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Geography in the News: Ebola Terror

By Neal Lineback, Baker Perry and Mandy Lineback Gritzner, Geography in the NewsTM

Ebola Virus Spreads to West Africa

Dangerous viral hemorrhagic diseases, particularly including the deadly Ebola, are emerging as threats to humans around the world.

The deadly disease Ebola has been the focus of intense news coverage since the publication of the book, The Coming Plague: Newly Emerging Diseases in a World Out of Balance (Penguin, 1995) by Laurie Garrett, aroused public interest in the threat of new infectious diseases.

A recent outbreak of Ebola in West Africa has medical personnel scrambling, as it has spread into Guinea, then into Liberia and Sierra Leone, according to news reports. It has now entered Guinea’s capital city of Conakry’s densely packed urban population of more than two million. At last reports, over 240 people had contracted the disease and it had killed more than 140 people. Suspicions are that the ebolavirus may have arrived in a fruit bat whose flesh might have come in contact with a human, although the source is still unsubstantiated.

Understanding the spatial distribution of disease is a critical component of public health. An example is the well-known case of Dr. John Snow, who mapped cholera deaths in London in 1854, establishing a relationship between contaminated water and cholera. This study demonstrated the importance of the spatial perspective in the study of disease.

Medical geography, as this specialization is termed, is crucial in understanding linkages and spatial patterns associated with the emergence of new infectious diseases on both a local and global scale. Finding the geographic origin of a disease is often critical in determining its ecology, its vector(s) and its spatial diffusion, all of which are important to its containment and treatment.

Viral hemorrhagic fevers are perhaps the most feared and least understood of the emerging infectious diseases.  Hemorrhagic fevers are divided into four main families: arenavirus, bunyaviridae, filovirus and flavivirus. Their symptoms consistently begin in humans as a headache, acute infection and fever, progressing to increased leakage of blood and fluids within the body. Finally, the progression of the disease leads to tissue degeneration and massive hemorrhaging from body orifices, most often leading to death.

Species of undomesticated (wild) animals are the primary reservoirs for most or all of the hemorrhagic viruses. Sometimes intermediate vectors, such mosquitos, fleas or ticks, may transmit the virus to humans. Transmission also may occur, however, through human contact with the raw flesh or body fluids of infected animals or humans, creating exceptional difficulties for family members and health workers who have to live with or deal with an infected person.

Among the viral hemorrhagic fevers, the filoviruses have aroused the most interest and concern. Since the discovery of Marburg virus in a German monkey house in 1967, officials have documented numerous outbreaks of Marburg and its close relative Ebola.

Mortality rates for Marburg and Ebola viruses are astoundingly high at 70 percent. In the past, Marburg outbreaks have occurred in Germany, Zimbabwe and Kenya. In recent years, however, outbreaks of Ebola have been more prevalent than close relative Marburg, but these viruses are unpredictable.

The Centers of Disease Control (CDC) further divide Ebola into at least four “subtypes,” based upon their geographies: Zaire, Sudan, Tai Forest (Ivory Coast) and Bundibugyo (Uganda) ebolaviruses (all of which may have somewhat different genetic compositions). Of the four, Ebola Zaire is reported as the most lethal, ultimately killing 83 percent of those infected during the outbreaks of 1976 and 1995 in Zaire. The current outbreak in West Africa may actually be a variant of the Zaire ebolavirus, rather than the region’s previously recognized nearby Tai Forest ebolavirus, according to the CDC.

gitn_1213_ebola
Map by Geography in the News
Boundaries and names shown do not necessarily reflect the map policy of the National Geographic Society.

All of the Ebola subtypes are found in the rain forest regions of Central and West Africa. An errant outbreak called here the Reston ebolavirus event appeared in a monkey house near Reston, Va., in 1989. This outbreak created much alarm and apprehension among the research and public health community. Although this particular subtype killed 85 percent of the monkeys infected, none of the four infected people died and the event was contained and eliminated.

Though most hemorrhagic viruses are sources of concern, it is equally important to recognize that they are not all relegated to the rain forests of Africa, but are indeed present in many countries of South America and even in the United States. But most of these are not as deadly as Ebola.

Excluding Ebola for the moment, the twenty-one year period since 1993 has witnessed numerous outbreaks of other viral hemorrhagic fevers, including some caused by totally new or previously unrecognized viruses. The hantavirus outbreaks in California, New Mexico and South America were traced to fleas from rodents, as was Bolivian hemorrhagic fever. Rift Valley fever and Crimean-Congo hemorrhagic fever outbreaks in Egypt and the United Arab Emirates apparently were linked to blood-sucking insects, probably mosquitoes and ticks.

Of all of the hemorrhagic fevers, however, Ebola is the most feared. Health researchers all over the world are working hard to trace the origins of this virus wherever outbreaks occur. It is extremely dangerous to residents and travelers alike, once it enters a population.

The West African outbreak raises a new series of questions. How can Ebola be contained after it arrives in densely populated urban areas, particularly in poor countries? What species other than monkeys and bats might be reservoirs for Ebola in any particular outbreak? How can it spread in its natural environment from species to species? Can insects spread the virus? How can the local population avoid contracting the disease in its early stages? The West African outbreak is providing a new, if extremely dangerous, laboratory for researchers.

As societies and places become more closely linked through globalization processes, these newly emerging viral hemorrhagic fevers may pose an even greater threat to humans worldwide. Being aware of the threat can go a long way in containment of viral outbreaks, as people take precautions to avoid behaviors that spread the disease.

And that is Geography in the News.

Source: GITN 405, “The Deadly Ebola Virus,” May 13, 1997.

Co-authors are Neal Lineback, Appalachian State University Professor Emeritus of Geography, and Geographer Mandy Lineback Gritzner. Dr. Baker Perry of Appalachian State assisted in writing this article. University News Director Jane Nicholson serves as technical editor. Geography in the NewsTM  is solely owned and operated by Neal Lineback for the purpose of providing geographic education to readers worldwide.

Comments

  1. abbdiol
    lafayette
    September 11, 11:32 am

    This map is a biggest lie. There is no EBOLA on IVORY COAST. you mentioned the countries where there is no ebola and don’t mention the ones where there is ebola ? where Is Liberia ? Where is Seria leonne ? Guinee ? Nigeriaa? those are the countries where you can find ebola .

    • Neal Lineback
      September 12, 5:24 pm

      Please refer to the posting date on this article about Ebola. It was written at the very beginning of the outbreak in West Africa, on April 28, 2004. The commenter above wrote his criticism on September 11, more than than four months later. Our article pointed out the huge dangers of Ebola spreading within the region, but we could not predict exactly where and when it would spread. We appreciate the commenter’s interest in our article and map and hope that this reply explains why the map does not show the latest geographical distribution of the disease in West Africa.

  2. Julie
    Suffolk
    July 25, 4:30 pm

    Thankyou for taking the time to do this blog. I have read every thing I can on the virus and sifted throught the information. Information is power people. The situation is of course serious for South Africa. There have been no cases out of Europe as yet. The scientists are doing there best.a doctor was infected . He is still alive to date.All we can do is wait

  3. Neal Lineback
    May 5, 9:13 am

    In answer to one of the questions in a comment regarding Ghana and Ebola, there was an article in the Washington Post about a month ago: http://www.washingtonpost.com/news/morning-mix/wp/2014/04/07/the-african-pandemic-that-keeps-getting-worse/

  4. Carolyn korzen
    California
    May 3, 11:43 am

    How much of West Africa is affected
    by outbreak ?
    What about Ghana and that area ?

  5. Sarah Jane
    April 30, 12:40 am

    “Does history repeat itself??? In the 1300′s-Bubonic Plague.
    50% of Europe population died. Started in China with two armies catualpoting dead, diasesed bodies at each other.
    Rat ticks climbed on ships from China to europe. Bubonic
    plague started with blood transfer from rat ticks to humans.
    back and forth. Virus mutated to bodily fluids. Mutated again
    to airborne. Virus wins, humans lose. 50% died.”

    The Bubonic Plague is caused by bacteria. The fact that you don’t know that simple fact makes you one of the last people I’d want to take medical advice from. No offense.

  6. Duncan Marshall
    uk
    April 29, 7:50 pm

    Could we not just nuke Africa , ends all the suffering , since I was a kid some 40 years ago nothing but an empty pit throwing charity money into it , which never gets to the true people it only makes government people more richer. Just a thought.

  7. Zapper Dave
    US
    April 29, 2:02 pm

    It is good to see in depth articles on the threat and reality of Ebola. However, the coverage is not as complete as it should be. In reality, the world has been fortunate in that these epidemics have not become worse. All it would take is for one Ebola infected body to fall into a major drinking water supply or even a place frequented by bathers. Possibly worse could be the transmittal of the virus to cattle or goats from a seriously infected herder.

    On the other hand, those responsible for containing the epidemics, while taking some heroic measures, are negligent in their efforts. Anything that might possibly have a benefit in saving lives or reducing suffering should be investigated.

    There is a known ability of using electric pulses to destroy many different virus contaminants in juices, water, and milk. This is well known but the medical establishment has been negligent in its lack of effort to transfer this practice to fighting bacterial and viral illnesses in humans or animals.

    The use of LVPEF ( low voltage pulsed electric fields ) is known to a limited few and has been suppressed over the years in preference to more profitable drugs and vaccines.

    There are people all over the world using technologies such as Rife, Lakhovshy, Beck, and Clark devices. Despite this, the people in power are doing all that they can to suppress the knowledge of this, to the point of suppressing the information posted on the internet and even destroying as many of these devices as possible.

    It is time that we open the doors to a real modern world where we actively seek real cures and not just medicating the symptoms.

  8. Julie
    April 29, 11:51 am

    I am a little confused about the statement that Ebola is one of the most contagious diseases. I believe it can only be transmitted by contact with bodily fluid and does not become airborne. I fail to see how it can be more contagious than diseases that are transmitted more easily.

    • Neal Lineback
      April 29, 12:40 pm

      Thanks again for the many comments to this article. Based on these comments and more recent published research, we made a few changes in our article to accommodate the suggestions and research. First, what makes Ebola so contagious among people residing in close quarters is often poor sanitation and perhaps reliance on “bush meat,” as well as poor diagnosis and poor access to health care. Secondly, how the virus is transported, whether through movements of people or wild animals, is still a question to be researched. (For instance, how did the Zaire ebolavirus jump from Zaire to Guinea?)

      Finally, we had not previously heard about any recent ebolaviruses cases showing up anywhere else in the world. Until we have considerable verification and substantiation, we only count such information as baseless rumors or misdiagnoses.

  9. Adam
    April 29, 11:29 am

    I trust that this article was written with good intentions but you should have had a medical expert provide a fact check prior to publication.

    There are numerous fallacies in this article (the subspecies of the disease, the locations of the current outbreak, etc.) but let’s focus on the one that will cause the most panic among those who do not have experience with infectious diseases.

    “The world’s most contagious and deadly disease is now spreading from human to human.”

    Such a statement is ignorant at best and journalistic fear mongering in hopes of attracting page views at worst.

    Ebola is actually relatively “hard” to catch; this is a scientific fact and supported by the World Health Organization. In order to contract the disease, you would have to come in direct contact with either an infected or deceased person’s bodily fluids. It is not airborne like the flu and cannot survive for long outside of a host’s body (such as on a counter top or door nob). Furthermore, infected persons are only contagious once they become symptomatic.

    The reason that a disease like Ebola spreads so easily in third world nations is their poor medical infrastructure. Infections can go undiagnosed for months before the arrival of international aid organizations that can effectively quarantine and treat victims using modern medical techniques.

    Articles like this are irresponsible and can cause unjustified panic and adverse economic consequences in the affected regions (where the populaces are already among the poorest in the world).

  10. zakhele Stanley
    south Africa(mpumalanga)
    April 29, 3:33 am

    Thank you for the information i hope all those who are infected can be treated soon and everyone must be tested.

  11. Nicholas
    April 29, 12:31 am

    The information on Sierra Leone is quite easily obtainable from a direct source, rather than an outdated secondary source. The suspected cases were Lassa Fever, not Ebola.

    http://www.who.int/csr/don/2014_04_07_ebola/en/

    It is also well-established that this is not the Tai Forest ebolavirus. It was initially reported as Zaire ebolavirus, sharing 98 per cent homology, and later revealed to be a new ebolavirus.

    http://www.cidrap.umn.edu/news-perspective/2014/04/study-growing-guinea-outbreak-caused-new-ebola-strain

    It is particularly ludicrous to describe it as the “world’s most contagious disease” given that it spreads through direct contact with bodily fluids and is readily contained with barrier nursing procedures and contact tracing – as it has been in Liberia and four of six regions in Guinea already.

  12. Jeanne
    April 29, 12:08 am

    My question since your talking geography of this virus is it or is it Not in Italy????
    http://yottafire.com/2014/04/ebola-virus-likely-to-have-spread-to-italy-officially-unconfirmed-news/

  13. John Baldwin
    Colorado, US
    April 28, 11:32 pm

    There are reports that it has spread to Europe specifically Italy. Any comments?

  14. Dee
    April 28, 10:12 pm

    What is more concerning is the W. African government does not want to continue disclosing the infected amount of people, deaths or locations of the Ebola virus. There was also a boat of 40+ W. Africans that are now in Pisa, Italy and the hospital where they are located has been closed and isolated. They will not share details with the public on how many of them are infected. They had fevers and symptoms of Ebola. Something is being hidden from the global public. Internet updates have also been scarce and not updated daily given the criticality of the situation.

  15. Deborah
    Sydney
    April 28, 8:29 pm

    Are you suggesting that the current outbreak has been caused by Tai Forest Ebolavirus? The WHO’s website states that the current ebolavirus outbreak in West Africa ‘…is now confirmed to be caused by a strain of ebolavirus with very close homology (98%) to the Zaire ebolavirus’, not Tai Forest Ebolavirus.
    So surely this raises greater questions and concerns as to how the virus has (potentially) spread from the Democratic Republic of Congo in Central Africa to Guinea/West Africa?

  16. Snake
    April 28, 7:37 pm

    At one time, I proposed to the CDC an experiment dealing with the vector of virus via mosquitoes. The Mosquito I proposed as a carrier was the Aedes albopictus.

    The Asian tiger mosquito (Aedes albopictus) is native to Southeast Asia and is currently established in the south and southeastern United States. This aggressive, day-time biting mosquito can potentially transmit the viruses that cause dengue, chikungunya, encephalitis, and canine heartworm. Asian tiger mosquitoes are responsible for recent outbreaks of dengue virus in Florida, Hawaii, and Texas.

    I questioned the validity of the press and the scientists who stated no mosquito can carry HIV. To put my theory to a test, I purposed setting an plastic aquarium (55 gallon) divided into three segments with barriers between. Holes at the top would allow this organism to travel from one side to the other. The middle would have a pan a water for the mosquitoes to breed but no water would be able to physically contact either of the other two segments. Both segments would have hairless mice. One set of mice would be infected with HIV, the other not and certified to be free of HIV. The experiment would last no more than two months. The non infected mice would be tested for antibodies of HIV. This would clearly indicated the transference of the pathogenic material via the vector of the Aedes albopictus. Since this is a class 4 organism this test would be conducted under the control and certified class 4 lab of the CDC.

    Because of the political correctness of the medical field, I received zero replies from the CDC. I had sent the letter Registered to the Director of the CDC at that time, it was signed and the card returned.

    One or more things could have happened

    1. They were upset not believing a mosquito which has the ability to carry not only the primary virus dengue, but now able to carry and transmit chikungunya, encephalitis, and canine heart worm and now, yellow fever.

    2. Being politically correct, they did not wish to OFFEND the homosexuals who are only 1.2-1.5 of our total population.

    3. If they ignore my letter, then they hope I will go away. Well in a sense I did, but the mosquitoes and viruses have not, but only expanded their field of infections.

    Contact me if you desire. You have my Email address.

    Respectfully submitted

    Snake

  17. TH
    April 28, 5:35 pm

    The World Health Organization has not confirmed ebola cases in either Ivory Coast or Sierra Leone. Where are you getting your information?

    • Neal Lineback
      April 28, 5:48 pm

      Apparently, there was evidence in the mid-1990s that the Ebola virus was in Ivory Coast, but only recently did it show up in Guinea and Sierra Leone (See the ABC URL found in this comments section). We assumed that this Ebola outbreak was likely a similar variety that had been in Ivory Coast 20 years earlier, but we admit that that is speculation, although a logical conclusion. Can readers help us verify that connection?

  18. Richard Stevenson
    Madison Heights, (near Detroit), Michigan
    April 28, 3:28 pm

    Does history repeat itself??? In the 1300′s-Bubonic Plague.
    50% of Europe population died. Started in China with two armies catualpoting dead, diasesed bodies at each other.
    Rat ticks climbed on ships from China to europe. Bubonic
    plague started with blood transfer from rat ticks to humans.
    back and forth. Virus mutated to bodily fluids. Mutated again
    to airborne. Virus wins, humans lose. 50% died.

  19. Adrienne
    SierraLeone
    April 28, 11:48 am

    Can you please get your facts straight as you blog from the comfortable confines of your sofa. Comments such as these have such a negative impact on countries. Kindly confirm your source with regards to confirmed Ebola cases in Sierra Leone? Get your facts straight!!

    • Neal Lineback
      April 28, 2:34 pm

      We really appreciate all responses to our post. Please see the URL on the article by ABC suggested by Margo Santoro below. I added that URL to our post too, as breaking news about the Ebola outbreak in West Africa is occurring faster than we can keep up. The background given in our article, however, is our attempt to educate our readers on the larger picture of this and its related viruses.