Ebola - Hemorrhagic Fever

What is Ebola Hemorrhagic Fever?:

Due in part to the 1994 best-selling book by Richard Preston, The Hot Zone and to the 1995 movie Outbreak with Dustin Hoffman, Ebola hemorrhagic fever has become a relatively well-known viral infection.

It is a severe and usually fatal disease that is known to exist in monkeys, chimpanzees, and gorillas. As a zoonotic disease, it has been known to jump from animals to infect humans. It is named after a river in Africa where the infection was first recognized. It is one of two members of a family of RNA viruses known as Filoviridae, with four subtypes.

Three of the four subtypes are known to cause disease in humans:

· Ebola-Zaire – deadliest form, killing 90% of all victims.

· Ebola-Sudan – mortality rate 50%.

· Ebola-Ivory Coast very mild.

· Ebola-Reston only causes disease in monkeys, responsible for the outbreak among the primates in Reston, VA at a research facility.

Ebola is found in nature:

Ebola is a mystery. The exact origin of the Ebola virus remains unknown. Its natural habitat has yet to be discovered. How it jumps from animals to humans is also unknown. The unknown about a highly fatal disease is what makes Ebola a disease of great interest whenever there is an outbreak somewhere in the world.

Based on many field investigations, it is believed that the virus exists in nature, and is normally carried by various animal hosts that are native to the African continent.

Ebola hemorrhagic occurrences:

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Confirmed cases of Ebola hemorrhagic fever have been found in the Democratic Republic of the Congo, in the Sudan, Gabon, the Ivory Coast, Uganda, and the Republic of the Congo. In England there was a laboratory worker who became ill with the virus after an accidental needle-stick. There have been no human disease cases reported in the United States, however the one non-human infecting virus did cause disease in monkeys that had been imported to research facilities in the United States and Italy. Several workers became infected with the virus during this time but did not become ill.

Ebola occurs in sporadic and unexplained outbreaks, with numerous outbreaks likely going unnoticed and unreported.

How the disease is spread:

Ebola hemorrhagic fever is a very acute infection. As a result, there is no carrier state. Because the natural reservoir of the virus still unknown, it has been impossible to determine how the manner of the virus first appears in humans at the start of an outbreak. One hypothesis is that the first patient likely becomes infected through contact with an infected animal.

This first case patient is considered to be a "ground zero" patient and from this point the virus can be transmitted in a variety of ways. Most people who are exposed to the Ebola virus from direct contact with blood or body fluids of an infected person will contract the disease, explaining why the virus is often spread within a family or a close circle of friends. Infection is also a risk with either accidental, or purposeful use of infected needles; explaining the need to understand the transmission of disease and not to use needles multiple times. In poorer nations, needles are often merely rinsed before being reinserted into vials of medicine. In this manner, numerous people can become infected.

Symptoms of Ebola hemorrhagic fever:

The incubation period for the Ebola virus ranges anywhere from two to twenty-one days. The patient quickly begins to experience flu-like symptoms of fever, headache, joint and muscle aches, sore throat, weakness. Soon afterward the patient will begin to experience diarrhea, vomiting, and stomach pain. Skin rash, red eyes, hiccups, and internal and external bleeding becomes apparent in some patients. As the disease continues to progress, the kidneys and liver may stop functioning normally. In fatal cases, the internal and external bleeding becomes uncontrollable, resulting in the vomiting of blood and bleeding from the eyes, ears, and nose. Medical researchers have not been able to establish why some people can recover from Ebola and others do not.

Establishing Clinical Diagnosis:

Because the early symptoms of Ebola mimic those of other less serious diseases such as red eyes and a skin rash, it is difficult to know that an Ebola infection has erupted in that patient. However, once it is suspected that the patient is infected with the Ebola virus, the patient MUST be isolated immediately and notification of local and state health departments as well as the CDC must be undertaken.

The truth about Ebola is that it is not really considered to be a human disease. It is believed to be carried in an animal or an insect and when a human becomes infected, it is thought to be an accidental infection. However, once a human is infected, the disease is quickly and easily spread to other humans through direct contact of the body or body fluids of the infected person. No airborne transmission of the disease has been documented among humans, though the Ebola-Reston disease did appear to spread among monkeys through airborne transmission.

Treating Ebola:

There is no standard treatment for Ebola. Patients are given supportive therapy which means giving them IVs in order to keep their fluid level up and their electrolytes balance. Their oxygen status must be maintained as well as their blood pressure. Any complicating infections can be treated with usual medications, but there is no known treatment for the Ebola virus.

Preventing Ebola:

This is the particular challenge in preventing Ebola outbreaks. Because the identity of the natural mode of transmission is unknown as is the location of the origin, there are very few preventive measures.

Preventing the spread of the disease is a bit easier. Once the disease erupts, then the spread of the disease can be prevented if the correct measures are undertaken. Unfortunately, because Ebola typically erupts in less developed parts of Africa, the spread of the epidemic within the healthcare facility can easily happen. Patient isolation is the first line of defense as are the use of barrier nursing techniques that keep the caregivers from becoming infected. These techniques include using protective clothing such as masks, gowns, gloves, and even goggles. Other infection control measures include completely sterilizing or disposing of all equipment used on an infected patient.

The idea is to avoid contact with any bodily fluids, blood, serum, emesis, diarrhea among other secretions. Contact with a deceased Ebola patient must be prevented and undertaken only with the proper precautions.

CDC and WHO have worked together to establish a set of tools to help to meet the needs of health-care facilities that handle Ebola patients. The manual describes how to recognize cases of viral hemorrhagic and to prevent spread of infection within the facility.

Surveillance of Ebola:

The greatest problem with Ebola infections is lack of information about the source, which requires ongoing systematic collection and analysis of data of any Ebola outbreaks anywhere in the world.

The fact is that Ebola has killed fewer than 1000 people since 1976. That number is matched in any large city by pneumonia deaths. Tuberculosis kills five times that many people every day. Even in Africa, more than 700,000 people die from malarial infections, and over 900,000 die from diarrhea alone.

Because Ebola is so deadly, it raises fear to near-panic levels. There is the fear that someone infected with the virus will get on an airplane, fly around the world and cause a major Ebola epidemic somewhere in the world. Epidemiologists believe such a risk is near zero because Ebola is really most contagious during its final stages of illness, when the patient is near death. The other reason Ebola does not seem to present pandemic problems is due to its high mortality rate. Killing the host effectively stops the spread of the disease.