title: What factors might have led to the emergence of Ebola in West Africa?
abstract: An Ebola outbreak of unprecedented scope emerged in West Africa in December 2013 and presently continues unabated in the countries of Guinea, Sierra Leone, and Liberia. Ebola is not new to Africa, and outbreaks have been confirmed as far back as 1976. The current West African Ebola outbreak is the largest ever recorded and differs dramatically from prior outbreaks in its duration, number of people affected, and geographic extent. The emergence of this deadly disease in West Africa invites many questions, foremost among these: why now, and why in West Africa? Here, we review the sociological, ecological, and environmental drivers that might have influenced the emergence of Ebola in this region of Africa and its spread throughout the region. Containment of the West African Ebola outbreak is the most pressing, immediate need. A comprehensive assessment of the drivers of Ebola emergence and sustained human-to-human transmission is also needed in order to prepare other countries for importation or emergence of this disease. Such assessment includes identification of country-level protocols and interagency policies for outbreak detection and rapid response, increased understanding of cultural and traditional risk factors within and between nations, delivery of culturally embedded public health education, and regional coordination and collaboration, particularly with governments and health ministries throughout Africa. Public health education is also urgently needed in countries outside of Africa in order to ensure that risk is properly understood and public concerns do not escalate unnecessarily. To prevent future outbreaks, coordinated, multiscale, early warning systems should be developed that make full use of these integrated assessments, partner with local communities in high-risk areas, and provide clearly defined response recommendations specific to the needs of each community.
authors.affiliation: Department of Fisheries and Wildlife Conservation, Virginia Tech, Blacksburg, Virginia, United States of America.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Alexander
authors.affiliation: Department of Fisheries and Wildlife Conservation, Virginia Tech, Blacksburg, Virginia, United States of America.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Sanderson
authors.affiliation: Department of Computer Science, Virginia Tech, Blacksburg, Virginia, United States of America; Network Dynamics and Simulation Science Laboratory, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, Virginia, United States of America.
authors.forename: Madav
authors.initials: M
authors.lastname: Marathe
authors.affiliation: Network Dynamics and Simulation Science Laboratory, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, Virginia, United States of America.
authors.forename: Bryan L
authors.initials: BL
authors.lastname: Lewis
authors.affiliation: Network Dynamics and Simulation Science Laboratory, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, Virginia, United States of America.
authors.forename: Caitlin M
authors.initials: CM
authors.lastname: Rivers
authors.affiliation: Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Shaman
authors.affiliation: Odum School of Ecology, University of Georgia, Athens, Georgia, United States of America.
authors.forename: John M
authors.initials: JM
authors.lastname: Drake
authors.affiliation: Network Dynamics and Simulation Science Laboratory, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, Virginia, United States of America.
authors.forename: Eric
authors.initials: E
authors.lastname: Lofgren
authors.affiliation: Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America.
authors.forename: Virginia M
authors.initials: VM
authors.lastname: Dato
authors.affiliation: Departments of Epidemiology and Mathematics, University of Michigan, Ann Arbor, Michigan, United States of America.
authors.forename: Marisa C
authors.initials: MC
authors.lastname: Eisenberg
authors.affiliation: Network Dynamics and Simulation Science Laboratory, Virginia Bioinformatics Institute, Virginia Tech, Blacksburg, Virginia, United States of America.
authors.forename: Stephen
authors.initials: S
authors.lastname: Eubank
mesh_terms: D000354:Africa, Western / Q000453:epidemiology; D021821:Communicable Diseases, Emerging / Q000453:epidemiology*; D004196:Disease Outbreaks / Q000517:prevention & control*; D029043:Ebolavirus / Q000502:physiology*; D019142:Hemorrhagic Fever, Ebola / Q000453:epidemiology*; D006801:Humans; D012307:Risk Factors