1
|
Dembek Z, Hadeed S, Tigabu B, Schwartz-Watjen K, Glass M, Dressner M, Frankel D, Blaney D, Eccles Iii TG, Chekol T, Owens A, Wu A. Ebola Virus Disease Outbreaks: Lessons Learned From Past and Facing Future Challenges. Mil Med 2024:usae204. [PMID: 38743575 DOI: 10.1093/milmed/usae204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION The purpose of this review is to examine African Ebola outbreaks from their first discovery to the present, to determine how the medical and public health response has changed and identify the causes for those changes. We sought to describe what is now known about the epidemiology and spread of Ebola virus disease (EVD) from the significant outbreaks that have occurred and outbreak control methods applied under often challenging circumstances. Given the substantial role that the U.S. Government and the U.S. DoD have played in the 2014 to 2016 West African Ebola outbreak, the role of the DoD and the U.S. African Command in controlling EVD is described. MATERIALS AND METHODS A descriptive method design was used to collect and analyze all available Ebola outbreak literature using the PubMed database. An initial literature search was conducted by searching for, obtaining, and reading original source articles on all major global Ebola outbreaks. To conduct a focused search, we used initial search terms "Ebola outbreak," "Ebola virus disease," "Ebola response," "Ebola countermeasures," and also included each country's name where Ebola cases are known to have occurred. From the 4,673 unique articles obtained from this search and subsequent article title review, 307 articles were identified for potential inclusion. Following abstract and article review, 45 original source articles were used to compile the history of significant Ebola outbreaks. From this compilation, articles focused on each respective subsection of this review to delineate and describe the history of EVD and response, identifying fundamental changes, were obtained and incorporated. RESULTS We present known Ebola virus and disease attributes, including a general description, seasonality and location, transmission capacity, clinical symptoms, surveillance, virology, historical EVD outbreaks and response, international support for Ebola outbreak response, U.S. DoD support, medical countermeasures supporting outbreak response, remaining gaps to include policy limitations, regional instability, climate change, migration, and urbanization, public health education and infrastructure, and virus persistence and public awareness. CONCLUSIONS The health and societal impacts of EVD on Africa has been far-reaching, with about 35,000 cases and over 15,000 deaths, with small numbers of cases spreading globally. However, the history of combatting EVD reveals that there is considerable hope for African nations to quickly and successfully respond to Ebola outbreaks, through use of endemic resources including Africa CDC and African Partner Outbreak Response Alliance and the U.S. African Command with greater DoD reachback. Although there remains much to be learned about the Ebola virus and EVD including whether the potential for novel strains to become deadly emerging infections, invaluable vaccines, antivirals, and public health measures are now part of the resources that can be used to combat this disease.
Collapse
Affiliation(s)
- Zygmunt Dembek
- Support to DTRA Technical Reachback, Battelle Memorial Institute, Columbus, OH 43201, USA
| | - Steven Hadeed
- Support to DTRA Technical Reachback, Battelle Memorial Institute, Columbus, OH 43201, USA
| | - Bersabeh Tigabu
- Support to DTRA Technical Reachback, Global Systems Engineering (GSE), Alexandria, VA 22312, USA
| | - Kierstyn Schwartz-Watjen
- Support to DTRA Technical Reachback, Applied Research Associates (ARA), Albuquerque, NM 87110, USA
| | - Michael Glass
- SME Support to DTRA Technical Reachback, Manta Solutions, Charlottesville, VA 22901, USA
| | - Michelle Dressner
- Office of the Command Surgeon, U.S. Africa Command, APO, AE 09751, USA
| | - Dianne Frankel
- Office of the Command Surgeon, U.S. Africa Command, APO, AE 09751, USA
| | - David Blaney
- Office of the Command Surgeon, U.S. Africa Command, APO, AE 09751, USA
- Office of Readiness and Response, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | | | - Tesema Chekol
- Support to DTRA Technical Reachback, Battelle Memorial Institute, Columbus, OH 43201, USA
| | - Akeisha Owens
- Technical Reachback, Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA
| | - Aiguo Wu
- Technical Reachback, Defense Threat Reduction Agency (DTRA), Fort Belvoir, VA 22060, USA
| |
Collapse
|
2
|
Koch EM, Du J, Dressner M, Alwasti HE, Al Taif Z, Shehab F, Mohamed AM, Ghanem A, Alhajeri A, Alawadhi A, Almoamen N, Ashoor K, Hasan S, Haghighi A, Sunyaev S, Farhat M. Demographic and Viral-Genetic Analyses of COVID-19 Severity in Bahrain Identify Local Risk Factors and a Protective Effect of Polymerase Mutations. medRxiv 2023:2022.08.13.22278740. [PMID: 36032980 PMCID: PMC9413726 DOI: 10.1101/2022.08.13.22278740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A multitude of demographic, health, and genetic factors are associated with the risk of developing severe COVID-19 following infection by the SARS-CoV-2. There is a need to perform studies across human societies and to investigate the full spectrum of genetic variation of the virus. Using data from 869 COVID-19 patients in Bahrain between March 2020 and March 2021, we analyzed paired viral sequencing and non-genetic host data to understand host and viral determinants of severe COVID-19. We estimated the effects of demographic variables specific to the Bahrain population and found that the impact of health factors are largely consistent with other populations. To extend beyond the common variants of concern in the Spike protein analyzed by previous studies, we used a viral burden approach and detected a protective effect of low-frequency missense viral mutations in the RNA-dependent RNA polymerase (Pol) gene on disease severity. Our results contribute to the survey of severe COVID-19 in diverse populations and highlight the benefits of studying rare viral mutations.
Collapse
Affiliation(s)
- Evan M. Koch
- Department of Biomedical Informatics, Harvard Medical School
| | | | | | | | - Zahra Al Taif
- Public Health Laboratories, Public Health Directorate, Bahrain Ministry of Health
| | - Fatima Shehab
- Public Health Laboratories, Public Health Directorate, Bahrain Ministry of Health
| | - Afaf Merza Mohamed
- Public Health Laboratories, Public Health Directorate, Bahrain Ministry of Health
| | - Amjad Ghanem
- Public Health Laboratories, Public Health Directorate, Bahrain Ministry of Health
| | - Amani Alhajeri
- Genetic Department, Government Hospitals, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Amna Alawadhi
- Genetic Department, Government Hospitals, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Nabeel Almoamen
- Genetic Department, Government Hospitals, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Khulood Ashoor
- Genetic Department, Government Hospitals, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Sara Hasan
- Genetic Department, Government Hospitals, Salmaniya Medical Complex, Manama, Kingdom of Bahrain
| | - Alireza Haghighi
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital
- Department of Genetics, Harvard Medical School
- Broad Institute of MIT and Harvard
| | - Shamil Sunyaev
- Department of Biomedical Informatics, Harvard Medical School
- Division of Genetics, Department of Medicine, Brigham and Women’s Hospital
| | - Maha Farhat
- Department of Biomedical Informatics, Harvard Medical School
- Pulmonary and Critical Care Medicine, Massachusetts General Hospital
| |
Collapse
|