Ebola Response and Mitigation in Central and Western Africa: A Literature Review Public

Abstract

Background Since 1976, Ebola has plagued Central and Western Africa causing twenty-two separate outbreaks resulting in over 15,000 deaths. Ebola, while a rare disease, has an average mortality rate of 50% however has been as high as 90%. Only in the last few years have there been major improvements in vaccine and therapeutic development. However, despite these improvements, Ebola outbreaks have continued. Since 2014, there have been nine separate outbreaks including both the longest and the deadliest on record. Fighting Ebola in Central and Western Africa must identify and address challenges to improve their response to this deadly disease.

Methods A narrative review of peer-reviewed and gray literature was conducted utilizing electronic databases PubMed, Embase, and Google Scholar and published after January 1^st, 2016. Articles were screened to include geographical countries in Central and Western Africa and Ebola response related terms such as vaccine, surveillance, transmission, and diagnostics.

Results 55 total sources were included for review. These sources included 43 peer reviewed articles and 12 sources from government and NGO documents. The literature showed various challenges Central and Western Africa face in addressing Ebola. These challenges include weak health infrastructures that lead to decreased vaccination, treatment, and diagnostic testing, interruptions to contact tracing and surveillance due to civil unrest, new concerns of sexual transmission of the virus months after initial infection, and distrust towards local governments among the population.

Conclusion The literature highlighted several challenges that need to be addressed to improve Ebola response in Central and Western Africa, including strengthening the overall health infrastructure of Ebola affected countries, further improve vaccine and therapeutic development and distribution, and address perceptions and mistrust of the public.

Table of Contents

Introduction........................................................................................... 1

Background..................................................................................... 1

Problem Statement ..........................................................................3

Purpose Statement ...........................................................................3

Significance Statement .....................................................................4

IRB Considerations........................................................................... 4

Methods........................................................................................... 4

Literature Review.............................................................................. 5

Figure 1. Timeline of Major Ebola Events............................................ 5

Figure 2. Map of Ebola Outbreaks....................................................... 6

Table 1. List of all Ebola Outbreaks with Total Case and Death Totals.... 7

Transmission.................................................................................... 7

Surveillance..................................................................................... 10

Diagnostic Testing.................................................................................. 11

Treatment....................................................................................... 12

Vaccines.......................................................................................... 14

Health Infrastructure........................................................................ 16

Population Perceptions..................................................................... 17

Militia Violence...................................................................................... 18

Impact of COVID-19 on Ebola Outbreaks........................................... 19

Discussion....................................................................................... 20

Further Development of Treatment Therapies....................................... 21

Improving Vaccination Strategy........................................................ 21

Improving Health Infrastructure. ......................................................23

Addressing Population Perceptions and Mistrust ............................... 24

Conclusion and Public Health Implications. ...................................... 25

References...................................................................................... 27

Tables and Figures.......................................................................... 32

Figure 1. Timeline of Major Ebola Events.......................................... 32

Figure 2. Map of Ebola Outbreaks..................................................... 32

Table 1. List of all Ebola Outbreaks With Total Case and Death Totals. 33

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Mot-clé	Literature Review Western Africa Ebola Central Africa
Committee Chair / Thesis Advisor	Robert Bednarczyk, Emory University
Committee Members	Gaelle Sabben, Emory University

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