BACKGROUND INFORMATION – EBOLA VIRUS DISEASE

Infectious Disease Published May 2018 www.BioInteractive.org

Ebola virus disease (EVD) in humans is caused by four of five viruses belonging to the genus Ebolavirus. Although most
new EVD infections in humans arise from direct contact with the blood or other body fluids of infected people, scientists
suspect that transmission from animals to humans may occur through consumption of or contact with infected bats and
monkeys living in nearby rainforests. Ebola virus is known to infect animals such as apes, monkeys, and bats in addition
to humans, and is considered a zoonotic pathogen. Once a person is infected, they typically suffer from high fever,
vomiting, diarrhea, and sometimes muscle pain, headaches, and bleeding, which often lead to death.

Since EVD was first identified during a 1976 outbreak in Zaire (now the Democratic Republic of the Congo, DRC),
deadly outbreaks have repeatedly occurred in certain regions of Africa. Person-to-person transmission of the virus is
rapid. This, combined with the frequency of ground travel, remoteness of outbreaks leading to slow detection and
response, and healthcare and funeral practices that lead to transmission, can make containing an outbreak extremely
challenging. For example, during a 2014-2016 outbreak, which began in West Africa and is currently the largest Ebola
outbreak in history, individuals living in Europe and the United States also became infected. Ultimately, the outbreak
infected 28,652 people in at least 10 countries, killing 11,325 people.

These outbreaks are devastating to the communities in which they occur, including the DRC, which has suffered the most
outbreaks since 1976. While containment has been the primary method of controlling EVD outbreaks, the scale and
duration of the 2014-2016 outbreak caused scientists to ramp up their efforts to develop vaccines, leading to the
development of at least one potential candidate vaccine in 2017.

While communities await an effective vaccine, epidemiologists continue to pursue other strategies for the prevention or
control of future EVD outbreaks. In this study, researchers analyzed patterns of disease spread, such as the frequency of
EVD infection in people of different ages or sex. In the above figure, scientists compiled data on 996 suspected, probable,
or confirmed cases of EVD in the DRC between 1975 and 2014. The cases span all seven outbreaks that occurred in the
country during that time period.

Video: Think Like a Scientist – Natural Selection in an Outbreak

This video focuses on the 2013-2016 Ebola outbreak in West Africa. Consider the elements of transmission, mutation and
natural selection at work in the Ebola outbreak. Consider how they might related to other outbreaks, including the 2019-
2020 Coronavirus outbreak.

INTERPRETING THE GRAPH

In an age structure diagram, adding the horizontal bars of a given color together represents 100% of the population. In this
case, the orange bars represent the total population of the DRC between the years 1975 and 2010 (referred to as the
background population). The purple bars represent the total number of EVD cases across the seven outbreaks between
1975 and 2014.

The figure shows that more females than males in the DRC became infected with EVD in every age group. Using the 25-
64 age group as an example, we can see that a nearly equal percentage of the background population is female (about 17%
of total) and male (about 16% of total). However, when you look at the purple bars, which represent the subset of the
population diagnosed with EVD, we see that about 38% of all EVD cases in this same age group were in females,
compared to only 30% in males. In addition, the number of EVD cases was disproportionately higher in the 25-64 age
group than in the other age groups, compared to the background population. The authors speculate that this may be due to
the fact that more women than men tend to be care- givers and that care-givers (either in the home or by profession) are
more likely to fall in the 25-64 age range. This increased exposure of women in this age range to individuals infected with
EVD makes them more likely to contract the disease themselves. The authors note that these findings could inform which
age groups should be targeted first for interventions such as vaccines.
AGE STRUCTURE OF EBOLA OUTBREAKS
Infectious Disease Published May 2018 www.BioInteractive.org
Caption: Cases of Ebola virus disease (EVD) in the Democratic Republic of the Congo (purple bars) are grouped by age and sex and are compared to the
demographics of the background population (orange bars). The data represent 996 suspected, probable, or confirmed cases of EVD documented during
the seven Ebola outbreaks that occurred between 1975-2014 and the background population from 1976-2010.

1. Describe the groups of people most and least likely to contract EVD. Use evidence from the figure to support
your claim.

2. Explain how the purple bar can be bigger than the orange bar for the 25-64 and 65+ age groups.

3. What factors do you think make one group more likely to contract EVD than another?

4. Why is it important to examine infection rates in people based on sex and age group?

5. Why do you think the authors selected these age categories? How might a different age categorization provide
different results?

6. If an effective EVD vaccine were available, which age group would you suggest giving it to first? Why?

7. How could the results of this study be used to prevent or manage future EVD outbreaks?
 BACKGROUND INFORMATION – CORONAVIRUS DISEASE
Watch the Video COVID-19 (Coronavirus Disease 19) by Osmosis on YouTube. This video was produced in February
2020.

1. As you watch, write the multiple names for Covid-19, noting which are official/unofficial.

2. How might COVID-19 have moved from animals to people?

3. How does the mortality rate of COVID-19 compare to other recent outbreaks?

4. Describe the structure of coronavirus.

5. What are some symptoms of coronavirus?

6. What is the main cause of death for people with the infection?

7. Who is most at risk of serious coronavirus infections?

8. How is coronavirus spread?

9. What is the incubation period for coronavirus?

10. What is the current estimated R-naught (R0) value for coronavirus?

11. Diagnosis includes a real-time ____________________ chain reaction (rt-PCR) that can detect small amounts of
viral ______.

12. What are some recommendations for healthy people to prevent coronavirus infection?

13. What are some safety measures taken by healthcare workers who are around people with COVID-19?

For more information on Coronavirus Disease 2019 (COVID-19), reference the Centers for Disease and Control
Prevention or the World Health Organization.
CHINA POPULATION DATA, 2019
PopulationPyramid.Net

China Population Data, 2019

A population pyramid illustrates the age and sex structure of a country's population and may provide insights about
political and social stability, as well as economic development. The population is distributed along the horizontal axis,
with males shown on the left and females on the right. The male and female populations are broken down into 5-year age
groups represented as horizontal bars along the vertical axis, with the youngest age groups at the bottom and the oldest at
the top. The shape of the population pyramid gradually evolves over time based on fertility, mortality, and international
migration trends.

China Population Data, 2019

Age M F
0-4 45106267 39934767
5-9 46319087 40225712
10-14 45044032 38648113
15-19 44286173 38535391
20-24 46956410 41620012
25-29 54633535 49681080
30-34 65544747 61670474
35-39 49370823 46920301
40-44 51155493 48766184
45-49 62836913 60442592
50-54 60946291 59710325
55-59 47588180 46379016
60-64 38607054 38368062
65-69 35185041 36260434
70-74 19746314 21631501
75-79 11801212 13715744
80-84 6808650 9097473
85-89 2787103 4583542
90-94 748881 1525990
95-99 140322 386612
100+ 11731 56108

CHINA COVID-19 DATA, FEB 2020

Statista.com

Breakdown of 44,672 sample patients infected with novel coronavirus COVID-19 in China as of February 11, 2020, by
age group:
Age M F Total Age M F Total
0-9 202 200 402 50-59 5403 4604 10,007
10-19 274 262 536 60-69 4502 4074 8576
20-29 1917 1701 3618 70-79 2045 1887 3932
30-39 4025 3569 7594 80+ 744 685 1429
40-49 4630 3948 8578
Use the provided data to create an age structure diagram for the coronavirus outbreak in China, comparing the number of
cases to the population. You will need to decide on appropriate age categories, determine which data you need to use, and
do some data manipulation (i.e. calculate percentages from raw data or add percentages). Use color coding and create a
key.

1. Describe the groups of people most and least likely to contract EVD. Use evidence from your figure to support
your claim.

2. What factors do you think make one group more likely to contract coronavirus than another?

3. Why did you select the age categories you did?

4. Does coronavirus infect differently based on sex? Use evidence from your figure to support your claim.