The Ebola virus disease or EVD has a high fatality rate of 50 percent according to the World Health Organization. The organization also noted that past outbreaks have fatality rates varying from 25 percent to 90 percent.
Despite the fact that the disease can be very deadly, it is worth mentioning that the number of fatalities from influenza is higher. In the United States, for example, the U.S. Centers for Disease Control and Prevention reported that 56000 Americans died from flu from 2012 to 2013 and another 80000 dies from 2017 to 2018. On the other hand, the 2014-2016 Ebola outbreak in West Africa involved over 28000 cases of EVD and over 11000 deaths.
It is important to note that influenza is more contagious than Ebola. The influenza virus spreads airborne. A single cough or sneeze from an infected version ejects half a million virus particles. Meanwhile, the Ebola virus spreads only through direct contact with body fluids such as blood and other secretions that can enter broken skin or mucous membranes.
What are the causes of Ebola outbreak? What are the factors contributing to an Ebola epidemic? Despite the direct-contact transmission mode of the Ebola virus, it is interesting to note why the virus easily spreads across a community and an entire country.
The Causes of Ebola Outbreak: The Major Factors
1. Traditional and Religious Practices
Cultural inclinations have been regarded as one of the factors or causes of Ebola outbreak in African communities. A review and commentary article by A. Manguvo and B. Mafuvadze has enumerated and discussed specific traditional and religious beliefs and practices that contributed to the transmission of the Ebola virus.
For example, in the context of West Africa, a number of communities perceive diseases and death as a product of natural and metaphysical causes. The people generally reject scientific bases for understanding illnesses and medical conventions for managing such. Hence, when it came to the emerging 2014-2016 Ebola outbreak, they refused to seek medical attention and some resisted scientific methods.
Traditional and spiritual healing partly contributed to the spread of Ebola. Community healers were called to attend to the sick. They performed practices that promoted direct contact and thus, human-to-human transmission of the virus. These healers ended up contracting the virus themselves and passing it to other patients and people they encounter. In addition, those who believed on these healers essentially deprived the sick of proper medical attention and measures needed to contain the outbreak.
Another cause of Ebola outbreak is funeral and burial practices. Studies have found out that rituals that involved the washing and cleaning of the dead body contributed to the 2004 outbreak in Uganda and the 2014-2016 outbreak in West Africa. Other practices include touching the deceased to cement the unity between the living and the ancestral spirits, as well as laying beside the corpse of prominent people like community healers and leaders.
2. Exposure to and Contact with Bats
Numerous studies have contended that bats are the normal nature carrier of ebolaviruses. As a natural reservoir, the viruses live and replicate in these bats. Furthermore, these bats are able to spread the virus either to other primates or humans without being affected by it through spillover or cross-species transmission.
Other studies have focused on understanding and explaining how exactly the virus gets transmitted from fruit bats to humans. For example, the study of E. M. Leroy et al. that focused on the 2007 outbreak in the Democratic Republic of Congo explained that communities there hunt and eat these bats. During the annual mass migration of these animals, villagers would hunt them down using guns, thus causing bleeding and subsequent direct exposure to Ebola-infected blood upon preparation.
The review part of the study of H. M. De Nys et al. noted that each outbreak of EVD most likely resulted from different and independent zoonotic events. Transfer can also be indirect according to the review. Nonhuman primates and other wild animals can be infected or carrier of the virus if they have direct contact with bats or other infected animals. In certain African communities, these wild animals serve as a source of bushmeat.
Another study by G. Vogel echoed the fact that the causes of each Ebola outbreak stem from independent events. To be specific, findings from the study hypothesized that a hollow tree in the village of Meliandou in Guinea might have been the ground zero for the 2014-2016 outbreak in West Africa. Accordingly, this tree was home to a population of bats that came into contact with a toddler. This toddler has also been hypothesized as patient zero.
3. Issues with the Community Systems
The World Health Organization noted that proper facilities for good sanitation and provision of clean water supply, in addition to established practices in good hygiene are key to preventing or containing disease outbreaks, including Ebola outbreak. Communities and healthcare facilities should have adequate infrastructures and systems for promoting personal hygiene and environmental cleanliness.
A review article by E. M. Burd noted that poor sanitation and unsafe medical facilities facilitated the continued spread of the virus during the 2014-2016 outbreak in West Africa. Note that another article by A. Delamou et al. noted that the same outbreak was unique in geography and extent. Weak infrastructures that hampered logistics and the delivery of medical attention, as well as population density and significant cross-border population mobility, are critical factors or causes of Ebola outbreak in poor countries.
The same study also explained that weak governance, low funding in the healthcare sector, poor coordination of vertical programs, and political instability all play a role in contributing to the spread of Ebola virus in impoverished communities. To be specific, Delamou et al. explained that these factors hampered the immediate and effective response to the outbreak
Essentially, the issues or problems with the community systems mentioned above collectively constitute a public health crisis. The presence of these factors within a community or country signifies the absence of a proper healthcare system and all of its major and supplementary components needed to respond to epidemics.
Conclusion: Understanding Ebola Outbreak Factors
Based on the discussion above, the causes of Ebola outbreak collectively demonstrate an interplay between cultural, environmental, biological, and sociopolitical factors. Although each outbreak mostly likely resulted from independent event, there are critical factors that determine the extent at which ebolaviruses and the corresponding Ebola virus disease spread within a community.
FURTHER READINGS AND REFERENCES
- Burd, E. M. 2014. Ebola Virus: A Clear and Present Danger. Journal of Clinical Microbiology. 53(1): 4-8. DOI: 10.1128/jcm.03115-14
- Centers for Disease Control and Prevention. 2017. “2014-2016 Ebola Outbreak in West Africa.” Centers for Disease Control and Prevention. Available online
- Delamou, A., Delvaux, T., El Ayadi, A. M., Beavogui, A. H., Okumura, J., Van Damme, W., and De Brouwere, V. 2017. “Public Health Impact of the 2014-2015 Ebola Outbreak in West Africa: Seizing Opportunities for the Future.” BMJ Global Health. 2(2). DOI: 10.1136/bmjgh-2016-000202
- De Nys, H. M., Kingebeni, P. M., Keita, A. K., Butel, C., Thaurignac, G., Villabona-Arenas, C. J…Peters, M. 2018. “Survey of Ebola Viruses in Frugivorous and Insectivorous Bats in Guinea, Cameroon, and the Democratic Republic of the Congo, 2015–2017.” Emerging Infectious Diseases. 24(2): 2228-2240. DOI: 10.3201/eid2412.180740
- Dyer, O. 2018. “US Had Record Flu Deaths Last Year, Says CDC.” The BMJ. 2018: 363. DOI: 10.1136/bmj.k4136
- Leroy, E. M., Epelboin, A., Mondonge, V., Pourrut, X., Gonzalez, J.P., Muyembe-Tamfum, J. J., and Formenty, P. 2009. “Human Ebola Outbreak Resulting from Direct Exposure to Fruit Bats in Luebo, Democratic Republic of Congo, 2007.” Vector-Borne and Zoonotic Diseases. 9(6): 723-728. DOI: 10.1089/vbz.2008.0167
- Vogel, G. 2015. “Bat-Filled Tree Source of Ebola Epidemic?” Science. 347(6218): 142-143. DOI: 10.1126/science.347.6218.142-h
- Manguvo, A. and Mafuvadze, B. 2015. “The Impact of Traditional and Religious Practices on the Spread of Ebola in West Africa: Time for a Strategic Shift.” The Pan African Medical Journal. 22(1): 9. DOI: 10.11694/pamj.supp.2015.22.1.6190
- World Health Organization. 2018. “Ebola Virus Disease.” Fact Sheets. World Health Organization. Available online.
- World Health Organization. 2014. Ebola Virus Disease: Key Questions and Answers Concerning Water, Sanitation, and Hygiene. World Health Organization