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Ebola Outbreak in West Africa, 2014 2016 See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/342052580 Ebola outbreak in West Africa, 2014 -2016: Epidemic timeline, differential diagnoses, determining factors, and lessons for future response Article in Journal of Infection and Public Health · May 2020 DOI: 10.1016/j.jiph.2020.03.014 CITATIONS READS 0 152 3 authors: R.T Kamorudeen Kamoru A. Adedokun Hospital Management Board, General Hospital Asubiaro, Osogbo. Nigeria King Saud University Medical City 5 PUBLICATIONS 2 CITATIONS 21 PUBLICATIONS 28 CITATIONS SEE PROFILE SEE PROFILE Ayodeji O. Olarinmoye King Saud University 33 PUBLICATIONS 103 CITATIONS SEE PROFILE Some of the authors of this publication are also working on these related projects: Breast Cancer View project Diabetes View project All content following this page was uploaded by Kamoru A. Adedokun on 10 June 2020. 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G Model JIPH-1319; No. of Pages 7 ARTICLE IN PRESS Journal of Infection and Public Health xxx (2020) xxx–xxx Contents lists available at ScienceDirect Journal of Infection and Public Health journa l homepage: http://www.elsevier.com/locate/jiph Ebola outbreak in West Africa, 2014 – 2016: Epidemic timeline, differential diagnoses, determining factors, and lessons for future response a,b c,∗ Ramat Toyin Kamorudeen , Kamoru Ademola Adedokun , d,e Ayodeji Oluwadare Olarinmoye a Public Health Department, University of South Wales, Pontypridd, United Kingdom b Children Welfare Unit, Osun State Hospital Management Board, Asubiaro, Osogbo, Osun State, Nigeria c Department of Oral Pathology, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia d Engineer Abdullah Bugshan Research Chair for Dental and Oral Rehabilitation (DOR), King Saud University, Riyadh, Kingdom of Saudi Arabia e Centre for Control and Prevention of Zoonoses (CCPZ), University of Ibadan, Ibadan, Nigeria a r t i c l e i n f o a b s t r a c t Article history: The outbreak of Ebola virus disease (EVD) that raged between 2014 and 2016 in the West African sub- Received 24 January 2020 region was one of the global epidemics that spiked international public health concern in the last decade. Received in revised form 15 March 2020 Since the discovery of ebolavirus in 1976, the 2014-2016 epidemics have been the worst with significant Accepted 17 March 2020 case fatality rates and socioeconomic impact in the affected countries. This review looks at important health determinants that directly accounted for the spatial events of rapid spread and severity of EVD in Keywords: West Africa, with consequent high fatality rates. It also brings up a time-point health determinant model Ebolavirus to conceptualize understanding of this important outbreak with a view to enlightening the public and- Epidemic providing valuable recommendations that may be crucial to preventing or curtailing any future outbreak Case fatality of the disease. Health determinant model © 2020 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for West Africa Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/). Contents Introduction . .00 Outbreaks of Ebolavirus in Africa: Epidemic Timeline and Impacts . 00 Ebola and Other Infectious Diseases: Differential Diagnoses . 00 The Key Health Determinants Associated with High Mortality Rate of 2014-2016 West African Ebola Epidemics . 00 Medical Attention and Government Policy: Combinatorial Effects . 00 Social factors . 00 Seasonal and Climatic Factor. .00 Physical Environment . 00 Health Status and Human Biology . 00 Individual risk behaviour . 00 Conclusion . 00 Recommendations . 00 References . 00 Introduction Ebola virus disease (EVD) also known as viral hemorrhagic fever and hereinafter referred to as Ebola, is a rare but deadly illness ∗ which primarily occurs as a result of the transmission of a deadly Corresponding author. E-mail address: [email protected] (K.A. Adedokun). ebolavirus from wild animals particularly fruit bats, to human pop- https://doi.org/10.1016/j.jiph.2020.03.014 1876-0341/© 2020 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Kamorudeen RT, et al. Ebola outbreak in West Africa, 2014 – 2016: Epidemic timeline, differential diagnoses, determining factors, and lessons for future response. J Infect Public Health (2020), https://doi.org/10.1016/j.jiph.2020.03.014 G Model JIPH-1319; No. of Pages 7 ARTICLE IN PRESS 2 R.T. Kamorudeen et al. / Journal of Infection and Public Health xxx (2020) xxx–xxx Table 1 Mortality and Morbidity Measures of Ebola Outbreak in West Africa from 2014 to 2016. Year Country Population Cases Death Case Fatality Rate, CFR (%) Incidence Proportion Per 100,000 2014 *DR Congo 73,767,447 66 49 74.2 0.09 2014 Nigeria 176,404,902 20 8 40 0.01 2014–2015 Mali 16,934,214 8 6 75 0.04 2014–2016 *Sierra Leone 7,328,834 14,124 3,956 28 192.7 *Liberia 4,243,000 10,675 4,809 45 251.6 *Guinea 11,738,441 3,811 2,543 66.7 32.5 Key: *Countries that experienced widespread transmission. ulations [1]. Indeed, the predominant feature of an Ebola outbreak is Overall, no less than 20 Ebola outbreaks with about1, 743 reported the involvement of human-to-human transmission. Ebolavirus is a human cases were recorded in Africa, between 1977 and 2014 [2]. genus of the virus family Filoviridae. Six species identified from the However, an outbreak which began in late 2013 (but spread widely genus (ebolavirus) are- Zaire virus, Bundibugyo virus, Sudan virus, between 2014 and 2016) was the largest and first outbreak that Taï Forest virus, Reston virus and Bombali virus. Of these species, reached epidemic level and it involved a few West African countries the Zaire virus or Zaire ebolavirus has been the most fatal and (see Table 1).This outbreak was the deadliest and it prompted inter- most predominant in global outbreaks till date. Since1976, when national public health concern by August of 2014. It resulted in over Ebola was first discovered in the Democratic Republic of Congo, 28,600 laboratory confirmed cases and nearly 11,300deaths within not less than thirty-eight outbreaks have been reported across the a short period in the three worst affected countries - Guinea, Liberia, globe. Although, some outbreaks are limited, in most cases Ebola and Sierra Leone –and an economic cost of about $4.3billion US outbreaks are widespread [2]. Dollars[2,7]. Another report documented the death of many health It is important to know that most Ebola outbreaks were success- workers in Guinea, Liberia and Sierra Leone [8]. It is important to fully put under control in a short time. However, the 2014-2016 mention that apart from these epicenters of the disease, minor Ebola outbreaks in West Africa matchlessly reached epidemic pro- outbreaks also occurred in other West African countries including portions with more than 11,000 deaths recorded as a result of rapid Nigeria, Mali and Senegal. spread, and involvement of several countries, among other factors Nigeria recorded the first case of Ebola in July 2014 when an [2,3]. Indeed, the Ebola outbreaks across West Africa resulted in infected Liberian-American flew into Lagos, a highly populated city significant human fatalities (till date the worst on record), and in the southwest region of the country. Following this, a nurse who it had a huge impact on lives and livelihoods of residents of attended to the Liberian later died after contracting the disease [9]. countries such as Guinea, Liberia, and Sierra Leone, where major Ebola briefly spread to other cities before Nigeria undertook a fran- outbreaks occurred. Those Ebola outbreaks led to the World Health tic effort to forestall further spread. Altogether, Nigeria recorded Organization (WHO) declaration of a Public Health Emergency of 8 deaths out of 20 cases of Ebola. Four health workers (50% of International Concern in 2014 that was later ended in 2016, albeit, all infected) were among those that succumbed to the infection. with many cases subsequently recorded and attributed to flare-ups The effort at curtailing the spread of Ebola in Nigeria was regarded [3–5]. as a spectacular success, according to the WHO’s representative Although, many Ebola outbreaks preceded the massive 2014- who finally declared Nigeria Ebola free in October 2014, exactly 2016 epidemics across West Africa, in a spatiotemporal context, it 4 months after the first case was reported. Nigeria became the is desirable to know what really triggered its rapid spread across first African nation to be officially confirmed Ebola free [10,11]. the sub-region, despite an awareness of what it took to successful Apart from Nigeria, Mali and Senegal also had a few cases, 8 and halt its spread elsewhere on the continent [2].This review takes 1, respectively [2]. a critical look at some important health determinants that may Although, the 2014-2016 Ebola epidemics were initially have facilitated the epidemic in contrast to previous outbreaks. believed to be caused by Zaire ebolavirus [12], investigations later It utilizes a health determinant model (HDM) consisting of both linked this outbreak with two viruses, Sudan and Zaire ebolaviruses micro-determinants (such as religious rites, health provider com- [1]. In addition, far from West Africa, cases of Reston ebolavirus petency and nearness to forest) and macro-determinants (such were linked with monkeys imported to the United States from as culture and tradition, health quality system, and port of entry the Philippines [1]. Even though, the 2014-2016 Ebola epidemics security), to further enhance the conceptual understanding of this appears to have fully put under control, yet since 2016, cases of important epidemic.
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