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Ebola spreads to new territory
April 1, 2014 9:50 AM   Subscribe

There's been an ebola outbreak in Guinea, Liberia, and Sierra Leone. With 122 cases so far, this is the worst outbreak since 2007's 264-case outbreak. The worst outbreak was 2000-2001's 425 cases. What makes this one different is the way it has spread so widely.

Why is this one spreading more readily than before? There's no evidence that this is a new strain. An epidemiology expert at Columbia University says:
"[The spread is] a little bit unusual and suggests a human carrier. These outbreaks typically occur in jungles or rural areas where people come in contact with bush meat. It will be interesting as we do the postmortem [on the Guinea outbreak] to figure out how it crossed borders. It suggests to me probably [the transportation of] a dead body was involved."
posted by Sleeper (51 comments total) 7 users marked this as a favorite

 
News like this can be disheartening, but take solace: Southeast Asia Free Of Polio As India Declares Health Victory
posted by Fizz at 10:11 AM on April 1 [6 favorites]


And I was just taking my copy of "The Hot Zone" to the used-bookstore the other day. (They didn't take it, but I found the dust-jacket and will try to re-submit it.. )
posted by k5.user at 10:12 AM on April 1


Worth remembering that the last ebola outbreak was stopped with spray bottles of bleach. This one will too.
posted by ocschwar at 10:17 AM on April 1


Wait, did I accidentally wander back into the Black Death thread?
posted by The Underpants Monster at 10:19 AM on April 1 [7 favorites]


Worth remembering that the last ebola outbreak was stopped with spray bottles of bleach.

I'll try to remember that tip the next time someone comes running at me, bleeding out of his eyeballs.
posted by Blazecock Pileon at 10:25 AM on April 1 [26 favorites]


Yeah, a link followed from the linked article, "Black Death is so 14th century. Ebola is spreading in West Africa now." The first paragraph;
While the weekend's revelations about the plague from teeth of 14th-century skeletons were riveting the Internet, medical workers and health authorities in West Africa were working to stop a more modern threat: the spread of the Ebola virus. The current outbreak has already killed 78 people, according to the Associated Press.
I'm not a fan of death but it seems in this case that the threat might be a bit overstated.
posted by vapidave at 10:34 AM on April 1


I'm not a fan of death but it seems in this case that the threat might be a bit overstated.

All it takes is one person travelling to come into contact with a lot of people.

posted by roomthreeseventeen at 10:38 AM on April 1 [2 favorites]


I've been reliably informed by several people that ebola is no big thing
posted by Ray Walston, Luck Dragon at 10:46 AM on April 1 [1 favorite]


The book that has most stuck in my mind, and terrified me, was Laurie Garrett's The Coming Plague. Now, every time I see a news article on Ebola (or any number of similar things), it's got my attention; more so since being seriously ill through H1N1 (Swine Flu) a few years back.

Perhaps we are one mutation of a high fatality virus away from civilization taking a heavy knock; perhaps not.
posted by Wordshore at 10:51 AM on April 1 [2 favorites]


I've been reliably informed by several people that ebola is no big thing


Yeah, fungal meningitis is really where it's at now.
posted by TheWhiteSkull at 10:53 AM on April 1 [1 favorite]


vapidave: "I'm not a fan of death...

You're missing out!
posted by symbioid at 10:53 AM on April 1 [1 favorite]


Having just returned (Friday) from doing research on primates in western Côte d'Ivoire, I admit that this all has me a bit freaked. Not for my own safety, but for the folks I worked with and in particular people in the area who are still eating bushmeat. One easy route of transmission is during butchering of infected meat; much of the bush meat in the area is coming from Liberia and, to a lesser extent, Guinea. Plus that it is in Conakry already is pretty concerning! This may not be the big one yet, but all it takes is a mutation, or someone from Conakry without symptoms deciding to visit Lagos, for this to become really bad really quickly.
posted by ChuraChura at 10:55 AM on April 1 [11 favorites]


> All it takes is one person travelling to come into contact with a lot of people.

Unlike measles, which is transmitted by aerosol, ebola is transmitted by direct contact w. bodily fluids. So that person would not only have to be well enough to travel, he'd have to come into some very significant contact with others.
posted by Westringia F. at 10:59 AM on April 1 [1 favorite]


I have never before been so happy to have stumbled across a random link to contribute to a MeFi discussion:

Early-Stage Ebola Vaccine Could Be Given To Guinea On “Compassionate Grounds,” Says UTMB Researcher
posted by KatlaDragon at 11:03 AM on April 1 [3 favorites]


(I meant to add -- and that's why the epidemiologist in the 2nd fine article linked above speculates the geographic spread of this outbreak is due to the transport of a body for funeral rites, not a run-of-the-mill traveller.)
posted by Westringia F. at 11:07 AM on April 1


Is this Ebola Zaire or Ebola Sudan?

One positive aspect (if there is such with these types of diseases) is that the extreme mortality typically reduces the overall impact of the disease as people often die before they can spread the illness too far.

Still scary shit especially if it ever does what Ebola Reston or Marbug did and presumably become aerosolized.
posted by vuron at 11:08 AM on April 1 [2 favorites]


I'll try to remember that tip the next time someone comes running at me, bleeding out of his eyeballs.

This is why I don't associate with people who watch The Following.
posted by echocollate at 11:12 AM on April 1 [1 favorite]


> Still scary shit especially if it ever does what Ebola Reston or Marbug did and presumably become aerosolized.

Neither Ebola nor Marbug are spread by aerosol under natural (non-laboratory) conditions. Cites: 1, 2.
posted by Westringia F. at 11:18 AM on April 1 [4 favorites]


Still scary shit especially if it ever does what Ebola Reston or Marbug did and presumably become aerosolized.

Yeeeah... I was trying to remember the details of Reston, and found out that, according to the BBC, "Canadian scientists have shown that the deadliest form of the ebola virus could be transmitted by air between species."

Do not want!
posted by KatlaDragon at 11:19 AM on April 1 [1 favorite]


Contagion is still one of the most terrifying films I've seen in recent memory.
posted by Fizz at 11:24 AM on April 1 [5 favorites]


The only reason I would ever want to own a gun is so I could put a bullet in my head if ebola came to town.
posted by b1tr0t at 11:24 AM on April 1 [2 favorites]


My understanding was that Reston (which doesn't impact humans afaik) can be spread through the air and from Monkeys to Pigs (go team!) I was remembering Marburg infection vectors incorrectly.
posted by vuron at 11:25 AM on April 1


I'll try to remember that tip the next time someone comes running at me, bleeding out of his eyeballs.

The next time? Ye gods, how often does this happen to you?
posted by FelliniBlank at 11:29 AM on April 1 [3 favorites]


Spillover by David Quammen is a more recent (and very well-written) book which updates and gives a new angle on ideas from books like The Coming Plague (and actually debunks some of the hyperbole from The Hot Zone).
posted by matildaben at 11:31 AM on April 1 [7 favorites]


Is this Ebola Zaire or Ebola Sudan?

The story posted on CNN said that it was Ebola Zaire.
posted by smoothvirus at 11:38 AM on April 1


Worth remembering that the last ebola outbreak was stopped with spray bottles of bleach. This one will too.


This will be true right up until it isn't.
posted by Camofrog at 11:59 AM on April 1 [1 favorite]


This is freaky but after reading the Wikipedia entry it sounds like, as others have said above, the chance of an epidemic is mitigated by:

* need for fluid transmission
* quick appearance of symptoms (i.e. you know you're sick right away)
* high mortality rate

Can an epidemiologist confirm and/or elaborate?
posted by freecellwizard at 12:06 PM on April 1


Still scary shit especially if it ever does what Ebola Reston or Marbug did and presumably become aerosolized.

For those who aren't already familiar with the story, yes, that's Reston, Virginia.

You can't see the building anymore though; it was demolished in 1995 and is now a day care center.
posted by Kadin2048 at 12:16 PM on April 1


Early-Stage Ebola Vaccine Could Be Given To Guinea On “Compassionate Grounds,” Says UTMB Researcher

Unfortunately, there's a huge risk due to concerns with doing clinical trials in less-developed countries due to abuses in the past where trials were done fast and ethically loose in these countries. There are still people who believe that HIV originated from the oral polio vaccine distributed in Africa 50 years ago. That's not to say that there haven't been ethical abuses but I hope we don't throw the baby out with the bathwater on this one; if I was at risk for an Ebola infection, you better believe I would take my chances on an unproven vaccine.

Very nice link, thank for posting.
posted by roquetuen at 12:25 PM on April 1 [1 favorite]


Perhaps we are one mutation of a high fatality virus away from civilization taking a heavy knock; perhaps not.
posted by Wordshore at 1:51 PM on April 1 [+] [!]


In 1918 it was a flu virus that decimated populations. People say pish-posh we know better now...do we? Do we know enough about ebola?
posted by Gungho at 12:47 PM on April 1


Well, the transmission to Liberia happened when someone ill who had beento Guinea was taken to a hospital. Someone ending up in a hospital in Lagos or Abidjan or Accra would almost certainly infect at least a few healthcare workers before folks figured out what was going on.
posted by ChuraChura at 12:51 PM on April 1


As long as it stays out of Madagascar.
posted by T.D. Strange at 1:21 PM on April 1 [7 favorites]


In 1918 it was a flu virus that decimated populations. People say pish-posh we know better now...do we? Do we know enough about ebola?

To an extent, it doesn't matter how much we know about ebola or the flu, it will matter how much our bodies know about it, and what lucky percentage of the population have natural or inherited immunity to it. Small-pox was effective at wiping out Native Americans, because european settlers had some inherited immunity. If you have european ancestors, you likely have some immunity to the Plague. Even people at Reston were exposed and infected, but didn't develop symptoms.

Don't get me wrong our technology of of like, germ theory, hand washing and blood-lettings/leeches falling out of fashion will be helpful. But if SHTF, if we hit our bottleneck event, our continued survival will be due to genetic diversity, the most powerful tool we have.
posted by fontophilic at 2:16 PM on April 1 [3 favorites]


Pig to pig Ebola infections raise concerns
posted by The Whelk at 2:28 PM on April 1 [1 favorite]


Ebola largely doesn't scare me. Sure, the mortality rate of infected people on some strains is unbelievably high (talking greater than 80%, while most diseases a high mortality rate is over 20%). But barrier techniques are extremely effective.

What really keeps me up at night is TB. The recent Frontline segment on MDR and XDR TB in Africa highlights what we really need to be worrying about in emerging diseases. Reminds me of stories about the early days in the AIDS epidemic, of people wasting away slowly while no one can help them.
posted by sbutler at 2:33 PM on April 1 [6 favorites]


One easy route of transmission is during butchering of infected meat; much of the bush meat in the area is coming from Liberia and, to a lesser extent, Guinea.

When I was there every market was full of bushmeat. (Smelly stinky bushmeat mostly, and some strange species.) I'm sure I ate a fair bit though people selling cooked food always claimed it was goat or whatever. I mostly hoped to avoid monkey but probably ate some.

Bushmeat is still a big deal and gets transported all over; I can see how it could be a vector.
posted by Dip Flash at 3:11 PM on April 1


As I understand it, for ebola to become a major epidemic or pandemic, it would need to be transmitted via aerosol, plus have a longer infectious-but-asymptomatic phase, and probably some sort of gross mishandling of the first cases (denial, media blackouts, misidentification, use as a WMD, etc). So, not really a concern here in the US, but that could change rapidly.
posted by Blackanvil at 3:11 PM on April 1


it would need to be transmitted via aerosol

You're right about the other aspects (Ebola infections would need a longer asymptomatic phase and lower mortality to spread further, like HIV) but you might be interested to read The Whelk's link about pigs.
posted by Blazecock Pileon at 3:17 PM on April 1


Is the Washington Post link turning up this notice for anyone else?

"To our Readers:
washingtonpost.com is undergoing maintenance and some sections of the site are temporarily unavailable. We apologize for the inconvenience. Of course, the latest news and updates will continue to be available on our home page."
posted by mollymayhem at 6:07 PM on April 1


Yep.
posted by Blazecock Pileon at 6:28 PM on April 1


yup
posted by caphector at 6:37 PM on April 1


Epidemiologist (in training!) here.

This is freaky but after reading the Wikipedia entry it sounds like, as others have said above, the chance of an epidemic is mitigated by:

* need for fluid transmission
* quick appearance of symptoms (i.e. you know you're sick right away)
* high mortality rate

Can an epidemiologist confirm and/or elaborate?


Yep, Ebola doesn't freak me out. One way we talk about diseases and their spread is through the reproductive number (R-naught). R-naught is the product of the number of contacts that an infectious person makes, the probability of disease transmission for each contact, and the amount of time the person is infectious. Since Ebola is so visible and debilitating, the number of contacts that each infected person makes is low. Since people die (Zaire has a case fatality rate of ~90%), often quickly, the amount of time they're contagious and in contact with others is (comparatively) low. Since the virus is not transmissible by air, the probability of contagion for contacts is low. Ebola is a scary and dramatic disease, but it's not a big killer.

330 people died of measles today. Measles is very, very, very contagious (there is an outbreak on the campus I attend and work at), very, very transmissible, and much, much less dramatic. I don't say this to guilt trip people into feeling bad about measles, but to put into context how worried we are normally about contagious diseases that are, for many of us, an ocean away.

I find it weird but somehow charming (?!) that Doctors Without Borders is instagramming their work on Ebola, including using hashtags.
posted by quadrilaterals at 7:53 PM on April 1 [11 favorites]


You say it's very contagious and very infectious. As a layman, I don't understand the distinction between the two terms.
posted by Sleeper at 8:06 PM on April 1


Sleeper, according to the CDC, the differences are as follows:

Infectious disease: a disease caused by a microorganism and therefore potentially infinitely transferable to new individuals. May or may not be communicable. Example of non communicable is disease caused by toxins from food poisoning or infection caused by toxins in the environment, such as tetanus.

Communicable disease: an infectious disease that is contagious and which can be transmitted from one source to another by infectious bacteria or viral organisms.

Contagious disease: a very communicable disease capable of spreading rapidly from one person to another by contact or close proximity.

So as I understand it, a disease such as HIV is infectious but not highly contagious. However, the internet also says the terms tend to be used interchangeably.
posted by ghost dance beat at 8:36 PM on April 1


The World Health Organization notices from which the Post article is drawn can be found on this page. Here's WHO's Ebola factsheet, and CDC's Ebola page, and Canada's Public Health Agency's summary (needs updating but thorough) - I would depend on those before Wikipedia.

Yeah, I'm an epidemiologist, too (I work on noninfectious diseases these days) and the main reason that Ebola's not a huge risk is that it requires direct contact with bodily secretions of an infected person or animal for transmission. The fact that secondary cases are primarily in household contacts (and other people who prepare the body for burial) and health care workers demonstrates that it's not transmissible through casual contact and probably upholds the too-sick-to-go-out theory (although there's transmission during the asymptomatic period and by asymptomatic non-human hosts like bats to complicate that.)

I don't find the distinction between contagious and infectious very helpful; I find it more useful to talk about routes of transmission (sexual contact, fecal-oral, arthropod-borne, airborne, etc.), infectivity (how easily an organism can infect a host) and virulence (the amount of damage the agent causes to its host). Ebola's super-virulent, and it's pretty infective (the infectious dose is 1-10 virions, as opposed to, say, Salmonella, which takes about 10^5 organisms), but the route of transmission and degree of host-susceptible mixing really cut down on the pandemic potential. (Natural pandemic, I mean. Bioterrorism is a whole different beast.)
posted by gingerest at 9:07 PM on April 1 [8 favorites]


Thanks, ghostdancebeat and gingerest.
posted by Sleeper at 10:09 PM on April 1


Sleeper, I didn't mean any distinction; I used them interchangeably above. Sorry for the confusion.
posted by quadrilaterals at 8:21 AM on April 2


Ray Walston, Luck Dragon: "I've been reliably informed by several people that ebola is no big thing"

I saw this article and my heart sunk. One of those people poking fun at you about the flu being much deadlier than Ebola was me.

At the end of the day you have to know that know that Ray Walston, Luck Dragon winning the lottery is never, ever gonna happen. The flu wins every time.
posted by Sphinx at 3:05 PM on April 2


Why anthropologists join an Ebola outbreak team (NPR article)

Cultural contexts of Ebola in Northern Uganda (Academic article about the anthropology of Ebola from the 2003 outbreak, open access)
posted by ChuraChura at 5:53 PM on April 2


Reuters: "Mob attacks Ebola treatment centre in Guinea, suspected cases reach Mali"
An angry crowd attacked an Ebola treatment centre in Guinea on Friday...[Medecins Sans Frontieres] spokesman Sam Taylor [said] that the attackers in Macenta, around 425 km (265 miles) southeast of the capital Conakry, had accused staff of bringing the disease to the town. "We have evacuated all our staff and closed the treatment centre," he said. "We have the full support of the local leaders and we're working with the authorities to try and resolve this problem as quickly as possible so we can start treating people again."
...
In a statement broadcast on state television late on Thursday, Mali's government announced that three people had been placed in quarantine and samples sent off to Atlanta in the United States for tests.
posted by cjelli at 8:46 AM on April 5


Ebola outbreak in Guinea is a new strain of Ebola Zaire. It is different enough to suggest that this virus was not introduced into Guinea from sub-saharan Africa, but evolved in parallel with EBOV from Gabon and Congo.

Emergence of Zaire Ebola Virus Disease in Guinea — Preliminary Report
In March 2014, the World Health Organization was notified of an outbreak of a communicable disease characterized by fever, severe diarrhea, vomiting, and a high fatality rate in Guinea. Virologic investigation identified Zaire ebolavirus (EBOV) as the causative agent. Full-length genome sequencing and phylogenetic analysis showed that EBOV from Guinea forms a separate clade in relationship to the known EBOV strains from the Democratic Republic of Congo and Gabon. Epidemiologic investigation linked the laboratory-confirmed cases with the presumed first fatality of the outbreak in December 2013. This study demonstrates the emergence of a new EBOV strain in Guinea.
posted by Blasdelb at 1:18 AM on April 18


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