Ebola Virus


Overview

Bringing forth socioeconomic chaos and major causes of death in the region, the Western African Ebola virus epidemic which took place in 2013–2016 was the most widespread outbreak of Ebola virus disease in history, starting in Guinea then moving across land borders to Sierra Leone and Liberia. Small outbreaks occurred in Nigeria and Mali, whilst consequently there were isolated cases and secondary infections of medical workers occurring in the United States, Spain, Senegal, United Kingdom and Italy.

Although the virus was first discovered in 1976 near the Ebola River, the ongoing outbreak re-emerged in the Democratic Republic of the Congo in August 2018. Primarily with an experimental vaccine ready to be used, public health officials were hopeful they would be able to contain it. However with violent attacks on healthcare workers and hindered access to the locations most in need of care and equipment, such hopes soon disappeared. The sudden arrival of outsiders interested in regions where there’s been violence for years makes people from the local communities feel cynical, and the actions of armed groups limit medical intervention.

Criticisms on pharmaceutical companies and NGO’s from the Congolese Health Department has only amplified suspicions within local communities. In the Congo these circumstances are among the main reasons for the spread of Ebola. With more than 100 armed groups active in this region, the epicentre of the Ebola outbreak is in North Kivu, which has been an area of conflict for over 25 years. Also neglected by international stakeholders and the Congolese government, the region Beni, which stands at the heart of the Ebola epidemic has been gripped by violence from armed groups for decades. Access to health care for these communities has been restricted due to the violence and political unrest, even though the number of new confirmed Ebola cases have continued to grow.

By making it difficult to trace contacts, conduct vital community outreach activities and identify new cases, security constraints are hindering the Ebola response. While Ebola could be eradicated temporarily, other threats could still arise in this zone dangering public health and the security of the region, if the international community does not seriously commit to finding a security solution to the situation in the DRC. The World Health Organisation has declared the Democratic Republic of the Congo’s Ebola epidemic as a global health emergency of international concern.

Facts

Key Actors

Total number of major outbreaks: 24

Major outbreak examples:

  • 1976: South Sudan and the Democratic Republic of the Congo (DRC)
  • 2014-2016: Starting in Guinea and spreading to other West African countries
  • 2018-2020: Democratic Republic of Congo (DRC)

Statistics:

  • Human Cases: 34,718
  • Human Deaths: 15,311

Ebola vaccines?

  •  rVSV-ZEBOV/Ervebo

Licensed in February 2020 by four African countries—Burundi, the DRC, Ghana and Zambia. Already approved by the United States, European Union, and WHO, the vaccine was highly effective in trials during the West African outbreak and more recent DRC outbreaks. WHO Director-General hailed the licensing as a “milestone in the fight against this unforgiving disease.”

What is Ebola?

Ebola, formerly known as the Ebola haemorrhagic fever is a life-threatening disease that attacks the immune system causing extreme fluid loss often leading to death.

How do Ebola outbreaks start?

The disease is contracted by people from being in contact with animals—usually bats but sometimes primates or from cooking or eating contaminated foods. Through their bodily fluids, human carriers can then transmit Ebola to others. After death, their bodies remain contagious.

Why was the 2014 outbreak in West Africa so deadly?

This epidemic had spread to several communities before being identified as Ebola, unlike past outbreaks, which were generally confined to remote areas in Central Africa. In early March 2014 by the time the first diagnosis was made, cases were suspected in Liberia and Sierra Leone and the virus had already struck multiple villages in Guinea. Experts say the poor health infrastructure of the stricken countries was the reason the disease was able to spread so quickly.

The Ebola virus to begin with was first linked to an outbreak of a haemorrhagic disease in Democratic Republic of Congo (previously known as Zaire) in 1976. The most recent outbreak of Ebola in the Democratic Republic of the Congo started in May 2020 and is currently ongoing. The DRC is the epicentre of the Ebola virus and this EVD outbreak is the tenth one occurring there.

The Sudan Ebola virus species has a single virus member (SUDV). The name Sudan Ebola virus originates from Sudan which is the country where the Sudan Ebola virus was first discovered. A large outbreak of haemorrhagic fever which afterwards was called Ebola haemorrhagic fever occurred between June and November 1976 in southern Sudan. The outbreak in the town of Nzara appears to have originated with workers of a cotton factory.

With 3 previous Ebola outbreaks, Gabon’s most recent outbreak was in November 2001, which occured an area near the border of the Republic of the Congo. The WHO was informed in December and an international team from the Global Outbreak Alert and Response Network swiftly came in to Gabon to support the Ministry of Health in containing the outbreak. The Gabonese Ministry of Health and the WHO are currently to set up a safety strategy to avoid any spread of Ebola in the country after the outbreak of the disease in the Democratic Republic of the Congo.

Along Uganda’s south-western border people regularly cross into and out of the Democratic Republic of the Congo. They come to sell goods at Ugandan markets, to visit family, to seek health care, or to seek refuge from the ongoing conflict in DRC. However, because the Ebola outbreak is still active in DRC and taking into consideration the historical susceptibility of Uganda to the virus, the people crossing the border might be carrying the deadly virus and could be putting the country at risk.

Clinicians, government ministers, and public health experts have all criticised the World Health Organization during a parliamentary evidence session on its handling of the Ebola virus outbreak in West Africa. The World Health Organization’s (WHO) reputation became irrefutably damaged during the Ebola outbreak, with a general consensus in the global health community that it fell short of its leadership responsibilities. While the WHO did offer some normative leadership during the Ebola outbreak, as per its constitution, it did not provide an effective operational response.

Like other partners, the African Union, through the Africa Centres for Disease Control and Prevention (Africa CDC), has been supporting the efforts of the government of the DRC from the beginning of the outbreak. Given the health, economic, and security threat that this deadly disease poses to the continent, the Africa Union is calling for mobilization of all Africans and friends of Africa to show increased solidarity with communities affected and those at highest risk.

The mission, known as the African Union Support to the Ebola Outbreak in West Africa (ASEOWA) was, according to its concept of operations “an AU led military and civilian humanitarian mission comprising medical doctors, nurses and other medical personnel, as well as military personnel, as required for the effectiveness”.

The European Union has been active in the response to the Ebola emergency from the start. It has mobilised all available political, financial and scientific resources to help contain, control, treat and ultimately defeat Ebola. In October 2014 the European Council appointed Christos Stylianides, EU Commissioner for Humanitarian Aid and Crisis Management, as EU Ebola Coordinator.

Timeline

The outbreak happened in the cities of south Sudan Tumbura, Juba, Maridi and Nzara. Workers in a cotton factory were the index cases. Usually from patients to their nurses, the disease was spread by close contact with an acute case. Amongst the infected were many medical personnel.

Country – Sudan

Virus – SUDV

Human Cases – 284

Human Deaths – 151

Case fatality rate 53%

Presently known as the Democratic Republic of the Congo, the outbreak occurred in the city of Yambuku. It spread through the use of contaminated needles in hospital/clinics and also through personal contact.

Country – Democratic Republic of Congo

Virus – EBOV

Human Cases – 318

Human Deaths – 280

Case fatality Rate – 88%

This was a recurrent outbreak in Maridi and Nzara, which took place at the same location as the 1976 Sudan epidemic

Country – Sudan

Virus – SUDV

Human Cases – 34

Human Deaths – 22

Case Fatality Rate – 65%

The outbreak occurred in Makokou and deep in the rain forest along the Ivindo River in gold mining camps. It had been wrongly classified as yellow fever until 1995.

Country – Gabon

Virus – EBOV

Human Cases – 52

Human Deaths – 31

Case Fatality Rate – 60%

A patient who worked in a forest adjoining the city of Kikwit is where the outbreak was traced to. Mainly through families the epidemic was spread but also hospital admissions too.

Country – Zaire

Virus – EBOV

Human Cases – 315

Human Deaths – 254

Case Fatality Rate – 81%

The outbreak occurred in the village of Mayibout and its surrounding areas. A chimpanzee found dead in the forest was eaten by villagers hunting for food. Whilst more cases occurred in their family members, nineteen people involved in the butchery of the animal became ill.

Country – Gabon

Virus – EBOV

Human Cases – 31

Human Deaths – 21

Case Fatality Rate – 68%

With transport of patients to Liberville the outbreak occurred in the Booue area. A hunter who lived in a forest timber camp was the index case patient. At the time a dead chimpanzee was determined to be infected which was found in the forest. Close contact with infected people is how the disease spread.

Country – Gabon

Virus – EBOV

Human Cases – 60

Human Deaths – 45

Case Fatality Rate – 75%

The districts located in Uganda called Masindi, Mbarara and Gulu is where the outbreak occurred. The three greatest risks associated with Sudan virus infection were providing medical care to case-patients without using suitable personal protective procedures, having contact with case-patients in one’s family and attending funerals of case-patients. Victims included Matthew Lukwiya.

Country – Uganda

Virus – SUDV

Human Cases – 425

Human Deaths – 224

Case Fatality Rate – 53%

This outbreak occurred on both sides of the border between Gabon and the Republic of the Congo.

Country – Gabon

Virus – EBOV

Human Cases – 65

Human Deaths – 53

Case Fatality Rate – 82%

This outbreak occurred on both sides of the border between Gabon and the Republic of the Congo (RC). Ebola virus disease in the Republic Of Congo had its first reported occurrence included in this outbreak.

Country – Republic Of Congo

Virus – EBOV

Human Cases – 59

Human Deaths – 44

Case Fatality Rate – 75%

The outbreak occurred in the Cuvette-Ouest Department in the districts of Mobomo and Kelle

Country – Republic Of Congo

Virus – EBOV

Human Cases – 143

Human Deaths – 128

Case Fatality Rate – 90%

located in Mbomo District in the Cuvette-Ouest Department, the outbreak occurred in the villages of Mbomo and Mbandza.

Country – Republic Of Congo

Virus – EBOV

Human Cases – 35

Human Deaths – 29

Fatality Rate – 83%

In Western Equatoria, which in the present day is known as south Sudan, the outbreak occurred in the Yambio county. Several suspected EVD cases were reclassified later as measles cases because this outbreak was concurrent with an outbreak of measles in the same area.

Country – Sudan

Virus – SUDV

Human Cases – 17

Human Deaths – 7

Case Fatality Rate – 41%

Occurred in the Etoumbi district of Cuvette Ouest Department of the Republic of the Congo

Country – Republic Of Congo

Virus – EBOV

Human Cases – 12

Human Deaths – 10

Case Fatality Rate – 83%

Country – Democratic Republic Of Congo

Virus – EBOV

Human Cases – 246

Human Deaths – 187

Case Fatality Rate – 71%

The outbreak occurred in western Uganda’s Bundibugyo’s District. This was the first identification of the Bundibugyo virus (BDBV).

Country – Uganda

Virus – BDBV

Human Cases – 149

Human Deaths – 37

Case Fatality Rate – 25%

This outbreak occurred in the Mweka and Luebo health zones of the Kasaï-Occidental province.

Country – Democratic Republic Of The Congo

Virus – EBOV

Human Cases – 32

Human Deaths – 14

Case Fatality Rate – 45%

This outbreak occurred in the Kibaale District.

Country – Uganda

Virus – SUDV

Human Cases – 24

Human Deaths – 17

Case Fatality Rate – 71%

This outbreak occurred in the Orientale Province.

Country – Democratic Republic Of Congo

Virus – BDBV

Human Cases – 57

Human Deaths – 29

Case Fatality Rate – 51%

In regards to both the number of human cases and fatalities, this was the most severe Ebola outbreak in recorded history. In December 2013 it began in Guéckédou, Guinea and spread abroad. Whilst flare-ups of the disease still continued into 2016 the outbreak was declared over on 9 June 2016.

Countries –      Liberia, Sierra Leone, Guinea (Widespread)

                            Nigeria, Mali, United States, Senegal, Spain, United Kingdom, Italy (Limited and Local)

 

Virus – EBOV

Human Cases – 28,616

Human Deaths – 11,310

Case Fatality Rate – 70 -71%

 Appealing to member States with experience, AU Ministers of Health convened in Angola to assist with action and fight Ebola.

Announcing cooperation on a plan to co-ordinate support to combat the epidemic, the World Health Organization (WHO) arranged an emergency meeting with health ministers from eleven countries.

Seventeen suspected Ebola patients were missing in Liberia after a health centre in the capital was attacked, the government says. The attack on the quarantine centre in Liberia, took place in Monrovia’s densely populated West Point township. There were conflicting reports over what sparked the riot, in which medical supplies were stolen. Assistant Health Minister Tolbert Nyenswah said the protesters were unhappy that patients were being taken there from other parts of the capital. Other reports suggested the protesters had believed Ebola was a hoax and wanted to force the centre to close.

Ebola was declared a threat to international peace and security by the UN Security Council

There was Ebola related violence and rioting in the eastern town of Koidu, with police imposing a curfew. Local youth fired at police with shotguns after a former youth leader refused health authorities permission to take her relative for an Ebola test. Several buildings were attacked and youth gangs roamed the streets shouting “No more Ebola”. A local leader reported seeing two bodies with gunshot wounds in the aftermath. Police denied that anyone had been killed. Doctors reported two dead. The local district medical officer said he had been forced to abandon the local hospital because of the rioting.

The outbreak occurred on the 24th of August in Equateur province. As of 28 October 2014, according to the WHO, twenty days had passed since the last reported case was cleared and no new contacts were being followed. Declared over on 15 November 2014.

Country – Democratic Republic Of Congo

Virus – EBOV

Human Cases – 66

Human Deaths – 49

Case Fatality Rate – 74%

Making it the first reputable vaccine against the disease, a study found the VSV-EBOV vaccine to be 95–100% effective against the Ebola virus.

In the northwestern town of Bikoro, the government of the Democratic Republic of the Congo reported two confirmed cases of Ebola infection, On 8 May 2018. In the city of Mbandaka On 17th May, a case was confirmed. An experimental Ebola vaccine rVSV-ZEBOV had been developed to contain the outbreak which health authorities were planning on using to ring vaccinate. On July 24, 2018 the outbreak was declared over.

Country – Democratic Republic Of Congo

Virus – EBOV

Human Cases – 54

Human Deaths – 33

Case Fatality Rate – 61%

When 4 individuals tested positive for the Ebola virus On 1 August 2018, the Democratic Republic of the Congo Ministry of Health declared an outbreak. After being diagnosed with Ebola the WHO confirmed that a five-year-old boy in Uganda died On 11 June 2019. On 25 June, 2020 the second biggest EVD outbreak ever was declared over.

Country – Democratic Republic Of Congo and Uganda (Widespread)

Human Cases – 3470

Human Deaths – 2280

Case Fatality Rate – 66%

Ebola prevention activities have been suspended in the DRC city of Beni after a deadly rebel attack. Lasting for several hours the rebel attack in Beni killed eighteen people including 14 civilians.

Although not confirmed local sources say that behind the attack was a Ugandan Islamist militant group active in the area since the 1990s.

Two attacks in eastern Democratic Republic of the Congo (DRC) have killed 4 workers responding to the Ebola outbreak and injured 5 others. The attacks occurred overnight on a shared living camp in Biakato Mines and an Ebola response coordination office in Mangina. The dead include a member of a vaccination team, two drivers and a police officer.

Separate to the ongoing Kivu Ebola epidemic, on May 31st an announcement was made by the DRC Health Minister Eteni Longondo that there is an additional Ebola outbreak. Equateur province is where the latest outbreak is located (which is the same place the 2018 Equateur province Ebola outbreak took place). Due to the EVD outbreak, on the 21th of August it had become 100 cases with 43 deaths.

Country- Democratic Republic Of Congo

Virus – EBOV

Human Cases – 100

Human Deaths – 43

Case Fatality Rate – Ongoing

Carrying the virus without being affected by it, a significant source of infection are so-called reservoir hosts. For the various types of the Ebola virus, the most likely involved reservoir hosts are various species of bats and fruit bats.

Scientists have discovered for the first time, where nine of such bat and fruit bat species may encounter suitable habitats and climatic conditions in Africa. Based on ecological niche modelling the respective bat and fruit bat species are able to thrive in West and East Africa, including large parts of Central Africa. 

Located between the Ubangi and Congo rivers, the latest area affected by Ebola is Bomongo. Out of the health zones that border the Republic of the Congo, this is the second one to be affected.

At 46 strategic points of control, the WHO said it had screened nearly 1 million travellers for Ebola to prevent the outbreak from spreading further. Helping to reduce the disease’s spread, it said those efforts had identified 72 suspected cases of Ebola.

 

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