From time to time mankind has been terrorized by the emergence of fatal, rapidly spreading, incurable diseases. In the long list of scary outbreaks of SARS, Bird flu and Swine flu, Ebola is the new addition.
Though Ebola fever has been known to exist for a long time, not much has been known about it, as the occasional outbreaks have been confined only to African countries. In this modern era of transport and communication, there are numerous opportunities for spread of such a disease from one part of the world to other if proper preventive measures are not employed. This article will make you aware of the facts about Ebola Virus disease and wipe away the myths.
What is Ebola Virus Disease [EVD]?
Ebola virus disease or Ebola hemorrhagic fever as previously called is a dangerously fatal communicable disease caused by a group of 5 Virus which belong to genus Ebola Virus. They are Bundibugyo Ebola virus, Zaire Ebola virus, Sudan Ebola virus, Reston Ebola virus and Tai forest virus based on their territory of distribution, of which the first three are associated with more severe outbreaks than the other two. [1, 3, 4]
What is Ebola virus?
Ebola virus is an enveloped virus. It contains a single strand of helical negative sense RNA as its genetic material which is attached with different protein molecules in its core called nucleocapsid. The virus is actually tubular in structure but appears in various forms like coiled and loops after various procedures used to visualize the virus.
When the virus enters into the human body, it attacks the immune system of the body and lowers the protective cells and the cells necessary for blood clot formation. This lowers the ability of our body to form clots which leads to severe internal and external bleeding which causes the person to bleed to death. [1, 2, 3]
Picture 1: Microscopic view of Ebola virus
Image Source: 360nobs.com
Picture 2: Ultra structure of Ebola virus
Image Source: popularmechanics.com
How is Ebola virus disease transmitted?
Ebola is primarily concentrated in the tropical rainforests of the African continent. Ebola virus disease gets transmitted from animals to humans initially which then involve human to human transmission.
Fruit bats act as the intermediate host for this dangerous virus and humans, primates like monkeys and chimpanzees and pigs are the end hosts.
The virus gets transmitted from animal or one person to another through physical contact with bodily secretions, organs, inanimate objects with dried secretions from the infected animal or human being. It is believed that the initial outbreaks occurred when people handled dead infected chimpanzees and monkeys. [1, 3, 4]
Picture 3: Ebola Virus cycle
So, the possible ways of transmission of Ebola virus and high risk situations are
- Coming in physical contact with the secretions and fluids like blood and saliva of an infected person/animal or someone who have died of this disease
- Coming in physical contact with inanimate objects with dried secretions of infected person/animal like needles, intravenous lines, cotton swabs used for the infected person
- People who handle burial ceremonies of the infected people who have died which poses high risk for exposure to the virus
- Health care workers who have very high risk of exposure to the diagnosed and undiagnosed patients
- Lab workers who handle samples for diagnosis and for research purpose [1,4,5]
It is to kept in mind that, this disease does not spread by air as droplet infection.
Symptoms and Signs of Ebola Virus disease
Ebola virus disease is an acute viral illness. When someone is exposed to Ebola virus, the clinical features of the disease develop in 2-21 days. The initial symptoms include sudden fever associated with body pain, fatigue, and headache, sore throat which may be followed by vomiting blood, coughing up blood or bloody diarrhea. There may be fiery rash over the body.
The condition of the patient deteriorates very rapidly causing damage to liver and kidney which aggravates the condition resulting in death due to uncontrollable bleeding. As the initial symptoms are non specific and are found in numerous other common diseases, high level of suspicion is necessary to diagnose it early based on the rapid severity of symptoms. [1, 4, 6,7]
Picture 4: Hemorrhagic rash which occurs over entire body
Image Source: ebolavirus2014.com
How to diagnose Ebola Virus Disease?
Diagnosing Ebola virus disease is an essential step to break the spread and to treat the patient. Location of a person in a geographic area of Ebola, History of recent trip to an Ebola affected area, Occupation related to high risk of exposure along with rapidly deteriorating health condition with above said symptoms must elicit suspicion.
Other diseases associated with similar clinical features like malaria, cholera, typhoid and other hemorrhagic fevers must be ruled out first, as they are more prevalent. [1, 4, 6]
- Ebola virus disease can be confirmed by the following methods
- Enzyme Linked Immunosorbent Assay
- Reverse Transcriptase Polymerase Chain Reaction
- Antigen Detection Tests
- Isolation of the virus by cell culture
- Identifying the virus through electron microscopy
As, handling the samples is highly dangerous, all the diagnostic tests should be done in a maximum containment facility with proper protection gears.
Picture 5: Containment facility
Prevention and Treatment of Ebola Virus Disease
Till date, there are no preventive vaccines or specific drugs available for the treatment and cure of Ebola virus disease, but development of drugs are being undertaken by various pharmaceutical companies like Mapp Biopharmaceutical Inc which has developed an experimental drug called ZMapp which is a combination of three different monoclonal antibodies which bind to the Ebola virus and act. The NIH’s National Institute of Allergy and Infectious diseases are backing up the development of vaccines for Ebola. But all these efforts are in the initial stage and no drug or vaccine have been tested for its effectiveness against the disease in humans. [1, 4, 7, 8]
Treatment for Ebola virus disease
- Intensive supportive measures
- Maintenance of fluid and electrolytes
- Maintenance of oxygen level and respiration
- Medications as per the need of the patient
Even with intensive medical support the fatality of this disease is 90%
So prevention is the only possible way to save ourselves from this disease.
- As Ebola virus is susceptible to various disinfectants like sodium hypochlorite, methyl alcohol etc, animal farms in the reservoir areas must be cleaned properly with appropriate disinfectants
Picture 6: Spraying of disinfectant in hospital waiting area
Image Source: silverbirdtv.com
- If there arises a suspicion that, the animals might have become sick with Ebola virus, veterinary doctor and public health person must be notified immediately
- The infected animal must be quarantined and culling should be done. The carcass of the dead animal must be buried deep or incinerated and proper disinfection should be carried out.
- Movement of the animals must be restricted to prevent an outbreak.
- People who handle infected animals and carcass should wear a full protection gear including goggles and containment suits and animal handling should be reduced or avoided if possible
Picture 7: complete protection gear for high risk people
Image Source: jto.s3.amazonaws.com
- Reduce the physical contact with patients with Ebola virus disease
- Health personals and Lab workers must handle the samples and objects with utmost care
- Hand washing and Protection gear should never be forgotten
- Prompt burial of the dead body should be carried out
Picture 8: Handling of dead victims
Image Source: grabghana.com
- To prevent the spread from an epidemic to an unaffected place, all means of immigration facilities like airports and ports must be under strict surveillance and the staffs should be trained to identify people who show symptoms of Ebola Virus Disease
Public awareness is the key to break the spreading of such a dreaded disease
Ebola fever was first identified in 1976 in an African village called Yambuku on the banks of River Ebola from where this deadly disease gets its name. The first outbreak happened simultaneously in 2 different African countries and usually the Ebola outbreaks are associated with more number of deaths. Sometimes the disease occurs sporadically. The recent outbreak in 2014 has happened in Liberia, Sierra Leone and Guinea.
The death toll has crossed over 1000 according to the WHO reports. Efficient steps have been taken by the CDC and other health organization to stop the spread of this outbreak. Treating the victims, contact tracing and quarantine are the effective means by which previous outbreaks have been stalled.
Though the disease is rare and have very less chance of getting introduced into non African countries, it is necessary for everyone to be aware about the basic facts and myths of this disease to play their part well in the protection of their own health and that of the community as well. [1, 4]