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Fighting Ebola

The key to stopping the virus: Behavior change.

Story by Alexander Gelfand • Infographic by Karbel Multimedia • Sources: WHO, CDC,

About Ebola

Ebola Virus

Subtypes: E. Sudan, E. Zaire, E. Reston, E. Tai Forest, E. Bundibugyo

Incubation period: 2-21 days

Symptoms: High fever, diarrhea, vomiting, respiratory disorders and hemorrhaging

Confronted with a fast-moving Ebola epidemic, Guinea, Liberia and Sierra Leone declared national emergencies and called for international assistance. These were important moves, but a Bloomberg School alum and a DrPH student contend the key to containing Ebola will be a straightforward yet deeply challenging task: changing people’s behaviors.

Initially, misinformation and rumors ruled, says Tolbert Nyenswah, MPH ’12, Liberia’s assistant minister of health. Many denied the existence of an outbreak, believing instead that Western powers had fabricated the crisis to harvest body parts, or that local officials had invented it to attract international aid.

Ebola Sources

Ebola virus hemorrhagic fever is a zoonotic disease transmitted by direct contact with infected live or dead animals. Deaths in wildlife tend to precede and to be linked to human infections.

Gorillas and Chimps

Gorillas and Chimpanzees
Hunters may have contracted virus when handling dead carcasses.


3 species may be reservoirs as well as vectors for spreading the virus.

Human Transmission

Human Transmission

Some scientists argue that biological and sociological factors drove the virus to emerge from the forests. But sociopolitical factors are also driving the outbreak, with the poorest countries in the world also suffering the worst Ebola outbreaks.

Washing bodies
Poor families preparing loved ones for burial may not be protecting themselves from contamination.

Unprotected health workers
Rural clinics often do not have supplies (gloves, masks, etc.) to prevent contamination.

At the same time, cultural practices such as bathing the dead prior to burial drove up infection rates. Villagers opposed health workers who sought to dispose of infected corpses according to safety protocols. And many health workers also fell ill, in part because they simply were not trained to deal with the virus, which had previously been confined to smaller outbreaks in Central Africa. Some failed to protect themselves properly or to isolate themselves once infected.

As a result, health agencies have had to mount vigorous public information and social mobilization efforts. In addition to appealing to the West for health workers trained in Ebola case management, Nyenswah appeared in Liberian media to personally tamp down false rumors of cures and vaccines. He also coordinated a massive campaign urging people to avoid contact with the bodily fluids of victims, eschew travel and seek immediate treatment if ill, and notify public health authorities of suspected cases. But results will take time. “Denial has been overcome,” he says, “but behavioral change has not taken place yet.”

Deadly Disease

The current outbreak has exploded since August, with officials expecting a very large increase in the coming months.

March 22

March 22 49

total clinical cases
29 deaths (59.1%)

May 23

May 23 258

total clinical cases
29 deaths (11.2%)

July 24

July 24 1,093

total clinical cases
660 deaths (60.3%)

September 24

September 24 6,263

total clinical cases
2,917 deaths (46.6%)

The Future?
In late September 2014, the CDC posited two scenarioes for late January 2015.
Best case: With stepped up control and treatment, Ebola is largely contained.
Worst case: 1.4 million people are infected.

In Guinea, meanwhile, the Red Cross adopted a culturally sensitive approach to body management. In addition to clearly explaining why bodies must be isolated and disinfected, volunteers now also offer family members the opportunity to don protective gear and observe the process themselves, says Tim Roberton, a DrPH candidate who traveled to Guinea in July to analyze emergency response efforts by the Red Cross.

“Typically, case management gets the most attention,” says Roberton. “But what’s going to stop this outbreak is changing people’s behavior in the community.”

Ebola Outbreaks

Most of the cases are coming from three countries in West Africa. Health officials cite several cultural factors for the spread of the disease, which has killed thousands in four outbreaks since 1976.

1976-2004 Outbreaks

Ebola Outbreaks 1976 - 2004

South Africa
1 case traveled from Gabon in 1994-1997 outbreak

The 2000-2001 outbreak is the second largest outbreak with 425 cases and 224 deaths.

2013-2014 Outbreak

Ebola Outbreaks 2013-2014

1 case

635 deaths; 1,022 cases

1,677 deaths; 3,280 cases

8 deaths; 20 cases

Sierra Leone
597 deaths; 1,940 cases

1,677 deaths; 3,280 cases

Democratic Republic of Congo
41 deaths; 68 cases

The first recorded outbreak, with 318 cases, was in 1976 in Yambuku, Zaire (now Democratic Republic of Congo). The country's current outbreak—its seventh—is unrelated to the West Africa epidemic.

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