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case study

- West Africa 2014 Outbreak
- Location: Guinea, Liberia, Sierra Leone in the west of Africa off the Gulf of Guinea
- Ebola is zoonosis
- 70% of patients die especially those over 44 and under 5
- By end of 2014, approx. 20,000 cases


key words

- Fomites: physical objects that carry infection
- Zoonosis: infection transmitted from animals to man


physical causes of Ebola

- Reservoir is fruit bats
- Contact with animals eaten as bush meat that have been infected by the fruit bat
- Spreads from person to person via body fluids, fomites and over short distances as droplets


causes of the spread

- Weak health care system
- Slow reaction from government and international community
- Distrust of foreigners
- Distrust of government
- Traditional beliefs about the source of the disease
- Denial


SHEEPT factors

- S: population movement, cultural practices education levels lead to ignorance, perception towards treatment
- H: no previous outbreaks in the region so no experience
- E: only in rural areas
- E: poor health, transport and communication infrastructure
- P: decades of civil war, corruption, no trust in government
- T: Vaccines are being trailed and tested but there was no working vaccine before the outbreak


Ebola impacts on economy, people, environment

- No schools
- No touching/shaking hands
- Market closed
- Affected farming (food is more expensive)
- Not attending funerals
- Strain on economy to accommodate the needs of people



- Day 0-3: fever, malaise, fatigue and body aches
- Day 3-10: Nausea, vomiting, diarrhoea, headache and other pains, fever, and confusions
- Day 7-12: either shock (circuitry system failure which leads to organ damage, decreased consciousness, coma and death) or improvement (diarrhoea and vomiting stop)
- Most people who make it to 13 days survived


can be stopped by these three strategies

- Patient identification and isolation
- Contact tracing with diagnosis and isolation
- Community understanding with safe patient and body transport systems, and safe burials



- Personal Protective Equipment
- Contains gown, mask, gloves and face shield
- Use as protection against Ebola
- Must be carefully donned and doffed to control the spread


contact tracing

- Main purpose is to identify new cases among close contacts of known Ebola patients
- Key element to control to isolate people as soon as possible
- Takes 5-8 days for people to seek treatment
- Treatment early on increase likelihood to survive
- Contact team will follow contacts for 21 days (door to door visits, ask about symptoms)
- Awareness
- Stop at peak of epidemic (too big)


non-government response

- Medecins Sans Frontieres (Doctors Without Borders)
- Treated around 4400 confirmed Ebola patients in Guinea, Liberia, Mali and Sierra Leone
- WHO declared public health emergency and provided field teams to Guinea


grassroot response

- Home kits with bleach, water, etc.
- Providing food
- Training traditional healers