( reposted with some updates)

The Ebola virus was first identified in Western Equatoria State of South Sudan and in a nearby region of Zaire (now the Democratic Republic of the Congo) in 1976 after significant epidemics in Yambuku, northern Zaire, and Nzara, Southern Sudan. Ebola Virus Disease, formerly known as Ebola Hemorrhagic Fever (EHF) is one of the most virulent diseases known to humankind. It causes death in 50-90% of all clinically ill cases. The disease is caused by infection with the Ebola virus, named after a river in the Democratic Republic of the Congo (Ebola River). Reports indicate that current outbreak has a fatality rate of 50-70%.

How Ebola Outbreaks Start

First human cases start with infection by an animal-Chimpanzees, gorillas, monkeys, forest antelopes, fruit bats, porcupines… However the origin of the current outbreak is unknown.

Infection from person-to-person creates an outbreak

-Direct or indirect physical contact with body fluids of infected person (blood, saliva, vomitus, urine, stool, semen)

Well known locations where transmission occurs

– Hospital: Healthcare workers, other patients, unsafe injection practices, poor management of infectious waste

-Communities: Family, friends and contacts caring for patients Funeral practices including body handling, communal hand washing

Ebola transmission

• Direct contact with wounds, body fluids like blood, saliva, vomitus, stool and urine of a person suffering from Ebola or splashing of such fluids from an infected person into another person’s eyes
• Direct physical handling of dead bodies of persons who have died of Ebola
• Handling dead animals especially monkeys
• Infection can also occur if broken skin or mucous membranes of a healthy person come into contact an Ebola patient’s infectious fluids such as soiled clothing, bed linen, or used needles.
• Health workers frequently get exposed to the virus when caring for Ebola patients, when they do not wear personal protection equipment, such as gloves, masks when caring for the patients.

The incubation period of Ebola

The time interval from infection to onset of symptoms is 2 to 21 days.

During this time, the patient becomes contagious once they begin to show symptoms.

They are not contagious during the incubation period

Clinical Symptoms of Ebola

Initial Phase:

• Sudden onset of fever
• Intense weakness
• Muscle pain
• Headache and sore throat

Second phase

• Vomiting, diarrhea and skin rash
• Impaired kidney and liver function, and
• In some cases both internal and external bleeding

Severe Cases:

• Bleeding under skin and internal organs

Laboratory diagnosis

At the initial stages of the infection clinical diagnosis may be difficult because the early symptoms like fever, vomiting and diarrhea are often seen in other diseases that occur more frequently.

Ebola virus infections can only be confirmed through advance laboratory testing.

Testing is conducted in selected laboratories with maximum biological containment standards because

Ebola samples are an extreme biohazard risk.

Ebola treatment / supportive therapy

There is currently no specific treatment to cure the disease, however, new drug therapies ( eg. Zmap) are under evaluation and trial. Brincidofovir was recently approved by FDA. Blood transfusion from Ebola survivors have also been used in few patients.

Severely ill patients require intensive supportive care which includes intravenous fluids or oral rehydration with solutions that contain electrolytes because they are frequently dehydrated.

Some patients will recover with the appropriate medical care.

To prevent further spread of the virus, people that are suspected to have the disease should be isolated from other patients and treated by health workers using strict infection control precautions

 Prevention and Control

• Currently there is no licensed vaccine for Ebola virus disease, several vaccines are being tested but none is available for clinical use.
• Avoid direct contact with body fluids, blood, saliva, vomitus, urine, and stool by wearing protective materials like gloves and goggles.
• Do not touch wounds of an infected person with unprotected hands.
• Do not use skin piercing instruments that have been used on a patient suffering from Ebola.
• After handling a patient suffering from Ebola, you must wash your hand thoroughly with soap and water.
• Animal products (blood and meat) should be thoroughly cooked before consumption.
• Avoid handling sick or dead animals such as non-human primates and other forest animals like fruit bats and porcupines.
• Persons who have died of Ebola must be handled by trained health staff wearing strong protective wear and buried immediately to prevent spread of the disease.
• Avoid feasting and funeral gatherings during Ebola outbreaks.
• Raising awareness of the risk factors and measures people can take to protect themselves are the only ways to reduce illness and deaths.

Educational public health messages for risk reduction should focus on:

• Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes, and the consumption of their raw meat
• Handle animals with gloves and other appropriate protective clothing
• All animal products (blood and meat) should be thoroughly cooked before consumption
• Avoid any contact with Ebola patients
• Gloves and personal protective gear should be worn when taking care of patients at home
• Regular hand washing should be practiced at all times, and should be strictly done when taking care of patients
• Burial of people who have died of Ebola should be conducted as soon as possible, under supervision of trained health personnel

Essential components of control

• National leadership
• Strong community awareness and support
• Immediate care of affected patients
• Strengthen the capacity of the local health system

Stop transmission:

• Actively identify, investigate ALL new cases, contacts, deaths
• Maintain detailed databases
• Monitor contacts for 21 days (isolate if ill)
• Confirm absence of virus by testing during recovery

Prevent

• Informed healthcare workers, consistent infection control /prevention
• Culturally-sensitive practices to reduce transmission

 Dr Mamude Dinkiye is a pediatrician. He completed medical school at Jimma Univerisity and a speciality training in Pediatrics from the School of Medicine at  Addis Ababa University. He also holds a Mater of Public Health degree from the School of Public Health at Hawassa University. He currently practices and lives in South Sudan.