When Does an Outbreak Become a Threat?

Since August various outbreaks have made headlines, including the plague outbreak in Madagascar, the monkeypox outbreak in Nigeria, and the Marburg virus outbreak in Uganda. During the same period there have been several outbreaks of cholera, dysentery, malaria and diarrhoea some of which have gone unnoticed but are affecting children, and families in many regions of the world.

Why are some outbreaks given priority while others seemingly go unnoticed?

Some of the reasons some outbreaks make headlines could be due the virulent nature of the disease, how fast they can spread within a community, and the fatality or survival rate. A closer view on the diseases that were making headlines the past months can shed some light in this regard.

Marburg virus:

Marburg virus or Marburg haemorrhagic fever is a severe disease that is in the same family as Ebola

The disease which is passed on from non-human primates e.g. bats to humans and later from human to human is a cause for concern. With a case fatality rate varying between 24% – 88%; this a disease that cannot be taken lightly. Just like Ebola, Marburg virus disease can spread through contact with body fluids from the infected individual. There is currently no treatment for the disease.

Plague:

Plague is a dangerous disease that wiped entire villages in the middle ages (The Black death from 1347-1350 in Europe)

Even though currently the disease has a cure and is endemic only in a few countries with Democratic Republic of Congo, Madagascar and Peru being the most endemic, it is extremely dangerous if it gets out of control. Bubonic plague is the most common form and can be treated if detected early but pneumonic plague is the most virulent and can spread very rapidly through the population.  Plague is transmitted from animals to humans through a bite from an infected flea and can spread from human to human through direct contact with infected tissues and inhalation of infected respiratory droplets.

Monkeypox virus

Although similar to the eradicated smallpox virus

Monkeypox virus is milder with a case fatality rate between 1% and 10%. The disease is transmitted from wild animals to humans with limited spread from human to human. Even though the case fatality is low, the disease has no cure although the smallpox vaccine was highly effective in preventing monkeypox.

Of the three diseases outlined, one common factoris the affected population. These three disease outbreaks started in rural villages in Uganda, Madagascar and Nigeria respectively.

Rural populations carry most of the infectious disease burden in developing countries

The outbreak in Uganda started with a male game hunter who lived near caves with a heavy presence of bats. The man got sick and was nursed by his family and died. No samples were collected. A few days later the sister who nursed him died and so did another brother. Both the sister and the brother nursed the game hunter. After the death of the game hunter and after the sister got sick, the brother refused to be hospitalized and went back to the community.  This was after the infection was confirmed to be Marburg virus. The question arises, how could be allowed to go home when we had been in contact with two people who died from such a dangerous disease?

In the case of the plague outbreak in Madagascar, a man visited a rural plague endemic area and traveled by public taxi where his symptoms developed. The taxi ride took the man through two major cities, and was treated without following safety procedures for plague cases. The people who shared the taxi with the symptomatic man, and those who treated him without safety procedures, were also exposed to the disease.

Monkeypox virus is transmitted from animals to humans hence contact with infected wild animals or their carcass could lead to exposure to the virus. Rural communities living in close proximity to forests and nature reserves where wild animals are still available, exploit the forests and the wild animals as source of livelihood.

The role livelihood plays in infectious disease acquisition and spread should not be disregarded

Most of the affected communities have faced these outbreaks before, while in others, they are an annual occurrence. The question arises what is the missing link? Apart from rare outbreak, some of the outbreaks such as cholera, diarrhoea and skin infections, for example scabies and ringworm (taeniasis), are a common occurrence that at times they don’t even make global headlines. In as much as these diseases are almost always linked to poverty, could the livelihoods in the affected communities be contributing to these seasonal outbreaks? Apart from the presence of the disease causing agents, what are the human factors that perpetuate diseases within these communities?

It is time to think outside the box of poverty and cast the net wider

Simplifying that diseases are due to poverty could blind stakeholders other underlying factors perpetuating disease in poor rural communities.

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