Ebola Virus Disease: Source, Transmission, Vaccination and Public Health Management

This assignment discusses the source of the infection and transmission of the Ebola virus, rationale for no vaccination, public health management after epidemic and prevention of the deadly disease. It also highlights the challenges faced by the global health community and the need to develop preventive measures.

Running head: PUBLIC HEALTH
Public health
Name of the Student
Name of the University
Author note

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Introduction
The assignment deals with the Ebola a viral disease. It is a deadly disease that kills upto
90% of the effected people. The virus first appeared during two outbreaks in Africa, 1976. The
Ebola virus disease is the “public health emergency of international concern” as declared by
“World Health Organization” or WHO in 2014 (WHO, 2018). The outbreak of Ebola turned
epidemic in 2016. It lasted for two years and infected around 26,700 people. It resulted in 11,300
deaths (World Health Organization, 2016). In regards to this deadly the disease the assignment
aims to discuss the source of the infection and transmission of the virus as per the literature
available. The report highlights the rationale for no vaccination for Ebola disease. It is compared
and contrasted to other diseases that have vaccine while giving the insightful thinking. Next, the
report highlights the public health management after epidemic and the prevention of the deadly
disease. Based on the extensive research in this area and the valuable insights gained, an overall
conclusion will be drawn.
Source of Ebola and transmission
The name of the disease and virus comes from Ebola River, in a city in Democratic
Republic of Congo. The outbreak in the West Africa first started in the single infected person as
per the recent genetic analysis. This was traced to event where a person was infected with bat.
The single introduction led the major outbreaks. The source of the virus was found to be
originated in Guinea. It was then observed to spread to Sierra Leone and Liberia in an outbreak.
It was spread by human beings repeatedly being infected and not spread by animals infecting
people repeatedly. The virus has been traced to have a common source as per the senior associate
member at Harvard University. In Sierra Leone, a traditional healer treated infected patients

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from Guinea and after her death the patients flocked to her funeral and infected ten more people.
Genetic sequences taken from one of the infected pregnant women confirm these findings. The
evolution of the virus was traced by the mutation studies of the Virus (Osterholm et al., 2015).
In West Africa it was found to mutate twice and was the reason for widespread outbreak.
Ebola also known as haemorrhagic fever is highly infectious viral disease. It is
transmitted by direct and indirect contact with the infected person and body fluids according to
WHO. It includes blood, urine, saliva, vomit, breast milk, semen, and vaginal fluid. The most
infectious body fluids are vomit, faeces, blood. In males the semen contains virus persistently.
The symptoms of the vaccine are diarrhea, rash, muscle pain, headache, fever, as well as
bleeding in some cases (Muyembe-Tamfum et al., 2012). The virus is also known to be
transmitted by the indirect contact to previously contaminated surfaces. The virus is known as
deadly for its attack on the immune system cells thereby releasing the army of inflammatory
molecules. It causes the bursting of tiny blood vessels which drops the blood pressure. It results
in multiple organ failure (Osterholm et al., 2015). As per epidemiological data the soared of this
virus is no the same as that of thee influenza vaccine.
No vaccines and compare and contrasts
There are no vaccines licensed for Ebola as there is still lack of data from medical
standpoint on long term effects of the infection. Until the outbreak in 2013, the Ebola vaccine
research was abandoned. There are several challenges faced by the researchers as the virus is
very complicated to study. It has been observed since ages that researchers have tough time
studying and developing treatments for viral diseases (Kibuuka et al., 2015). Folayan et al.
(2016) argued that the unlike the antibacterial therapy, the antiviral therapy has always lagged

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behind. Virus being small molecules has fewer targets for treatment due to less protein.
Therefore, there is fewer targets for the person’s immune system primed by the vaccines. The
other barriers identified are the quick evolution of the virus. Therefore, there is huge uncertainty
that the vaccine developed today would be effective against the future outbreaks. Considering
the high mortality rate that is 90%, it implies for the researchers to work with high level safety
precautions and facilities. Not all the cities have biosafety level 4" laboratory needed for Ebola
experimentation. A potential treatment for Ebola has been found to be promising in the animal
models. A compound has been identified that interferes with the viral replication. Further
treatment is targeted towards preventing the viral entry into cells by blocking the surface proteins
that bind the virus. This vaccine was known as rVSV-ZEBOV. Another possible therapy that is
in progress is the antibodies against viral parts raised in mice. In 2012, this formulation when
applied on monkeys showed survivorship within two days. The vaccine rVSV-ZEBOV against
Ebola met the safety criteria by the scientists but the efficacy trial does not indicate protection
gains’ all the viral strains (Kibuuka et al., 2015).
There are challenges to the recruitment of the health care workers for research on Ebola
vaccine. The workers may have mistaken beliefs when treating the patients that the vaccine may
be beneficial. It may result in coercion and hamper the equity and justice. It is because the study
does not involve participants who are not skilled health care providers. They may not be
prioritised for vaccination. It is not yet clearly addressed if the study participants would contract
the infection despite the use of experimental vaccine and provision of standard care. These
concerns must be addressed transparently. It must be formalised as a part of ethics. For accessing
the study products the TRIPS agreement needs must also be considered. There is a need of
international support in this regard (Campoy Rubio, 2015). It may be possible only by engaging

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stakeholder at the regional, local, and international levels using various channels of
communication. These concerns need to be addressed not only for the present but also the future
epidemics. Even when there is no vaccine for Ebola, the complications of the illness can
however be treated.
The point to be wondered here is the vaccination available for Influenza and not for
Ebola although both have the potential to kill people. Unlike the influenza virus, Ebola does not
spread by contaminated air. Ebola causes multi-organ failure and rapidly spreads through body
fluids despite early treatment. It is also evident from the infected health care workers who
returned from US after disease management for the patients. These care providers knew the
process of the disease transmission and used personal protective equipment. It is indication of the
highly contagious nature of the vitus (Uyeki et al., 2016). On the contrary, it was the same
condition for Tuberculosis at one point of time. One third of the world’s population has been
exposed to this disease and yet today there is better vaccination available in developing and
developed countries. The airborne infection prevention was considered sinister but Ebola proved
it wrong. Perspectives from the nurses and the physicians caring for Ebola patients, highlighted
that the there are equal challenges with influenza as it is for Ebola caring. The influenza virus too
mutates into new strains which may be beyond the available vaccinations. Yet the vaccination
seems to work well even with evolution of different influenza strains argued (Håberg et al.,
2013). Inspite of this development the vaccination is not considered the means to prevent the
Ebola disease.

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Public health management and prevention of Ebola
There is no exact cure or preventive treatment for Ebola despite intense research in the
field. The fatal symptoms of the Ebola are managed by the administering the patients with fluids
and electrolytes, oxygen, anti-hypertension medications, blood transfusions, and treatment for
other infections. Treatment presently considered is the use of experimental serum destroying the
infected cells (Uyeki et al., 2016). However, there are several measures taken to avoid contacting
with infected people. It includes avoiding the contact with body fluids of the infected people. It is
also recommended to people for avoiding contact with dead bodies of Ebola infected people.
There are stringent protocols in discarding the medical equipments used for Ebola patients such
as needles. Health care workers are trained to use PPE in handling patients and control risk of
infection (World Health Organization, 2014). The health care professionals, infected and
uninfected patients are educated to avoid contacting with wild animals as they are source of
transmission. Effective hand hygiene protocols are designed for infection control (Camacho et
al., 2014). However, these measures are only useful to prevent spread of infection.
Based on interactions from the Ebola survivors and the care process delivered by the
health care professionals, there are strategies evolved that may help with future outbreaks. It
includes ongoing specialised health care to the survivors. The health management for the
infected individual has been has been well established in the urban locations of major cities.
However, it is has been difficulty transporting for people in remote areas and with orphaned
children (World Health Organization, 2014). Therefore, accessing services in right time is the
major barrier. Further, barriers to health management to the Ebola virus affected individuals are
the associated comorbidities. There are several health concerns for survivors including the joint
pains, cataracts, and others. These comorbidities hamper the ability to give mental labour in

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patients especially in trading, and farming. There is lack of guidelines to facilitate high quality
care to minimise the effects of infection (Alfaki et al., 2016). The concerns related to surgery
and treatment is still questionable.
Lack of training among health care providers hinders the public health management after
the epidemic ends. It is due to stigma, preventing the trading with survivors or sharing meal with
them. Sexual life of male survivors is affected as there is no estimate on the presence of virus in
semen (World Health Organization, 2014). In this regard Alfaki et al. (2016) argued that health
care professionals are found to lack knowledge of the care needs and concerns of the patients. It
has also been observed that the nurses and other care providers refuse to treat the patients. It is
assumed that the survivors are still carrying the infection. The nurses and physicians must be
trained that there is no harm in providing the non-invasive care to the survivors.
There is a need of livelihood support for the survivor. The patients receive no
opportunities when the epidemic is over. During hospitalisation they receive great attention and
also given livelihood opportunities. The patients were found with positive health outcomes in the
isolation centres and hospitals. Stigmatisation and discrimination reduce the livlihood
opportunities for the survivors. The recent data from randomised trials and the meta-analysis
regards to vaccination is not yet disseminated. The new knowledge of the virus is not well
circulated to the citizens in most affected countries. There is a need of community engagement
method, in response to Ebola to reach out those in need (Alfaki et al., 2016). Ebola preventive
measures are not yet detailed in literature. However, patient may be educated about preventive
steps for future outbreaks.

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It is evident from the existing literature that the affects of Ebola outbreaks will be
continued for next few years across the world. There is a need to develop preventive measures
for challenges faced by the global health community not only concerning the brief outbreak but
also the future outbreaks
Conclusion
In the history of the outbreaks the Ebola epidemic and outbreaks has been deadliest. It
can be controlled from the discussion that the global efforts in developing therapies for Ebola
infection, prevention and management are still laudable. There are several ethical concerns
associated with emergency immunisation plan for health care workers using experimental
vaccines. Successful development of the Ebola vaccine requires the concerted efforts at public
dialogue. The need is to address the misconceptions in selecting participants for clinical trials as
well as equity and justice. There is need to discuss with patients honestly about the risks, and
benefits associated with participation. Futter research in this area require effective
communication with people, trusted locals, researchers, ethics committee, and the same must be
negotiated between communities.

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References
Alfaki, M. M., Salih, A. M., Elhuda, D. A. L., & Egail, M. S. (2016). Knowledge, attitude and
practice of health care providers toward Ebola virus disease in hotspots in Khartoum and
White Nile states, Sudan, 2014. American journal of infection control, 44(1), 20-23.
DOI: https://doi.org/10.1016/j.ajic.2015.07.035
Camacho, A., Kucharski, A. J., Funk, S., Breman, J., Piot, P., & Edmunds, W. J. (2014).
Potential for large outbreaks of Ebola virus disease. Epidemics, 9, 70-78. DOI:
https://doi.org/10.1016/j.epidem.2014.09.003
Campoy Rubio, J. (2015). Ebola, R&D on Neglected Diseases and the Health Impact
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