Ebola Awareness by Sr. Rhodah Nkowani, GSSC
The 2014 Ebola outbreak started in Guinea in December 2013 and now Guinea, Sierra Leone and Liberia are all severely affected. It is the largest outbreak to date, at the time of writing there were over 9,000 confirmed or suspected cases.
There is a recognition from international organisations and Governments that the investment of finances and resources must be used to tackle Ebola in West Africa. This will be how this outbreak will be brought under control.
However, there are also concerns, following a small number of travel related cases and healthcare worker infections that the risks of Ebola in unaffected countries must be addressed and prepared for.
There is no currently established treatment for Ebola or any vaccine available. There have been a number of unregistered drugs and therapies used during the current outbreak and the World Health Organisation (WHO) have decided that with safeguards in place, this can be an ethical option. There has also been an international push to ensure research and testing can be done on these potential vaccines and treatments to have them available as soon as possible.
1 Ebola virus disease
Ebola virus disease, formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.1 It is a rare disease in humans and non-human primates caused by the Ebola virus, a filovirus that was first recognised in 1976 and has caused sporadic outbreaks since then in several African countries.
Chronology of major Ebola outbreaks
Year Location Cases Deaths
1976 Zaire (now Democratic Republic of Congo) 318 288
1976 Sudan 284 151
1979 Sudan 34 22
1994 Gabon 52 31
1995 Democratic Republic of Congo (formerly Zaire) 315 250
1996-97 Gabon 97 66
2000-01 Uganda 425 224
2001-02 Gabon 65 53
2001-02 Congo 57 43
2002-03 Congo 143 128
2004 Sudan 17 7
2007-08 Uganda 149 37
2008-09 Democratic Republic of Congo 32 15
2012 Uganda 11 4
2012 Democratic Republic of Congo 36 13
2014- Multiple Countries 8,033 3,865
Source: cdc.gov; WHO GAR Situation Reports
There are five different strains of the Ebola virus, four of which have caused infection in humans. The current outbreak is caused by the Zaire strain.
Ebola is a severe acute viral illness.3 Once the virus enters the body it can replicate very quickly, causing a range of symptoms of increasing severity. The disease is fatal in 50-90% of cases. Classically, symptoms can include fever, intense weakness, muscle pain, headache and sore throat, vomiting and diarrhoea, impaired kidney and liver function, and in some cases, both internal and external bleeding.4
The incubation period (the time interval from infection with the virus to onset of symptoms) is
2 to 21 days.
1.2 Diagnosis and treatment
The symptoms of Ebola virus infection can be similar to other infections such as malaria, cholera and typhoid fever. Definitive diagnosis can be made using a number of laboratory tests. The tests chosen may depend on how long the patient has been experiencing symptoms.
There is no established treatment currently for Ebola virus infection- management is supportive care. This is likely to include oral or intravenous rehydration as patients are often dehydrated.
There is no current effective vaccine for the virus but several are being tested. A number of new treatments have been trialled during the 2014 Ebola outbreak, more information on these is provide in section 5 of this note.
Transmission of Ebola can be from animal to human or human to human contact.
Infection has been documented as a result of handling infected wild animals in some parts of Africa. The virus is transmitted between humans through close contact with bodily fluids from symptomatic people.
Healthcare workers are vulnerable to infection when they have close contact with patients without proper protective clothing. Burials where people have close contact with the deceased can also transmit the disease.
Transmission may also occur following sex with an infected person or from touching the soiled clothes of an infected person.
It is important to note that Ebola is not as infectious as many other diseases (for example, Influenza) and is usually not spread through everyday social contact. Close contact is normally needed for transmission.5
Some media coverage has questioned whether or not the Ebola virus could, in future, change its mode of transmission to become airborne, following comments made by the UN Secretary General’s special representative.6 7 A number of infectious diseases and public health experts have provided reaction to these reports. They have stated that this mutation would be highly unlikely and to suggest otherwise was irresponsible:
To suggest that Ebola could become airborne is completely irresponsible. The way the virus is spreading is consistent with what we’ve seen in all previous 25 outbreaks, only transmitting through blood and bodily secretions. There is no precedent for a virus changing its mode of transmission so drastically. Other viruses such as HIV – which transmit in the same way, have passed through millions of humans, and are known to mutate more than Ebola – have not become airborne. Making such claims is an unwelcome distraction from the urgent need to scale up the international response to the ongoing humanitarian crisis in West Africa.
The World Health Organisation have also addressed these claims. They advise that any speculation that the Ebola virus may mutate to a new airborne form is unsubstantiated.9
Following the Ministerial statement on the UK response to Ebola in the Parliament on 13
October, Professor Lord Robert Winston asked for reassurance that the low risk of possible mutation of the virus was being looked at, to ensure that the mode of transmission does not change. The Under-Secretary of State for Health stated that there was close monitoring of the virus and the way in which it mutates.
The World Health Organisation and Public Health England both provide guidance to healthcare workers and others on how to protect against transmission.
For further info visit CDC