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Non Commercial Use Only Journal of Public Health in Africa 2016 ; volume 7:534 Ebola viral disease in West African countries. Although interventions by the United Nations and other international Correspondence: Semeeh Akinwale Omoleke, Africa: a threat to global development agencies could ultimately halt the Immunization, Vaccines and Emergencies, World health, economy and political epidemic, local communities must be engaged Health Organization, Kebbi State Field Office, stability to build trust and create demand for the public Nigeria. health interventions being implemented in the E-mail: [email protected] Ebola-ravaged populations. In the intermediate Semeeh Akinwale Omoleke,1 Key words: Ebola viral disease; West Africa; Ibrahim Mohammed,2 Yauba Saidu3 and long term, post-Ebola rehabilitation should Globalization; Drivers of spread; Zoonosis. focus on strengthening of health systems, 1World Health Organization (IVE), improving awareness about zoonosis and Contributions: the authors contributed equally. 2 Nigeria; United Nations Children’s Fund health behaviors, alleviating poverty and miti- 3 (EPI), Nigeria; Clinton Health Access gating the impact of triggering factors. Finally, Conflict of interest: the authors declare no poten- Initiatives, Yaounde, Cameroun national governments and international devel- tial conflict of interest. opment partners should mobilize huge resources and investments to spur or facilitate Received for publication: 22 February 2016. R&D of disease control tools for emerging and Revision received: 4 August 2016. Abstract pernicious infectious diseases (not limited to Accepted for publication: 15 August 2016. EVD). This work is licensed under a Creative Commons The West African sub-continent is currently Attribution NonCommercial 4.0 License (CC BY- experiencing its first, and ironically, the NC 4.0). largest and longest Ebola viral diseases (EVD) outbreak ever documented in modern medical Introduction ©Copyright S.A. Omoleke et al., 2016 Licensee PAGEPress, Italy history. The current outbreak is significant in Journal of Public Health in Africa 2016; 7:534 Ebola virus disease (EVD) is one of the most several ways, including longevity, magnitude doi:10.4081/jphia.2016.534 of morbidity and mortality, occurrence outside dreaded infectious diseases known to mankind the traditional niches, rapid spread and poten- in the 21st century. Its high mortality rate, only ease.7 This is a concern partly because the tial of becoming a global health tragedy. The which ranges from 25 and 90% has made the health systems of these nations are extremely authors provided explicit insights into the cur- disease one of the most challenging public weak (Table 1)8-11 and so, they may not be able rent and historical background, drivers of the health issues in recent years.1 The disease was to effectively handle an EVD outbreak. epidemic, societal impacts, status of vaccines first described in 1976 in Zaire,use now EVD is caused by one of five species of Ebola and drugs development and proffered recom- Democratic Republic of Congo (DRC), follow- viruses, namely, Zaire (most fatal), Sudan, Tai mendations to halt and prevent future occur- ing an outbreak of a previously unknown acute Forest, Bundibugyo and Reston.12 These five rences. The authors reviewed mainly five data- viral hemorrhagic fever.2 Since then, deadly species, which were identified at different bases and a hand search of key relevant litera- outbreaks have been reported in Congo, DRC, times, are genetically distinct and have caused ture. We reviewed 51 articles that were rele- Gabon, Sudan and Uganda, with a median of 3 outbreaks that differ in geographical spread vant up until the 18th of August 2014. The outbreaks (range 3-7) per country.3 In 2014, authors supplemented the search with refer- the largest and deadliest EVD outbreak in his- and magnitude. In sub-Saharan Africa, most ence list of relevant articles and grey literature tory was recorded in West Africa, representing fatal outbreaks have been caused by Zaire as well as relevant Internet websites. Article the first occurrence of the disease outside its ebolavirus, Sudan ebolavirus and Bundibugyo searches were limited to those published traditional niche in Central Africa. Unlike pre- ebolavirus, with mortality ranging from 30- 1 either in English or French. There are strong vious outbreaks that were easily contained, 90%. Zaire and Sudan ebolaviruses have indications that the EVD may have been trig- commercialthis current outbreak is quite significant in caused repeated outbreaks in Central Africa gered by increased human activities and several ways, including its longevity, rapid since their discovery close to 4 decades ago encroachment into the forest ecosystem spread, unprecedentedly high mortality and while Bundibugyo ebolavirus was first identi- spurred by increasing population and poverty- morbidity, and the real potential to become fied in 2008 following a large outbreak in 13 driven forest-dependent local economy. globalized in this fast-paced-highly-inter-con- Bundibudyo, Uganda. Prior to the current Containment efforts are being hamperedNon by nected-world.4 outbreak, little was known about EVD occur- weak and fragile health systems, including In view of the aforementioned threats or rence outside its traditional niche in Central public health surveillance and weak gover- considerations, the World Health Organization Africa, except for a single reported case of nance, certain socio-anthropological factors, (WHO) recently declared the disease as an human infection with the Tai specie resulting fast travels (improved transport systems) and International Public Health Emergency and from contact with an infected chimpanzee in globalization. The societal impacts of the EBV warned that EVD caseload in the crises coun- the Tai forest of Ivory Coast.14 Initial molecular outbreak are grave, including economic shut- tries could exceed 20,000 by November 2014.5 analysis of the isolates suggested that the out- down, weakening of socio-political systems, Another expert agency, United States Centre break, which has been ravaging West Africa for psychological distress, and unprecedented con- for Disease Control and Prevention (US-CDC), close to a year, was caused by a separate clade sumption of scarce health resources. The has forecasted that the caseload in Liberia and of virus from known ebolavirus strains from research and development (R&D) pipeline for Sierra Leone could reach 0.55-1.4 million by DRC and Gabon.15 However, ensuing analysis product against EBV seems grossly insuffi- January 2015, if additional interventions are indicated that the outbreak was caused by a cient. The outbreak of Ebola and the seeming not deployed or if cultural practices that do not strain that diverged from the Central African difficulty to contain the epidemic is simply a promote good health continue to persist.6 In Zaire ebolavirus about a decade ago, rather reflection of the weak health system, poor sur- addition, there are concerns that the disease than emergence of a separate clade of an veillance and emergency preparedness/ may evolve and linger in several African coun- endemic virus.16 response, poverty and disconnect between the tries (Figure 1),6 a situation that will place Although the outbreak was only officially government and the people in many West about 22 million individuals at risk of the dis- reported to the World Health Organization on [Journal of Public Health in Africa 2016; 7:534] [page 27] Review March 12, 2014, epidemiologic findings bases and a hand search of the reference list of through contact tracing suggest that the out- key articles. We reviewed 51 articles that were Threat of neglected tropical break dated back to December 2, 2013 or possi- relevant up until the end date of the search on disease such as Ebola viral bly earlier.15 The outbreak is traceable to a sin- August 18, 2016. Specifically, we searched gle index case (a 2-year old child in Gueckedou databases such as PubMed, the WHO Library disease in the context Prefecture of Guinea who died of the disease and Information Networks for Knowledge of globalization on Dec 6, 2013), whose family admitted to hav- Database, the Science Citation Index and ing hunted two species of bat-Hypsignatus Social Sciences Citation Index, the WHO The bio-security threat of EVD, which was monstrosus and Epomops franqueti, which are International Clinical Trials Registry Platform, recognized close to four decades ago, is a chal- both reservoir species for Ebolaviruses.17,18 Google Scholar, and supplemented these by lenging global health problem.2 The threat is Subsequent spread of the disease occurred via also searching bibliographies and relevant particularly acute in most part of Sub-Sahara close contacts with blood or body fluids of Internet websites. Africa, where health systems do not have the infected persons at family, community and/or We used search terms and key words such necessary capacity to contain the disease. hospital settings, and by the time the disease as Ebola Virus Disease, Ebola Viral Disease, Most countries lack isolation and treatment was recognized in March 2014, it was present Ebola Hemorrhagic Fever, Ebola/Marburg Fever, units to care for patients as well as disease in three countries. As at April 13, 2016, total Ebola Epidemic, Ebola Outbreak, Viral surveillance systems to trace and quarantine reported cases of EVD (confirmed, probable Hemorrhagic Fever, Viral Hemorrhagic Disease, contacts. Although previous outbreaks were and suspected)
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