Ebola historical perspective
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S., Guillermo Rodriguez Nava, M.D. [2]
Overview
The Ebola virus was named after the Ebola River Valley in the Democratic Republic of the Congo (formerly Zaïre), near the site of a 1976 outbreak at a mission run by Flemish nuns.[1] Since the initial discovery of the virus, five subtypes have subsequently been identified.
Historical Perspective
Discovery
- The Ebola virus was first recognized in 1976 as a result of outbreaks of Ebola hemorrhagic fever in Zaire and Sudan.
- The fist description of ebola virus disease was made by Doctor Ngoy Mushola, in his daily log:
| “ | The illness is characterized with a high temperature of about 39°C, hematemesis [the vomiting of blood], diarrhea with blood, retrosternal abdominal pain, prostration with "heavy" articulations, and rapid evolution death after a mean of three days... | ” |
- The virus was named after the Ebola river located in Yambuku, Democratic Republic of the Congo (formerly Zaire).
- The first outbreaks occurred almost simultaneously in Sudan between June and November 1976, due the so-called Sudan ebolavirus, and in Democratic Republic of the Congo (formerly Zaire) between August and November 1976 due the so-called Ebola Zaire.
- The table below summarizes the ebola virus strains identified until now:
| Ebola Virus Strain | Place of Discovery | Date Identified |
|---|---|---|
| Sudan ebolavirus | Nzara and Maridi, Sudan | Between June and November 1976 |
| Zaire ebolavirus | Yambuku, Democratic Republic of the Congo | Between August and November 1976 |
| Reston ebolavirus | Reston, Virginia, US. | November 1989 |
| Ivory Coast ebolavirus | Tai Forest, Ivory Coast. | November 1994 |
| Bundibugyo ebolavirus | Bundibugyo District, Uganda | November 2007 |
Impact on Cultural History
- Viruses that cause hemorrhagic fevers have been popularized by the media as fierce predators that threaten to devastate global populations.
- During the early- to mid-1990s, Ebola virus was portrayed as a global threat, a fierce predator emerging from tropical areas in Africa and spreading rapidly to the rest of the mobile and interconnected world. Therefore, cases of infection with Ebola virus required rapid international notification and response. Films and books, such as The coming plague by Laurie Garrett, The hot zone by Richard Preston and the movie Outbreak starring Dustin Hoffman, all created fear about Ebola virus disease in western populations.
- Some of these versions portrayed the Ebola virus as if it were an active agent going out on the attack, transmissible through air or touch, with no treatment available until a “high tech” scientist discovers a vaccine or other cure – otherwise everyone died. One of the key elements in these stories is the sense of scientific heroism, of individuals committed to discover, identify and conquer this virus. Panic, violence and competition are often portrayed as the common human responses to outbreaks of viral diseases. The perception that the 1995 outbreak in the Democratic Republic of the Congo “was going to spread to the rest of the world” was one of the factors that built political momentum leading to the revision of the International Health Regulations in 2005.
- Now, ebola virus disease is viewed as a deadly local disease requiring a universal kind of “rapid response,” based on standard public health strategies to halt transmission and control outbreaks at the source.
- Ebola virus disease has attracted a lot of attention for being a very fierce, rapidly lethal filoviral disease that causes death in 50–90% of clinically diagnosed cases. So far there is no antiviral or vaccine available against Ebola hemorrhagic fever – it is a disease with no cure. But when one look at African outbreaks, one notice that, despite their increasing frequency, the overall numbers of deaths are relatively small. The dramatic fear and perception of the global spread of Ebola virus has motivated international and some national health and government officials to develop policies based on this vision. Meanwhile, media coverage has increased public interest and support for tackling this disease. In this respect, Ebola hemorrhagic fever is kind of an “exceptional” or “master status” disease.
- Some commentators to suggest that Ebola fever is perhaps “much ado about nothing.” It is locally devastating but has little international importance. Lassa fever, on the other hand, seems to be an unheralded problem. The number of deaths and of infected cases is high and disproportional with the disease's international profile and the scale of western media attention. Lassa fever requires more sustained engagement of health teams and measures to deal with its more endemic character.
- There is evidence that Ebola fever has been around for hundreds of years in some communities. Local people living in disease-affected areas are often portrayed by the media as ignorant, mired in misguided tradition and dangerous cultural practices. There is certainly danger in some of these practices, such as remaining close to the sick family member to nurse him/her; touching the dead at funerals; and applying traditional healers’ treatments including cutting a patient’s skin with unsterilized knives and applying blood to the skin.
- There are also examples of beneficial practices. An example of a local approach to these diseases comes from the work of anthropologist Barry Hewlett, who learned how the Acholi people in Uganda deal withgemo (a word that means epidemic illness). Social protocols for prevention and control include isolating the patient in a house at least 100 metres from other houses; having a survivor of the epidemic feed and care for the patient; identifying houses with ill patients with two long poles of elephant grass; limiting general movement, advising people to stay within their household and not move between villages; and, finally, keeping patients who no longer have symptoms in isolation for one full lunar cycle before allowing them to move about freely in the village.
- Ebola virus disease is sensationalized because it is very scary. But there are ways in which we can harness the resources and experiences to address other health priorities, such as insisting on safe practices when handling body fluids for prevention of infectious diseases in general. Health care workers also must be careful that a disease outbreak does not distract from providing an integrated response to health problems. People who live in the areas that suddenly attract attention from the international community owing to an ebola virus disease outbreak may have been dealing with HIV infection, malaria, diarrhea and other health problems that are regarded as far more important to them in a day-to-day sense.[2]
Notable Cases
- Nurse Mayinga N'Seka was the index case in an Ebola epidemic in Democratic Republic of the Congo and may represent the only case of airborne ebola virus infection.
- The non-fatal case of a Swiss 34-year-old female ethologist, in the Taï National Park, Ivory Coast, is infected by what was later recognized as a new strain of ebola virus after she performed a necropsy of a chimpanzee found death with signs of hemorrhage.[3]
References
- ↑ Bardi, Jason Socrates (2002). "Death Called a River". Scribbs Research Institute. 2 (1). Retrieved 2006-12-08.
- ↑ "Time to put Ebola in context".
- ↑ Formenty P, Hatz C, Le Guenno B, Stoll A, Rogenmoser P, Widmer A (1999). "Human infection due to Ebola virus, subtype Côte d'Ivoire: clinical and biologic presentation". J Infect Dis. 179 Suppl 1: S48–53. doi:10.1086/514285. PMID 9988164.