Social Pathways for Ebola Virus Disease in Rural Sierra Leone, and Some Implications for Containment.

The current outbreak of Ebola Virus Disease in Upper West Africa is the largest ever recorded. Molecular evidence suggests spread has been almost exclusively through human-to-human contact. Social factors are thus clearly important to understand the epidemic and ways in which it might be stopped, but these factors have so far been little analyzed. The present paper focuses on Sierra Leone, and provides cross sectional data on the least understood part of the epidemic—the largely undocumented spread of Ebola in rural areas. Various forms of social networking in rural communities and their relevance for understanding pathways of transmission are described. Particular attention is paid to the relationship between marriage, funerals and land tenure. Funerals are known to be a high-risk factor for infection. It is suggested that more than a shift in awareness of risks will be needed to change local patterns of behavior, especially in regard to funerals, since these are central to the consolidation of community ties. A concluding discussion relates the information presented to plans for halting the disease. Local consultation and access are seen as major challenges to be addressed. Author Summary: Ebola virus disease is a disease of social intimacy. The main infection pathways are through nursing of the sick and through preparation of corpses for burial. In African rural communities these are activities mainly undertaken by close family members. Infection thus spreads to those most intimate with the patient. In effect, Ebola virus disease exacts a high price for family loyalty. It also causes a potential breach between family members and the authorities responsible for imposing infection control. Understanding the social pathways through which infection spreads, and the conflict of human values invoked by infection control are thus key topics in managing the current Ebola epidemic in Upper West Africa. The paper offers a picture, based on case study data from central Sierra Leone, of some of the social factors to be taken into account in efforts to control the epidemic. [ABSTRACT FROM AUTHOR]