The increasing population growth, global warming, globalization, and liberalization have an impact on public health risks (Oosthuizen, 2012; and Cromar, Cameron & Fallowfield, 2004). These changes increase the possibility of people mingling while global warming may rate of virulence of infectious microbes (Buckingham & Turner, 2008). Public health is concerned at prevention and managing population based issues in a society. Among the major risk of infections public health problems include overcrowding, which makes it easier for pathogens to be transmitted from infected to susceptible host (CDC, 2015). In this paper, the discussion will revolve around risk of Ebola virus transmission in a commercial air travel environment. The Ebola virus is a lethal infections pathogen, which can have catastrophic impact on a crowd such as those traveling by air using commercial flight (European Centre for Disease Prevention and Control, 2014). The recent outbreak of Ebola virus in West African motivated different countries and states to re-evaluate their disaster preparedness, especially from biological threats, which can be exported by air in an infected person (Bogoch, et al., 2015).
Figure 1: Ebola Virus
3.0 Review of Ebola Virus and Its Threats in Congested Environments
3.1 Background of Ebola Virus
The Ebola virus causes Ebola Virus Disease (EVD), which was previously categorized under haemorrhagic fevers (Lefebvre et al., 2014). The condition an acute and seriously fatal. The virus is said to have originated from a fruit bat, but also evidenced in wild animals such as the chimpanzees, monkeys, and gorillas (WHO, 2015). The first know episode of Ebola fever was reported in Democratic Republic of Congo and the current South Sudan in 1976 (Farrar & Pilot, 2014; and WHO, 2015). The most severe outbreak of Ebola was reported from March 2104 in West Africa, affecting countries such as Guinea, Sierra Leone, and Liberia, the three countries that were heavily affected (Gatherer, 2014). Other countries that had Ebola incidences reported following the West Africa Ebola outbreak included Nigeria, USA, Senegal, Mali, and Spain (Arwady et al., 2015). The response towards this outbreak brought awareness to the world the severity of Ebola virus.
3.2 Health Impacts
The signs and symptoms of ebola include fever, severe headache, muscle pain, lassitude, unexplained bleeding, and gastrointestinal issues such as vomiting, abdominal pain, and diarrhoea (Arwady et al., 2015; WHO, 2015). Complications can lead to kidney, liver failure, and death. Ebola Virus Disease had a high case fatality rate of between 25% and 90% before the West Africa outbreak, whose case fatality rate was between 60% and 70% (Lefebvre et al., 2014; and Craig et al., 2015). The main contributor to increased mortality and morbidity of Ebola in West Africa was poor disaster preparedness and weak healthcare system (Bogoch et al., 2015). Between December 2013 and October 2014, the reported fatalities was 4,493 people and roughly 9000 cases of infected people (Gatherer, 2014). The disease long-term health impacts include hearing loss, joint pain, and in some cases there is reproduction complications (CDC, 2015). The virus is said to persist in the testicles even after the serum test indicate negative Ebola Virus results (Koonin et al., 2015). Health impact is complicated depending on the immunity level of the infected person.
3.3 The Pathogenesis and Transmission of Ebola Virus
The Ebola Virus runs a course of between 2 – 21 days from the day the virus gain entry into the body to presentation of symptoms. The virus is transmitted directly through contact to human body fluids (blood, urine, saliva, or sweat), stools, contact to injectable, or from a carrier animal (Chowell & Nishiura, 2015).
Once introduced in the body, the virus targets the macrophages and monocytes rendering them ineffective (Hoenen, Groseth, Falzarano & Feldmann, 2006). The virus utilizes the inflammatory cells for fast spread into the body. Effect on macrophages elicits inflammatory response and production of cytokines. The cytokines increases epithelial permeability and increase while increased inflammatory cells, which comprise of macrophages increases the room for virus multiplication. The virus also attacks the liver cells; thus, impairing the ability of the toxins to be neutralized by the body in the liver. The viruses us the GP-mediated receptors to penetrate into the endothelial cells (Hoenen, Groseth, Falzarano & Feldmann, 2006). The process result in trapping the white blood cells in the blood system while the macrophages and monocytes continues to produce factors that destroys the endothelial cells and activating coagulation. Therefore, the infected person is at great risk of hypovolemic and haemorrhagic shock.
Based on the pathogenesis of the disease, the immune system is adversely affected. People with compromised body immune system are at high risk of contracting the Ebola virus (Lefebvre et al., 2014). These include children, pregnant women, the elderly, and those already seek (UNICEF, 2015). In addition, health care workers attending to the sick have an accelerated risk for Ebola virus, due to their increases possibility of being exposed to patients’ fluids (WHO, 2015). The relative and those close to the infected person are also at risk of Ebola virus due to possibility of being exposed to the infected person’s body fluids (Lefebvre et al., 2014), especially in cases of late diagnosis.
Ebola Virus Disease is not airborne, but requires a susceptible person physically coming in contact with secretions or fluids from the infected person (Tan, Korkmaz, Reiter & Manchester, 2014). Such contact can be directly (touching the infected person’s bodily matter) or indirectly such as touching contaminated surfaces). In a congested such as a commercial air-travel can experience may have people sharing utilities such as toilets, checkpoints, seats, shaking hands, having direct body contact or excretes such as vomits (Koonin et al., 2015). These close contact increases the risk of people commercial air travel becoming exposed to Ebola. However, since the virus does not spread by air, being close, but not having contact to bodily fluids cannot risk contracting the virus. Following the West Africa Ebola outbreak, several countries imposed travel bans to the West African region in fear of “importing” the problem. Later on, World Health Organization (WHO) and Center for Disease Control and Prevention (CDC) offered guideline on safe travel. These measures involved border check, Ebola screening before and after a flight, and guidelines for air medical travel of individuals already diagnosed with Ebola Virus Disease.
Quantifying the permissible exposure levels for Ebola virus has been challenging due to lack of active human experiment (Hoenen, Groseth, Falzarano & Feldmann, 2006). Much of the details regarding Ebola pathogenesis has been established through laboratory experiments. In addition, the virus multiplies at a fast rate, compromising any chances of allowing exposed individuals into the population. Therefore, there is inadequate of literature on the permissible population based exposure for the Ebola virus.
Ebola virus poses a major public health risk, especially due to fact that the disease signs and symptoms mimic those of other conditions such as malaria, typhoid, or food poisoning (Koonin et al., 2015). The risk is further exacerbated by the fact that seek people attract sympathy from the public, and good Samaritans can offer to help contaminating themselves; hence, acquiring the virus (United Nations Development Group, 2015). The minimal incubation rate increases the rate of disease spread, unless early interventions are instituted immediately signs starts to show. The public health has the mandate to ensure the public is well educated on signs, symptoms, prevention, and reporting Ebola cases or any suspicious case that mimic Ebola Virus Disease (Chowell & Nishiura, 2014). An outbreak such as the one witnessed in West Africa has illuminated on the need to have a well established disaster response worldwide, which can combat such international threats. Though the outbreak had graving impact in the West Africa region, the whole world perceived the threat (Lefebvre et al., 2014). The occurrence of emergence conditions such as Ebola and H1N1 should elicit interest in public health to understand the possible triggers of such trends, especially the relationship between increased population growth, global warming, and virulence.
The recommended measures that can help assist in reducing the risk of Ebola virus on commercial air travel include;
- Vibrant public health education of Ebola Virus Disease including the signs and symptoms; preventive measures, mode of Ebola virus spread, and communication channels in case of a suspected or diagnosed case. This will empower the public, which may reduce ignorant contamination of the infected materials (Koonin et al., 2015).
- Sound education of response measures among the health care workers include disease identification, isolation, and self-protection from the patients. This will reduce fear of helping the sick and careless exposure to infectious content of the patient (CDC, 2015).
- The travel terminals should enforce screening of people boarding the commercial flights. This will ensure that people travelling have not signs and symptoms of the disease, which will reduce disease spread to other susceptible victims in the plane (Bogoch et al., 2015).
- All commercial air travel should have an equipped biological emergency health response team that is well trained to respond without creating tension in the public. Such a team can respond to any reported suspected cases (WHO, 2015)
- Person attending to those infected during a flight or on the ground should be supplied with personal protection equipment to reduce their exposure risk to Ebola virus (Koonin et al., 2015; and CDC, 2015).
- In case of any identified case, contact tracing should be initiated to ensure that all those at risk of direct exposure to the Ebola virus are assessed and monitored for any signs and symptom of EVD. This will reduce the rate of spreading from the original source (Resnik, 2013; and CDC, 2015).
In conclusion, the public health sector is facing challenges from emerging diseases such the Ebola Virus Disease, which are mostly occurring due to the changing demographics in the contemporary world. Changes such as climatic changes and the increased rate of people interaction across regions increase the need for vibrant environmental health risk assessment. Commercial air travel constitute one of the congested areas where people from different locations may converge. Inadequate assessment of those traveling can pose a major threat of Ebola spread. Although Ebola is not spread by air, congestion brings people close making it possible for physical contact or exposure form contaminated services especially the shared amenities such as toilets. Therefore, there is need for vibrant health education on Ebola, having trained staff to handle emergencies, have vibrant Ebola surveillance system, and provide protective equipment to those attending suspected or diagnosed Ebola patients.