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Ebola Hemorrhagic Fever: Coming Soon to a Gorilla Near You It typically begins with a sore throat. The fever and weakness set in about a day or two later, but by then, the severe headache blocks out most of your senses. Once the diarrhea hits, the only reprieve are the intermittent spells of vomiting. Generally, this is when you become bedridden by necessity and not by choice. From there, a horrific rash begins to creep along the skin forming huge bruises which slough off at the slightest touch. Then the bleeding begins. Blood oozes from the mouth, the tongue, the eyeballs, and countless other nameless orifices. The tissue in the heart begins to soften and the blood slowly leaks out as the other organs turn into a soupy mess. And then, in about 70% of these reported Ebola cases, you die (Peterson, 1994). The Ebola virus is incredibly contagious and devastatingly potent with no cure in site. However, understanding the ecological characteristics that dominate the outbreaks allow us to understand its virulence and origination and whether or not it will affect us in America. The well documented outbreaks of the Ebola Virus Disease (EVD, also known as Ebola Hemorrhagic Fever, or EHF) have only produced human fatalities upon the African continent (with several asymptomatic cases reported in the Philippines). What is it about the intrinsic African ecological systems that make it more conducive to the outbreaks and subsequent fatalities? Why don't we see EHF manifest itself anywhere else? The answer stems from the animals that thrive in the African environment, the delicate interspecies interactions, and the poverty and customs of the African people. Ebola Virus Disease (named after a river in northern Congo) is indistinguishable from the Marburg Virus Disease and is typically categorized into five distinct subdivisions. Zaire Ebola Virus (ZEBOV) is by far the most deadly strain, killing up to 90% of its victims. The Sudan Ebola Virus (SEBOV) claims around 50% of its victims and is only found in the Sudan. Reston Ebola Virus (REBOV) is extraordinarily devastating in primates and pigs but has not caused disease in any exposed humans. Côte d'Ivoire Ebola Virus (CIEBOV) was discovered in chimpanzees along the Ivory Coast after their cannibalistic consumption of infected Western Red Colubus monkeys. The Bundibugyo Ebola Virus (BEBOV) recently emerged with an outbreak in Uganda in late 2007 and reappeared in 2012 with a 67% mortality rate in the Democratic Republic of the Congo (Genton, 2012). To understand the human to human transmittance, it's critical to comprehend how these strains initially infect homo sapien. EBV naturally resides within fruit bats of the Pterpodidae family (Nichol, 2000). The habitat for these bats covers the southern 2/3 of Africa, the southern coast of the Arabian Peninsula, India, Southeast Asia and the northern coast of Australia (Peterson, 2004). The hot bed for EHF outbreaks are the central African countries of Congo, Gabon and Sudan: the heart of these fruit bat populations. It should be no surprise: this region of the world proffers an ideal habitat for these types of animals. The bats tend to thrive in warmer climates, particularly when accompanied by densely forested regions and an abundance of fruit (Daszak, 2000). The tall, leafy trees of the rain forest serve as shady protection during the day as the bats roost and the undisturbed bodies of water allow them to flourish. The bats primarily act as reservoirs for the virus and exhibit no detectable symptoms; however, if the virus is transferred to gorillas, the terrors involved with Ebola rage in full force leaving central Africa littered their bloody, contagious carcasses. The western gorilla (Gorilla gorilla) roams freely and in great quantity throughout Congo existing largely upon fruit. These dietary habits bring them into contact with the half-consumed fruit and pulp left by the infected fruit bats as well as copious amounts of urine and feces from other infected primates. Gorillas also possess an innate inquisitiveness, and sadly, curiosity is not killing the cat, but infecting the gorillas in Western Africa. It's not uncommon for a gorilla to gingerly inspect the gruesome carcasses of the fallen family for evidence of the killer, effectively contaminating themselves in the process (Morse, 1995). Western gorillas organize themselves into troops with frequent interaction between the different members of the group. They also typically have a home range of up to 30 km, effectively widening the contamination radius (Morse, 1995). Gorillas are also unable to bury the biological cesspools of their infected kin, leaving virus-laden corpses strewn across the jungle floor. The 2004 outbreak in Odzala-Kokoua National Park eliminated 95% of the infected gorillas. The dramatic impact of Ebola led the International Union for Conservation of Nature (IUCN) to upgrade the status of western gorillas from ''endangered'' to ''critically endangered'' (Genton 2012). Gorillas aren't the only affected species. Recent studies are showing that more and more African animals are capable of contracting the disease and spreading it within their societies. There have been reported cases of duikers (small antelope) and porcupines carrying the virus (Leroy, 2004). Domesticated pigs are also susceptible to various strains (Ewald, 1998). Outbreaks of EVD may have been responsible for an 88% decline of observed chimpanzee populations in the Lossi Sanctuary between 2002-2003 (Leroy, 2004). And then the humans get involved. Gorillas typically avoid human populations and forage deep in the African forests, well away from human competition. Ironically, it's the humans that get themselves in trouble. Matters become complicated when the gold-mining industry pushes farther and farther into the deep African rain forest. This exposes humans to the habitats of both the infected bats AND gorillas. The miners are largely devoid of sanitation equipment and usually aren't even aware that they are at risk. All it takes is one carless worker to come in contact with any blood, fluid or semen of an infected individual and the process beings. For instance, the 1994 ZEBOV outbreak killed 31 workers in Gabonese gold mines, but it wasn't until 1995 that they finally diagnosed it correctly as Ebola (and not yellow fever) (Feldmann, 2004). Without proper education, it's difficult to implement precautionary regulations. It's not just accidental contact that's spreading Ebola. There exists a particularly large demand for monkey flesh or "bush meat" within central Africa and a marker for poachers that will do whatever it takes to get it. It's believed that the north region of the Democratic Republic of the Congo is home to at least 35,000 of an unusually large sub-species of chimpanzees. Although this represents the largest population of chimps in all of Africa, the hunger for chimp meat is so intense that the researchers believe the animals are facing a "major and urgent threat" and that northern Congo is now "witnessing the beginning of a massive ape decline" (Walsh, 2005). It is often sold in unseemly roadside shacks with no regulation, no sanitation, and no way to trace the source of the meat. Poachers employ simple wire snares to trap and strangle the animals. It's an effective method for gathering fresh meat, but it disproportionately traps weaker (and sicker) animals. Poaching (as opposed to simply shooting the animals) leaves the tainted blood inside of the animal and consequently all over the butchered meat. As much as the natural African environment influences Ebola's virulence, it's greatest friend is the poverty of the African human. The Democratic Republic of Congo is one of the poorest countries in the world, with per capita annual income of about U.S. $210 in 2011 and 71% being under the local poverty line with a life expectancy of 51.3 years (CIA, 2012). This is the result of years of mismanagement, corruption, and war (State, 2012). HIV/AIDS, Malaria and Influenza are the three leading causes of death accounting for a third of all Congolese deaths in 2010 (Coghlan, 2006). Regardless of the relentless efforts made by international groups (World Health Organization, Center for Disease Control, Doctors Without Borders, as well as the local Democratic Republic of Congo Health Ministry) to educate the public on the dangers of consuming the corrupted meat, the scarcity of viable food options makes the potentially infected meat an alluring option. After all, who can blame someone from staving off the inevitable threat of starvation with the chance of getting sick or dying from ingesting sullied bush meat? Poverty and lack of suitable options perpetuates the spread of Ebola within poor African nations (Farmer, 1996). Once the disease enters into the human population, human behaviors keep the virus present. EBV is spread from human to human in the same way that it passes between gorillas: close contact with blood, secretions, organs or other infected bodily fluids (Sokol, 2006). Sick houses and hospitals are notorious for enabling the spread of the disease. Often nurses and caretakers unknowingly transmit the fluids of their patience to their families and communities (Sokol, 2006). Burial services also enable to the virus to pass human-to-human because it can survive on a dead organism for several days. Ugandan rituals demand that the aunt of the deceased to undress the corpse, wash the body, and dress him or her in a favorite outfit. At the funeral services, all family members wash their hands in a communal bowl and leave a final touch (or "love touch"), typically upon the face of the departed family member. The body is then buried very close to his or her household (Hewlett, 2003). It's widely believed that that the most recent Ebola outbreak can be traced to the funeral of a 3-month-old girl who died of the deadly disease. Of the 65 people in attendance, 15 later contracted EHV and 11 of them have since died (Hewlett, 2003). Transmission via infected semen can also occur even up to seven weeks after clinical recovery, making it incredibly difficult to prevent the disease short of quarantining anyone who displaying any symptoms even close to those of Ebola for weeks on end (Sokol, 2006). Ebola communication is so devastating because it takes anywhere from 2 days to 3 weeks to start showing symptoms, and even then they begin mildly (Legrand, 2007). This means that infected individuals have the capacity to interact and infect others for a sizeable amount of time before effective measures can be implemented. This horror story beckons the question, is there a feasible cure? Quite simply, no. There are currently no proven treatment options that kill the Ebola virus and there is no vaccine that can prevent the infection (Morse, 2004). The only remedies that can be offered are breathing devices to help with ailing lungs, IV fluids to maintain hydration and electrolytes, medications to control fever and blood pressure, and antibiotics to prevent secondary infections. Frankly, a nurse's Ebola kit could consist of Gatorade, Ibuprofen, and simple antibiotics. It's little wonder that up to 90% die of the infection. Despite this disastrous confluence of characteristics (prime habitats for the disease carrying bats, infected gorillas dying unabatedly, and extreme African poverty), there are many scientists that hold that Ebola doesn't pose a significant threat to human civilization (Hélène, 2002). In fact, since Ebola was discovered in 1976, there have only been about 2,300 reported cases and approximately 1,500 deaths put it under 50 deaths a year (Leroy, 2004). While it is true that the gorilla populations are dwindling in central Africa, relatively few of them are currently infecting humans. In fact, the very ecological factors that allow Ebola to "make a killing" in Africa deem it unlikely to have success on American soil. To begin, we simply don't have the same ecosystems. Devoid of thick rain forests, America offers no practical home to the disease-carrying fruit bats. For similar reasons, we find no gorillas or chimpanzees within our borders. The scarcity of resources render our native ecosystems unable to support such a quantity of large mammals. The extensive troops of gorillas that roam the Congolese countryside would be unable to find sufficient fruit or shelter in Missouri or Oregon. We've also industrialized and domesticated most of our nation. Several of the outbreaks have been traced back to humans foolhardily delving into the territory of the animals with primitive instrumentation. We simply do not have the same expanses of undisturbed terrain. But just because the disease doesn't naturally reside on this hemisphere does not exclude the possibility of the infection. For example, in 1989 the Ebola-Reston virus was inadvertently introduced into a Virginia quarantine facility through chimpanzees imported from the Philippines. The same thing happened again with some Macaque monkeys in a Texas facility in 1996, and in 1990 some humans were even exposed to the virus at a lab in Virginia (Groseth, 2007). Even when the disease has made it to our shores, however, the relative wealth and medical treatment prevented fatalities and spread - the four asymptomatic humans in the Texas merely developed antibodies. The United States Food and Drug Administration enforces strict regulations on the meat that can be bought and sold, including specific restrictions on certain types of "downer" animals (animals that are unable to stand or walk on their own merit). The tainted meat that dominates the Congolese roadsides would never make it to the market in America. In the Virginia incident, the individuals were immediately quarantined and plugged full of the best medication available while the suspected monkeys were summarily executed by the local military. The deadliness of EHF, however, may ultimately be what prevents the disease from reaching pandemic levels. Once the virus enters human populations, it burns through them with alarming speed, effectively quarantining itself. A slower, less obvious illness lingers within a community and allows for maximum infection. Rarely does an infection pass from village to village; it simply kills its victims too quickly (Farmer, 1996). There is no doubt that the EBV is extraordinarily contagious. There is no doubt that thousands of gorillas are being slain by this disease every year. In fact Dr. Peter D. Walsh (an expert in how Ebola affects primates, especially in central African ecosystems) said it was his "educated guess" that between 1992 and 2011, Ebola may have killed as many as a quarter of the world's gorillas (Walsh, 2005). There is no doubt that the grotesque images of Ebola victims sell newspapers and inflame public fear. But there is so much that we do not understand about the virus. While it primarily stands as a feral threat in the African continent the fact that we do not have a viable cure for it is unsettling. At least in America, we can take refuge in the fact that the social and ecological factors that dominate Western Society make it unlikely that we'll see outbreaks of Ebola in our country. But then again... we might. WORK CITED · Bureau of African Affairs. (2011, 09 09). U.S. Department of State. Retrieved from http://www.state.gov/r/pa/ei/bgn/2823.htm · CIA World Factbook. (2012, March 19). Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/cg.html · Coghlan, B. (2006). Mortality in the Democratic Republic of Congo: A Nationwide Survey. Available from Science Direct. (367.9504). · Ewald, P. (1998). The Evolution of Virulence and Emerging Diseases. Available from Journal of Urban Health. (1099-3460). · Daszak, P. (2000). Emerging Infectious Diseases of Wildlife: Threats to Biodiversity and Human Health. Available from Science. · Farmer, P. (1996). Social inequalities and emerging infectious diseases. Available from Emerging Infectious Diseases. · Feldmann, H. (2004). Ebola Virus Ecology: A Continuing Mystery. Available from Trends in Microbiology. (15381189). · Genton C. (2012) Recovery Potential of a Western Lowland Gorilla Population following a Major Ebola Outbreak: Results from a Ten Year Study. PLoS ONE 7(5): e37106. doi:10.1371/journal.pone.0037106 · Groseth, A. (2007). The Ecology of Ebola Virus. Available from Trends in Microbiology. (17698361). · Hélène, J. (2002). Representations of Far-Flung Illnesses: The Case of Ebola in Britain. Available from Social Science & Medicine. · Hewlett, B. (2003). Cultural Contexts of Ebola in Northern Uganda. Available from Emerging Infectious Diseases. (PMC3033100). · Legrand, J. (2007). Understanding the Dynamics of Ebola Epidemics. Available from Epidemiology and Infection. (PMC2870608). · Leroy, E. (2004). Multiple Ebola Virus Transmission Events and Rapid Decline of Central African Wildlife. Available from Infectious Diseases. (1092528). · Morse, S. S. (1995). Factors in the Emergence of Infectious Diseases. (The Rockefeller University). · Morse, S. S. (2004). Factors and Determinants of Disease Emergence. (Columbia University). · Nichol, S. (2000). Emerging viral diseases. Available from The National Academy of Science. (210382297). · Peterson, A. T. (2004). Ecologic and Geographic Distribution of Filovirus Disease., Available from US National Library of Medicine - National Institute of Health. (PMC3322747) · Preston, R. (1994). The Hot Zone. (1st ed., p. 106). New York, NY: Anchor. · Sokol, D. (2006). Virulent Epidemics and Scope of Healthcare Workers' Duty of Care. Available from Emerging Infectious Diseases. (1238-1241). · Walsh P.D., (2005) Wave-Like Spread of Ebola Zaire. PLoS Biol 3(11): e371. doi:10.1371/journal.pbio.0030371 |
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