An Update on Ebola

Compiled by Dr. Surangani Abeysuriya Fernando

Following up on Zita's recent contribution on Ebola, Sura has forwarded some facts gleaned from medical information websites such as Medline, Medicine Net, Medscape and those of international health agencies such as the Centers for Disease Control and Prevention (CDC) and the World Health Organisation (WHO) regarding symptoms, transmission and management of the disease.

Since Ebola is a viral haemorrhagic disease like Dengue Haemorrhagic Fever (DHF ) which is widely prevalent in Sri Lanka, Sura's update may be of interest to our colleagues based in Sri Lanka and elsewhere in the world.  

 EBOLA VIRUS DISEASE

EBOLA VIRUS DISEASE-  (EVD; also Ebola hemorrhagic fever, or EHF), or simply Ebola, is a disease of humans and other primates caused by Ebolavirus -  Ebola  is a highly infectious virus that can kill up to 90% of the people who catch it,

-Ebola virus is one of a group of viruses that cause a hemorrhagic fever syndrome. Symptoms of Ebola virus infection are similar to those produced by other hemorrhagic fever viruses

One of the difficulties in identifying potential cases of Ebola infection is the nonspecific presentation of most patients. Fever/chills and malaise are usually the initial symptoms, so all medical personnel should maintain a high index of suspicion in these cases.

 

Symptoms

 Usually begin with a sudden influenza-like stage characterized by fever, fatigue, malaise, reddened eyes, weakness, joint pain, muscle pain, headache, nausea, vomiting, and diarrhea. Patients experience a loss of appetite and often stomach pains. Some patients experience sore throat, rash, cough, hiccups,, Next, shortness of breath and chest pain may occur.,

 Later, as the disease progresses and worsens in severity, symptoms can include bleeding at various sites within or outside of the body. . In about half of the cases, the skin may develop a Maculopapular rash - Wikipedia, the free encyclopedia (a flat red area covered with small bumps).

Disease transmission

  WHO states that between people, Ebola disease spreads only by direct contact with the blood or body fluids of a person who has developed symptoms of the disease

 (through broken skin or mucous membranes in, for example, the eyes, nose, or mouth) with

• Blood or Body fluids that may contain ebolaviruses.  This  include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and semen. of a person who is sick with Ebola
•  virus contaminated needles, syringes etc
• infected fruit bats or primates (apes and monkeys)
  
  
• The fluids in question are primarily vomit and diarrhea, which develop as Ebola infection progresses .Most people spread the virus through blood, feces and vomit.

 The WHO states that only people who are very sick are able to spread Ebola disease in Saliva -
Ebola virus has not been reported to be transmitted through sweat

Ebola is not spread through the air, by water, or in general, by food. 

Recent report by  the World Health Organization has admitted that “wet and bigger droplets from a heavily infected individual, who has respiratory symptoms caused by other conditions or who vomits violently could transmit the Ebola virus over a short distance to another nearby person.”

WHO said it could happen when “virus-laden heavy droplets are directly propelled, by coughing or sneezing onto the mucus membranes or skin with cuts or abrasions of another person.”

 Ebola  is not transmitted  from casual contact, like sitting next to an infected person.But kissing or sharing food or a drink with someone who has Ebola could be a risk, since you might get his saliva in your mouth.

 Ebola virus is usually detectable in patients’ blood at the time of fever and symptom onset.
The bodies of deceased Ebola-infected persons are highly infectious Therefore disposal of a dead body is of paramount importance.              

 Diagnosing Ebola in a person who has been infected for only a few days is difficult because the early symptoms, such as fever, are nonspecific to Ebola infection and often are seen in patients with more common diseases, such as malaria and typhoid fever, Dengue fever.

As given by CDC       Laboratory tests used in diagnosis include:

Timeline of Infection	Diagnostic tests available
Within a few days after symptoms begin	Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing IgM ELISA Polymerase chain reaction (PCR) Virus isolation
Later in disease course or after recovery	IgM and IgG antibodies
Retrospectively in deceased patients	Immunohistochemistry testing PCR Virus isolation

 Treatment

Recovery from Ebola depends on good supportive clinical care and the patient’s immune response.Fairly long lasting antibody response is seen after recovery Therefore rehydration with oral or intravenous fluids- and treatment of specific symptoms, improves survival.

No specific treatment or vaccine for the virus is commercially available .But research and trials are  ongoing
.The World Health Organization gave a green light to the use of experimental drugs to combat the Ebola outbreak in West Africa

Who is at risk Healthcare providers caring for Ebola patients and family and friends in close contact with Ebola patients are at the highest risk of getting sick because they may come in contact with the blood or body fluids of sick patients.

 Air travel  is of interest with the freedom of travel . Are we at risk if a passenger has Ebola infection.? , according to the WHO "It is highly unlikely that someone suffering such symptoms would feel well enough to travel,"

14 August 2014 ¦ GENEVA - The World Health Organization (WHO) today reiterated its position that the risk of transmission of Ebola virus disease during air travel remains low.

Protective measures recommended by CDC include

respiratory hygiene,
 use of personal protective equipment (to block splashes or other contact with infected materials), 

No skin should be exposed while wearing PPE

 safe injection practices

 extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials The most essential preventive measures is successive hand-washing 

 Safe  disposal of Ebola infected dead bodies.