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INTRODUCTION
In 2014, the world was taken off guard by the sudden emergence of an infectious hemorrhage
fever which was a viral disease that spread rapidly around the globe. The disease soon became
widely known as Ebola Virus Disease (EVD), resulting in thousands of deaths in Liberia, guinea
and Sierra Leone alone, and causing 4 known deaths in Nigeria. Ebola is another wake-up call
for the international community, demonstrating just how quickly diseases can emerge and spread
around the world.
This is an ongoing challenge. According to the World Health Organization (WHO), infectious
diseases are emerging more quickly than ever, with the discovery of nearly 40 new diseases that
were unknown a generation ago.
Disease epidemics that spread globally and affect populations worldwide, referred to as
pandemics, are a cause for great concern among public health professionals and the public alike.
The outbreak demonstrated that events starting in a country can quickly affect the continent. The
threat of imported diseases has increased, owing to several factors, including increased
opportunities for disease emergence due to the effects of globalization, international
Africans can, and should, take measures to protect themselves against diseases and other public
health threats. Public health officials continue to take steps to further safeguard the population
and respond to emerging and ongoing health threats. Local, provincial and territorial public
health authorities have all worked to enhance their ability to detect and respond to outbreaks.
While local, provincial and territorial authorities have done a lot of work since Ebola in
strengthening public health preparedness

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WHAT IS EBOLA?
Ebola virus disease (EVD) or Ebola hemorrhagic fever (EHF) is a disease of humans and other
primates caused by an ebola virus. Symptoms start two days to three weeks after contracting the
virus, with a fever, sore throat, muscle pain and headaches. Typically, vomiting, diarrhea and
rash follow, along with decreased functioning of the liver and kidneys. Around this time,
affected people may begin to bleed both within the body and externally.
The virus may be acquired upon contact with blood or bodily fluids of an infected animal.
Spreading through the air has not been documented in the natural environment. Fruit bats are
believed to carry and spread the virus without being affected. Once human infection occurs, the
disease may spread between people, as well. Male survivors may be able to transmit the disease
via semen for nearly two months. To make the diagnosis, typically other diseases with similar
symptoms such as malaria, cholera and other viral hemorrhagic fevers are first excluded. To
confirm the diagnosis, blood samples are tested for viral antibodies, viral RNA, or the virus
itself.

Prevention includes decreasing the spread of disease from infected animals to humans. This may
be done by checking such animals for infection and killing and properly disposing of the bodies
if the disease is discovered. Properly cooking meat and wearing protective clothing when
handling meat may also be helpful, as are wearing protective clothing and washing hands when
around a person with the disease. Samples of bodily fluids and tissues from people with the
disease should be handled with special caution.

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No specific treatment for the disease is yet available. Efforts to help those who are infected are
supportive and include giving either oral rehydration therapy (slightly sweet and salty water to
drink) or intravenous fluids. The disease has a high risk of death, killing between 50% and 90%
of those infected with the virus. EVD was first identified in Sudan and the Democratic Republic
of the Congo. The disease typically occurs in outbreaks in tropical regions of sub-Saharan
Africa. From 1976 (when it was first identified) through 2013, the World Health Organization
reported a total of 1,716 cases. The largest outbreak to date is the ongoing 2014 West Africa
Ebola outbreak, which is affecting Guinea, Sierra Leone, Liberia and Nigeria. As of mid-August
2014, 2,127 suspected cases resulting in the deaths of 1,145 have been reported. Efforts are
under way to develop a vaccine; however, none yet exists.The strain of Ebola that broke out in
the Democratic Republic of the Congo had one of the highest case fatality rates of any human
virus, 88%. The name of the disease originates from the first recorded outbreak in 1976 in
Yambuku, Democratic Republic of the Congo, which lies on the Ebola River.
In late 1989, Hazelton Research Products' Reston Quarantine Unit in Reston, Virginia, suffered a
mysterious outbreak of fatal illness (initially diagnosed as Simian hemorrhagic fever virus
(SHFV)) among a shipment of crab-eating macaque monkeys imported from the Philippines.
Hazelton's veterinary pathologist sent tissue samples from dead animals to the United States
Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick,
Maryland, where a laboratory test known as an ELISA assay showed antibodies to Ebola virus.
An electron microscopist from USAMRIID discovered filoviruses similar in appearance to Ebola
in tissue samples taken from crab-eating macaque imported from the Philippines to Hazleton
Laboratories Reston, Virginia.

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Shortly afterward, a US Army team headquartered at USAMRIID went into action to euthanize
the monkeys which had not yet died, bringing those monkeys and those which had already died
of the disease to Ft. Detrick for study by the Army's veterinary pathologists and virologists, and
eventual disposal under safe conditions.
Blood samples were taken from 178 animal handlers during the incident, of those, six animal
handlers eventually seroconverted. When the handlers did not become ill, the CDC concluded
that the virus had a very low pathogenicity to humans.
The Philippines and the United States had no previous cases of Ebola infection, and upon further
isolation, researchers concluded it was another strain of Ebola, or a new filovirus of Asian origin,
which they named Reston ebolavirus (REBOV) after the location of the incident.

CASUALTIES OF EBOLA
Cases / deaths (as of 18 August 2014)
Total: 2,473 / 1,350
Guinea: 579 / 396
Liberia: 972 / 576
Nigeria: 15 / 4
Sierra Leone: 907 / 374
As of 18 August 2014, the World Health Organization (WHO) reported a total of 2,473
suspected cases and 1,350 deaths (1,460 cases and 805 deaths being laboratory confirmed). On 8
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August, it formally designated the outbreak as a public health emergency of international
concern. This is a legal designation used only twice before (for the 2009 H1N1 (swine flu)
pandemic and the 2014 resurgence of polio) and invokes legal measures on disease prevention,
surveillance, control, and response, by 194 signatory countries.
Various aid organisations and international bodies, including the Economic Community of West
African States (ECOWAS), US Centers for Disease Control and Prevention (CDC), and the
European Commission have donated funds and mobilised personnel to help counter the outbreak;
charities including Médecins Sans Frontières, the Red Cross, and Samaritan's Purse are also
working in the area. Information Exchange between West Africa countries.

Guinea
The border between Guinea and Liberia remained open in April; Guinea's ambassador in
Monrovia noted his government's belief that efforts to fight the disease directly would be more
effective than closing the border. In early August 2014, Guinea closed its borders with both
Sierra Leone and Liberia to help contain the spreading of the disease, as more new cases were
being reported in those countries than in Guinea.

Liberia
By 23 July, the Liberian health ministry began to implement a strategic plan in line with the
Accra meeting's conclusions to improve the country's response to the outbreak.
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On 27 July, Ellen Johnson Sirleaf, the Liberian president, announced that Liberia would close its
borders, with the exception of a few crossing points, such as the country's principal airport,
where screening centres would be established, and the worst-affected areas in the country would
be placed under quarantine. Football events were banned, because large gatherings and the
nature of the sport increase transmission risks. Three days after the borders were closed, Sirleaf
announced the closure of all schools nationwide, including the University of Liberia, and a few
communities were to be quarantined. Sirleaf declared a state of emergency on 6 August, partly
because the disease's weakening of the health care system had the potential to reduce the
system's ability to treat routine diseases such as malaria; she noted that the state of emergency
might require the "suspensions of certain rights and privileges." On the same day, the National
Elections Commission announced that it would be unable to conduct the scheduled October 2014
senatorial election and requested postponement, one week after the leaders of various opposition
parties had publicly taken different sides on the question.

Nigeria
There are twelve confirmed cases of Ebola in Nigeria as of 18 August 2014. The first was an
imported case of a Liberian-American, Patrick Sawyer, who travelled by air from Liberia and
became violently ill upon arriving in the city of Lagos. On 20 July, Sawyer flew into Nigeria via
Lomé and Accra from Liberia, and he died five days later in Lagos. In response, the Nigerian
government increased surveillance at all entry points to the country; health officials were placed
at entry points to conduct tests on people arriving in the country. Initial reports noted that sixty-
nine people previously in contact with Sawyer (including airport staff, fellow flight passengers
and health workers at the hospital where Sawyer was hospitalised) were placed under close
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surveillance without symptoms. On 4 August, it was confirmed that the doctor who treated the
patient tested positive for the virus strain and was being treated. On 6 August, Nigerian
authorities confirmed the Ebola death of a nurse who had treated Sawyer. The doctor who treated
Sawyer, Ameyo Adadevoh, died in the afternoon of 19 August 2014. The Commissioner of
health in Lagos announced that 4 people of the 12 confirmed cases, including the index case, had
recovered.
On 9 August 2014, the Nigerian National Health Research Ethics Committee, the organization
regulating research ethics in the country, issued a statement waiving the regular administrative
requirements that limit the international shipment of any biological samples out of Nigeria. The
statement also supports the use of non-validated treatments without prior review and approval by
a health research ethics committee.
On 14 August the Nigerian government said Aliko Dangote had donated $150 million to halt the
spread of the 2014 West Africa Ebola virus outbreak.

Sierra Leone
Sierra Leone has instituted a temporary measure which includes reactivation of its "Active
Surveillance Protocol" that will see all travellers into the country from either Guinea or Liberia
subjected to strict screening to ascertain their state of health. The government of Sierra Leone
declared a state of emergency on 30 July and deployed troops to quarantine the hot spots of the
epidemic.
Awareness campaigns in Freetown, Sierra Leone's capital, were delivered in August 2014 on the
radio or through car loudspeakers. The major problem the south countries have always had is the
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inability to exchange information effectively. This problem has also extend to the deadly ebola
virus because even though the countries are facing a similar problem the exchange of
information is still non-existent. Looking at the developed countries (north) exchange of news or
information one can easily see that West African countries are still lagging behind in terms of
information dissemination or distribution from one country to another.

ROLE OF PUBLIC HEALTH
Public health should be a shared responsibility in Africa. To detect and monitor emerging disease
threats, all levels of the public health system (local, provincial, territorial, federal) should collect
information to track changes in disease trends (surveillance). Disease trends are also used to
monitor the impact of public health prevention and control measures (e.g. immunization, health
promotion). Information collected locally should be shared with the province or territory and the
Agency as appropriate. Public health authorities should analyze this information to assess the
risk to people and issue alerts when there is a threat.
Often described as a “bottom up” system, the initial and ongoing responsibility for investigation
and response to public health events, including infectious disease outbreaks, occurs at the
local/municipal level. As needed, depending on the severity, complexity, extent and nature of the
public health issue, provincial, territorial and federal systems may be engaged to provide
assistance and resources as requested and/or required by local authorities and facilities managing
the situation. All levels of government have their own legislation in order to protect their
populations. For example, provincial or territorial Chief Medical Officers of Health can
quarantine people within their jurisdiction to limit spread of disease. Partnerships among all
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levels of government allow countries to increase its capacity to prepare and respond to public
health events.
Local and Provincial/Territorial Roles
Local authorities are responsible for providing public health services in Africa. During a
domestic infectious disease outbreak, local public health officials are the front-line public health
responders, working with other health care providers. Their role includes monitoring and
detection of health events and carrying out outbreak investigation to identify the source,
including laboratory testing if available, isolation and treatment of the sick, and follow-up with
close contacts of the sick.
Outbreaks are also often detected by provincial and territorial public health authorities. If an
outbreak spreads beyond local boundaries or has serious human health implications, the province
or territory will assume leadership in coordinating the management of the response. Provincial
and territorial public health authorities also establish standards and guidelines and provide
assistance to local authorities, including laboratory services.
Federal Role
Before an outbreak even occurs, the Agency should be involved in the routine detection,
monitoring and analysis of national and international trends and spread of infectious disease
threats. As diseases and patterns can change, ongoing review is critical. The Agency led the
development of national standards for detection and reporting of these infectious diseases,
including case definitions and protocols for reporting to allow Country-wide comparison. When
there is an international effort to control or eliminate a disease (e.g. polio, measles), the Agency
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is responsible for ensuring that domestic reporting and control measures align with international
standards.
While local public health authorities may detect unusual clusters of disease or illness in their
communities, the linkage of information at the national level may detect geographically
dispersed but related cases (e.g. outbreaks due to a contaminated food item that has been widely
distributed). The Agency has also developed mechanisms to monitor other information sources,
such as global media and newswires, which can help detect health issues abroad that may
potentially have an impact on the health of people. When the Agency detects a potential threat
abroad through unofficial information sources, it verifies the information with the WHO and
other official government channels. Likewise, Countries contributes to the global picture of
disease. For example, we are part of an extensive network that monitors the ever-evolving
influenza viruses and their spread around the world.
In managing domestic outbreaks, the federal government may take on an advisory role in
addition to monitoring and communicating with provinces and territories. For example, the
federal government may link with national and international experts to provide advice to health
care providers on public health measures, laboratory testing and clinical management as well as
providing information to the general public and at-risk groups. When outbreaks involve more
than one province or territory, the federal government takes on a leadership role to coordinate the
response. At times, outbreaks that are geographically localised can be large (i.e. affect many
people) and may overwhelm provincial or territorial resources. Provinces and territories may
then request federal assistance to support or lead the investigation and response. The federal
government is also involved when there is potential for spread of the disease into or out of
Country.
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Infectious disease outbreaks are only one type of event that can have an impact on the health of
people. That is why the federal government has to work to strengthen the country’s overall
capacity to prepare for and respond to any emergency where the health of the population may be
affected, including floods, fire, and other natural or human-caused disasters. Similar to outbreak
response, emergency management uses a “bottom up” approach. Local authorities prepare and
respond to emergencies using local resources and emergency management systems. When an
emergency exceeds local capacity or if it becomes larger in scope, provinces and territories, as
well as the federal government may become involved to coordinate and assist, as needed.

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REFERENCE
Li Y. H., Chen S. P. (2013). Evolutionary history of Ebola virus. Epidemiol Infect. 2013 Sep
16:1 -8.
Emond R. T. , Evans B., Bowen E. T. , Lloyd G. (1977); A case of Ebola virus infection. Br Med
J. 1977 Aug 27;2(6086):541
Roddy P, Howard N, Van Kerkhove MD, Lutwama J, Wamala J, Yoti Z, et al (2012). Clinical
manifestations and case management of Ebola haemorrhagic fever caused by a newly identified
virus strain, Bundibugyo, Uganda, 2007 – 2008. PLoS One. 2012;7(12):e52986.
European Centre for Disease Prevention and Control. ECDC fact sheet: Ebola and Marburg fever
[internet]. ECDC; 2014 [cited 2014 Mar 20]. Available from:
http://www.ecdc.europa.eu/en/healthtopics/ebola_marburg_ fevers/pages/index.aspx
Bannister B (2010). Viral haemorrhagic fevers imported into non-endemic countries: risk
assessment and management. Br Med Bull. 2010;95:193-225.
World Health Organization (2012). Ebola haemorrhagic fever -Fact sheet [internet]. WHO
Media centre; 2012 [cited 2014 Mar 20]. Available
from:http://www.who.int/mediacentre/factsheets/fs103/en/
Tamfum J. J., Mulangu S., Masumu J., Kayembe J. M., Kemp A., Paweska J. T. (2012). Ebola
virus outbreaks in Africa: past and present. Onderstepoort J Vet Res. 2012;79(2):451.
Wood JL, Leach M, Waldman L, Macgregor H, Fooks AR, Jones KE, et al. A framework for the
study of zoonotic disease emergence and its drivers: spillover of bat pathogens as a case study.
Philos Trans R Soc Lond B Biol Sci. 2012 Oct 19;367(1604):2881-92.
13

Hayman DT, Yu M, Crameri G, Wang LF, Suu-Ire R, Wood JL, et al. Ebola virus antibodies in
fruit bats, Ghana, West Africa. Emerg Infect Dis. 2012 Jul;18(7):1207-9.
Pourrut X, Delicat A, Rollin PE, Ksiazek TG, Gonzalez JP, Leroy EM. Spatial and temporal
patterns of Zaire ebola virus antibody prevalence in the possible reservoir bat species. J Infect
Dis. 2007 Nov 15;196 Suppl 2:S176
Piercy TJ, Smither SJ, Steward JA, Eastaugh L, Lever MS. The survival of filoviruses in liquids,
on solid substrates and in a dynamic aerosol. J Appl Microbiol. 2010 Nov;109(5):1531
Public Health Agency of Canada. Ebola virus. Pathogen Safety Data Sheet Infectious substances
[internet]. Public Health Agency of Canada.; 2010 [cited 2014 Mar 31]. Available from:
http://www.phac-aspc.gc.ca/labbio/res/psdsftss/ebolaeng.php
Colebunders R, Borchert M. Ebola haemorrhagic fever a review. J Infect. 2000 Jan;40(1):16-20.
Dowell SF, Mukunu R, Ksiazek TG, Khan AS, Rollin PE, Peters CJ. Transmission of Ebola
hemorrhagic fever: a study of risk factors in family members, Kikwit, Democratic Republic of
the Congo, 1995. Commission de Lutte contre les Epidemies a Kikwit. J Infect Dis. 1999
Feb;179 S
uppl 1:S87 - 91.
Francesconi P, Yoti Z, Declich S, Onek PA, Fabiani M, Olango J, et al. Ebola hemorrhagic fever
transmission and risk factors of contacts, Uganda. Emerg Infect Dis. 2003 Nov;9(11):1430.
Raabea VN, Borcherta M. Infection control during filoviral hemorrhagic Fever outbreaks. J Glob
Infect Dis.2012 Jan;4(1):69-74.
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Ftika L, Maltezou HC. Viral haemorrhagic fevers in healthcare settings. J Hosp Infect. 2013
Mar;83(3):185
Formenty P, Hatz C, Le Guenno B, Stoll A, Rogenmoser P, Widmer A. Human infection due to
Ebola virus, subtype Cote d'Ivoire: clinical and biologic presentation. J Infect Dis. 1999 Feb;179
Suppl 1:S48
World Health Organization. Ebola haemorrhagic fever Global Alert and Response (GAR).
[internet]. 2014 [cited 2014 Mar 22]. Available from: http://www.who.int/csr/disease/ebola/en/
Feldmann H, Jones S, Klenk HD, Schnittler HJ. Ebola virus: from discovery to vaccine. Nat Rev
Immunol. 2003 Aug;3(8)
Marzi A, Feldmann H. Ebola virus vaccines: an overview of current approaches. Expert Rev
Vaccines. 2014 Apr;13(4):521
Saphire EO. An update on the use of antibodies against the filoviruses. Immunotherapy. 2013
Nov;5(11):1221