebola - narratives of discovery

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Ebola - narratives of discovery

"A Witness to Ebola's Discovery" - New York Times (08/09/2014)

Enabled: Statistics TrackingAn interview with Dr. Frederick Murphy, then chief of the viral pathology branch atthe Centers for Disease Control and Prevention, who was the first to see the thenunnamed organism under an electron microscope.

Close, Ebola: Through the Eyes of the People (2002)

William T. Close (father of the actress Glenn Close) was a practicing physician inZaire (now Democratic Republic of Congo) in 1976 when the first outbreak ofEbola occurred there. (A different strain of the organism had caused an outbreakin southern Sudan earlier that year.) Close was out of the country when theoutbreak first occurred. By the time he returned to his clinic in Yambuku, nearthe Ebola River (whence the disease got its name), 11 of the 17 medical personnelat his hospital had already died. By enforcing sterilization and the use ofprotective gear, he was able to assist in quelling the outbreak.

Close later retired to Wyoming and there wrote up an account of his experiences.This was first published in Dutch in 1991, with a first English edition appearing in1995 under the title Ebola: A Documentary Novel of Its First Explosion in Zaire bya Doctor who was There (New York: Ballantine Books, 1995). It was publishedunder a new title in 2002: Ebola: Through the Eyes of the People, Expanded,revised edition, illustrations by Itoko Maeno (Marbleton, Wyoming: MeadowlarksSprings Productions, 2002).

Other first-person accounts by CDC people of the same generation are:

1. Joseph B. McCormick and Susan Fisher-Hoch, Level 4: Virus Hunters of theCDC (Atlanta: Turner Publishing, Inc., 1996).2. C.J. Peters, Virus Hunter: Thirty Years of Battling Hot Viruses Around the World(NY: Anchor Doubleday, 1997).3. Ed Regis, Virus Ground Zero: Stalking the Killer Viruses with the Centers forDisease Control (New York: Pocket Books, 1996).


Ebola - narratives of discovery https://myasucourses.asu.edu/webapps/blackboard/content/listC...

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(My thanks to Ann Carmichael for these recommendations.)

Piot, No Time to Lose: A Life in Pursuit of Deadly Viruses (2012)

Peter Piot is currently Director of the London School of Hygiene & TropicalMedicine and Professor of Global Health. He was formerly Under Secretary Generalof the United Nations and founding Executive Director of UNAIDS, and Presidentof the International AIDS Society. He was in Yambuku at the time of the first Ebolaoutbreak in Zaire (now Democratic Republic of Congo) and aided both in quellingthat outbreaking and in identifying the causative organism. His autobiography is: Peter Piot, No Time to Lose: A Life in Pursuit of Deadly Viruses (New York: W. W.Norton, 2012).

"Ebola: Diary of a Killer" (1996)

Enabled: Statistics TrackingThis is an hour-long documentary of the outbreak in 1995. The link will lead youto the ASU Library's subscription.

"Ebola, one of the most deadly viruses known to humankind, struck a town inZaire in January 1995, ultimately causing the agonizing death of 80 percent of itsvictims—many of them health-care workers. This riveting documentary traces theprogress of this outbreak and reports on its aftermath. Doctors at the Centers forDisease Control and Prevention discuss current research, the virus’s possiblereemergence, and what the international medical community is doing to prepareitself. We visit a ready-response medical unit where health-care workers are beingtrained to deal with future outbreaks. English narration and subtitles. (61minutes)"

Garrett, The Coming Plague: Newly Emerging Diseases in a WorldOut of Balance (1994)

Enabled: Statistics TrackingLaurie Garrett is a journalist who has been covering the "emerging diseases" beatfor the past several decades. This book, a major part of which is devoted to thefirst Ebola outbreak in 1976, was what made her name in the field. This from herwebsite: "Laurie Garrett wrote her first bestselling book, THE COMING PLAGUE:Newly Emerging Diseases in a World Out of Balance, while splitting her timebetween the Harvard School of Public Health and the New York newspaper,Newsday. In the 1992-93 academic years Garrett was a Fellow at Harvard, whereshe worked closely with the emerging diseases group, a collection of faculty


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concerned about the surge in epidemics of previously unknown or rare virusesand bacteria. The book was published in hardcopy by Farrar, Straus, and Giroux in1994, and spent 19 weeks on the New York Times bestseller list."

Note that this was published one year before the 2nd largest Ebola outbreak, thatin Zaire (now Democratic Republic of Congo) in 1995.

The full citation is: Laurie Garrett, The Coming Plague: Newly Emerging Diseasesin a World Out of Balance (New York, NY: Farrar, Straus & Giroux, 1994).

Johnson et al., "Ecology of Ebola Virus: A First Clue?" (1981)

Enabled: Statistics TrackingAttached Files:

Johnson et al Ecology of Ebola Virus A First Clue 1981.pdf (493.283 KB)

Karl M. Johnson, Curtis L. Scribner, Joseph B. McCormick, "Ecology of Ebola Virus:A First Clue?," The Journal of Infectious Diseases, Vol. 143, No. 5 (May, 1981), pp.749-751.

Heymann et al., "Ebola Hemorrhagic Fever: Tandala, Zaire,1977-1978" (1980)


Heynmann et al Ebola Hemorrhagic Fever- Tandala, Zaire, 1977-1978 1980.pdf (815.824 KB)

Heymann, D. L.; Weisfeld, J. S.; Webb, P. A.; Johnson, K. M.; Cairns, T.; Berquist, H.(1980). "Ebola hemorrhagic fever: Tandala, Zaire, 1977-1978". The Journal ofinfectious Diseases 142 (3): 372–376. doi:10.1093/infdis/142.3.372.

Abstract: Ebola virus was recovered from a nine-year-old girl who died of acutehemorrhagic fever in June 1977 at Tandala Hospital in northwestern Zaire, in thefirst reported recognized case of this disease since the discovery epidemics of1976 in Zaire and Sudan. Investigations undertaken in the Tandala regionrevealed that two previous clinical infections with Ebola virus had occurred in1972 and that about 7% of the residents had immunofluorescent antibodies to thevirus. Females younger than 30 years of age had a higher prevalence ofantibodies than males of comparable age, but above the age of 30 years therewas no sex difference. No other clues to the still-mysterious natural reservoir ofEbola virus were uncovered.

CDC, "Ebola Hemorrhagic Fever - Southern Sudan" (1979)


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MMWR Ebola Hemorrhagic Fever — Southern Sudan 1979.pdf (1.084 MB)

"Ebola Hemorrhagic Fever — Southern Sudan," Morbidity and Mortality WeeklyReport, Vol. 28, No. 47 (November 30, 1979), pp. 557-559 Published by: Centersfor Disease Control & Prevention (CDC).

Proceedings of the 1977 Ebola Virus Conference (1978)

Ebola virus haemorrhagic fever : proceedings of anInternational Colloquium on Ebola Virus Infection and otherHaemorrhagic Fevers, held in Antwerp, Belgium, 6-8December, 1977 / editor, S. R. Pattyn.

International Colloquium on Ebola Virus Infection and other Haemorrhagic Fevers(1977 : Antwerp)Amsterdam ; New York : Elsevier/North-Holland Biomedical Press ; New York :sole distributors for the USA and Canada, Elsevier North-Holland, 1978.

Coulaud, "La maladie du virus Ebola" (1978)

J.P. Coulaud, "La maladie du virus Ebola" [Review Article], Médecine et MaladiesInfectieuses, Volume 8, Issue 3, 1978, Pages 114-120

WHO, "Ebola haemorrhagic fever in Zaire, 1976: Report of anInternational Commission" (1978)


Ebola haemorrhagic fever in Zaire, 1976 - Bull WHO 1978.pdf (3.058 MB)

WHO, "Ebola haemorrhagic fever in Zaire, 1976: Report of an InternationalCommission," Bulletin of the World Health Organization, 56 (2): 271-293 (1978). This was the first official report of the outbreak in 1976, the first time the diseasehad been identified as a distinct clinical condition.

Johnson et al., "Isolation and Partial Characterization of a New


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Virus Causing Acute Haemorrhagic Fever in Zaire" (1977)

Enabled: Statistics TrackingK.M Johnson, J.V Lange, P.A Webb, F.A Murphy, "Isolation and PartialCharacterization of a New Virus Causing Acute Haemorrhagic Fever in Zaire,"The Lancet, Volume 309, Issue 8011, 12 March 1977, Pages 569-571.

"After Marburg, Ebola" - The Lancet (1977)

Enabled: Statistics TrackingAttached Files: After Marburg Ebola - Lancet 1977.pdf (310.593 KB)

AFTER MARBURG, EBOLA ... The Lancet, Volume 309, Issue 8011, 12 March1977, Pages 581-582

British Medical Journal, "Ebola Virus Infection" (1977)

Enabled: Statistics TrackingAttached Files: BMJ Ebola Virus Infection 1977.pdf (580.439 KB)

"Ebola Virus Infection," The British Medical Journal, Vol. 2, No. 6086 (Aug. 27,1977), pp. 539-540. A brief initial report raising questions about thispuzzling disease, which had already manifested itself both in Sudan and inZaire (now, Democratic Republic of Congo).


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ASB301-87024-88306-88305 Ebola Current Research on Ebola

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Success: General Note on Ebola Science edited.

Current Research on Ebola

General Note on Ebola Science

This is not meant to be an exhaustive list of scientific studies on Ebola. For that,you can check PubMed and the other science databases. Rather, this is intendedto capture the emerging narratives about Ebola as they relate to a global healthperspective. The main questions I have identified are:

how does the strain causing the current outbreak in West Africa relate toother known strains? (Note that the initial claims of Baize et al. publishedin April 2014 that the West African strain was a new clade (claims repeatedby Gatherer 2014) have been challenged by subsequent studies by Dudasand Rambaut (2014) and Calvignac-Spencer et al (2014), who argue insteadthat it is rooted squarely within the Zaire strain.) Answering this questionwill have direct implications for determining how long the strain has beenin West Africa and how it got there.is Ebola a "new" disease or does it pre-date the 1970s, when it was firstidentified in human populations? (Answers, like Li and Chen 2013-2014's,push the filoviruses' origins back 1000s of years, raising the question ofwhat reservoir species have they been in all this time?)no matter the organisms' age, what are the reservoir species now? Although bats are most often mentioned as the reservoir species, this hasnot been confirmed by finding the live virus in any bats. (Antibodies havebeen found.) There have been massive die-offs of gorillas and othernon-human primates (NHPs) in Central (and West?) Africa in the pastdecade or so. This actually points the finger away from NHPs as thereservoir, since they seem to die too quickly to sustain the infection as apopulation. But it has not been satisfactorily explained how it gets intothese communities in the first place. Nor, from what I can see, has thespread through primate communities itself been treated as a mechanism ofgeographic spread to new reservoirs.

The fact that the source of the current West African outbreak is unknown (evenassuming the emerging narrative of a single "Patient Zero" is correct) suggeststhat even if the current outbreak is brought under control within the next coupleof months, the potential for a repeat outbreak cannot be dismissed.


Science and Science Translational Medicine articles on Ebola

Enabled: Statistics TrackingThe leading journal Science and its subsidiary, Science Translational Medicine,have removed the paywalls on their articles relating to Ebola. As ASU students,you already have access to these journals via the Library. But you can feel free toshare this link with friends, family, and colleagues elsewhere who otherwisewould not have access: http://www.sciencemag.org/site/extra/ebola/.

The Ebola Virus: A 3-D Model

This will lead to a study that produced a 3-D model of the Ebola virion. Thevirion is 80 nm in diameter and up to 1,400 nm in length. The HIV virion, incontrast (which is basically spheroid) has a diameter of 100–120 nm.

Changula et al, "Ebola and Marburg virus diseases in Africa:Increased risk of outbreaks in previously unaffected areas?"(2014)


Changula et al Ebola and Marburg virus diseases in Africa- Increased risk ofoutbreaks in previously unaffected areas 2014 - preprint.pdf (324.104 KB)

Microbiol Immunol. 2014 Jul 17. doi: 10.1111/1348-0421.12181. [Epub ahead ofprint] Ebola and Marburg virus diseases in Africa: Increased risk of outbreaks inpreviously unaffected areas? Changula K, Kajihara M, Mweene AS, Takada A.

Abstract: Filoviral hemorrhagic fever (FHF) is caused by ebolaviruses andmarburgviruses in the family Filoviridae. Egyptian fruit bats (Rousettusaegyptiacus) are the most likely natural reservoir for marburgviruses and entryinto caves and mines where they stay was often associated with the past Marburgvirus disease (MVD) outbreaks. On the other hand, the natural reservoir forebolaviruses remains elusive, though handling wild animal carcasses has beenassociated with some of the past Ebola virus disease (EVD) outbreaks. There hasbeen an increase in the incidence of FHF outbreaks in Africa in the last twodecades, with some caused by a newly found virus and some occurring inpreviously unaffected areas such as Guinea, Liberia and Sierra Leone, whichsuffered the most recent EVD outbreak in 2014. Indeed the predictedgeographic distribution of filoviruses and their potential reservoirs in Africaincludes many countries where FHF has not been reported. To minimize the

Current Research on Ebola https://myasucourses.asu.edu/webapps/blackboard/content/listC...

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risk of virus dissemination in previously unaffected areas, there is a need forincreased investment in health infrastructure in African countries, policies tofacilitate collaboration between health authorities from different countries,implementation of outbreak control measures by relevant multi-disciplinaryteams and education of the populations at risk.

Bausch and Schwarz, "Outbreak of Ebola Virus Disease in Guinea:Where Ecology Meets Economy" (2014)

Enabled: Statistics TrackingDaniel G. Bausch and Lara Schwarz, "Outbreak of Ebola Virus Disease in Guinea:Where Ecology Meets Economy," PLoS Neglected Tropical Diseases July 2014 |Volume 8 | Issue 7 | e3056.

"Ebola virus is back, this time in West Africa, with over 350 cases and a 69% casefatality ratio at the time of this writing. The culprit is the Zaire ebolavirus species,the most lethal Ebola virus known, with case fatality ratios up to 90%. Theepicenter and site of first introduction is the region of Guéckédou in Guinea'sremote southeastern forest region, spilling over into various other regions ofGuinea as well as to neighboring Liberia and Sierra Leone. News of this outbreakengenders three basic questions: (1) What in the world is Zaire ebolavirus doing inWest Africa, far from its usual haunts in Central Africa? (2) Why Guinea, where noEbola virus has ever been seen before? (3) Why now? We'll have to wait for theoutbreak to conclude and more data analysis to occur to answer these questionsin detail, and even then we may never know, but some educated speculation maybe illustrative."

This essay raises important questions about the role of deforestation and thecrumbling infrastructures in the affected countries.

Gatherer, "The 2014 Ebola virus disease outbreak in West Africa"(2014)

Derek Gatherer, "The 2014 Ebola virus disease outbreak in West Africa," Journal ofGeneral Virology 95, no. 8 (August 2014), 1619-1624, Early online date 2 May2014.

Abstract: On the 23rd March 2014, the WHO issued its first communiqué on anew outbreak of Ebola virus disease (EVD) which began in December 2013 inGuinée Forestière (Forested Guinea), the eastern sector of the Republic of Guinea.Located on the Atlantic coast of west Africa, Guinea is the first country in thisgeographical region in which an outbreak of EVD has occurred, leaving aside thesingle case reported in Ivory Coast in 1994. Cases have now also been confirmedacross Guinea as well as in the neighbouring Republic of Liberia. The appearanceof cases in the Guinean capital, Conakry, and the transit of another case through


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the Liberian capital, Monrovia, presents the first large urban setting for EVDtransmission. By 20th April 2014, 242 suspected cases had resulted in a total of147 deaths in Guinea and Liberia. The causative agent is now identified as anoutlier strain of Zaire ebolavirus (EBOV). The full geographical extent and degreeof severity of the outbreak, its zoonotic origins and its possible spread to othercontinents are sure to be subjects of intensive discussion over the next months.

Note that Gatherer's essay went to press before the work by Dudas and Rambaut(2014) and Calvignac-Spencer et al (2014) appeared, which contested the claim inBaize et al. 2014 that the West African outbreak was caused by a new clade of theZaire virus. Nor is he aware of Li and Chen (2013)'s postulation of a rather deephistory for the filoviruses. In other words, this presents a tidier picture of ourknowledge of Ebola than is perhaps yet warranted.

Dudas and Rambaut, "Phylogenetic Analysis of Guinea 2014 EBOVEbolavirus Outbreak" (2014)

Enabled: Statistics TrackingGytis Dudas and Andrew Rambaut, "Phylogenetic Analysis of Guinea 2014 EBOVEbolavirus Outbreak," PLoS Currents: Outbreaks, 2 May 2014, edition 1: 1–11.

Abstract: Members of the genus Ebolavirus have caused outbreaks ofhaemorrhagic fever in humans in Africa. The most recent outbreak in Guinea,which began in February of 2014, is still ongoing. Recently published analyses ofsequences from this outbreak suggest that the outbreak in Guinea is caused by adivergent lineage of Zaire ebolavirus. We report evidence that points to the sameZaire ebolavirus lineage that has previously caused outbreaks in the DemocraticRepublic of Congo, the Republic of Congo and Gabon as the culprit behind theoutbreak in Guinea.

Dudas and Rambaut's argument is further supported by this subsequent study inJune 2014: Sébastien Calvignac-Spencer, Jakob M. Schulze, Franziska Zickmann,and Bernhard Y. Renard, "Clock Rooting Further Demonstrates that Guinea 2014EBOV is a Member of the Zaïre Lineage," PLOS Currents Outbreaks. 2014 Jun 16.Edition 1.

Abstract: While initial phylogenetic analyses concluded to Guinea 2014 EBOVfalling outside the Zaïre lineage (ZEBOV), a recent re-analysis of the same datasetby Dudas and Rambaut (2014) suggested that Guinea 2014 EBOV actually isZEBOV. Under the same hypothesis as used by these authors (the molecular clockhypothesis), we reinforce their conclusion by providing a statisticalassessment of the location of the root of the Zaïre lineage. Our analysisunambiguously supports Guinea 2014 EBOV as a member of the Zaïre lineage. Inaddition, we also show that some uncertainty exists so as to the location of theroot of the genus Ebolavirus. We release the software we used for thesere-analyses. RootAnnotator allows for the easy determination of branch rootposterior probability from any posterior sample of clocked trees and is freelyavailable at http://sourceforge.net/projects/rootannotator/.


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Brown and Kelly, Material Proximities and Hotspots: Toward anAnthropology of Viral Hemorrhagic Fevers" (2014)

Hannah Brown and Ann H. Kelly, "Material Proximities and Hotspots: Toward anAnthropology of Viral Hemorrhagic Fevers," Medical Anthropology QuarterlyVolume 28, Issue 2, pages 280–303, June 2014. Article first published online: 21APR 2014

Abstract: This article outlines a research program for an anthropology of viralhemorrhagic fevers (collectively known as VHFs). It begins by reviewing the socialscience literature on Ebola, Marburg, and Lassa fevers and charting areas forfuture ethnographic attention. We theoretically elaborate the hotspot as a way ofintegrating analysis of the two routes of VHF infection: from animal reservoirs tohumans and between humans. Drawing together recent anthropologicalinvestigations of human–animal entanglements with an ethnographic interest inthe social production of space, we seek to enrich conceptualizations of viralmovement by elaborating the circumstances through which viruses, humans,objects, and animals come into contact. We suggest that attention to the materialproximities—between animals, humans, and objects—that constitute the hotspotopens a frontier site for critical and methodological development in medicalanthropology and for future collaborations in VHF management and control.

This rather long essay engages with its own genesis in anthropological theorymore than non-anthropologists may find interesting. One might, moreover,question their choice of the scintillating term "hot spot" to refer to loci where"viruses, humans, objects, and animals come into contact." "Hot" implies atransience, when it seems to be the normativeness of transpecies interactions thatfacilitates zoonotic disease genesis. As they themselves note (p. 282), "thehotspot speaks to the mundane interactions that create the conditions ofpathogenic possibility" (my emphasis). Still, this is an engaging example ofmethodological theorizing, and it will likely be a study that is returned to after thecurrent outbreak is over.

Baize et al., "Emergence of Zaire Ebola Virus Disease in Guinea —Preliminary Report" (2014)

Sylvain Baize, Delphine Pannetier, Lisa Oestereich, Toni Rieger, Lamine Koivogui,N’Faly Magassouba, Barrè Soropogui, Mamadou Saliou Sow, Sakoba Keïta, HildeDe Clerck, Amanda Tiffany, Gemma Dominguez, Mathieu Loua, Alexis Traoré,Moussa Kolié, Emmanuel Roland Malano, Emmanuel Heleze, Anne Bocquin,Stephane Mély,Hervé Raoul, Valérie Caro, Dániel Cadar, Martin Gabriel, MeikePahlmann, Dennis Tappe, Jonas Schmidt-Chanasit, Benido Impouma, Abdoul


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Karim Diallo, M.D., Pierre Formenty, Michel Van Herp, and Stephan Günther,"Emergence of Zaire Ebola Virus Disease in Guinea — Preliminary Report," NEJMApril 16, 2014DOI: 10.1056/NEJMoa1404505.

Abstract: In March 2014, the World Health Organization was notified of anoutbreak of a communicable disease characterized by fever, severe diarrhea,vomiting, and a high fatality rate in Guinea. Virologic investigation identified Zaireebolavirus (EBOV) as the causative agent. Full-length genome sequencing andphylogenetic analysis showed that EBOV from Guinea forms a separate clade inrelationship to the known EBOV strains from the Democratic Republic ofCongo and Gabon. Epidemiologic investigation linked the laboratory-confirmedcases with the presumed first fatality of the outbreak in December 2013. Thisstudy demonstrates the emergence of a new EBOV strain in Guinea.

This study, drawing largely on epidemiological information gathered by Médecinssans Frontières, is the most thorough epidemiological report of the West AfricanEbola outbreak published to date. They argue that the entire outbreak resultsfrom a single chain of human-to-human transmissions. (This served as the mainbackground for a New York Times account of "patient zero" published 09 August2014.) However, its conclusions about this being a new strain of the Ebola virushave been challenged by Dudas and Rambaut (2014) and Calvignac-Spencer et al(2014).

Vogel, "Are Bats Spreading Ebola Across Sub-Saharan Africa?"(2014)

An early summary report on the 2014 outbreak in Science. Vogel's report reflectsthe early puzzlement over why the West African outbreak was caused by the Zairestrain, which hitherto had never been found further than the Democratic Republicof Congo. Gretchen Vogel, "Are Bats Spreading Ebola Across Sub-Saharan Africa?,"Science 11 April 2014: Vol. 344 no. 6180 p. 140, DOI:10.1126/science.344.6180.140

Li and Chen, "Evolutionary history of Ebola virus" (2013/2014)

Enabled: Statistics TrackingLi YH, Chen SP. "Evolutionary history of Ebola virus," Epidemiology and Infection2014 Jun;142(6):1138-45. doi: 10.1017/S0950268813002215. Epub 2013 Sep16.

Abstract: Since Ebola virus was discovered in 1970s, the virus has persisted inAfrica and sporadic fatal outbreaks in humans and non-human primates havebeen reported. However, the evolutionary history of Ebola virus remains unclear.In this study, 27 Ebola virus strains with complete glycoprotein genes, includingfive species (Zaire, Sudan, Reston, Tai Forest, Bundibugyo), were analysed. Here,


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we propose a hypothesis of the evolutionary history of Ebola virus which will behelpful to investigate the molecular evolution of these viruses.

The hypothesis boils down to this: "Before EBOV emerged around 751 (95% HPD1320 B.C.–A.D. 1872), the viruses had been circulating in small mammals (bats,rodents, shrews, tenrecs, marsupials, etc.). Although these animals (such as bats)were infected, there was no evidence to show that they would die whichsuggested a balance between these reservoirs and EBOV. However, this balancewas broken around 1900 which was characterized by a rapid drop in geneticdiversities of EBOV. During this process, most lineages of each species becameextinct due to many factors, such as climate change, human activities, a sharpdecrease in the numbers of reservoir animals or other possibilities. However,probably due to positive selection on GP which is well-known to be involved inreceptor binding and fusion with cellular membranes, few lineages whichobtained broader tropism and higher fitness thus had the ability to infectprimates around 1970 by direct exposure."

Kupferschmidt, "Link to MERS Virus Underscores Bats' PuzzlingThreat" (2013)


Kupferschmidt Link to MERS Virus Underscores Bats’ Puzzling Threat 2013.pdf (379.609 KB)

"What is it about bats? . . . Is there something special about these mammals thatturns them into flying repositories of pathogens?" This brief essay by Sciencemagazine's "cultural interpreter" will answer some questions. (And remind youwhy these "rat got wings"--thank you, Carly Simon, for perfect mood music--areso creepy.)

The full citation is: KAI KUPFERSCHMIDT, "Link to MERS Virus Underscores Bats'Puzzling Threat," Science, New Series, Vol. 341, No. 6149 (30 August 2013), pp.948-949.

Luis, et al., "A Comparison of Bats and Rodents as Reservoirs ofZoonotic Viruses: Are Bats Special?" (2013)


Luis et al A comparison of bats and rodents as reservoirs of zoonotic virusesAre bats special 2013.pdf (518.028 KB)

Angela D. Luis, David T. S. Hayman, Thomas J. O'Shea, Paul M. Cryan, Amy T.Gilbert, Juliet R. C. Pulliam, James N. Mills, Mary E. Timonin, Craig K. R. Willis,


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Andrew A. Cunningham, Anthony R. Fooks, Charles E. Rupprecht, James L. N.Wood, Colleen T. Webb, "A comparison of bats and rodents as reservoirs ofzoonotic viruses: are bats special?," Proceedings of the Royal Society. Section B:Biological Sciences, Vol. 280, No. 1756 (7 April 2013), pp. 1-9.

Abstract: Bats are the natural reservoirs of a number of high-impact viralzoonoses. We present a quantitative analysis to address the hypothesis that batsare unique in their propensity to host zoonotic viruses based on a comparisonwith rodents, another important host order. We found that bats indeed hostmore zoonotic viruses per species than rodents, and we identified life-historyand ecological factors that promote zoonotic viral richness. More zoonotic virusesare hosted by species whose distributions overlap with a greater number of otherspecies in the sametaxonomic order (sympatry). Specifically in bats, there wasevidence for increased zoonotic viral richness in species with smaller litters (oneyoung), greater longevity and more litters per year. Furthermore, our resultspoint to a new hypothesis to explain in part why bats host more zoonoticviruses per species: the stronger effect of sympatry in bats and more virusesshared between bat species suggests that interspecific transmission is moreprevalent among bats than among rodents. Although bats host more zoonoticviruses per species, the total number of zoonotic viruses identified in bats (61)was lower than in rodents (68), a result of there being approximately twice thenumber of rodent species as bat species. Therefore, rodents should still be aserious concern as reservoirs of emerging viruses. These findings shed light ondisease emergence and perpetuation mechanisms and may help lead to apredictive framework for identifying future emerging infectious virus reservoirs.

Carroll, et al., "Molecular Evolution of Viruses of the FamilyFiloviridae Based on 97 Whole-Genome Sequences" (2013)


Carroll et al Molecular Evolution of Viruses of the Family Filoviridae Based on 97Whole-Genome Sequences 2013.pdf (885.674 KB)

Serena A. Carroll, Jonathan S. Towner, Tara K. Sealy, Laura K. McMullan, Marina L.Khristova, Felicity J. Burt, Robert Swanepoel, Pierre E. Rollin, and Stuart T. Nichol,"Molecular Evolution of Viruses of the Family Filoviridae Based on 97 Whole-Genome Sequences," Journal of Virolology, Mar 2013; 87(5): 2608–2616. doi:10.1128/JVI.03118-12 PMCID: PMC3571414

Abstract: Viruses in the Ebolavirus and Marburgvirus genera (family Filoviridae)have been associated with large outbreaks of hemorrhagic fever in human andnonhuman primates. The first documented cases occurred in primates over 45years ago, but the amount of virus genetic diversity detected within batpopulations, which have recently been identified as potential reservoir hosts,suggests that the filoviruses are much older. Here, detailed Bayesian coalescentphylogenetic analyses are performed on 97 whole-genome sequences, 55 ofwhich are newly reported, to comprehensively examine molecular evolutionary


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rates and estimate dates of common ancestry for viruses within the familyFiloviridae. Molecular evolutionary rates for viruses belonging to different speciesrange from 0.46104 nucleotide substitutions/site/year for Sudan ebolavirus to8.21104 nucleotide substitutions/ site/year for Reston ebolavirus. Most recentcommon ancestry can be traced back only within the last 50 years for Restonebolavirus and Zaire ebolavirus species and suggests that viruses within thesespecies may have undergone recent genetic bottlenecks. Viruses within Marburgmarburgvirus and Sudan ebolavirus species can be traced back further andshare most recent common ancestors approximately 700 and 850 yearsbefore the present, respectively. Examination of the whole family suggests thatmembers of the Filoviridae, including the recently described Lloviu virus, shared amost recent common ancestor approximately 10,000 years ago. These datawill be valuable for understanding the evolution of filoviruses in the context ofnatural history as new reservoir hosts are identified and, further, for determiningmechanisms of emergence, pathogenicity, and the ongoing threat to publichealth.

Olson et al., "Dead or alive: animal sampling during Ebolahemorrhagic fever outbreaks in humans" (2012)

Sarah H. Olson, Patricia Reed, Kenneth N. Cameron, Benard J. Ssebide, Christine K.Johnson, Stephen S. Morse, William B. Karesh, Jonna A. K. Mazet, and Damien O.Joly1, "Dead or alive: animal sampling during Ebola hemorrhagic fever outbreaksin humans," Emerging Health Threats Journal 2012; 5: 10.3402/ehtj.v5i0.9134.Published online Apr 30, 2012. doi: 10.3402/ehtj.v5i0.9134 PMCID: PMC334267.

Abstract: There are currently no widely accepted animal surveillance guidelinesfor human Ebola hemorrhagic fever (EHF) outbreak investigations to identifypotential sources of Ebolavirus (EBOV) spillover into humans and other animals.Animal field surveillance during and following an outbreak has several purposes,from helping identify the specific animal source of a human case to guidingcontrol activities by describing the spatial and temporal distribution of wildcirculating EBOV, informing public health efforts, and contributing to broader EHFresearch questions. Since 1976, researchers have sampled over 10,000 individualvertebrates from areas associated with human EHF outbreaks and tested for EBOVor antibodies. Using field surveillance data associated with EHF outbreaks, thisreview provides guidance on animal sampling for resource-limited outbreaksituations, target species, and in some cases which diagnostics should beprioritized to rapidly assess the presence of EBOV in animal reservoirs. In brief,EBOV detection was 32.7% (18/55) for carcasses (animals found dead) and 0.2%(13/5309) for live captured animals. Our review indicates that for the purposes ofidentifying potential sources of transmission from animals to humans andisolating suspected virus in an animal in outbreak situations, (1) surveillance offree-ranging non-human primate mortality and morbidity should be a priority, (2)any wildlife morbidity or mortality events should be investigated and may hold themost promise for locating virus or viral genome sequences, (3) surveillance ofsome bat species is worthwhile to isolate and detect evidence of exposure, and (4)morbidity, mortality, and serology studies of domestic animals should prioritize


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dogs and pigs and include testing for virus and previous exposure.

Muyembe-Tamfum, et al., "Ebola virus outbreaks in Africa: Pastand present" (2012)

J.J. Muyembe-Tamfum; S. Mulangu; Justin Masumu; J.M. Kayembe; A. Kemp;Janusz T. Paweska, "Ebola virus outbreaks in Africa: Past and present,"Onderstepoort Journal of Veterinary Research, vol.79 no.2 Cape Town 2012.

Abstract: Ebola haemorrhagic fever (EHF) is a zoonosis affecting both human andnon-human primates (NHP). Outbreaks in Africa occur mainly in the Congo andNile basins. The first outbreaks of EHF occurred nearly simultaneously in 1976 inthe Democratic Republic of the Congo (DRC, former Zaire) and Sudan with veryhigh case fatality rates of 88% and 53%, respectively. The two outbreaks werecaused by two distinct species of Ebola virus named Zaire ebolavirus (ZEBOV) andSudan ebolavirus (SEBOV). The source of transmission remains unknown. Aftera long period of silence (1980–1993), EHF outbreaks in Africa caused by the twospecies erupted with increased frequency and new species were discovered,namely Côte d’Ivoire ebolavirus (CIEBOV) in 1994 in the Ivory Coast andBundibugyo ebolavirus (BEBOV) in 2007 in Uganda. The re-emergence of EHFoutbreaks in Gabon and Republic of the Congo were concomitant with an increasein mortality amongst gorillas and chimpanzees infected with ZEBOV. The humanoutbreaks were related to multiple, unrelated index cases who had contact withdead gorillas or chimpanzees. However, in areas where NHP were rare orabsent, as in Kikwit (DRC) in 1995, Mweka (DRC) in 2007, Gulu (Uganda) in2000 and Yambio (Sudan) in 2004, the hunting and eating of fruit bats mayhave resulted in the primary transmission of Ebola virus to humans. Human-to-human transmission is associated with direct contact with body fluids ortissues from an infected subject or contaminated objects. Despite several, oftenheroic field studies, the epidemiology and ecology of Ebola virus, includingidentification of its natural reservoir hosts, remains a formidable challenge forpublic health and scientific communities.

Grard et al., "Emergence of Divergent Zaire Ebola Virus Strains inDemocratic Republic of the Congo in 2007 and 2008" (2011)


Grard et al Emergence of Divergent Zaire Ebola Virus Strains in DRC in 2007 and2008 2011.pdf (408.18 KB)

Gilda Grard, Roman Biek, Jean-Jacques Muyembe Tamfum, Joseph Fair, NathanWolfe, Pierre Formenty, Janusz Paweska, and Eric Leroy, "Emergence of DivergentZaire Ebola Virus Strains in Democratic Republic of the Congo in 2007 and 2008,"


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Journal of Infectious Diseases (2011) 204 (suppl 3): S776-S784doi:10.1093/infdis/jir36.

Abstract: Background. Zaire ebolavirus was responsible for 2 outbreaks inDemocratic Republic of the Congo (DRC), in 1976 and 1995. The virus reemergedin DRC 12 years later, causing 2 successive outbreaks in the Luebo region, KasaiOccidental province, in 2007 and 2008.Methods. Viruses of each outbreak were isolated and the full-length genomeswere characterized. Phylogenetic analysis was then undertaken to characterize therelationships with previously described viruses.Results. The 2 Luebo viruses are nearly identical but are not related to lineage Aviruses known in DRC or to descendants of the lineage B viruses encountered inthe Gabon–Republic of the Congo area, with which they do, however, share acommon ancestor.Conclusions. Our findings strongly suggest that the Luebo 2007 outbreak didnot result from viral spread from previously identified foci but from anindependent viral emergence. The previously identified epidemiological link withmigratory bat species known to carry Zaire ebolavirus RNA support the hypothesisof viral spillover from this widely dispersed reservoir. The high level of similaritybetween the Luebo2007 and Luebo2008 viruses suggests that local wildlifepopulations (most likely bats) became infected and allowed local viral persistenceand reemergence from year to year.

Barrette et al., "Current perspectives on the phylogeny ofFiloviridae" (2011)


Barrette et al Current Perspectives on the Phylogeny of Filoviridae 2011.pdf (378.498 KB)

Roger W. Barrette, Lizhe Xu, Jessica M. Rowland, Michael T. McIntosh, "Currentperspectives on the phylogeny of Filoviridae," Infection, Genetics and Evolution2011 Oct;11(7):1514-9. doi: 10.1016/j.meegid.2011.06.017. Epub 2011 Jun 30.

Abstract: Sporadic fatal outbreaks of disease in humans and non-humanprimates caused by Ebola or Marburg viruses have driven research into thecharacterization of these viruses with the hopes of identifying host tropisms andpotential reservoirs. Such an understanding of the relatedness of newlydiscovered filoviruses may help to predict risk factors for outbreaks ofhemorrhagic disease in humans and/or non-human primates. Recent discoveriessuch as three distinct genotypes of Reston ebolavirus, unexpectedly discovered indomestic swine in the Philippines; as well as a new species, Bundibugyoebolavirus; the recent discovery of Lloviu virus as a potential new genus,Cuevavirus, within Filoviridae; and germline integrations of filovirus-likesequences in some animal species bring new insights into the relatedness offiloviruses, their prevalence and potential for transmission to humans. These newfindings reveal that filoviruses are more diverse and may have had a greater


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influence on the evolution of animals than previously thought. Herein wereview these findings with regard to the implications for understanding thehost range, prevalence and transmission of Filoviridae.

Feldmann and Geisbert, "Ebola haemorrhagic fever" - TheLancet (2011)


Feldmann and Geisbert Ebola Haemorrhagic Fever 2011 (review article).pdf (2.077 MB)

Heinz Feldmann and Thomas W Geisbert, "Ebola haemorrhagic fever," TheLancet, Volume 377, Issue 9768, 5–11 March 2011, 849-862.

Devos et al., "Monitoring population decline: can transectsurveys detect the impact of the Ebola virus on apes?" (2008)

Céline Devos, Peter D. Walsh, Eric Arnhem and Marie-Claude Huynen,"Monitoring population decline: can transect surveys detect the impact of theEbola virus on apes?," Oryx 42, no. 3 (June 2008), pp 367-374.

Abstract: In 2004 the Ebola virus caused a drastic decline in western gorillaGorilla gorilla abundance at Lokoue´ Bai, a clearing in Odzala National Park,Republic of Congo. This decline was detected by observations of gorillasvisiting the clearing. We confirm that the sympatric chimpanzee Pantroglodytes population was also affected by the Ebola outbreak, and testwhether the decline in the ape population would have been detected withlinetransect surveys, the most commonly used wildlife monitoringmethodology in Central Africa. We also evaluate the potential of transectsurveys for describing the extent and pinpointing the timing of drasticpopulation declines when this information is not known from other evidence.Both nest survey using the marked nest count method and standing stocksurvey of other signs of ape presence (dung, feeding remains, prints) wereable to detect the decline. However, only nests and dung were reliable indicesfor estimating the magnitude of the decline and accurately pinpointing thetiming. It was necessary to pool data across many survey replicates becauseof small samples sizes. Our results suggest that transects methods are ableto detect drastic changes in ape abundance but that large sample sizes arenecessary to achieve adequate statistical power. We therefore recommendthat those intending to use transect methods as tools for monitoring largeforest mammals evaluate in advance how much effort will be necessary todetect meaningful changes in animal abundance.


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Hewlett and Hewlett, Ebola, Culture and Politics (2008)

Ebola, culture, and politics : the anthropology of anemerging disease / Barry S. Hewlett, Bonnie L. Hewlett.

Hewlett, Barry S., 1950-Australia ; Belmont, CA : Thomson, c2008.

Lahm et al., "Morbidity and mortality of wild animals inrelation to outbreaks of Ebola haemorrhagic fever inGabon, 1994—2003" (2007)


Lahm et al Morbidity and mortality of wild animals in relation tooutbreaks of Ebola haemorrhagic fever in Gabon, 1994—2003 2007.pdf

(1.013 MB)

Sally A. Lahm, Maryvonne Kombila, Robert Swanepoel, Richard F.W.Barnes, "Morbidity and mortality of wild animals in relation to outbreaksof Ebola haemorrhagic fever in Gabon, 1994—2003," Transactions of theRoyal Society of Tropical Medicine and Hygiene (2007) 101, 64—78.

Abstract: Antibody to Ebola virus was found in 14 (1.2%) of 1147 humansera collected in Gabon in 1981—1997. Six seropositive subjects werebled in the northeast in 1991, more than 3 years prior to recognitionof the first known outbreak of Ebola haemorrhagic fever (EHF),whilst eight came from the southwest where the disease has notbeen recognised. It has been reported elsewhere that 98 carcasses ofwild animals were found in systematic studies in northeastern Gabon andadjoining northwestern Republic of the Congo (RoC) during five EHFepidemics in August 2001 to June 2003, with Ebola virus infection beingconfirmed in 14 carcasses. During the present opportunisticobservations, reports were investigated of a further 397 carcasses,mainly gorillas, chimpanzees, mandrills and bush pigs, found by ruralresidents in 35 incidents in Gabon and RoC during 1994—2003. Sixteenincidents had temporal and/or spatial coincidence with confirmedEHF outbreaks, and the remaining 19 appeared to representextension of disease from such sites. There appeared to be sustainedEbola virus activity in the northeast in 1994—1999, with sequentialspread from 1996 onwards, first westwards, then southerly, and thennortheastwards, reaching the Gabon—RoC border in 2001. This impliesthat there was transmission of infection between wild mammals, butthe species involved are highly susceptible and unlikely to be


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natural hosts of the virus.

Walsh et al., "Potential for Ebola Transmission betweenGorilla and Chimpanzee Social Groups" (2007)


Walsh et al Potential for Ebola Transmission between Gorilla andChimpanzee Social Groups 2007.pdf (502.43 KB)

Walsh, P. D., Breuer, T., Sanz, C., Morgan, D., Doran-Sheehy, D.2007. Potential for Ebola Transmission between Gorilla andChimpanzee Social Groups. American Naturalist, 169 (5), 684-689. Abstract: Over the past decade Ebola hemorrhagic fever hasemerged repeatedly in Gabon and Congo, causing numerous humanoutbreaks and massive die-offs of gorillas and chimpanzees. WhyEbola has emerged so explosively remains poorly understood.Previous studies have tended to focus on exogenous factors such ashabitat disturbance and climate change as drivers of Ebolaemergence while downplaying the contribution of transmissionbetween gorilla or chimpanzee social groups. Here we report recentobservations on behaviors that pose a risk of transmission amonggorilla groups and between gorillas and chimpanzees. Theseobservations support a reassessment of ape-to-ape transmission asan amplifier of Ebola outbreaks.

"Tracking Ebola’s Deadly March Among Wild Apes"(2006)

Enabled: Statistics TrackingThis "cover essay" and the more detailed scientific piece thataccompanies it raise very serious questions about how we arecreating epidemiological narratives of diseases. If Ebola could killsome 5000 gorillas (an already endangered species) over the courseof just a few years, can we really say that the disease has"disappeared" even if there are no major human outbreaks in thisperiod? The full citations are: Gretchen Vogel, "Tracking Ebola'sDeadly March Among Wild Apes," Science 8 December 2006:1522-1523; and Magdalena Bermejo, José Domingo Rodríguez-Teijeiro, Germán Illera, Alex Barroso, Carles Vilà, and Peter D. Walsh,"Ebola Outbreak Killed 5000 Gorillas," Science 8 December 2006:Vol. 314 no. 5805 p. 1564, DOI: 10.1126/science.1133105.


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Mahanty and Bray, "Pathogenesis of filoviralhaemorrhagic fevers" (2004)

Siddhartha Mahanty and Mike Bray, "Pathogenesis of filoviralhaemorrhagic fevers," The Lancet Infectious Diseases, Aug2004, Vol. 4 No. 8 pp 487-498.

Huijbregts et al, "Ebola and the decline of gorillaGorilla gorilla . . ." (2003)

Bas Huijbregts, Pauwel De Wachter, Louis Sosthène NdongObiang and Marc Ella Akou, "Ebola and the decline of gorillaGorilla gorilla and chimpanzee Pan troglodytes populations inMinkebe Forest, north-eastern Gabon," Oryx Vol 37 No 4October 2003, 437-43.

Abstract: During 1998–2000 extremely low densities of gorillasGorilla gorilla gorilla and chimpanzees Pan troglodytestroglodytes were found in the Minkebe Forest block in north-eastern Gabon. When compared with data collected before1994, these data suggest a catastrophic decline in apepopulations in the area. We believe that this decline wascaused by a disease epidemic. The period of declinecorresponds with the Ebola outbreaks of 1994 and 1996 thatoccurred in the human population in the same area. Deaths ofgorillas and chimpanzees were associated with both Ebolaoutbreaks. Data from nearby sites indicate that the epidemicwas limited to the Minkebe Forest. Occurrence of such epidemicdie-offs should be taken into account in conservation strategiesfor the long-term survival of ape populations. At the time ofwriting, an Ebola epidemic among humans in the ZadiéDepartment east of Minkebe Forest has resulted in 53 deaths. Inthe neighbouring Republic of Congo, authorities have reported43 deaths and at least 12 other cases of Ebola. These epidemicsare believed to be linked to the handling and eating of deadapes.

Hewlett and Richard P. Amola, "Cultural Contexts of


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Ebola in Northern Uganda" (2003)

This is an excellent analysis, made by anthropologists, ofthe need to incorporate deep anthropologicalunderstanding into any public health intervention with adisease so intimately connected with basic life practices. Barry S. Hewlett and Richard P. Amola, "Cultural Contexts ofEbola in Northern Uganda," Emerging Infectious DiseasesOct 2003; 9(10): 1242–1248. doi:10.3201/eid0910.020493.

Gonzalez, et al., "Ebola and Marburg virusantibody prevalence in selected populations ofthe Central African Republic" (2000)


Gonzalez et al Ebola and Marburg virus antibodyprevalence in selected populations of the Central AfricanRepublic 2000.pdf (180.512 KB)

Jean Paul Gonzalez, Emmanuel Nakoune,Werner Slenczka,Pierre Vidal, Jacques M. Morvan, "Ebola and Marburg virusantibody prevalence in selected populations of the CentralAfrican Republic," Microbes and Infection, 2, 2000, 39-44.

Abstract: With the natural history of the filovirus familyseemingly unknown, filovirus ecology in its naturalenvironment remains a rudimentary field of research. Inorder to investigate the maintenance cycle of filovirus inCentral Africa, a study was conducted within the rain forestof the Central African Republic. The epidemiological studydetermines the frequency and distribution of filovirusseroprevalence in a selected human population. Using anELISA, serum samples from Pygmy and non-Pygmypopulations were tested for Ebola-Zaire virus and Marburg(MBG) virus antibody. Filovirus antibody reacting sera werefound in all zones investigated, and in all populationsstudied (Ebola virus IgG 5.3%; Marburg virus IgG 2.4%).Pygmies appeared to have a significantly higherseroprevalence ( P < 0.03) against Ebola-Zaire virus(7.02%) than non-Pygmies (4.2%). MBG virus or relatedunknown filovirus strains also seem to be present in thewestern part of Central Africa. MBG virus antibodies werepresent in different Pygmy groups (ranging from 0.7 to5.6%, mean 2.05%) and in several non-Pygmy populations(ranging from 0.0 to 3.9%, mean 3.4%) without an overall


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significant difference between the two groups ( P =0.14). The potentialities of nonpathogenic filovirusstrains circulating in the Central African Republic arediscussed.

Baize et al., "Defective humoral responsesand extensive intravascular apoptosis areassociated with fatal outcome in Ebolavirus-infected patients" (1999)


Baize et al Defective humoral responses andextensive intravascular apoptosis are associated withfatal outcome in Ebola virus-infected patients1999.pdf (201.93 KB)

Baize, S. et al. (1999) Defective humoral responses andextensive intravascular apoptosis are associated withfatal outcome in Ebola virus-infected patients , NatureMedicine 5, 423–426.

Here is the summary of its main implications fromColin Michie, "Lessons from the survivors of Ebolainfection," Molecular Medicine Today, Volume 5, Issue7, 1 July 1999, Page 285:

Ebola virus, which causes viral hemorrhagic fever,is one of humankind’s most pathogenic infections,and has a mortality rate of 60–80%. Against suchodds, do host or viral factors determine survival?In a study of two clusters in Gabon in 1996, Baizeet al. measured viral load, antibody responses,mRNA for T-cell-activation markers, T-cellapoptosis and circulating interferon g (IFN- g )levels in Ebola patients. Clear distinctionsbetween individuals were evident, withsurvivors developing specific immunoglobulinG within five days of illness and cytotoxic Tlymphocyte (CTL)-responses shortlyafterwards. Those who did not survive, bycontrast, had a poor immunoglobulin response,rising IFN-g levels and dramatic T-cell apoptosis(consistent with the lymphoreticular damagecharacteristic of such patients at post mortem).Viral loads differed little between groups,suggesting that the early host response wascritical in determining outcome. Specific


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antibodies were directed against a viralnucleoprotein and several smaller proteinsrather than against transmembranestructures. Thus early T-cell responsesdetermined survival, as has been found inrodent models of Ebola infection; suchresponses direct the production ofappropriate antibodies. This informationshould help direct Ebola vaccine development,and raises questions as to how cliniciansmight enhance T-cell response times.

Formenty, "Ebola Virus Outbreak AmongWild Chimpanzees Living in a Rain Forestof Côte d'Ivoire" (1999)


Formenty et al Ebola Virus Outbreak amongWild Chimpanzees Living in a Rain Forest of Côted'Ivoire 1999.pdf (1.408 MB)

Pierre Formenty, Christophe Boesch, MoniqueWyers, Claudia Steiner, Franca Donati, FredericDind, Francine Walker, and Bernard Le Guenno,"Ebola Virus Outbreak among Wild ChimpanzeesLiving in a Rain Forest of Côte d'Ivoire," The Journalof Infectious Diseases 1999; 179 (Suppl1):S120-S126.

An outbreak of Ebola in nature is described for thefirst time. During a few weeks in November 1994,~25% of 43 members of a wild chimpanzeecommunity disappeared or were found dead in theTai National Park, Côte d'Ivoire. A retrospectivecohort study was done on the chimpanzeecommunity. Laboratory procedures includedhistology, immunohistochemistry, bacteriology,and serology. Ebola-specific immunohistochemicalstaining was positive for autopsy tissue sectionsfrom 1 chimpanzee. Demographic, epidemiologic,and ecologic investigations were compatible with apoint-source epidemic. Contact activitiesassociated with a case (e.g., touching deadbodies or grooming) did not constitutesignificant risk factors, whereas consumption ofmeat did. The relative risk of meat consumptionwas 5.2 (95% confidence interval, 1.3-21.1). A


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similar outbreak occurred in November 1992among the same community. A highmortality rate among apes tends to indicatethat they are not the reservoir for thedisease causing the illness. These points willhave to be investigated by additional studies.

Le Guenno et al., "Ebola virusoutbreaks in the Ivory Coast andLiberia, 1994-1995" (1998)

Le Guenno, B., Formenty, P. & C. Boesch.1998. Ebola virus outbreaks in the Ivory Coastand Liberia, 1994 - 1995. In: Marburg andEbola Viruses (Klenk, H.-D., ed.), Berlin,Springer Verlag, pp. 77:84.

Johnson et al., "Marburg and EbolaVirus Antibodies in Kenyan Primates"(1981)


Johnson et al Marburg and Ebola VirusAntibodies in Kenyan Primates 1981.pdf (384.85 KB)

B.K. Johnson, L.G. Gitau, A. Gichogo, P.M.Tukei, J.G. Else, M.A. Suleman, and others.MARBURG AND EBOLA VIRUS ANTIBODIES INKENYAN PRIMATES, The Lancet, June 27, 1981,Vol. 317 No. 8235 pp 1420-1421.


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Global History of Health - Teaching Notes on Ebola (08/13/2014)