Ebola has gone quiet in the news. This is typical of our global press. When a topic is hot, its hot, then they get tired of it. But this does not mean the disease has been eradicated. We all need to be aware of potential dangers, particularly if contemplating travel to infected countries. It’s good to know what are symptoms of Ebola, especially when travelling to Africa.
SO WHAT IS EBOLA?
Ebola is a rare and deadly virus. It causes Ebola Virus Disease (EVD). It is one of the few haemorrhagic viruses known to infect man, and as such, is one of those horrible diseases that most medical students remember with great relish due to its horrific effects in infected patients.
It is one of those disease often mimicked in Hollywood movies such as Outbreak or Contagion. 2-21days after exposure to the virus presentations include fever 38+ degrees C, severe headache, diarrhoea, vomiting and abdominal pain.
External and internal haemorrhage occurs late in the disease, with generalised organ failure in the final stages.
Depending on the type of Ebola, the mortality rate of those infected varies from 50-75%. The current outbreak appears to be around 50-55% with medical intervention, but almost 90% with none.
HOW DO YOU CATCH EBOLA?
Infection occurs by contact with body fluids such as vomit, faeces, blood, saliva, sweat and semen, or contaminated gowns or needles, after a patient is symptomatic.
It is not thought to be airborne but if coughing and sneezing can give rise to particles of sputum contaminated with the virus, then there is a possibility of transmission if those particles contact open skin wounds or mucosal surfaces of another person.
Thus close contact with an infected person is necessary for any risk of catching it.
OUTBREAKS OF EBOLA
It is thought that the virus reservoir is possibly bats and the disease is harboured in monkeys, gorillas, and chimpanzees and then transmitted to humans.
There are five species, four of which infect man. The first know outbreak was in Zaire in 1976 near the Ebola River, hence its name.
So far there have been 24 African epidemics. The popular eating of bush meat infected with Ebola is one way of transmission.
The latest outbreak in West Africa is thought to have started in a young child in Ghana, in December 2013 possibly from eating infected bush meat, the child died shortly after but was unfortunately taken across country borders to be buried.
It thus rapidly spread to Liberia, with cases now reported in Sierra Leone, Mali, Nigeria, Senegal, as well as USA and Spain.
Ten patients have been treated in the USA, so far two have died. However rumours are that Senegal and Nigeria are now free of the disease by increasing detection rates and quarantining cases.
The above table shows only 800 infected cases in 2014, obviously printed early in the outbreak.
When we were in South Africa in August 2014, the cases were quoted as 5000 infected, with approx. 2000-2500 deaths. But as of 7th November 2014, 9 weeks later, the numbers are now in the order of:
Total Cases: 13268; Laboratory-Confirmed Cases: 8168; Total Deaths: 4960; Infected health care workers: 500<
These numbers may well be higher due to widespread under-reporting. Even though we have mounted the greatest global response in the history of the CDC (Centre for Disease Control, USA) with over 1000 health workers fighting it, including 150 workers across the three main countries, it is not enough. The CDC estimates that there will be 1.4M affected cases by January 2015.
WHY IS THIS OUTBREAK SO BAD?
The devastating course of this particular epidemic is not due to the virulence of the virus, but to the high population mobility, local customs, dense populated capitals and lack of trust in the authorities in affected areas.
It crossed the porous borders of three West African nations very quickly initially before being diagnosed.
They have very little health infrastructure and no experience in combating Ebola. In many rural areas in these poor countries, it is difficult to access health systems and many infected patients and their families are reluctant to cooperate with aid workers.
There are also many other causes of fever in these parts, including malaria and tuberculosis.
Testing and diagnosis need to be rapid or by the time the result comes through, the patient has infected many others or already died.
It can be impossible to quarantine everyone with a fever, and one may end up treating patients who don’t have Ebola but have something else (up to 30-50% of patients).
There is also international indifference which has hampered aid and the provision of trained health workers and the equipment necessary for early diagnosis and to combat the disease.
It is also difficult to completely close country borders as people always find a way through. So 100% quarantine of large areas is not possible.
Global travel also means that infected cases can leave those countries if asymptomatic at the time of travel.
HOW CAN WE TREAT EBOLA?
At this current time, there is no proven treatment. Patients with a fever are currently quarantined for up to 21 days, meanwhile being tested for the disease.
Quarantine of infected patients and aggressive symptomatic treatment with fluids, pain relief, antibiotics for secondary infections and so on, are the order of the day.
Early diagnosis and treatment has the most favourable results.
Experimental treatment includes ‘ZMapp’ which is a cocktail of antibiotics which has apparently worked on primates. But it is in short supply and is not approved as yet. But it has been used on two infected American health aid workers who both survived.
TKM-Ebola is another drug under trial and brincidofovir used for adenovirus and cytomegalovirus infections.
There are two vaccines being tested in the US, Mali and Switzerland. It is hoped that by December we should know if they are safe to be used.
If safe, WHO (World Health Organisation) will use them in Africa, initially in health care workers.
Some are also using the plasma from cured cases, and this serum should be available in Liberia in weeks.
HOW DO I PROTECT MYSELF AGAINST EBOLA?
Ebola is spread only by being intimate with an infected person, so travellers are at a very low risk. But if you must travel to a region affected by an Ebola outbreak, you can protect yourself by:
• Wash hands frequently and use an alcohol-based sanitizer.
• Avoid contact with blood and body fluids of other humans, especially someone who is sick.
• Do not handle items that have been in contact with an infected person’s blood or body fluids.
• Do not touch a person who has died from Ebola.
• Do not touch bats, non-human primates or their blood and fluids, and do not touch or eat raw meat from these animals.
• Avoid facilities where Ebola patients are being treated.
• Seek medical care immediately if you develop fever, headache, muscle pain, fatigue, diarrhoea, vomiting, stomach pain, bruising or bleeding.
• Limit your contact with people until you go to your doctor. Do not travel anywhere else besides a healthcare facility.