Research Topic

Understanding Ebola: a global health challenge

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The recent Ebola Virus Disease (EVD) outbreak, which was first identified in Guinea in March 2014, and subsequently spread in West Africa to Sierra Leone, Liberia Nigeria, Senegal, Mali, and then outside Africa to United States of America and Spain, was by far the largest in history. The outbreak has led to ...

The recent Ebola Virus Disease (EVD) outbreak, which was first identified in Guinea in March 2014, and subsequently spread in West Africa to Sierra Leone, Liberia Nigeria, Senegal, Mali, and then outside Africa to United States of America and Spain, was by far the largest in history. The outbreak has led to an estimated 27,984 cases and 11,298 deaths, as compared to 2,388 cases in all previous identified outbreaks.

EVD first appeared in 1976 in 2 simultaneous outbreaks in Sudan, and Zaire (now, the Democratic Republic of Congo); subsequent outbreaks were confined to Sub-Saharan Africa. Ebola and Marburg viruses are two genera of the family Filoviridae, and are among the most pathogenic organisms known to humans. The genus Ebola virus is divided into five species (Zaire, Sudan, Ivory Coast, Bundibugyo, and Reston); the Zaire virus species is the etiologic agent of the 2014-2015 epidemic in West Africa.

Although the viral reservoir for Ebola has not been definitely established, preliminary data is suggestive that bats are one of the reservoir hosts of Ebola virus. The reservoir for the current 2014-2015 Ebola epidemic in West Africa is thought to have been a fruit bat that presumably transferred Ebola virus to a human via fruit consumption.

Human transmission of Ebola virus occurs when an individual with EVD transmits infected body fluids via direct contact with another human. Blood, urine, and semen have been identified as body fluids that can transmit the Ebola virus. The surface of a body can also serve to transmit Ebola virus even after death. The traditional burial practices that involve the washing of the body have been associated with Ebola virus transmission in this most recent, and previous epidemics.

Until the West African outbreak, there was limited public interest in EVD and a limited body of research. The large number of cases and the unprecedented media coverage has created an awareness, which hopefully will translate into an ability to learn much about this specific disease and to apply new knowledge to the prevention and mitigation of future outbreaks of EVD and other infectious diseases. Towards this end, significant strides have been made as to innovations in the prevention, treatment and vaccine development (i.e. ChAd3-ZEBOV, which uses a chimpanzee adenovirus vector, and rVSV-Ebov, which uses an attenuated vesicular stomatitis virus) against this deadly disease. Further, research should however look broadly at the factors that enabled the virus to take hold and spread in an uncontrolled manner, and cause a large burden of disease and death. Lastly, EVD significantly compromised the economies of the affected countries.

Research should lead to a better understanding of the transmission factors, clinical manifestations, and intervention options that may lead to better prognoses and more timely control of spread. Ebola has had effects well beyond the direct effects on the health system. What are the consequences of this disaster on the function of an already fragile health system? What can be done to protect and prepare health systems in other low income countries? Research should also allow the global community to reflect and learn how, and why we need to be concerned about emerging diseases even if they occur elsewhere in the world. There should also be a focus on how we can more effectively support disease prevention and timelier outbreak response, in an ethical manner, whilst minimizing infringement of human rights both at home and abroad. What were the different approaches in this outbreak compared to other disasters and what mechanisms were important to facilitate and improve international response, and to what extent and in which way did international assistance contribute to halting the epidemic?

The aim of this Research Topic is to stimulate interest in the generation of new research knowledge, and to allow opportunities for analysis, reflection and knowledge exchange related to the subject. It is intended to cover a broad range of Ebola related interests generally categorized along the following themes:

1) Evaluation of predisposing risk factors for the Ebola epidemic.
2) Primordial and primary prevention of human disease (reducing exposure, increasing resilience, addressing zoonotic factors).
3) Clinical research regarding the 2014-2015 epidemic including: disease manifestations, diagnostics including rapid diagnostics, infection prevention and control, patient management including insights of Ebola holding/treatment centers, OB/GYN and EVD, and mental health.
4) Epidemiological studies or case investigations on the various on-going transmission chains in the 2014-2015 Ebola epidemic.
5) Outbreak control including public health interventions such as surveillance, case prevention, isolation and contact tracing, knowledge and societal factors as well as religious beliefs.
6) Sociological factors including insights around quarantining homes and associated complications, inconsistent service provision, and issues surrounding human rights and authoritarian control measures.
7) Disaster and event management and the international response, including the complexities of multiple agencies working together.
8) Reports of shortcomings of the international response, what took so long and the extent to which the “humanitarian” response was adapted to the needs at ground level.
9) Field reports, case studies and examples of what worked and what did not work.
10) Ethical considerations including the complex considerations of privacy, confidentiality and provider responsibility in the setting of an epidemic.
11) The indirect effects of the outbreak on the health system in both the short and long term.
12) Lessons learned in general about models of response and specifically what training is needed.
13) New research, explanations of new theories or observations, opinion articles and reviews, are all welcome.


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