A guest article by Alexandra Johansson and Kirsty Toms
Ebola Virus Disease, also known as Ebola Haemorrhagic Fever, is a disease which has been in the news with increasing frequency lately.
This article aims to give you an overview of what Ebola is, why it’s so dangerous and what can be done to prevent it. As this current outbreak is of an unprecedented magnitude, it is not something most doctors have been taught much about or have any experience with. Therefore the following is based on our own research. For more information on Ebola, the WHO has produced a fact sheet which is available on the Internet.
WHAT IS EBOLA?
Ebola is a virus carried by fruit bats, which don’t become ill despite being infected. The first known case was recorded in 1976 and occurred by the Ebola River in the Democratic Republic of Congo (DRC). It spreads to humans and other primates that consume bat meat or fruit contaminated with bat droppings. Humans can also contract it from handling primate carcasses or eating bush meat such as gorillas and chimpanzees.
Ebola spreads between humans via bodily fluids such as blood, sweat, saliva, urine, stools and semen (men can transmit Ebola in their semen up to two months after recovering from the virus) and vaginal secretions. The virus remains infective in these body fluids once someone has died. It can enter the body via your mouth, eyes, small cuts in your skin or by using contaminated needles. This means that if you touch the soiled clothing or sheets of someone who has Ebola and subsequently touch your eyes or mouth, you could contract the virus.
WHAT ARE THE SYMPTOMS OF EBOLA?
Symptoms appear 2 days to 3 weeks after being exposed to the virus. The initial symptoms start suddenly and are usually flu-like, including fever, headache, joint pain, muscle pain, fatigue and abdominal pain. People may then get a skin rash, vomiting, diarrhoea and decreased appetite. The above symptoms can easily be mistaken for a number of different illnesses, for example dengue, malaria, leptospirosis, typhoid, cholera, other haemorrhagic fevers and even chikungunya.
Around 50% of those infected go on to develop bleeding, also known as haemorrhages, 5-7 days after their first symptoms begin. This bleeding may be from the mouth, digestive tract, eyes and vagina etc. The patient may have red eyes, vomit blood and have bruised skin. Their ability to clot blood is also impaired. These symptoms indicate a poor prognosis.
People usually die from Ebola due to a combination of bleeding and dehydration, which causes organ failure. The death rate is extremely high – it is estimated to be anywhere from 50-90%. WHO reports that the rate in the current outbreak is around 60-65%.
People who survive Ebola may suffer from long term complications such as joint pain, muscle pain, skin peeling, hair loss, inflamed testicles, light sensitivity and other eye problems including blindness.
HOW IS IT DIAGNOSED?
The doctor will want to know about recent work, travel and exposure to wild animals. Ebola is diagnosed using a blood test. People suffering from Ebola will be closely monitored for their vital signs, temperature, blood clotting, haemoglobin and kidney function.
HOW IS IT TREATED?
There are currently no specific treatments for Ebola. The most important aspect of management is to replace fluid losses with salt and sugar solutions.
Some experimental drugs have also been given to selected patients via ‘named patient programs’. This is where a drug that is not licensed and hasn’t completed appropriate clinical trials, is given when all other treatment options have been exhausted. The patient must give consent and be carefully monitored as this is not something which is done routinely.
WHAT CAN BE DONE TO PREVENT EBOLA?
It extremely important that any one infected with Ebola is isolated from other people. Those in contact with Ebola sufferers must wear protective clothing which completely covers their body. This includes masks, gloves, gowns and goggles (and somewhat resembles a space suit). It is also essential to stick to strict hygiene procedures such as hand washing, sterilising equipment at very high heat and cleaning all surfaces using strong detergents. Furthermore, having large stocks of protective clothing and disposable equipment, like needles, are important, as reusing these can transmit Ebola.
Other measures to prevent the spread of Ebola include information campaigns about the virus to dispel rumours and educate people about symptoms and seeking help early. This has been an issue in West Africa where around half of the population cannot read and it is therefore very difficult to spread information. These societies also have strong spiritual beliefs, for example the washing and embalming of the dead. Medical staff have prevented families from caring for their relatives and washing their dead bodies, in order to prevent the spread of the disease. This has been met with suspicion in some areas and sparked rumours that Ebola is a hoax invented by medical professionals to hide acts of cannibalism, which has obviously not helped the situation.
WHY IS THE CURRENT OUTBREAK SO SERIOUS?
The current outbreak started in West Africa, an area that has never experienced an Ebola epidemic before. Ebola classically affects rural areas of central Africa, such as Uganda and the DRC, where small outbreaks tend to happen every few years and are usually reasonably well contained. The first case this time around occurred in December 2013, but it took until March 2014 for Ebola to be identified as the cause. During this time many more people had been infected, especially as the outbreak began in a border area of Guinea where people travel quite frequently.
The affected countries are Guinea, Liberia, Sierra Leone and Nigeria. There is also an ongoing epidemic in the DRC, but this appears to be unrelated to the outbreak in West Africa.
As of the 28th of August, 3069 people have been infected and 1552 of those have died of Ebola. The WHO believes that actual figures may be 2-4 times higher than this as not all sufferers have sought medical help. Parts of West Africa have also lost great proportions of their healthcare staff due to lack of sufficient protective clothing, clean water and detergents. This will have implications for many years to come.
EBOLA AND DOMINICA
To prevent Ebola from reaching Dominica we think that the authorities need to keep a close eye on its spread, especially if it reaches other Caribbean islands. It is important to have a plan in place for how to deal with potentially infected travellers entering the country, recognise their symptoms and have them isolated. To achieve this it is necessary to train staff in both the public and private health sectors, educate other public sector workers and have access to protective clothing for healthcare staff. The nightmare scenario is not so much someone infected with Ebola entering the country, but that they enter undetected and proceed to infect others. The key point is that vigilance and good preparation are required to curb the threat of Ebola.
See you next week.
Alexandra Johansson and Kirsty Toms are medical students at the University of Glasgow in Scotland, on attachment with Dr. Emanuel for the month of August.