Emile Ouamouno was a two year old boy who loved playing ball and listening to the radio. But in December, 2014 Emile spiked a high fever, began vomiting, and passed black stools. Within a few days, Emile was dead. Although, tragically, children in Africa die all too frequently of fevers and diarrheal diseases, this sickness seemed different. Before December was over, Emile’s sister, mother, and grandmother suffered similar symptoms and died. Two mourners were stricken and died after attending the grandmother’s funeral as did the village midwife who passed the disease on to her relatives.

In March, 2015, this terrifying disease was identified as Ebola. By this time the disease had moved from Emile’s tiny village of Meliandou, Guinea in West Africa to eight other communities in Guinea and into the bordering countries of Liberia and Sierra Leone. By the end of 2015, more than 28,637 people had contracted the disease worldwide and 11,315 people had died of Ebola primarily in Guinea, Liberia and Sierra Leone. Researchers believe this epidemic, the worst in history, started with Emile.

Africa has witnessed Ebola outbreaks before this last one. Past outbreaks were attributed to the hunting, selling, and eating of wild animals such as bats and non-human primates that are known to carry the virus. In these past outbreaks, the first cases were normally seen in adults who captured, butchered, and prepared the animals for consumption. But this outbreak was different in that the first case observed – patient zero –was a small child who would have had little or no contact with infected meat. Careful interviewing of villagers living in Meliandou led researchers to suggest that this deadly outbreak may have started in a hollow tree filled with Angolan bats where children from the village frequently played. Perhaps Emile was bitten by an infected bat or the children captured and cooked a few bats and shared the meal with Emile. However, definitive proof that these bats were the source of this outbreak is still lacking.

The rapid spread of this outbreak was also unusual and could be the result of the increased mobility of individuals in and out of the village. Past outbreaks most likely remained confined to sparsely populated, forested areas where human-to- human transmission was rare and sporadic. By comparison, Emile’s village was much more densely populated, with people routinely traveling in and out, taking the virus with them.

Ebola virus disease is considered an emerging infectious disease, that is, a disease that has appeared in a population in the last 20 to 40 years and whose incidence appears to be increasing. Where did the disease come from? Why is it so deadly? What caused this particular outbreak to spread to epidemic proportions? Could it have been stopped sooner? Can future outbreaks be prevented? Should Americans be worried?