CDC Confirms First Ebola Case Diagnosed in U.S.


We can rationalize it as much as we want to, but it still happened. Now we are left with an opportunity to look at the exact number of people possibly in direct, indirect and atmospheric to inferred indirect contact. Directly and indirectly infected places versus infected people can be documented. Right now it is only a case that is a loner within the lone star state. It is not how many cases there have been and how many of these were fatal that matters so much any more. The question might do become what stage in that exponential growth curve are we in? and what is the doubling time? Right now we are in the first stage of disease ecological development in a spatial diffusion process. Pure spatial features defining this outbreak make it a radial event to imagine. Hierarchical human diffusion pattern make us worry about whether there is (will be or could be) a direct flow of the contagion between airports impacting other latitudes in the US, or might it be restricted mostly to intrastate patterns? Due to incubation times, we may now have to wait two or three weeks to find out. Fortunately, seasonal climate changes are on our side, since the cooler months of winter are approaching in Texas. Geography and climate are in favor of the outbreak for the next month or two spatially. The lack of US engagement in this crisis several months ago means we are directly responsible for our own fate at this point. There was no reason or logic for our failure to engage in appropriate preventive health care practices two to three months ago. The outbreak status here has moved from prevention to containment stage. By now, if we are fully prepared in Atlanta, transportation analysts should know the flow patterns in and around this new potential nidus–by air, land and even water. If not, we’ve been caught with our guards down. By tomorrow we’d better know how a potential host-vector relationship might develop. Even once human cases are fully contained, an animal born ecological nidus can still develop. An eastward, northeastward flow pattern out of Texas is therefore favored. But I am really just looking at worst scenarios here. Let’s hope this Texas case remains on its own turf and hospital bed in the Lone Star state. History show us that it is nearly impossible to prevent foreign born diseases from coming to the U.S. We can delay entry, but if ecology is in favor of transmission and human behavior remains the same, nature simply waits until we let our guards down again. When it comes to man versus nature, we may first win out spatially. However, temporally, nature is not on our side.

See on Scoop.itMedical GIS Guide

As in Bubonic Plague, carried by various mammals, esp. prairie dogs in the western and southwestern U.S. Associated with flea vectors. Pest: Yersinia pestis….


Geographically, you’d expect the plague to be western-bound.  But significant numbers of cases are reported all over the United States since 2010.  


The east coast peaks in cases demonstrate something unexpected about this diseases.  Historically, we think of it as the great bubonic plague, once gone awry but now under considerable control.  In the U.S., we often learn about the association of the plague with prairie dogs.  Since the flea is its vector, you need only be near a prairie dog colony to potentially be exposed to this organism.  (Not great news for us Western field epidemiologists out there dealing with other zoonotic diseases.)


But the matching high peaks along the west coast points to population density as well influencing where the cases are reported.  This should be no surprise, since peoples’ presence is needed for human cases to be developed, and then later reported.


So initially, this map tells us that the plague could be transmitted by many other diseases, in both natural and human ecological manners, and unfortunately bearing reasons for its potential urban impacts that in some ways are very different from why and how it becomes a rural epidemiological event.


However, people travel, and in-migration routes makes their way to the heavily populated ports for international shipping.  


Is latitude a feature in how and where an imported case of the plague might enter the U.S.?  Perhaps, since climate does impact both vector and host activity patterns and willingness to travel or change both animal and environmental settings.


Population density is more a concern for international spread of Yersinia pestis should some new, resistant strain emerge.  


Is the Pacific Rim a route of travel to consider?  If you ask a west coast public health economist or epidemiologist, most certainly.


Still much of the commercial travel from the Orient follows traditional routes, and the more heavily, most heavily populated regions of the east coast are very likely to produce some of the first cases if their origins were abroad.  


This leaves only a single isolated peak in the midwest to be better understood.

The ratio of Mosquito diseases, like Chikungunya, to Primate hosted diseases like Ebola, is 700:1 (rounding Ebola cases to 500 total).  yet the fatality of Ebola is so horrendous, visual and high in terms of percentages, that we focus much more on the Ebola outbreak than we do a disease creeping into our ecology slowly by means of ongoing host-vector behaviors.  There are other diseases that penetrated the ecology of North America even more slowly that those which are mosquito borne.  




The very slow migrating tick borne diseases such as lyme disease remains a very important public health issue, but its victims remain uncounted by most news writers. Lyme disease victims do have their issues you know.



1. Lyme Victims from Around US to Gather at IDSA Headquarters and Demand Changes to Guidelines for Lyme
Thursday, 15 May 2014. 

2. Views: Give Lyme victims same rights as other patients
Holly Ahern. Poughkeepsie Journal. 


In August 2013 it was estimated by CDC that about 300,000 new lyme disease cases are identified each year (as many as twice of much are estimated however due to underreporting; CDC. .


If the same holds true for 2014, that means the ratio of the three diseases so far discussed are 700:600:1, for Chikungunya:Lyme:Ebola.  [For CDC info page on Lyme, see ]


Not add to this west nile cases, which are incredibly scarce.  So far, perhaps <50 in the U.S., but it is still quite early.   (see; and July 8 data– &nbsp ;)


Still in spite of all of these significant number differences, the public is in general most reactive to Ebola, because it is so deadly (30-50%), and because there’s that expectation for what might happen.  


West Nile is deadly too, but mostly to elders and children and those of a weak immune system or "constitution", and even so, deaths are infrequent to rare.  There are no deaths as of yet in the U.S. due to Ebola, but such a case would take center stage if it were ever to happen.  Lyme disease we’ve grown adjusted to.  Chikungunya we’ve also got our eyes upon.  




Anthrax, Arboviral diseases, neuroinvasive and nonneuroinvasive, 
Powassan virus, Cholera, Dengue Virus Infection, Dengue fever, Dengue hemorrhagic fever, Dengue shock syndrome, 
Hansen disease (leprosy), Malaria, Plague, Poliomyelitis – paralytic
Poliovirus infection – nonparalytic, Psittacosis, Q fever, Severe acute respiratory syndrome-associated coronavirus (SARS-CoV) disease, Omsk Fever, Russian Tick Disease(s), Shiga toxin-producing (STEC), Shigellosis, Trichinellosis, Tuberculosis, Tularemia, Typhoid fever, Vibriosis, Viral hemorrhagic fevers, New World Arenavirus, Crimean-Congo hemorrhagic fever virus, Ebola virus, Lassa virus, Marburg virus, Yellow fever, and dozens more which we can’t immediately recall the names of.




My "Foreign Disease Intrusion" list (no NPHG video links) at;


National Institute of Allergy and Infectious Diseases.  Emerging and Re-emerging Infectious Diseases. and


Deborah A. Adams, Kathleen M. Gallagher, Ruth Ann Jajosky, et al.  (2012).  Summary of Notifiable Diseases — United States, 2010.  MMWR.  June 1, 2012 / 59(53);1-111


Ronald Barrett, Christopher W. Kuzawa, Thomas McDade, and

George J. Armelagos.  (1998).  EMERGING AND RE-EMERGING
INFECTIOUS DISEASES: The Third Epidemiologic Transition.  Annu. Rev. Anthropol. 1998. 27:247–71.;   


Brian D. Gushulak, and Douglas W. MacPherson.  Globalization of Infectious Diseases: The Impact of Migration

Clin Infect Dis. (2004) 38 (12): 1742-1748.  doi: 10.1086/421268;


Manny Alvarez.  July 7, 2014.  Dr. Manny: Is America on the verge of a major health crisis?;


Cal Thomas.  (July 8, 2014).  Immigration crisis: Our Constitution doesn’t guarantee entry to the United States.;


The concerns about IN-MIGRATING DISEASE PATTERNS are reviewed in the following reports:  


Robbie J. Totten.  Contagious Disease, Epidemics, National Security, and U.S. Immigration.  CDC, 2012.  Historical Policy Responses.


Association of State and Territorial Health Officials . (2013).  Global Infectious Disease Impact on State and Territorial Health.  

ASTHO Global Health Meeting, July 31, 2013, Washington, DC.—Impact-on-State-and-Territorial-Health/&nbsp;


Ruth Ellen Wasem.  Specialist in Immigration Policy, Congressional Research Service.   April 28, 2014.  Immigration Policies and Issues on Health-Related Grounds for Exclusion. &nbsp;


Other MEDICO-POLITICAL NEWS regarding disease patterns and immigration:


Immigration Issues. Illegal Immigration and Public Health (2009)


PolitiFact Texas.  Dan Patrick has called illegal immigration an invasion and said immigrants bring ‘Third-World diseases’


Marc Siegel.  Fox News.  Immigration crisis: US experiencing major public health crisis, too.;

Ryan Lovelace.  William F. Buckley Group Fellow.  Texas Immigration Center a Magnet for Disease.  Border Patrol union says poor medical screening risks new virus outbreak. &nbsp;


Laura Murphy.  The Guardian.  The Mexican ‘germ invasion’ is just the right’s latest anti-immigration myth. [note: potential bias noted due to relation to missionary activities]


MY RESEARCH on this (one of several NPHG video sets of foreign born viral, vectored, hosted and/or zoonotic diseases, in YouTube:  

By diseases —;

By regions or countries —


“Doctors say they are concerned about false rumors and “hysteria” that the unaccompanied children coming across the border from Mexico into Texas are carrying diseases such as Ebola and dengue fever.”  


Source:  NBC News.  Maggie Fox. (dated July 9, 2014).  “Vectors or Victims? Docs Slam Rumors That Migrants Carry Disease”




As is often the case, concerns, fear and even panic arise with some of the worst logic.   The fear may be right and have good reasons for its existence, but unless we consider the alternatives for how else it might apply, we could result in two series of negative historical epidemiology events–ignoring the original claim because it is misapplied, and missing the boat as how to better apply it.  


NPHG mapping doesn’t support the claim that in-migrating from Mexico and lower parts of the Americas  in unlikely to bring in diseases for us to be concerned with. 


Ecological fallacy is when you believe your observations and deductions pertain to a much larger area or population.  Such is the case for those arguing these "false rumors."


The support for the "possibility" (a term we should even consider removing from this sentence)  that in-migration patterns do not increase the risk of behaviors and disease coming in from other areas, peoples and culture is absurd.  We can try arguing the point that immunizable diseases is not a concern, because we can simply provide these as soon as they come in, although many underprivileged classes in this country also in need of these medicines will most certain fell neglected, and rightfully so.


The article is right in stating the concerns about dengue fever are overrated (see video), and my Ebola work is appearing to show that this is also unlikely to be linked to Mexico in-migration, as much as Caribbean or Natural Animal in-migrating patterns.


The argument that sufficient quarantine and public health monitoring strategies are in place only holds for those who enter this country legally.  


The real indicators here are the presence of in-migrated diseases from countries to the south, such as the most obscurest of ICDs with a well-defined cultural relationship–Chiclero’s Ear and Pinta.


But we can add more to this if need be.  Vibrio cholera outbreaks from a strain bred in Peru, Brazilian blastomycosis, and venezuelan encephalitis.


As I recently demonstrated on one of my ScoopIt! pages about Ebola, the most likely route of entry naturally is via the Caribbean and/or South to Central American route, through the eastern Texas-Mexico border, directed Northnortheastward.  The human in-migration route, more likely, involves major airports from Africa.




Dengue, at;


El Tor cholera at;(demonstrates a nidus in the NYC area, due to rule outs and high density of cases, but the major localized cluster in the Southwest)


Brazilian Blastomycosis,


Chiclero’s Ear (route very strongly demonstrated),


Pinta, using an earlier and very unique presentation technique, at


Venezuelan Encephalitis,


Disease distributions in the US for ICDs linked to Middle and South America,


My coverage of the disease in-migration for numerous parts of the world:




There have been 48 confirmed cases of the mosquito-borne illness in Florida.


This pattern is behaving very predictably, based on yellow fever behaviors documented since 1797, and some of the vibrio cholera patterns in U.S. soil since 1832.   There is a northward transgression of mosquito born diseases (for obvious reasons).   As documented in some west nile work from 2000-2005, ecological methods may be used to predict ecosystems most likely to harbor the species that serve as the most active vectors.  (see my canopy light penetration field work for starters – at ;).


Further comparing vibrio and chikungunya, vibrio is water dependent and ecologically bound to it deltaic settings (i.e. New Orleans and Galveston area–though some will dispute me about this), and is fully dependent upon isopods.  On the other hand, chikungunya behaves according to mosquito patterns much like the yellow fever and dengue, and lacks the stricter peri- and subaquatic requirements.  


My standards for performing mosquito vector disease ecology research as a small area GIS study are provided at


Remote sensing methodologies are reviewed in detail at;


The following outline begins at;


 West Nile Surveillance –;  The Research Area  –;  Vectors –;  Assigning Risk –;  Host Surveillance –;  Vector Ecology and Surveillance –;  Plant Ecology –;     Topography –;   NLCD Grid Mapping and West Nile –  West Nile – Light Penetration Study –;  Remote Sensing – West Nile –;   Case-related Surveillance –;





Images from : Wikipedia, Florida and Polk County,, National Park Service (Everglades project – “Lightscape / Night Sky” at, and South Florida Aquatic Environments, at

This set of maps can be reviewed in detail at


The Geography of Ebola, goes one step beyond the environmental ecological concept of Ebola patterns.  Past geographers had a unique way of evaluating disease long before the microbial (pre-bacterial) theory became popular in the mid-1870s.  Using some of these older methods of spatially reviewing disease behaviors, we discover some important insights worth pursuing as spatial epidemiologists.  Amongst these are spatial theories linked to density, diffusion processes and the natural history of disease over time as natural endemic or epidemic disease processes.


By 1800, the latitude theory for disease was already well established.  This identified certain regions close to the equator and hot, humid climates as most conducive to bad health (see; ).  Matching the latitude theory was the longitude theory, which had its support as well in the form of diseases that remained in the Americas and failed to infect Europe, at least in the initial years.  The prime example of this was yellow fever during its first decade or two of infecting North American coastal cities (this are on the map is from Alexander Keith Johnston’s map, which I review extensively at &nbsp ;).  Race and place of origin have also been linked to sickness, based on the argument of certain kinds of people being more “adapted” to specific settings.  The belief that climate and weather were related to diseases was as old as the study of medicine itself.  Adding to these early hypotheses by the mid-1800s were the ecological and natural history theories, based upon topography, soil, water, and unique features like slope and aspect (angle relative to the sun, for example for a mountain face).


20th century renderings of climate, weather, vegetation zones, and an areal feature known as the Köppen-Geiger climate classification system has become important in understanding global ecology. [for an original map see &nbsp;  ].  Understanding global ecology is important to understanding the geography of Ebola.  Ebola is specific to certain Köppen-Geiger  regions ‘Af’, ‘Am’ and ‘Aw’ in Africa, and therefore similar regions in other parts of the work are more like to support the natural migration of this disease elsewhere.  The Amazon Basin is the only part of the Americas that match the equatorial tropical rainforest region in African where Ebola erupted from.  In the above map illustrated I have termed this the U.S.-Middle America Neotropical region.  These region in both South America and Africa very much mimic the “Torrid Regions” defined around 1800 by famous geographer Alexander Humboldt. [See ].


The African bats linked to Ebola are fruit-eaters (frugivores).  This differentiates them from nearly all North American bats which are insectivores.   In Middle America, are a variety of nectar-feeding and fruit-feeding bats, in particular that Jamaican fruit bat (Artibeus jamaicensis), of which at least four varieties occupy the Caribbean environments (see insets in upper map above, and &nbsp ;).  Thus the link between the African diffusion process and the American diffusion process are these fruit bats, for the time being.


The barriers to Ebola diffusion in nature are the non-tropical forest, very dry and arid climatic regions along most of the western U.S. Mexican border.  This barrier mimics the barrier the Sahara is to natural northward migration of Ebola.  Thus only the entry though the San Antonio, Texas area appears to have feasible climate, topography and environmental settings required for such a host or carrier to follow nature and carry the disease northward to the more heavily populated latitudes.


The Neotropical shorelines of this region extend eastward towards Florida, which due to their combined climate and floral features could  support the frugivore bats, but an even more adventitious route for the travel of Ebola from Brazil to the U.S. is via the Caribbean.  This route was favored by yellow fever, Asiatic cholera, malaria, dengue, and most recently Chikungunya.


The transportation map at the bottom shows two types of disease diffusion routes–the natural ecology routes (linear, radial, mixed or non-hierarchical, red and orange) and the human driven hierarchical transportation based routes (white to cream).  The above maps focus on the natural history of this part of the globe relative to the disease ecology for Ebola.  It is just as possible for human transportation to be the primary means this disease attempts to strike the U.S. (white to cream colored routes).


Meanwhile, the natural history derived routes, for an in-migrating disease like Ebola, which I placed on the second map (in red and yellow), are for the most part speculative, but stand as useful and testable prediction models.


Readings and more related to the above:


Global Disease Detection Center.  [CDC set up these facilities to monitor, perhaps suppress diffusion.]  Info and a map detailing their locations (in Guatemela, as of 2006) is at



Hierarchical Diffusion modeling, my review at:


and a contemporary application of it:


Studies and news quips about Ebola and other bat-carried diseases:





Pierre Rouquet, Jean-Marc Froment, Magdalena Bermejo, AnnelisaKilbourne, William Karesh,Patricia Reed,Brice Kumulungui, Philippe Yaba, André Délicat, Pierre E. Rollin, and Eric M. Leroy. (2005).  Wild Animal Mortality Monitoring and Human Ebola Outbreaks, Gabon and Republic of Congo, 2001–2003. 11(2), serial on the internet, available at, or



Ivan V. Kuzmin, Brooke Bozick, Sarah A. Guagliardo, Rebekah Kunkel, Joshua R. Shak, Suxiang Tong and Charles E. Rupprecht.  (2011).  Bats, emerging infectious diseases, and the rabies paradigm revisited.  Emerging Health Threats Journal 4, incl Supplements.  At:


Jorge Ortega and Iva´n Castro-Arellano. (2001). Artibeus jamaicensis.  Mammalian Species, 662, 1–9.  At


Alfonso Valiente-Banueta, María Del Coro Arizmendia, Alberto Rojas-Martíneza, & Laura Domínguez-Cansecoa. (1996). Ecological relationships between columnar cacti and nectar-feeding bats in Mexico. Journal of Tropical Ecology, 12(1), 103-119. doi:  [Note: nectar feeders, Mexico species, not demonstrated to be a potential carrier as of yet.]




Yale Edu.  15 OCT 2009 REPORT:  The Spread of New Diseases:

The Climate Connection.  At


The African ICDs work is from NPHG modeling of ICDs.  I describe my process for this at

The following also relate:

Survey_AfricanDiseasesinGeneral AfricanMedicineUS_4_JPG


The blue maps are SAS produced krigged data maps.  In other words they are very accurate.  One has to image the US figure drawn on them, however, for some of the versions I produced.



The two maps are at




JULY 4, 2014.  Ebola News and Information Updates.  


July 14, 2014.  The long term predictions for Ebola are not overly surprising.    


A fairly realistic view of outbreaks like those for Ebola rely upon the assumption that these outbreaks are primarily of natural and human ecological in nature.  In the long run this can means that they are more difficult to suppress than a disease diffusion process that lacks a natural ecological component, and is dependent mostly upon just people interacting with other people, mostly in human occupied places.


We learn about future disease patterns for a disease from other countries by looking at how similar diseases behaved in the past.  The behaviors of west nile for example to date have been very much like those of the early 19th century yellow fever.  The diffusion processes for the recent outbreaks from the Caribbean of Chikungunya are very similar to vector-host relationships, climate of origin and diffusion by transportation for the 19th century typhoid fever.  As for Ebola, . . . 

these few observations beg the question:  If we apply to this same logic to Ebola, relying upon matchable natural and human ecological matching disease patterns, what might we come up with?  


Current speculation is we are still far from the opportunity for a diffusion of Ebola to other parts of the world.  Ebola’s zoonotic behaviors suggest a limited "metazoonotic" region (according to Pavlovsky’s and Voronov’s definitions) for the time being.  Until the host-vector ecology is somehow changed, or its genetically defined tendencies to survive based on interactions with nature change, the "metaecology" of host, vector, organism and combinations thereof remain the limiting factor(s).




UK NEWS.  (July 3).  W. African Ebola epidemic ‘likely to last months’, says UN.  At;    



CBS News (July 2).  Ebola rages through West Africa, with no signs of stopping.   At;    


The Guardian.  (July 2).  Monica Mark. Fear and ignorance as ebola ‘out of control’ in parts of west Africa.    At;    


ALJAZEERA.  (July 2).  

Ghana hosts crisis talks as Ebola toll rises.Ministers from 11 African nations meet to plan "drastic action" as death toll from haemorrhagic fever reaches 467.


THE TELEGRAPH.  Mike Pflanz.  (July 3).    Ebola ‘out of control’ in West Africa as health workers rush to trace 1,500 possible victims.  Fear, mistrust of Western medicine and difficulties reaching remote areas mean hundreds of potentially infected people have not yet been found.  At;    


CNN NEWS.  Laura Smith-Spark.  (July 3).  Ebola virus: Can nations stop deadliest ever outbreak from spreading?  At;    


BBC NEWS.  (July 3).  Ebola outbreak: West African states agree strategy.    At;    

CBC NEWS.  Daniel Schwartz. (July 4). Ebola epidemic unlikely to spread beyond Africa. Deadliest outbreak of the disease still a challenge to contain. At






European Centre for Disease Control and Prevention.   Chikungunya.;     

Eric M. Leroy, Dieudoné Nkoghe, Benjamin Ollomo, Chimène Nze-Nkogue, Pierre Becquart, Gilda Grard, Xavier Pourrut, Rémi N. Charrel, Grégory Moureau, Angélique Ndjoyi-Mbiguino, and Xavier de Lamballerie.  (2007).  Concurrent Chikungunya and Dengue Virus Infections during Simultaneous Outbreaks, Gabon, 2007

Emerging Infectious Diseases.  Volume 15, Number 4—April 2009.  At


NBC News –  MAGGIE FOX.  Bugs at Your July 4th BBQ? Beware of Chikungunya and West Nile.   At;      

MICHAELEEN DOUCLEFF.   Chikun-What? A New Mosquito-Borne Virus Lands In The U.S.   At;;    


For more on the Russian philosophy of disease ecology, by Evgenii Nikanorovich Pavlovsky (1884-1965), and A. Georgy Voronov, see:


—my thesis, Overview at, or full project and supplement chapters, not published except on the web, detailing the history of the medical geography and disease ecology fields, at;    



—my webpage and dedication to , "Zoonosis and Russian Medical Geography", at;    


or, the following classical reference:


—Human Diseases with Natural Foci.  (Abstract/Description for purchase) 1963.   At:;jsessionid=05B0F21042EF4956C63AE975AC35B36D&nbsp;      






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