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What You Need to Know About Ebola

By Lauren Ditzian

The 2014 Ebola epidemic was the largest outbreak in history, mostly affecting Liberia, Guinea and Sierra Leone. Approximately 11,000 people died in West Africa and of the four cases in the United States, one died. Thankfully, the outbreak is now under control and on its way to containment. However, at any moment Ebola virus disease (EVD) could potentially return. Needless to say, Ebola is a scary topic shrouded in misinformation and unknowns. Here are the facts about this harrowing disease.

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What is Ebola?
Ebola is a rare and severe disease caused by a virus. Like all viruses, the Ebola virus cannot survive on its own, but must live inside other cells. Once it has entered a human cell, it furiously reproduces, and its many copies eventually break through the host cell membrane, destroying the host cell and quickly spreading throughout the body.

Ebola is one of the deadliest pathogens in the world, with fatality rates as high as 90 percent, although experts believe that with access to the enhanced medical care in the developed world, this rate would be substantially lower.

What Are the Symptoms of Ebola?
Symptoms typically appear between two and 21 days following exposure to the Ebola virus, with an average incubation period of nine to 11 days. If there is any possibility that you have been exposed to Ebola, watch for the following symptoms: severe headache, fever, muscle pain, diarrhea, vomiting and unexplained bleeding and/or bruising. The initial symptoms of Ebola are similar to other common diseases like malaria and typhoid, making it difficult to diagnose in its early stages. If you believe you may have been in contact with an infected person and you exhibit any of the above symptoms, immediately call 911 and the appropriate public health authorities. Make sure to tell them if you have been exposed to someone with Ebola.

How is Ebola Transmitted and Who is At Risk?
The current theory of transmission contends that fruit bats serve as reservoir hosts for the Ebola virus. Even when the disease is not present in humans, the virus continues to live harmlessly in bats. It is not entirely known how the virus transmits to humans, but it is likely through contact with an infected animal. Once one human becomes infected, they can transmit the virus to others through direct contact with bodily fluids. Thus, an outbreak begins. There are four primary modes of transmission:

1) Through washing or preparation of dead bodies during burial practices

2) Through caring for sick family or community members

3) Health care workers are at high risk, especially if the health facility does not have infection prevention and control (IPC) procedures

4) Through sexual contact with a contagious EVD patient or survivor with persistence of virus in sexual fluids

A study published in the New England Journal of Medicine found the presence of the Ebola virus for up to nine months in the semen.

How Did Ebola Spread in 2014?
Laura Miller, Ebola Technical Advisor for the International Rescue Committee (IRC), explains, "The largest Ebola outbreak in history resulted from what we could only call a perfect storm.  An index case originated in a part of the world that connected three countries with extremely porous borders and a highly mobile population that were using newly paved roads that allowed travel out of a densely forested area. The three countries are some of the poorest in the world, geopolitically insignificant, and have weak health systems and endemic corruption. There were also three different colonial powers (British, American and French) and an international public health and humanitarian system that was not prepared for a communicable disease outbreak of this magnitude."

Changing behaviors to stop the chain of transmission is challenging. Burial practices in West Africa put people at extreme risk of contact with the fluids of an infected person. Common death rituals include touching and even kissing the body of the deceased. When a high-ranking official dies, hundreds of people might come into contact with their body as way of paying respects. During previous outbreaks, infrastructure in these countries was scarce. However, recent decades have brought much economic development. Now, many people still live in villages despite working in cities, leading to highly mobile populations, providing Ebola with the perfect opportunity to spread.

What is the Status of Ebola in 2015-2016?
On November 7, 2015, the World Health Organization (WHO) declared Sierra Leone free of Ebola, following the passage of 42 days (which is two times the incubation period) since the last known Ebola patient had tested negative. At the start of 2016, the country underwent a 90-day period of "enhanced surveillance." Liberia, on the other hand, was declared Ebola-free in May 2015, but the tenacious virus re-emerged in September 2015.

All travelers leaving Guinea, Sierra Leone and Liberia are currently subject to intensive screening to prevent the global spread of the disease. In addition, the United States has taken extra precautions to monitor people entering the country from high-risk locales.  Be sure to check the Centers for Disease Control and Prevention website ( for the most up-to-date travel guidelines and screening protocols.

– Lauren Ditzian

Lauren Ditzian, L.M.F.T., is a Licensed Marriage and Family Therapist in Northern California. Originally from Madison, CT, Ditzian studied philosophy at Brown University and earned a master’s degree in somatic psychology at The California Institute of Integral Studies in San Francisco. For the last four years she has worked at expressive arts centers and community mental health agencies in Northern California.


1. Centers for Disease Control and Prevention

2. The New England Journal of Medicine

3. San Francisco Department of Public Health




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