Academic journal article Africa Policy Journal

The Ebola Challenge: West and Central Africa's Containment Strategy

Academic journal article Africa Policy Journal

The Ebola Challenge: West and Central Africa's Containment Strategy

Article excerpt

Ebola Chronicles

The First Recorded Ebola Outbreak

On 27 June 1976 in a southern township in Nzara, Sudan, the Ebola disease takes its first Sudanese casualty, a factory storekeeper.1 This day marks the start of the world's first recorded epidemic of the Ebola virus. The Sudanese casualty becomes ill, showing symptoms such as high fever, diarrhea, and vomiting. After a period of five days, he dies,2 followed by 151 deaths out of the 284 infected casualties, with a casualty fatality rate (CFR) of 53 percent.3 The second outbreak took place a few months later that same year in the village of Yambuku in the Democratic Republic of Congo (formerly Zaire) with a higher CFR of 88 percent. The death toll in Zaire was 280 out of 318 infected patients.4 Since 1976, four out of five of the known strains of the Ebola family of viruses reared themselves in Africa approximately twenty-two times.5 A third strain, a Philippine subtype, spread through primate importation into Reston, Virginia, in the United States and became known as the Ebola Reston (EBOR) subtype.6

Ebola 2014

The 2014 Ebola virus disease in Guinea marks the twenty-third outbreak on the African continent and the first in West Africa.7 In February 2014, southeastern Guinea saw its first infection of the Ebola virus which progressed by 22 March 2014, recording cases of forty-nine in total, with twenty-nine deaths and a CFR of 59 percent in the capital city of Conakry and local districts of Gu?ck?dou, Macenta, Nz?r?kor?, and Kissidougou. From the disease epicenter in Guinea, the disease made its way through humans in transit from Guinea to the neighbouring countries of Sierra Leone (in the Kailahun district) and Liberia (in the counties of Lofa, Nimba, and Margibi).8 As of 1 April 2014, the Ministry of Health (MoH) of Guinea reported a total of 127 confirmed and unconfirmed cases with a death toll of 83, raising the CFR to 65 percent.9 In Guinea, 24 of the cases tested positive for the Zaire ebolavirus strain.10

Of the eight cases in Liberia,11 the Ministry of Health in Liberia reported two laboratory confirmed cases as the Zaire ebolavirus from the Lofa district.12 The species of Zaire ebolavirus was confirmed as a 98 percent match through genetic analysis.13 In Sierra Leone, two cases were recorded, both of whom died.14 The casualties from Liberia and Sierra Leone were travellers to Guinea, and further investigations on these suspect cases are pending.15 As of Sunday, 6 April 2014, the death toll rose to ninety, with new suspected cases in Mali and Ghana.16 By 14 April 2014, the MoH of Guinea reported a total of 168 clinically compatible cases of EVD and 108 deaths.17 The latest virology analysis suggests that the EBOV strain in Guinea has evolved in parallel with the strains from the Democratic Republic of Congo (DRC) and Gabon and was not imported to Guinea.18 The Guinea strain may have evolved from an ancestor and could have started as early as December 2013.19

By 8 August 2014, the EVD status escalated to a Public Health Emergency of International Concern (PHEIC)20 moving beyond the primary zone of impact-that is Guinea, Liberia, Sierra Leone, and Mali-with a single case in Senegal, an isolated spread of small cases in Nigeria and the DRC, and the disease moving beyond the African continent recording international cases in the United States within the healthcare fraternity (one death21 and three recoveries22) and one person in Spain. Since the officially recorded outbreak in Guinea in March 2014, the EVD has claimed approximately 5,420 lives in the region.23 As of 26 November 2014, the WHO reported that a total of 15,935 EVD cases were reported with a death toll of 5,689.24 It may be stated with a degree of certainty that the actual numbers of case morbidity and mortality are indeed higher than the recorded counts with gaps in the system whereby infected persons have evaded detection, diagnosis, and treatment; suspected EVD deaths and burials without an autopsy diagnoses; and the added statistical gaps where laboratory counts have not been included in a regional database. …

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