By Muneeba Azmat, Ayub Medical College, Abbottabad
Ebola virus disease or Ebola hemorrhagic fever is a lethal infectious disease that has become the topic of many tabloids and papers after the March 2014 Ebola outbreak in West Africa. The outbreak that was first reported from Guinea, has now spread to Sierra Leone, Liberia and Nigeria and is the largest Ebola epidemic in the history. There have been more than 4,100 reported cases and 2400 deaths since the discovery of Ebola Virus and the current outbreak is the largest claiming more than 1552 deaths to date. Ebola first appeared in the Democratic Republic of Congo and Sudan back in 1976 and 432 people died due to the fever. The disease is caused by an infection from the Ebola Virus characterized by fever, body aches and eventually bleeding from body. The outbreak usually begins as few cases that spread via human to human contact and amplify into a full scale epidemic. Once someone contracts Ebola infection, the chances of survival are very rare (10%). Due to its virulent nature and threat to public health, efforts are being directed to fight this viral disease. Since Ebola Virus Disease is a relatively recent disease, a very ardent search for a cure or a vaccine is still unrewarded. Until any such miraculous drug is made, our only hope lies in prevention through awareness and exercising caution.
ABCs OF THE DISEASE
The Ebola virus disease presents as sudden fever, severe muscle weakness, pains, vomiting, diarrhoea, rash and decreased liver and kidney functions. Eventually it leads to bleeding/haemorrhage from inside and outside the body, and hence the name, Ebola haemorrhagic fever. The Ebola virus disease is caused by a group of single stranded RNA viruses of the genus Ebolavirus and family Filoviridae. Out of the group, Zaire ebolavirus is the most dangerous specie whereas Reston virus does not produces any detectable disease in the human species. 90% of the people diagnosed with Ebola disease die, if infected with the Zaire ebolavirus (case fatality between species range from 25-90%).
TRANSMISSION
This infection affects both the humans and the animals. The virus lives inside the body of fruit bats without producing any disease. From there it is shed in the environment through body fluids like saliva, bat droppings, etc and causes disease in the animals that come in contact with the body fluids.
These affected animals when consumed or carelessly handled by humans allow the virus to enter humans via blood, secretions, organs or other bodily fluids of infected animals. Within humans, the virus spreads through direct contact of broken skin or mucous membrane of healthy individuals to blood, saliva, sweat, secretions, organs or other bodily fluids of infected people. Men who have recovered from the disease keep shedding the virus in their semen till 7 weeks after recovery. Fortunately the virus is NOT transmitted by air.
Medical professionals (disease spread by physical contact with patients), families of Ebola affectees, hunters, burial providers, people who consume raw or improperly cooked meat of infected animals are at risk of acquiring the infection. The disease is also transferred via sexual contact and blood transfusions. In a nutshell, anyone who comes in contact with the body fluids of infected animals or humans is at risk of getting the infection.
DIAGNOSIS AND TREATMENT
The disease seems to appear with signs and symptoms very much similar to malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers. The diagnosis is confirmed by laboratory tests that work directly by detecting viral components in the body (nucleic acid and antigens) and indirectly by detecting body’s response to these viral components (IgM and IgG antibody detection). Since there is no cure for Ebola virus, the treatment means supportive treatment. Fluid and electrolytes balance are kept in check and coagulation profile is maintained to prevent haemorrhage. Early detection and intervention with good supportive treatment yields improved prognosis. There is no vaccination successful against Ebola virus, however, a few experimental drugs that have been effective against Ebola in monkeys have been approved by the FDA on emergency basis for the treatment of Ebola Virus Disease; but the definitive treatment still mainly relies on supportive therapies.
PREVENTION
The main strategy of Ebola prevention is to avoid contact of healthy individuals with Ebola infected animals and humans. Awareness regarding early detection of sign and symptoms of disease and containment measures should be spread especially in Airplane staff travelling to epidemic area. The people who have visited an Ebola affected country should monitor their health for 21 days by checking temperature twice daily and must seek help immediately if they develop signs and symptoms that correspond with Ebola disease. Spread of infection has to be checked by routine disinfection, health checkups and avoiding contact with use of proper clothing. Care of the affectees by professionals in Ebola specialized care facilities and disposal of dead animals and humans by trained staff are a few ways Ebola assassin can be kept at bay.
CONCLUSION
Ebola Virus disease is a cause of major concern all over the world. We should also shun our casual attitude towards Ebola Virus Disease. The reason? Pakistan is, as of yet, an Ebola free country but all it takes for an epidemic to break out is a single Ebola infected individual. We have to keep our eyes open and our guards up against any Ebola invasion into our territory because once Ebola enters Pakistan, controlling the infection would be very hard indeed. We have our hands already full with fight against tuberculosis, dengue, malaria, polio etc and we cannot afford another assassin on the other side of the line of fire. Effective Ebola virus prevention strategies should be applied on individual and government level to ensure that we do not fall prey to a rapidly spreading and lethal epidemic.It is important that people coming from West Africa should be screened at airports. In August 2014, the Ministry of National Health Services, Regulation and Coordination has sent an advisory to all Health Departments to take protective measures against the Ebola disease to tackle this potential threat. This is a very critical step forward in curtailing this rampant syndrome.