In surreal scenes worthy of science fiction from Hollywood coming to the Third World, masked men and women dressed in sterile overalls started quarantining the crowded Gulu district of northern Uganda where 63 cases of the highly contagious and deadly Ebola virus were confirmed.
Unchecked Ebola, identified in 1976, can cut through a population like a scythe, killing everyone in contact with it.
There is no vaccination, no known cure, and it can kill in 48 hours, although incubation can take 14 days.
The only effective action is to isolate the infected area and allow those with the disease to die. Only three out of every 10 will survive.
In an outbreak in Uganda, in the blighted sprawl of Gulu - the region's largest town and a trading post on routes leading to the Democratic Republic of Congo (DRC) and Sudan - the government hospital couldn't cope.
According to the Independent Newspaper in the UK, Kenya has sent health officials to try to stem any influx of people from north-east Uganda.
Ebola, which causes victims to bleed to death through every orifice, is not airborne and spreads only through physical contact with an infected person or their fluids. In its early stages, the victims suffer high fever, severe muscle pain and oral bleeding. So, what is the ordinary citizen ought to know about this catastrophe in order to avoid unnecessary panic?
What is Ebola?
Ebola Hemorrhagic Fever (EHF), also nicknamed Ebola, is a severe and often deadly illness that can occur in humans and primates (monkeys, gorillas). Ebola Hemorrhagic Fever has made worldwide news because of its destructive potential.
Ebola is a filovirus named after a river in Zaire, its first site of discovery. This filovirus is usually fatal, and it affects monkeys, apes and humans. Filoviruses are string-shaped, with a little hook or loop at one end. Another filovirus is the Marbug virus, which gives similar symptoms to Ebola, but the chance of surving an infection of Marbug virus is higher.
The Ebola fever is a serious disease caused by the Ebola virus, which is named for the Ebola River in the Congo (formerly Zaire). Ebola Fever causes high fever, rash, and bleeding throughout the body. People with Ebola fever often die very quickly.
Although scientists know that the disease results from a viral infection, they still have not solved the mystery of its origin and mode of transmission to humans.
The Ebola virus belongs to the group of viruses called filoviruses, as do the Marburg and Reston viruses. Scientists first identified the Marburg virus in 1967, when it caused a small outbreak among sick monkeys brought from Africa to a medical laboratory in Marburg, Germany. In 1976, a filovirus named for the Ebola River in Zaire (now the Congo) caused an epidemic in central Africa that killed hundreds of people.
Smaller outbreaks have occurred in Africa since then. In 1989 and 1990, many monkeys shipped from Asia to a research laboratory in Reston, Virginia, died from a disease that was found to have been caused by a filovirus.
The Ebola virus is comprised of five distinct species: Bundibugyo, Ivory Coast, Reston, Sudan and Zaire. Bundibugyo, Sudan and Zaire species have been associated with large Ebola haemorrhagic fever (EHF) outbreaks in Africa, while the Ivory Coast and Reston species have not.
EHF is a febrile haemorrhagic illness which causes death in 25-90% of all cases. The Ebola Reston species, found in the Philippines, can infect humans, but no illness or death in humans has been reported to date. As I mentioned above, Ebola hemorrhagic fever (Ebola fever) is caused by a virus belonging to the family called Filoviridae.
Scientists have identified five types of Ebola virus. Three have been reported to cause disease in humans: Ebola-Zaire virus, Ebola-Sudan virus and Ebola-Ivory Coast virus. The human disease has so far been limited to parts of Africa. The Reston type of Ebola virus has recently been found in the Philippines.
The virus is one of two members of a family of RNA viruses called the Filoviridae.
How is Ebola virus spread?
Infections with Ebola virus are acute. There is no carrier state. Because the natural reservoir of the virus is unknown, the manner in which the virus first appears in a human at the start of an outbreak has not been determined.
However, researchers have hypothesized that the first patient becomes infected through contact with an infected animal. After the first case-patient in an outbreak setting is infected, the virus can be transmitted in several ways. People can be exposed to Ebola virus from direct contact with the blood and/or secretions of an infected person.
Thus, the virus is often spread through families and friends because they come in close contact with such secretions when caring for infected persons. People can also be exposed to Ebola virus through contact with objects, such as needles, that have been contaminated with infected secretions.
Nosocomial transmission refers to the spread of a disease within a health-care setting, such as a clinic or hospital. It occurs frequently during Ebola HF outbreaks. In African health-care facilities, patients are often cared for without the use of a mask, gown, or gloves. Exposure to the virus has occurred when health care workers treated individuals with Ebola HF without wearing these types of protective clothing.
In addition, when needles or syringes are used, they may not be of the disposable type, or may not have been sterilized, but only rinsed before reinsertion into multi-use vials of medicine. If needles or syringes become contaminated with virus and are then reused, numerous people can become infected.
What are the causes of Ebola?
The disease can be passed to humans from infected animals and animal materials. Ebola can also be spread between humans by close contact with infected body fluids or through infected needles in the hospital.
How is Filiovirus (Ebola) transmitted?
The earliest strains, as well as the new ones, were transmitted through bodily fluids such as during sexual intercourse. However, this was not just limited to sexual transmission, as the virus was spread orally via the transfer of saliva.
This also means that a bite from an infected animal would also transmit the virus. Newer strains of the virus have been shown to be transmitted solely through physical contact. Even the handling of monkeys, chimpanzees, and apes that are infected puts humans at a great risk for contracting the virus. The virus can still be spread easily through the dead bodies of monkeys, apes and humans. Therefore, this has led to a controversial practice of mass burnings of the infected dead.
Of course, the early stages of the virus are mild compared to the later stages. Infected humans cannot yet transmit the virus through contact. It is during this stage that the most hope comes for treatment and prevention. If treatment cannot be provided, then isolation is necessary. There is a great fear that Ebola will become airborne and spread across the globe.
In older days, it was thought that there was very little chance of this happening. However, in recent years, an outbreak of an airborne strain of Ebola infected and decimated a monkey population in Africa. Luckily, this strain could not infect humans and was contained before it spread too far.
In 2006, scientists developed a treatment to combat Ebola. In testing it on rhesus monkeys, they concluded that there was a seventy percent success rate. Human trials are expected to begin soon. These tests are still going on and are expected to be of value clinically in few years ahead.
What are the symptoms of Ebola?
So what are the symptoms of Ebola? How can you know that you have Ebola? It is not easy to know if you have Ebola, because the symptoms of Ebola generally resemble other common ailments such as Malaria or Typhoid, especially in its early stages.
However, with its progression, you can be able to detect it. During the incubation period, which can last about 1 week after infection, symptoms include: Arthritis, Backache, (low-back pain), Chills, Diarrheoa, Fatigue, Fever, Headache, Malaise, Nausea, Sore throat and Vomiting. Late symptoms include: bleeding from eyes, ears, and nose; bleeding from the mouth and rectum (gastrointestinal bleeding), depression, eye swelling (conjunctivitis), genital swelling (labia and scrotum), increased feeling of pain in the skin, rash over the entire body that often contains blood (hemorrhagic) and roof of mouth looks red.
And so, how is Ebola Haemorrhagic Fever (Ebola) clinically diagnosed?
Diagnosing Ebola HF in an individual who has been infected only a few days is difficult because early symptoms, such as red and itchy eyes and a skin rash, are nonspecific to the virus and are seen in other patients with diseases that occur much more frequently.
If a person has a constellation of symptoms and infection with Ebola virus is suspected, several laboratory tests should be done promptly. These include a blood film examination for malaria and a blood culture. If the suspected patient has bloody diarrhoea, a stool culture should also be performed.
As I have already mentioned, the Ebola virus is one of the most deadly pathogens in the world. The virus damages the lining of blood vessels and platelets, making it difficult for blood to coagulate. This, in turn, usually results in hemorrhagic fever. In short, if untreated the patient literally bleeds to death from the inside out with the virus ultimately liquefying the patient's internal organs.
Given the lack of medical facilities in many of the places where Ebola has broken out, and to be specific in Africa, reaching a definitive Ebola diagnosis can be a doctor's greatest challenge. Monitoring a patient's symptoms can be only partially effective in reaching a conclusive Ebola diagnosis, however, because the symptoms mirror so many other conditions including Typhoid fever, malaria, or the flu.
That said, initial symptoms come on suddenly and include muscle and joint pain, headaches, a high fever and abdominal pain. As the condition worsens, more prominent symptoms appear including bleeding from orifices, bloody diarrhea, and red, bloodshot eyes. Open wounds that have not yet healed completely may also bleed.
These latter symptoms are generally the more definitive ones used by physicians (in the absence of a blood test) when committing to an Ebola diagnosis of the patient. Other methods used in conclusively diagnosing Ebola (if and where available) are urine and blood tests. The most conclusive tests use a method that analyzes the patients immunoflourescent antibody levels.
Once an Ebola diagnosis is conclusively reached, there is little that can be done for the patient. The mortality rate for Ebola is extremely high, with most patients dying of organ failure brought on by hemorrhagic fever. For the most part, the patient is treated for secondary conditions such as dehydration and closely monitored for oxygen and blood pressure monitors. The replacement of coagulating elements has been shown to help stop the bleeding.
What laboratory tests are used to diagnose Ebola haemorrhagic fever?
This may sound too complicated for a layman unaccustomed to scientific escapades. However, I will mention it though it may be difficult to capture. Antigen-capture enzyme-linked immunosorbent assay, also called ELISA testing is performed. In addition, IgG ELISA, polymerase chain reaction (PCR), and virus isolation can be used to diagnose a case of Ebola HF within a few days of the onset of symptoms.
Persons tested later in the course of the disease or after recovery can be tested for IgM and IgG antibodies; the disease can also be diagnosed retrospectively in deceased patients by using immunohistochemistry testing, virus isolation, or PCR.
That said, what is the cure for Ebola virus?
There is absolutely no cure at all. There are currently no proven Ebola treatment options that can kill the Ebola virus. Ebola treatment focuses on providing relief of Ebola symptoms as the body fights the virus. This is called supportive care.
Ebola treatment can include supportive care such as: Intravenous (IV) fluids to maintain fluids and electrolytes (sodium, potassium, and chloride), oxygen and devices that help with breathing, medications to control fever, help the blood clot, and maintain blood pressure, antibiotics to prevent secondary infections from bacteria and good nursing care. Death occurs in 50 to 90 percent of Ebola cases.
Ebola research scientists do not understand why some patients are able to recover from Ebola Hemorrhagic Fever and others are not; however, it is known that Ebola victims usually have not developed a significant immune response to the Ebola virus at the time of death.
How can the Ebola Virus be prevented?
Once an Ebola outbreak begins, the effects of the virus can be devastating. It is an earthquake developing after a Tsunami. For there is no Ebola cure, and once a person develops an Ebola virus infection, the chance of death can be as high as 90 percent. Because there is no Ebola vaccine that is currently licensed, Ebola prevention focuses on preventing direct contact with body fluid of those infected with the virus.
Another aspect of Ebola prevention involves avoiding direct contact with the body of an Ebola victim who has died as a result of the virus. Ebola prevention in Africa presents many challenges. Because the identity and location of the animal host of Ebola virus are unknown, there are few established primary Ebola prevention measures.
If cases of Ebola do appear, current social and economic conditions often favour the spread of an epidemic within healthcare facilities; therefore, healthcare providers must be able to recognize a case of Ebola should one appear. They must also have the capability to perform Ebola diagnostic tests and be ready to employ practical Ebola isolation precautions or barrier nursing techniques. These techniques include: the use of infection-control measures, including complete sterilization of equipment, the isolation of patients with Ebola Hemorrhagic Fever from contact with unprotected people and the wearing of protective clothing, such as masks, gloves, gowns, and goggles.
For this reason, Ebola must be taken extremely seriously, for you can imagine its effects once it spreads in slums like Mathere, Mukuru wa Njenga or Kibera where population is overcrowded and whereby all that populace come to the city centre and shake hands with others. Its not just in the slums, the disease can spread wildly even in Lavington, but the use of slums here is an anology to indicate how the disease can spread faster than the winds of harmattan.
Is there light at the end of the tunnel?
Yes there is. As of 14th June 2012, Canadian scientists announced a potential breakthrough in the discovery of a known cure for the Ebola Virus. Canadian researchers reported a potential advance in the treatment of Ebola virus infection. Researchers from the National Microbiology Laboratory in Winnipeg are still reporting that monkeys deliberately infected with Ebola were successfully saved with a cocktail of antibodies against the virus.
Four of four monkeys given the treatment 24 hours after infection survived. And two of four monkeys treated 48 hours after infection also survived. Of course Ebola is an incredibly aggressive virus that kills 90 percent of people it infects, and it is often feared that its use as a biological weapon could wipe out millions of people—because it has no known cure.
Now, though, scientists are one step closer to finding a solution, because they can now successfully cure monkeys which contract the virus. There have been some suggested Ebola cures in the past, but they had to be administered within minutes of infection—which is completely impractical. Now, though, researchers from the National Microbiology Laboratory in Winnipeg, Canada, have developed a cocktail of antibodies called ZMAb which cures cynomolgus monkeys infected with the Zaire virus—the deadliest strain of Ebola.
The treatment works best when administered within 24 hours of infection, with 100 per cent of monkeys treated in such a way surviving. The researchers also report, however, that two of four monkeys given the medication 48 hours after infection also lived. By contrast, any monkey left untreated dies within five days.
The results appear in Science Translational Medicine. The antibodies used in the treatment are actually isolated from mice which are vaccinated with part of the virus, and the researchers are hopeful that they should also work in humans. The researchers plan to test the safety of the treatment in humans in a phase 1 clinical trial set to begin before the end of 2014. However, with all these medical advances, the best precaution is for individuals to be well informed and take precausative measures. For prevention is better than cure.
-Peter Nguli from England, United Kingdom
Email: pnn20@hotmail.com
