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Name: Brittney Nicole Johnson

Course: Introduction to Epidemiology

Assignment: Epidemiology Final - Ebola Research Paper

May 11, 2015

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Ebola viruses have been found primarily in most African countries. It was first

discovered in 1976. Since being discovered, the disease has spread increasingly all over Africa.

When the disease was found around the Ebola River, more and more viruses began to show.

Each virus is vital to the animal communities in Africa, which is even more vital to the people of

Africa and their welfare.

There were two simultaneous outbreaks in Nzara, Sudan and Yambuku, Democratic

Republic of Congo (where the Ebola River is located.) Although the true hosts of the diseases are

unknown, it has been rumored that fruit bats could be the host of Ebola. Ebola causes diseases in

both humans and nonhuman primates, such as: monkeys, gorillas, and chimpanzees. There are

five viruses in accordance with Ebola; four are carried to the human species. These four viruses

are the Ebola virus, Sudan virus, Tai Forest virus, and the Bundibugyo virus. Ebola enters into a

human population by being close into contact with the blood or organs of infected animals. Ebola

then spreads through humans with direct contact of an infected persons bodily fluids or blood.

People will remain infectious as their blood and body fluids are what contain the virus. When

looking for symptoms of Ebola in humans, there is the critical incubation period. It takes about

two to twenty-one days for symptoms to appear in a patient. It is known that humans are not

infectious until the symptoms begin to occur. Symptoms include: fever fatigue, muscle pain,

headache sore throat, vomiting, diarrhea, rash, impaired kidney and liver function, both internal

and external bleeding, low white blood cell and platelet counts, and elevated liver enzymes.

Ebola is created in animals and spread to other animals by contact of the infector’s blood or

bodily fluids. The same process happens through animal-to-human contact, as well as, human-to-

human contact. Known animals to carry the disease are monkeys, chimpanzees, and fruit bats.

There is no evidence that mosquitoes or other insects carry Ebola; only mammals. There is

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evidence, however, that Ebola can be spread through blood transfusions. There is also no

evidence that Ebola can be spread through coughing or sneezing. Treatment includes rehydration

with oral or intravenous fluids.

Too improve the survival rate of the patient; there are treatments of specific symptoms.

There is no proven treatment for Ebola. Ebola then spreads through humans with direct contact

of an infected persons bodily fluids or blood. People will remain infectious as their blood and

body fluids are what contain the virus. There are no licensed vaccines. Although, two different

vaccines are being safety tested for humans. Even though there is no miracle drug or vaccine,

there are medicines being experimented and were given an expert opinion through CNN. There

have also been grants, such as ZMapp, to try and find a cure for Ebola. “A whole menu of

antibodies have been identified as potentially therapeutic, and researchers are eager to figure out

which combinations are most effective and why,” a news release about the grant said. The main

prevention of the spread is controlling the outbreak. By doing this, awareness of the risk factors

for Ebola will be increased.

A protective measure that individuals can take is an effective way to reduce human

transmission. Also, reducing the risk of wildlife-to-human transmission and reducing the risk of

human-to-human transmission will help control the disease. For outbreak containment measures,

there will be safer burial of the deceased, identify possible candidates of Ebola and monitoring

their health for about 21 days, more of a caution with separating the healthy from the infected,

and more precautions with creating a clean environment with good hygiene. When inside of the

body, Ebola can last up to several days at room temperature. Once outside of the body, Ebola is

killed with hospital-grade disinfectants. But, the infection on dry surfaces can last for several

hours. After being cured of Ebola, recovery depends on the person’s immune system response

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and the amount and quality of clinical care being received. Antibodies of the people who recover

from Ebola last for about ten years or more. There is no known evidence of people being

immune for life after being infected with Ebola. Once a person is treated from Ebola, and is

cured, they no longer have the ability to spread the virus.

The entire country of Guinea, Liberia, and Sierra Leone; with effective control measures

affected areas are Scotland and England; previously affected countries are Nigeria, Lagos, and

Port Harcourt; Senegal, Dakar; Madrid, Spain; Dallas, Texas, New York City; Bamako, Mali. Up

to 2 February 9,019 people have reported as having died from the disease in six countries:

Liberia, Guinea, Sierra Leone, Nigeria, the US and Mali. The article reported that Sierra Leone

was investigated in May, Nigeria in July, Liberia in July, Sierra Leone in July, United Nations in

August, Senegal on August 29th, Mali on October 25th, and the United States on October 1st.

Germany, Norway, France, Italy, Switzerland and the UK have all treated patients who

contracted the virus in West Africa. A two year old from Guinea was identified as Patient Zero.

In December of 2013, the child became ill in Gueckedou. The symptoms were vomiting, fever,

and black stool. The family became completely exposed; fist with the mother on December 13, a

three year old sister on December 29, and grandmother on January 1. The grandmother passed

away. By the time it had been declared an epidemic in March, fifty-nine people in Guinea had

already died. In a study for the New England Journal of Medicine, a team of experts had traced

the disease to the village in Gueckedoiu, in southeastern Guinea, by reviewing hospital

documents and speaking to those involved. The Patient Zero for Ebola outbreak has killed more

than 4,900 people. In the space of four months after Patient Zero’s, Emile Ouamouno, death his

village buried fourteen residents.

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A young man from Guinea had travelled to Senegal despite having been infected with the

virus. Thomas Frieden, Director of the Centers for Disease Control and Prevention (CDC) said

that the Ebola outbreak in West Africa was unlike anything since the emergence of HIV/Aids. In

Mali, the first patient was a two-year-old girl. She had travelled hundreds of kilometers by bus

from Guinea through Mali showing symptoms of the disease. The first case of Ebola on US soil

was Thomas Eric Duncan. He contracted the virus in Liberia before travelling to the US. Two

medical workers in Dallas, Texas, who treated Duncan, tested positive for Ebla since his death

but have both recovered. Spanish nurse Teresa Romero was the first person to contract the virus

outside West Africa. She was part of a team of about thirty people at the Carlos II Hospital in

Madrid looking after two missionaries who returned from Liberia and Sierra Leone after

becoming infected. It is possible that the population of West Africa may be more susceptible to

infection because individuals from that region likely have had no prior exposure to the virus. The

United States’ built-in defenses are stronger than Ebola. Every Ebola patient on American soil

was infected either in Liberia or Sierra Leone or because they were treating Thomas Duncan.

Even though that nurse traveled on a plane, it’s possible that she didn’t infect a single person.

Health officials still have plenty of opportunity to keep the virus from spreading.

Nigeria has already dealt with an outbreak of Ebola, and stopped it. The CDC is

communicating health messages in West Africa and the United States, educating healthcare

workers in the U.S. and in West Africa, and advising travelers how to protect their health. The

authorities in several countries have implemented entry restriction to curtail the spread of Ebola

from countries that have Ebola from countries that have Ebola cases, while air carriers have

restricted flights or modified schedules. Flights serving destinations inside and outside Africa

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may also be subject to diversion r delay with little to no warning in order to quarantine

passengers suspected or claiming to be exhibiting Ebola-like symptoms.

Health screening has also been implemented at ports of entry and departure in various

countries throughout West Africa and is being introduced in Europe and North America

countries as well. Specific details of restrictions such as those listed below are difficult to verify

and subject to change, while the implementation of state-imposed entry conditions can vary.

Health workers have been chased out of the countries contaminated by Ebola because of how

fearful the neighborhoods and villages really are. Treatment centers had gained such reputations

as deathtraps that even desperately ill patients devoted their waning strength to avoiding them.

With the affected countries often lacking the most basic medical infrastructure, the health care

challenges proved staggering. But the most tragically missed opportunities stemmed from the

poor flow of information about who was infected and whom they might have exposed.

As of February 1st of, 2015 there have been multiple victims of the Ebola outbreak. In

Guinea, a total of 2,975 people have been infected and 1,944 have been killed; in Sierra Leone,

10,740 people have been infected with Ebola and 3,276 are now dead; in Liberia, 8,745 people

have been infected and 3,746 people have been killed because of Ebola. There continues to be

more and more cases of Ebola infection each week, it is constantly changing. As of February 8,

2015, in Guinea 1,995 people have died; in Liberia 3,826 have been killed; and in Sierra Leone,

3,341 people have died from the Ebola outbreak. In the United Kingdom, there has been one case

of an infected person, but there was no death. In Nigeria, there have been a total of 8 deaths. In

both Spain and Segal, there was one person in each country infected and neither has passed

away. In the United States, there have been four people infected with Ebola and one person has

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passed away. In Mali, there were eight cases of Ebola and six of those patients died. Healthcare

staff across the countries have been shown wearing full suits with respiratory protection.

“CDC has updated the guidelines for PPE to be worn in hospitals; specific

recommendations on other healthcare setting are not yet available. HCWs caring for Ebola

patients in hospitals should have no skin exposed. Single-use (disposable) fluid-resistant or

impermeable gown that extends to at least mid-calf or coverall without integrated hood.

Coveralls with or without integrated socks are acceptable. Single-use (disposable), nitrile

examination gloves with extended cuffs. Two pairs of gloves worn. At a minimum, outer gloves

should have extended cuffs. Single-use (disposable), fluid-resistant or impermeable apron that

covers the torso to the mid-calf should be used if Ebola patients have vomiting or diarrhea.

PAPR or N95 Respirator. Single-use (disposable) N95 respirator in combination with single-use

(disposable) surgical hood extending to shoulders and single-use (disposable) full face shield.”

First responders are equipped to handle and transport a suspected Ebola patient to a hospital.

With correct PPE and management of the patient being taken care of, the risk for a healthcare

employee being exposed to the Ebola virus is low.

In October, the U.S. Public Health Service sent healthcare providers to Liberia. There

were 62 officers and only five returned back to Virginia by December 20th. Since they were sent

to Liberia to help aid to patients with Ebola, the employees are under the risk exposure category.

America also sent troops to Liberia. They did this so soldiers could try and stop the virus before

it reached the U.S. completely. This mission is called “Operation United Assistance.” The team

sent to Liberia consists of troops, doctors, nurses, scientists, aviators, engineers, mechanics, and

technicians. Most of the team is volunteers. The goal is to set up a headquarters in Liberia for

military activities. Also, they will help coordinate aid from other agencies, appoint a General

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Officer, provide engineers to build Ebola Treatment Units, and establish a training site for health

care employees for directly caring for Ebola patients.

The World Health Organization originated the first efficacy trial of an Ebola vaccine in

an affected community. There have been many well-written responses on the testing of VSV-

EBOV in that same community. WHO’s mission is to help prevent Ebola outbreaks by

maintaining the surveillance of the disease and supporting the at-risk countries. They have

helped develop many strategized plans for the infected communities, of how to handle an Ebola

outbreak and patient. When an outbreak occurs, WHO responds by supporting community

engagement, case management, lab services, contact tracing, infection control, and assistance

with safe burial practices.

The Centers for Disease Control and Prevention has been working with the WHO

organization. They help each other in various centers, such as both the state and local health

departments and clinicians. They have helped the community to better understand and manage an

Ebola outbreak. There has been more of an organized way of showing the risks professed from

the Ebola virus. CDC recommends that Ebola testing should be conducted only through a person

who meets the certain criteria for a person under investigation and clinical syndromes. This

organization considers a single diagnostic test used in the absence of a confirmatory diagnostic

algorithm insufficient for public health decision-making.

There is no current Food and Drug Administration approved vaccines available for

prevention, post exposure, or treatment for the Ebola virus. Although, one investigational

vaccine has been used for post-exposure prophylaxis that is authorized by the FDA. It can

authorize access to potentially promising products through other mechanisms, individual-patient

or open-label expanded access Investigational IND application. Even though there are no

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working vaccines, yet, there are many set in place to be tested. To treat patients with an Ebola

virus, there have been many investigational drugs and convalescent plasma that was recovered

from previous Ebola virus disease patients. There have been some positive reports from a

vaccine being tested, known as VSV-EBOV, but there are still some safety concerns all around.

For an experimental treatment to be administered in the United States there must be certain

criteria met. Also, a request is required to be submitted and authorized by the Food and Drug

Administration organization.

There is no data on the safety, efficacy or effectiveness of any drugs, vaccines or

convalescent plasma for treatment of patients with Ebola to inform the management staff. Even

though there is no set vaccine to cure Ebola, there are vaccines being developed such as ChAd3-

ZEBOV and rVSV-ZEBOV. Both are proven to be saving and well tolerated with humans. There

is also a 2-dose vaccination for Ebola, developed by Johnson & Johnson and Bavarian Nordic.

The candidates are Ad26-EBOV and MVA-EBOV. There are many other vaccines being tested

out that are in a phase stage.

Liberia is one of the countries that Ebola has affected greatly. In this poor country of

Africa, about three-quarters of the labor is from agriculture, mining and commerce. Ebola has

affected people directly, but it has mainly affected the countries behavior. Since everybody is

afraid of this disease, there have been lower levels of employment, income, and demand for

goods. There has also been an increase in the local markets. Restrictions on the movement of

people throughout Liberia have extremely decreased for mining of gold and diamonds. Large

investments of oil planting have slowed because of the evacuations of managers and supervisors.

With agriculture being affected by Ebola, the main food crop areas have been mostly affected

and quarantined. Farms are being abandoned due to fear. Productions of paint, candles, water and

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beds are being affected when looking at Liberia’s manufacturing. Fuel, food and other goods

have decreased extremely so prices are rising. There are many concerns that the increase in

shipping insurance for transporting and exporting goods to and from Liberia could increase the

prices of foods and fuel as well. Exports have been postponed and the imports have improved in

the balance of payments. But, there is a bigger demand for food.

Sierra Leone is another country that has been affected by the Ebola virus. The spread of

Ebola has led to the quarantining of the most affected areas and has set forth restrictions on

internal travelling, market closures, and public gatherings. The national rice production for this

year’s season will be affected greatly. The closure of markets, internal travelling restrictions, and

the citizens’ fear of contagion have decreased the food trade, which has cause supply shortages.

There has been no cultivation due to these restrictions. The disruption to agriculture and food

production will have a strong effect on the nutrition of the communities; creating an extreme

malnutrition country. Iron ore dominates mining in Sierra Leone. There has been little effect on

this country’s mining. But, many are operating their companies with reduced employees and the

risk of disruption still continues. Most manufacturing enterprises are on a small scale and are

well suited to the economy’s landscape. Construction is extremely important to the economy.

The booming construction sector in Sierra Leone is a good leading indicator of a flourishing

economy. The effect of the Ebola virus on food prices remains unclear as of now. The balance of

payments financing gap will increase as imports expand in the failing export earning from

minerals and crops.

Guinea is also one of the poorest countries in Africa that has been affected by the Ebola

virus as well. The main economic impacts in this area have been on agriculture and services.

Agriculture in the infected areas has affected the key export commodities. Coffee productions

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have fallen by half; cocoa by a third; palm oil by seventy-five percent; and local water

production by twenty-nine percent. The growth in services for Guinea has fallen from 6.7 percent

to 3.8 percent. Airlines have reduced travel opportunities to Guinea and Senegal. Hotel

occupancy rates have fallen by half. The mining output has yet to be extremely effected by the

Ebola outbreak. There has been a slight change of the rates for exchange depreciation. Most

people have left their country.

Nigeria is another country that has been economically affected by this virus. Reports

from shopping centers and other businesses have indicated declines in demand. The early decline

in commerce hasn’t really reflected the shock or fear of the citizens in the infected areas.

Nigeria’s high dependence on oil to fund exports and provide budgetary resources may actually

be an advantage in the face of the Ebola outbreak. The oil sector has risen highly regionally in

concentrated areas with a lot of activity located offshore.

Senegal has been treated successfully from Ebola and the economic impact has been the

most modest by far. There was a delay in the onset of the rainy season and Ebola resulted in the

slowdown for growth. Senegal once closed their border with Guinea in an attempt to stop the

outbreak by banning flights and ships going to and from Senegal.

For this class, we were to watch a tragic video of what Ebola has truly done to the people

of Africa and others who have been infected. I personally thought that the video was

heartbreaking. I knew that the Ebola disease was a very serious virus that was killing people, but

to see how it affects the individual as well as the people close to them is just so tragic. It makes

me want to help in some way, even though I know I can’t. It’s not just the citizens in Africa that

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are passing away from this horrendous virus, the doctors, other volunteers and caretakers are

being infected and dying, just as quickly.

When you hear of the statistics of Ebola victims, you don’t hear about their families and

the troubles and hardships they all go through. Children are left alone and I honestly just felt like

crying. I could never imagine having to be the parents from the video who had to leave their

children in the village while they were headed to get treatment. It’s every day where more and

more people are infected and dying. I honestly didn’t realize that the outbreak was spreading so

quickly! I understand where the people of Africa are scared and frustrated. The villagers need to

trust the doctors and the people are there to help them, but once a rumor is released and there is

tension and stress between the societies as a whole, I can see where people began to riot. This

video has definitely put my perspective of the Ebola outbreak onto a whole new level. I have

such a risen respect for the people who have been infected, the people who have been affected by

the virus, and the people who have passed from Ebola. I think that the Frontline video was very

informative, personal, emotional, and respective. I now have a new look on not only with the

Ebola Outbreak, but also for my own life. Sometimes we take the simple things in life for

granted, and we forget how easily it can all be taken away.

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