Ebola

Ebola is the short name that everyone is familiar with for a rapidly progressive infection caused by the Ebola virus that begins with flu like symptoms of fever, body aches and headaches and progresses to generalized hemorrhage, multiple organ failure and death.

This disease falls under the category of viral hemorrhagic fevers and there are other examples with similar presentations- namely Lassa fever, Rift valley fever, Crimean-Congo hemorrhagic fever, and Marburg hemorrhagic fever.

Ebola’s notoriety is attributable to the mysterious way it suddenly appears, the incomplete knowledge about its origins and natural animal reservoirs, the uncertain nature of its initial spread and of course the severe and fatal nature of the disease. Its short marquee name with Hollywood appeal has given it prominence as well.

Till recently it has been an extremely rare disease with small outbreaks. The current outbreak started in December of 2013 in the forested regions of south east Guinea and has spread to Liberia and Sierra Leone. As of November 5, 2014 Ebola virus disease has involved about 13015 individuals with 7965 laboratory confirmed cases and 4808 deaths.

This is the most sustained outbreak of Ebola Virus Disease in history;vastly surpassing all the combined numbers from all the past Out breaks. The first cases were recorded in 1976 along a village near the Ebola river in the Democratic Republic of Congo and the virus was named for this river.

What if I had close contact with an infected person?

Observe for symptoms of fever, headache, body aches, nausea , vomiting and diarrhea for up to 3 weeks.

Avoid travel or exposure to others if you develop symptoms. If you have a high risk exposure seek medical help and avoid public places and activities till 3 weeks are past

Seek medical attention and inform them of the potential for having Ebola virus disease.

Where does it occur?

Naturally occurring cases had been entirely localized to sub-Saharan Africa: Democratic Republic of Congo, Republic of Congo, Cote ‘d’Ivoire, Sudan, Uganda and Gabon. Accidental exposures from laboratory animals have resulted in isolated cases in Europe and America. 

The current outbreak involves Guinea,Liberia and Sierra Leone. The first imported case occurred in Nigeria involving an individual who traveled after having taken care of a family member who succumbed to Ebola virus disease in Liberia. Subsequently imported cases involving travelers from Liberia have occurred in the United States among 3 people with limited transmission to 2 nurses who took care of one of them in Dallas, Texas. There has been a limited transmission to a nurse in Spain who took care of a patient with Ebola who was air lifted to the country.

There have been one imported case each in Senegal and Mali.  

A separate out break has occurred in the Democratic Republic of Congo; with 69 cases and 49 deaths from July 26 through October 7, 2014. This is unrelated to the large out break in West Africa. 

Distribution map showing districts and cities reporting suspect ceses of Ebola.  Suspected cases were reported in Kissidougou, Gueckedou, Macenta, and Nzerekore

 

How is it transmitted?

The knowledge of the initial transmission is evolving. Fruit bats are now considered to be the natural hosts for the virus; they do not get ill from the virus and silent spread it to other animals and potentially humans. Wild mammals like chimpanzees, gorillas and forest antelopes are felt to be the most likely conduit for human infections. They do succumb to the virus and there have been large population deaths in them that preceded human disease.

Humans likely contract the virus when they slaughter the animals or consume its meat or blood. A good majority of the recent outbreaks have been linked to the butchering and eating of dead chimpanzees and gorillas.

After the initial infection of one or few individuals, the majority of cases of subsequent infection in a community is by direct contact with blood, body fluids,skin and secretions of an infected patient. Funeral practices that involve touching and washing of the deceased is a major means of transmission of this virus. Once they reach a larger city and healthcare setting; the transmission is amplified due to initial misdiagnosis and thus lack of good isolation and personal protective practices.

There is no reliably confirmed airborne transmission among human beings to date.

Is it contagious from person to person?

Yes the infection can be spread by direct contact with blood, body fluids and skin of an infected person. The virus has been isolated in blood, feces, vomit, saliva, sweat, tears, urine, semen, vaginal secretions and breast milk.

What is the risk for travelers?

Risk for travelers in general is very low if personal protective measures are taken. The greatest danger is being involved in the healthcare setting in an area during the outbreak. This has  been demonstrated in the current outbreak in which 2 Americans involved in caring for these patients have become ill.

How soon after exposure will one develop symptoms?

Symptoms can develop within a few days to approximately 3 weeks after exposure, but commonly symptoms are seen within 7 - 10 days of exposure.

What are the signs and symptoms?

Approximately a week after exposure one abruptly develops fever with associated muscle pain, headache and fatigue. In 3-5 days one sees nausea, vomiting, abdominal pain, diarrhea, chest pain, cough sore throat etc. As the illness progresses; toward the 2nd or 3rd one can see the bleeding manifestations: red rash on the skin, bruises, bleeding from skin puncture sites (needles, IV’s), gums, eyes and lips. During the current outbreak bleeding has not been a prominent feature.

In the second week of the illness, one either recovers or progresses to multiple organ failure and death. The mortality rate is nearly 70-90% of infected individuals.

Is there any treatment?

The mainstay of care is good supportive measures with aggressive fluid resuscitation, management of electrolyte disturbances, medicines to deal with nausea,vomiting and diarrhea and anti bacterial antibiotics in cases of secondary infections.

Whole blood or serum from survivors of the infection contain antibodies that will kill the virus and has been used with success in small numbers of patients

Synthetic antibodies against Ebola virus have been use in limited numbers (ZMapp) with some success but its supply has run out. One or two patients have been given other medicines like TKM-ebola & Brincidofovir that interfere with viral multiplication; but one cannot make any judgements on efficacy.

3 Vaccine trials have begun starting in October of 2014 and results are to awaited.

Are there any lab tests to diagnose illness?

The standard test is a RT PCR performed on blood. If initial test is negative it needs to be repeated in 72 hours. 

Blood test to detect Antibodies against Ebola virus are not useful in the initial setting.

What preventive measures can be taken?

Avoid travel to an area during the outbreak, and stay away from any health care facilities in an area of outbreak.

If you are around someone with the illness you need to take full cap, face mask with eye protection , gown and glove precautions with approved devices  to prevent contact with body fluids, secretions and blood.

Clean contaminated surfaces with approved chlorine based agents.

advice for your illness and travel
learn about an exotic disease