Ebola Virus Disease Stigmatization; The Role of Societal Attributes


  • Titilola T. Obilade 1. Virginia Polytechnic Institute and State University 2. Formerly employed by Lagos University Teaching Hospital, Lagos, Nigeria when study was conducted




Ebola virus disease, cultural beliefs, stigmatization, EVD survivors, outbreak, Ebola, stigma, SARS, HIV/AIDS, Infectious diseases.


Globally, persons with diseases like leprosy, tuberculosis, H1N1, SARS or HIV/AIDS have been stigmatized. The ongoing Ebola virus disease (EVD) outbreak in West Africa has been the longest outbreak in the history of the disease and the first outbreak to ever occur in West Africa. The strain of ebolavirus in West Africa is one of the most virulent strains of the filoviridae family and case fatalities can be as high as 90%. Treatment of EVD is mainly supportive and societal attributes contribute to stigmatization of the disease and ultimately the spread of the disease. The method used in this study was a search in major databases including PUBMED and Google Scholar. The study also included a review of current events and data from the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC). In this review, an overview of filoviral hemorrhagic fevers was discussed.  The cultural beliefs on the causes of diseases and the stigmatization of infectious diseases in history were examined. In addition, the virulence between severe acute respiratory syndrome (SARS) and EVD were compared. Specifically, it examined Ebola stigmatization and identified societal attributes responsible for the stigma and the implications for controlling the spread. It also points to ways to reduce EVD stigmatization as a way of controlling the spread of EVD.  While there is a lot of ongoing research for the cure and control of EVD, little attention is being paid to the role of stigmatization in the control of the disease.  Fear is the driving force of EVD stigmatization because EVD is a virulent, fast killing disease that has no cure. Powerlessness is another driving force in stigmatization. The sensationalism in news reporting and the mistrust of the government are factors playing on fear and rumor. Counselling should be provided to the community before survivors of EVD return home. Survivors of EVD should be counselled before going home. The government should set up a task force on stigmatization and make efforts to regain the trust of the people. Memorials for those that died from EVD should be erected in each of the districts affected. Schools should not be closed for long periods and should only be closed if there is recourse to distance education. Faith based organizations can also use the methods for distance education as a means to encourage their followers.

Keywords: Ebola virus disease; cultural beliefs; stigmatization; EVD survivors; outbreak; Ebola; stigma; SARS;HIV/AIDS; Infectious diseases.




Geisbert TW, Jahrling PB. Exotic emerging viral diseases: progress and challenges. Nature medicine. 2004;10:S110-S21.

Paessler S, Walker DH. Pathogenesis of the viral hemorrhagic fevers. Annual review of pathology. 2013;8:411- 40.

Kiley M, Bowen E, Eddy G, Isaäcson M, Johnson K, McCormick J, et al. Filoviridae: a taxonomic home for Marburg and Ebola viruses? Intervirology. 1982;18(1-2):24-32.

Peters C, Jahrling P, Khan A. Patients infected with high-hazard viruses: scientific basis for infection control: Springer; 1996. Available online: http://link.springer.com/chapter/10.1007%2F978-3-7091-7482-1_13#page-1 (accessed on 24 December, 2014).

Biosafety in Microbiological and Biomedical Laboratories 5th Edition pp. 1- 8, pp. 24-26; CDC, USDHHS, NIH. Available online: http://www.cdc.gov/biosafety/publications/bmbl5/BMBL.pdf (accessed on 23 December, 2014).

Peters C, Jahrling P, Khan A. Patients infected with high-hazard viruses: scientific basis for infection control: Arch Virol (1996) [Suppl] 11: 141-168.

Martines RB, Ng DL, Greer PW, Rollin PE, Zaki SR. Tissue and cellular tropism, pathology and pathogenesis of Ebola and Marburg viruses. J Pathol. 2015;235(2):153-74.

Negredo A, Palacios G, Vázquez-Morón S, González F, Dopazo H, Molero F, et al. Discovery of an ebolavirus-like filovirus in europe. PLoS pathogens. 2011;7(10):e1002304.

Baize S, Pannetier D, Oestereich L, Rieger T, Koivogui L, Magassouba NF, et al. Emergence of Zaire Ebola Virus Disease in Guinea. N Engl J Med. 2014;371(15):1418-25.

Pigott DM, Golding N, Mylne A, Huang Z, Henry AJ, Weiss DJ, et al. Mapping the zoonotic niche of Ebola virus disease in Africa. eLife. 2014;3:e04395. Available online: http://dx.doi.org/10.7554/eLife.04395 Available online: http://elifesciences.org/content/3/e04395 (accessed on 23 December, 2014).

Maganga GD, Kapetshi J, Berthet N, Ilunga BK, Kingebeni PM, Mondonge V, et al. Ebola virus disease in the Democratic Republic of Congo. N Engl J Med. 2014. DOI: 10.1056/NEJMoa1411099

Feldmann H. Ebola—A Growing Threat? N Engl J Med 2014; 371:1375-1378October 9, 2014DOI: 10.1056/NEJMp1405314. Available online: http://www.nejm.org/doi/full/10.1056/NEJMp1405314 (accessed on 23 October, 2014).

Report on an International Commission. Ebola haemorrhagic fever in Sudan, 1976. Bulletin of the World Health Organization. 1978;56(2):247. Available online: http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2395561&blobtype=pdf (accessed on 25 December, 2014).

Report of an International Commission. Ebola haemorrhagic fever in Zaire, 1976. Bulletin of the World Health Organization 1978;56(2):271-293. Available online: http://www.ncbi.nlm.nih.gov.ezproxy.lib.vt.edu/pmc/articles/PMC2395567/pdf/bullwho00439-0113.pdf (accessed on 25 December, 2014).

Feldmann H, Geisbert TW. Ebola haemorrhagic fever. The Lancet. 2011;377(9768):849-62.Available online: doi: 10.1016/S0140-6736(10)60667-8 (accessed on 23 December, 2014).

Le Guenno, B., Formenty, P., Wyers, M., Gounon, P., Walker, F., & Boesch, C. (1995). Isolation and partial characterisation of a new strain of Ebola virus. The lancet, 345(8960), 1271-1274.

Ng S, Basta N, Cowling B. Association between temperature, humidity and ebolavirus disease outbreaks in Africa, 1976 to 2014. Euro Surveill. 2014;19(35):pii=20892. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20892 (accessed on 21 December, 2014).

Samaranayake L, Peiris J, Scully C. Ebola virus infection: an overview. British dental journal. 1996;180(7):264-6.

WHO. Sierra Leone: for Ebola survivors the pain goes on. Geneva: WHO, 2014. Available online:

http://www.who.int/features/2014/post-ebola-syndrome/en/ (accessed on 30 October, 2014).

Goffman E Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice Hall. 1963.

Weiss MG Ramakrishna J Somma D. Health-related stigma: rethinking concepts and interventions. Psychol Health & Med. 2006;11(3):277-87.

Piot P. No time to lose: A life in pursuit of deadly viruses: WW Norton & Company, London 2012.

Varkevisser CM, Lever P, Alubo O, Burathoki K, Idawani C, Moreira TM, et al. Gender and leprosy: case studies in Indonesia, Nigeria, Nepal and Brazil. Lepr Rev. 2009;80(1):65-76.

Nurge E. Etiology of illness in Guinhangdan. American Anthropologist. 1958;60(6):1158-72.

Available online: http://onlinelibrary.wiley.com/doi/10.1525/aa.1958.60.6.02a00100/pdf (accessed on 21 December, 2014).

Opala J, Boillot F. Leprosy among the Limba: illness and healing in the context of world view. Soc Sci Med. 1996;42(1):3-19.

Chapple A, Ziebland S, McPherson A. Stigma, shame, and blame experienced by patients with lung cancer: qualitative study.BMJ. 2004;328(7454):1470. Available online: http://www.bmj.com/content/early/2003/12/31/bmj.38111.639734.7C.full.pdf+html (accessed on 20 December, 2014). doi:10.1136/bmj.38111.639734.7C

Marlow LA, Waller J, Wardle J. Variation in blame attributions across different cancer types. Cancer Epidemiol Biomarkers Prev. 2010;19(7):1799-805.

Bloom JR, Hayes WA, Saunders F, Flatt S. Cancer awareness and secondary prevention practices in black Americans: implications for intervention. Family & Community Health. 1987;10(3):19-30.

Brieger WR, Oshiname FO, Ososanya OO. Stigma associated with onchocercal skin disease among those affected near the Ofiki and Oyan Rivers in western Nigeria. Soc Science & Medicine. 1998;47(7):841-52.

Bond V, Nyblade L. The importance of addressing the unfolding TBâ€HIV stigma in high HIV prevalence settings. Journal of Community & Applied Social Psychology. 2006;16(6):452-61.

Edginton M, Sekatane C, Goldstein S. Patients’ beliefs: do they affect tuberculosis control? A study in a rural district of South Africa. Int J Tuberc Lung Dis. 2002;6(12):1075-82

Gussow Z, Tracy GS. Status, ideology, and adaptation to stigmatized illness: A study of leprosy. Human Organization. 1968;27(4):316-25.

Cookson R, Rhodes S. Leprosy: India’s hidden disease. The Guardian. 24 March 2011. Available online: http://www.theguardian.com/lifeandstyle/2011/mar/24/leprosy-india-hidden-disease (accessed on 28 October, 2014).

Walsh F. The hidden suffering of India’s lepers. BBC. 31 Mar 2007. Available online: http://news.bbc.co.uk/2/hi/programmes/from_our_own_correspondent/6510503.stm (accessed on 28 October, 2014).

Sato H, Frantz JE. Termination of the leprosy isolation policy in the US and Japan: Science, policy changes, and the garbage can model. BMC Int Health Hum Rights. 2005;5(1):3.

CDC. Questions and answers on the executive order adding potentially pandemic influenza viruses to the list of quarantinable diseases. CDC. 2014. Available online: http://www.cdc.gov/quarantine/qa-executive-order-pandemic-list-quarantinable-diseases.html (accessed on 28 October, 2014).

US. Government Publishing Office. Federal Register. Department of Health and Human services. Centers for Disease Control and Prevention. 42 CFR Part 34. [Docket No. CDC–2009–0003]. RIN 0920–AA26. Medical Examination of Aliens— Removal of Human Immunodeficiency Virus (HIV) Infection from Definition of Communicable Disease of Public Health Significance. Available online: http://www.gpo.gov/fdsys/pkg/FR-2009-11-02/pdf/E9-26337.pdf (accessed on January 3, 2014).

Telegraph. Swine flu: Diplomatic row after China quarantines healthy Mexicans. The Telegraph. May 3, 2009. Available online: http://www.telegraph.co.uk/health/swine-flu/5268156/Swine-flu-Diplomatic-row-after-China-quarantines-healthy -Mexicans. html (accessed on 25 October, 2014).

Shrestha SS, Swerdlow D L, Borse RH, et al. Estimating the burden of 2009 pandemic influenza A (H1N1) in the United States (April 2009–April 2010). 2011 Clin Infect Dis, 52, 75-82.

WHO. Global Alert and Response;(GAR) update 49 - SARS case fatality ratio, incubation period. Geneva: WHO, 2003. Available online: http://www.who.int/csr/sarsarchive/2003_05_07a/en/ (accessed on 23 October, 2014).

WHO Global Alert Response (GAR) Ebola response Roadmap-Situation report 24 December 2014. Available online: http://apps.who.int/ebolaweb/sitreps/20141224/20141224.pdf (accessed on 24 December 2014).

WHO Ebola response team. Ebola Virus Disease in West Africa — The First 9 Months of the Epidemic and Forward Projections. N Engl J Med 2014; 371(16): 1481-1495. Available online: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1411100 (accessed on 13 October, 2014).

Gilman SL. Disease and stigma. The Lancet. 1999;354:SIV15.

CDC. H1N1 (originally referred to as Swine Flu). CDC. 2014. Available online: http://www.flu.gov/about_the_flu/h1n1/ (accessed on 28 October, 2014).

WHO Ebola virus disease, West Africa - update 28 August 2014. Available online: http://www.afro.who.int/en/clusters-a-programmes/dpc/epidemic-a-pandemic-alert-and-response/outbreak-news/4264-ebola-virus-disease-update-west-africa-28-august-2014.html (accessed on 24 December, 2014).

Bausch DG, Schwarz L. Outbreak of Ebola virus disease in Guinea: where ecology meets economy. PLoS neglected tropical diseases. 2014;8(7):e3056. doi:10.1371/journal.pntd.0003056

Lamontagne F, Clément C, Fletcher T, Jacob ST, Fischer WA, Fowler RA. Doing Today's Work Superbly Well — Treating Ebola with Current Tools. N Engl J Med. 2014;371(17):1565-6.

Piot P, Muyembe J-J, Edmunds WJ. Ebola in West Africa: from disease outbreak to humanitarian crisis. Lancet Infect Dis. 2014;14(11):1034-5.

WHO Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care; ARDs that may constitute a public health emergency of international concern covered in the current document. Available online: http://www.who.int/csr/resources/publications/WHO_CDS_EPR_2007_6c.pdf?ua=1 (accessed on 24 December, 2014).

Briand, S, Bertherat, E, Cox, P, et al. 2014. The international Ebola emergency. N Engl J Med.

CDC SARS Response Timeline;SARS: Key Events. CDC. 2013. Available online: http://www.cdc.gov/about/history/sars/timeline.htm (accessed on 31 October, 2014).

Hewlett B, Epelboin A, Hewlett B, Formenty P. Anthropologie médicale. Bull Soc Pathol Exot. 2005;98(3):230-6.

Hewlett BS, Amola RP. Cultural contexts of Ebola in Northern Uganda. Emerg Infect Dis, 2003;9(10):1242.

Hewlett B L, Hewlett BS. Providing care and facing death: nursing during Ebola outbreaks in Central Africa. J Nurs, 2005;16, 289-297.

BBC. Ebola Outbreak: Guinea health team killed. 18 Sept 2014. Available online: http://www.bbc.com/news/world-africa-29256443 (accessed on 28 October, 2014).

Kinsman J, A time of fear: local, national, and international responses to a large Ebola outbreak in Uganda. Glob Health. 2012;8:15.

Okware S, Omaswa F, Zaramba A, et al. An outbreak of Ebola in Uganda. Trop Med Int Health, 2002; 7, 1068 - 1075.

WHO. Global Alert and Response (GAR): Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. Geneva: WHO, 2013. Available online: http://www.who.int/csr/sars/country/table2004_04_21/en/ (accessed on 28 October, 2014).

WHO. Sierra Leone: for Ebola survivors the pain goes on. Geneva: WHO, 2014. Available online: http://www.who.int/features/2014/post-ebola-syndrome/en/ (accessed on 30 October, 2014).

UNDP Human Development Reports. Table 1: Human Development Index and its components. 2014. Available online: http://hdr.undp.org/en/content/table-1-human-development-index-and-its-components (accessed on 13 October, 2014).

Lamontagne F, Clément C, Fletcher T, Jacob ST, Fischer WA, Fowler RA. Doing Today's Work Superbly Well — Treating Ebola with Current Tools. N Engl J Med 2014;371(17):1565-6.

Gostin LO, Friedman EA. Ebola: a crisis in global health leadership. The Lancet. 2014;384(9951):1323-5.

Ebola: Three reasons why most US patients have survived. Available online: http://www.cbsnews.com/news/ebola-three-reasons-most-us-patients-survived/ (accessed on 25 December, 2014).

Reaves EJ, Mabande LG, Thoroughman DA, Arwady MA, Montgomery JM. Control of Ebola virus disease—Firestone District, Liberia, 2014. MMWR. 2014;63:959-65.

Obilade T T. Instructional technology and distance education in Nigeria; Historical background and a critical appraisal Distance Learning. 2013 10(1):25 -29.

BBC Why Ebola is so dangerous. 8 Oct 2014. http://www.bbc.com/news/world-africa-26835233 (accessed on 30 October, 2014).