Ebola West Africa, 2014-16: an analysis of a filovirus outbreak

Abstract

Purpose: Zoonotic infections are those that can be transmitted between animals and humans. Approximately two-thirds of human infections are zoonoses and caused by microorganisms as diverse as viruses, bacteria, fungi and parasites. Many of the pathogens causing zoonoses are considered to be either emerging or novel agents. Health of humans is inextricably linked to the health of animals and the environment. More broadly, the environment not only encompasses physical, geographical, climatic, ecological, agricultural and veterinary dimensions, but also the social, cultural, political and religious factors that influence those human behaviors that shape it. Addressing the connections between health and the environment requires an urgent expansion of interdisciplinary collaborations and strong political and global will. Viral hemorrhagic fever agents pose serious challenges to human health due to the fact that: (i) Filovirus outbreaks are largely created by man and driven by human behavior, (ii) there is significant nosocomial (hospital) amplification of disease, (iii) there is an associated high morbidity and mortality, (iv) case management is difficult and, as yet, there are no commercially available vaccines and therapeutic agents, (v) prevention of infections is fraught with difficulties, and (vi) infection prevention and control strategies can be frustratingly unsuccessful. Methods & Materials: Case study approach. Results: The presentation focuses on the complexity of the 2014-16 West African Ebola outbreak in which there has been multi-country involvement (Guinea, Liberia and Sierra Leone) and is deemed to be the largest Ebola outbreak ever described. Challenges and controversies related to VHF outbreak responses, international health regulations, environmental and sociocultural factors, as well as lapses in infection prevention and control interventions are contextualized. Current knowledge gaps, and future research areas, are highlighted. Conclusion: The viral hemorrhagic fevers (VHFs) of Africa, and more specifically, filoviral infections provide the perfect illustration of the interconnected nature of man, microbe and the environment. With the increasing frequency of filovirus outbreak reports and the threat that filoviruses pose to local, national and global health, knowledge gaps need to be urgently addressed with high quality interdisciplinary research. For this, the One Heath approach provides the perfect platform.