Concerns About Ebola Virus Outbreak Rise

Should Americans or other people around the world be concerned about an Ebola virus outbreak?

A deadly Ebola virus outbreak has been reported recently in the West African nation of Guinea. As of the latest reports in April 2014, it that has claimed 122 human lives in Guinea and Liberia. However, this is a rapidly changing situation, and the number of reported cases, contacts under observation, and deaths are subject to changes due to ongoing surveillance and investigations.

No vaccine or cure currently exists for the hemorrhagic fever caused by Ebola, causing public health officials to be concerned about spread of the virus in these regions. However, the World Health Organization has not recommended any restrictions on trade or travel to Guinea and Liberia, or neighboring countries like Mali and Sierra Leone.

What is Ebola Virus?

The virus, named after the Ebola River in the Zaire, now known as the Democratic Republic of Congo, caused the first outbreak in 1976, in a Congolese village, followed by another outbreak in Sudan. These outbreaks were contained through public health measures, including quarantines. But in the past seven years, the worst outbreak has been reported in Guinea and Liberia, which lie within the range of Zaire Ebola.

Ebolaviruses belong to a family of viruses called Filoviridae, which also includes the cuevavirus and the marburgvirus. The ebolaviruses have five distinct species while the cuevavirus and the marburgvirus has one known species each. All known ebolaviruses can infect humans, causing similar symptoms of hemorrhagic fever. However, they differ in virulence and disease progression. The Reston ebolavirus, which has been found in pigs form the Philippines, causes no symptoms in infected humans. There is only one recorded case of non-fatal infection with the Taï Forest ebolavirus, a researcher who got the virus from a chimpanzee while he was performing a necropsy. The three other types are more deadly, with the Bundibugyo ebolavirus causing 40% mortality, the Sudan ebolavirus accounting for 50% mortality and up to 90% for Zaire ebolavirus.

Except for Reston ebolavirus, the only Asian species of these viruses, which has been discovered in pigs, Ebolaviruses are typically harbored by various species of fruit bats from central and sub-Saharan Africa. These viruses are believed to be introduced into humans through direct contact with the bats or through their secretions or excretions. They may also spread through contact with other hosts, such as great apes.

However, the virus is not as contagious as other viruses like colds, flu or measles.

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Symptoms of Ebola Virus Infection

People infected with Ebola virus usually present with non-specific symptoms initially, and these include high fever, muscle aches, headaches, sore throat, vomiting and diarrhea. Hemorrhage (bleeding) occurs in less that 50% of cases. Eventually, the liver and kidneys begin to fail. Experts of infectious diseases report that patients can die quickly, within 7-14 days after the appearance of symptoms.

These symptoms may be due to suppression of immune function, increased leakiness (permeability) of the blood vessels, and impaired blood coagulation.

Is It Possible To Have An Ebola Virus Outbreak Outside Of Africa?

The WHO reports that in Africa, documented cases of people who have fallen ill with the Ebola virus were found to have contact with dead or infected fruit bats, chimpanzees, gorillas, monkeys, antelopes and porcupines. According to US Centers for Disease Control and Prevention (CDC) estimates, there have been more than 1,800 cases and more than 1,300 deaths in Africa due to Ebola virus.

According to University of Pittsburgh Medical Center associate Amesh Adalja, MD, of the Center for Biosecurity, all outbreaks have occurred in isolated communities in Africa, where the people are poor and have no resources to fly out of the country or to travel far. One Ebola virus strain that caused an outbreak in monkeys in a laboratory outside Washington, DC did not cause illness or death to persons who were exposed to the monkeys. They were, however, observed to develop antibodies (immune system defense) to the virus.

Kamiliny Kalahne, an epidemiologist from Medecins Sans Frontieres (MSF), says there have been no reports of any cases of Ebola spreading to a developed country. The reason may be that the virus is transmitted when people are very sick with high fever and other symptoms, but when they are most unlikely to travel. She also says that an outbreak usually spreads in hospitals that have poor control for infections and limited resources (ex. no running water).

What Now?

Some patients also develop rashes, red eyes, chest pains, hiccups, difficulty breathing and difficulty swallowing.

Recent reports of a Canadian man who was being treated in an intensive care unit in a hospital with symptoms of hemorrhagic fever resembling Ebola confirmed that he tested negative for the virus. The man, who was in critical condition, was isolated in a facility in Saskatoon, Saskatchewan province, after he came home from West Africa. He tested negative to Ebola virus, Marburg virus, Rift Valley fever, and Lassa fever. According to WHO, he may have been suffering from severe malaria.

At present there are no vaccines or medicines to prevent or treat Ebola virus infections. Treatment is mostly in the form of supportive therapy. However, clinical trials are being done in search for possible treatment for the deadly disease. One antibody treatment, which has been tried in monkeys, shows that it may be effective even after more than 3 days of infection. Other vaccines using recombinant technology are also underway.

Scientists are also conducting surveillance activities to map out the geographic distribution of known bat hosts, as well as rodents and primates who may be carrying the viruses.

While these are on-going, experts believe that the best response we can have to ebolavirus infection is to be able to diagnose the disease during an outbreak. Detection of antigens and antibodies in the blood is important in confirming the diagnosis. 

In Africa, eating of bat meat has been banned. CDC urges travelers and healthcare workers to avoid contact with blood and other body fluids from people who may be infected. One can do simple steps to control infection, such as using gloves, gowns, and eye protection, to bring an end to an Ebola outbreak. People who have symptoms of hemorrhagic fever must seek immediate medical care.

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Several organizations, including the WHO, MSF, UNHCR, Save the Children and other health partners, have provided medical supplies, medical equipment, isolation units, and personal protective equipment (PPE) for health care facilities in Africa. Training for health-care workers in affected areas is being conducted for management of cases. Community education and mobilization of various organizations, including religious leaders and social media are being done to help prevent and control outbreaks of Ebola virus.

In the US, airline workers are trained to spot passengers who may have symptoms of illnesses, while quarantine officers in 20 major U.S. airports are ready to respond to in-flight illnesses.