Cross-continental burden of Ebola hemorrhagic fever: A meta-analytical comparison, prevalence, mortality, and risk factors

Ebola hemorrhagic fever has increasingly spread beyond its traditional epicenters in Africa to other parts of the world, bearing significant implications for various health and non-health populations. This study examines Ebola's prevalence and burden in Africa, Europe, and North America, as well as the risk factors associated with it. A systematic review and meta-analysis were performed following PRISMA guidelines. Literature was searched through PubMed, Google Scholar, and the Cochrane Library, supplemented by manual searches and grey literature from authoritative health organizations. Meta-analysis was conducted using RevMan with a fixed-effects model and 95% confidence intervals (CI). There were 17 outbreaks covered in the included studies. There were 34,527 cases, 17,116 deaths, and an overall case fatality rate (CFR) of 49.57%. Regionally, Africa accounted for 99.96% of the cases and 99.98% of the reported deaths. The meta-analysis showed that the difference in the odds of infected healthcare workers dying from Ebola relative to non-healthcare patients was insignificant [OR=0.66, 95% CI, 0.39-1.12, I2=75%, p=0.12]. There was also no significant difference between the CFR of male and female patients infected by the virus, despite men being at a slightly higher risk of mortality from the infection compared to women [OR=0.88, 95% CI, 0.48-1.62, I2=0%, p=0.69]. This study showed that Africa continues to have the highest number of Ebola cases and deaths while retaining a high CFR. While there is no statistical difference in the odds of death among the non-health population, healthcare workers bear a higher burden of the outbreaks as they have higher odds of dying compared to non-healthcare populations. There is no significant difference in the CFR of male and female patients despite men being more likely to develop infections.