What is Ebola virus and why the scare?
(This post has been updated following new breakthrough in prevention of Ebola virus infection)
Ebola is a RNA. virus belonging to the filoviridae group.Marburg is the other virus belonging to this group which causes a similar disease but is antigenically distinct. Ebola causes Haemorrhagic fever.
It has 4 distinct family member all of which are of African origin . Ebola is a category 4 pathogen , due to its high associated mortality and potential for aerosol spread. No aerosol spread of Ebola has been documented in the current epidemic . There has been more than 20 Haemorrhagic fever outbreaks due to these 2 viruses but none has documented transmission before patient is symptomatic. Zaire Ebola virus is responsible for the 2014 West Africa outbreak. Experts opine that the current epidemic , occurred mainly due to lack of personal protection and absence of universal barrier nursing care .2 things which are unfortunately often the cause behind epidemics in developing countries.
Current status Ebola
As per data available with CDC the total number of laboratory confirmed cases (till 7th December 2014) is 11288.Of these the total number of deaths reported is 6388.This outbreak of Ebola haemorrhagic fever is the worst documented epidemic in West Africa in recent history.Grim stats no doubt but protection is possible.Knowledge like always is power if applied properly.
Who can spread Ebola?
Bats are reservoirs with transmission from bats to other wild animals and humans
- Symptomatic cases are contagious.
- Incubation period 7 to 10days ( range 3 to days)
- Symptoms:fever, severe headache, malaise , myalgia, nausea, vomiting, diarrhea,chest pain, cough.
- Bleeding may begin about days later from. any mucosal site and into the skin.
- Even when patient is declared cured virus may persist in semen and some other body fluids for several weeks.
How is Ebola virus spread?
Direct contact of mucous membrane, cut skin with:
- Blood products of Ebola cases
- Body fluids like sweat, saliva vomit, urine, faeces, semen of Ebola cases
- Needles, syringes etc contaminated with blood , body fluids of Ebola cases.
- Meat of infected animals
- Viral load increases with severity of illness of patients.
Ebola virus is a Biosafety level 4 pathogen as it is associated with high fatality rate and potential for aerosol infectivity. However generally sick patients rarely generate sufficient amount of aerosols to pose a significant hazard. But large droplets ( in the form of splashes or sprays) may cause potential hazard to exposed mucosa.Thus personal protective equipment for all healthcare workers is the best way to control spread.
Who needs protection?
High Risk Exposure:
- All family members in direct contact with symptomatic cases.
- All care givers of symptomatic cases.
- Healthcare workers exposed to Ebola cases .
- Travellers travelling to region with Ebola cases.
- All staff responsible for waste disposal of Ebola cases.All high risk
All high risk exposure cases need to be monitored, together with restriction of travel and general public activity.
How to protect yourself?
- Ebola virus is said to be inactivated by heat at about 60 degree celsius.It is also sensitive to household bleach etc.Personal protective equipment is essential for protection in a healthcare setup.Important guidelines to ensure your safety includes:
- Wash hands, use hand sanitizer
- Use household bleach , disinfectants on surfaces contaminated with blood, body fluids
- Use personal protective gear/ equipments if you are working in a healthcare setup / caring for patients with Ebola virus disease
- Dispose of used contaminated,needles, bedding, clothing in a hygienic manner.
- Do inform appropriate health care authority in case ,you are returning from travel in country with known outbreak of Ebola cases and running fever or any other symptoms of Ebola within 21 days of return.
- Inform appropriate healthcare authority in case you have been in direct ,unprotected contact with any patient of Ebola.
- Real Time PCR
- Antigen detection by ELISA
- Virus isolation
- immunohistochemistry and HPE
- Serology for IgM and IgG antibodies (only in confirmed cases)
- Supportive care is the mainstay of treatment
- Maintenance of fluid, electrolyte levels and acid -base balance
- Monitoring vital parameters
- Management of Shock and other complications when they appear
Human convalescent serum is a potential mode of treatment which is currently under evaluation by WHO.There exists no vaccine , antivirus drug ,immune mediated or any other definitive treatment for the Ebola virus.
Update on Ebola Virus management
A ray of hope .Prevention of Infection during epidemics of Ebola virus is under investigation. A rVSV -vectored ebola vaccine which is expressing the Ebola surface glycoprotein is being .
Initial results indicate that the rVSV-ZEBOV vaccine will be highly efficient in preventing Ebola virus disease.
It’s safety profile isgood.It is most likely be given to the population at risk by a ring vaccination strategy during Ebola outbreaks.
Hope, Pray and Prevent …. take home message
As always PREVENTION is better than cure.Extensive healthcare support provided by Doctors without borders and WHO has been possible due to strict adherence of these basic guidelines. Humane behaviour ,care towards those affected together with your own personal protection will help in fighting this fatal disease destroying Africa , with potential to destroy the world. Case fatality rate is as high as 50%to 70 % in the current epidemic.Significantly this rate is much lower when there is a good healthcare setup with intensive care facilities. Strict isolation and management of index cases is the best way to combat the disease when it appears in new territories. Training of airport staff who are screening travellers and exhaustive isolation and treatment protocols should be in place for all facilities responsible for taking care of cases and suspected cases. Above all Personal protective gear and training should be provided for all healthcare workers faced with the responsibility of caring for the sick. Unnecessary public hysteria , panic and social shunning of those suspected of this disease in other parts of the world will only help to spread the disease beyond its natural habitat. Stay informed, avoid panic and take care, the rest is God’s Will!
Harrison Internal Medicine
Disclaimer:The purpose of this article is strictly for educational interest and is not meant as a replacement for professional opinion.