Medical Implications of Ebola
Transmission of Disease
Transmission: The act or process by which something is spread or passed from one person or thing to another
Direct Contact: Body fluids from the infected has had contact with eyes, nose, mouth, cut, wound, or abrasion are routes of entry for Ebola. The Ebola virus spreads through direct contact of bodily fluids, contaminated needles, or infected bats or apes. Ebola in Africa spread can be through poorly handled food from animals. Coughing and sneezing isn’t proven to spread Ebola, but the drops of saliva or mucus could be infectious so take caution.
Body fluids:
Ebola can survive outside the body in dry surface for hours, and in bodily fluid outside the body for several days. Recovered patients develop antibodies that last for at least 10 years, but it is unknown if they become immune. Recovered patients cannot spread virus any longer, but traces found in semen so best to abstain from sex after being infected with Ebola. No known insect can spread Ebola and only mammals (bats, humans, monkeys, apes) have shown to be able to spread it and be infected with it.
Fruit bats of Pteropodidae family are natural hosts of the Ebola virus. Infected animals could be chimpanzees, gorillas, fruit bats, monkeys, forest antelope, and porcupines sick or dead in rainforest. Burial ceremonies involving mourners that have direct contact with body of deceased is the main cause of the spread of disease after death from Ebola.
Ebola can only be able to spread if patient begins to show symptoms. Processes of blood transfusions that clear viruses especially for lipid-enveloped viruses has kept transfusions clean; Ebola could be deactivated due to this method, but there have been no cases of Ebola spread through blood transfusion.
Direct Contact: Body fluids from the infected has had contact with eyes, nose, mouth, cut, wound, or abrasion are routes of entry for Ebola. The Ebola virus spreads through direct contact of bodily fluids, contaminated needles, or infected bats or apes. Ebola in Africa spread can be through poorly handled food from animals. Coughing and sneezing isn’t proven to spread Ebola, but the drops of saliva or mucus could be infectious so take caution.
Body fluids:
- Blood
- Saliva
- Mucus
- Vomit
- Feces
- Sweat
- Tears
- Breast milk
- Urine
- Semen
Ebola can survive outside the body in dry surface for hours, and in bodily fluid outside the body for several days. Recovered patients develop antibodies that last for at least 10 years, but it is unknown if they become immune. Recovered patients cannot spread virus any longer, but traces found in semen so best to abstain from sex after being infected with Ebola. No known insect can spread Ebola and only mammals (bats, humans, monkeys, apes) have shown to be able to spread it and be infected with it.
Fruit bats of Pteropodidae family are natural hosts of the Ebola virus. Infected animals could be chimpanzees, gorillas, fruit bats, monkeys, forest antelope, and porcupines sick or dead in rainforest. Burial ceremonies involving mourners that have direct contact with body of deceased is the main cause of the spread of disease after death from Ebola.
Ebola can only be able to spread if patient begins to show symptoms. Processes of blood transfusions that clear viruses especially for lipid-enveloped viruses has kept transfusions clean; Ebola could be deactivated due to this method, but there have been no cases of Ebola spread through blood transfusion.
Symptoms of Disease
Physical and Intracellular Symptoms
At first, Ebola symptoms appear like symptoms of any other virus:
Diagnostic Tests include:
Intracellular
- Incubation period is 2 to 21 days
- Symptoms appear within 8 to 10 days
- Not infectious until they express the symptoms
At first, Ebola symptoms appear like symptoms of any other virus:
- A fever greater than 101.5 degrees Fahrenheit (38.6 degrees Celsius)
- Muscle pain
- Body Aches
- Severe headache
- Weakness
- Diarrhea
- Vomiting
- Abdominal pain
- Sore throat
- Vomiting, diarrhea, rash, symptoms of impaired kidney and liver function
- Internal/ external bleeding
- Causes hemorrhagic syndrome in 30 to 50% of patients: bleed from the nose and mouth
Diagnostic Tests include:
- Medical professionals use a series of tests to diagnose EVD. According to WHO, common tests include the following:
- Virus isolation by cell culture
- Antibody-capture enzyme-linked immunosorbent assay (ELISA)
- Serum neutralization test
- Antigen-capture detection tests
- Electron microscopy
- Reverse transcriptase polymerase chain reaction (RT-PCR) assay
- Find low white blood cells and platelet count, and elevated liver enzymes
- Convulsions towards end, may splatter or smear blood everywhere, allowing the virus particles to spread to potential new hosts
Intracellular
- Wipes out the T-lymphocyte cells
- Cytokine storm releases a torrent of inflammatory molecules into your circulatory system
- Immune system, now completely out of control, attacks every organ in your body
- Small blood clots begin to appear in the bloodstream, and the blood thickens and slows, and clots begin to stick to the walls of blood vessels, known as pavementing, because the clots fit together in a mosaic. The mosaic thickens and throws more clots, and the clots drift through the bloodstream into the small capillaries, where they get stuck
- This shuts off the blood supply to various parts of the body, causing dead spots to appear
- It multiplies in collagen, the chief constituent protein of the tissue that holds the organs together; in this way, collagen in the body turns to mush, and the under layers of the skin die and liquefy
- Even while the body's internal organs are becoming plugged with coagulated blood, the blood that streams out of the body cannot clot; it resembles whey being squeezed out of curds
- Ebola multiplies so rapidly and powerfully that the body's infected cells become crystal-like blocks of packed virus particles known as viral bricks
- The bricks, or crystals, first appear near the center of the cell and then migrate towards the surface
- As a crystal reaches a cell wall, it disintegrates into hundreds of individual virus particles, and the broodlings push through the cell wall like hair and float away in the bloodstream of the host, known as the Lytic cycle
- The hatched Ebola particles cling to cells everywhere in the body, and get inside them, and continue to multiply
- It keeps on multiplying until areas of tissue all through the body are filled with crystalloids, which hatch, and more Ebola particles drift into the bloodstream, and the amplification continues inexorably until a droplet of the hosts blood can contain a hundred million individual particles
Treatments for Disease
Treatments of Ebola:
Recovery:
Recovery from Ebola depends on good supportive care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It is not known if people who recover are immune for life or if they can become infected with a different species of Ebola.
- Providing intravenous fluids (IV)
- Balancing electrolytes (body salts)
- Maintaining blood pressure
- Maintaining oxygen level
- Providing oxygen as needed
- Treating other infections if they occur or develop
- Replacement of lost blood
- There are also non FDA approved vaccines or medicines, such as antiviral drugs, are available for Ebola.
- Patients with Ebola should always have general medical support by the health care professionals. There is no specific surgical treatment, therapy, or vaccine for Ebola, however, a vaccine is being worked on.
- Replacement of coagulation factors and heparin if disseminated intravascular coagulation.
Recovery:
Recovery from Ebola depends on good supportive care and the patient’s immune response. People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It is not known if people who recover are immune for life or if they can become infected with a different species of Ebola.
Prevention Techniques
Because there is no vaccine to prevent the spread of Ebola, when travelling to another country that has a history of Ebola:
- Practice careful hygiene
- Wash hands with soap
- Hand sanitizer
- Avoid contact with blood and body fluids
- Don’t handle items that have been in contact with blood or body fluids including:
- Clothes
- Bedding
- Needles
- Avoid funeral/burial rituals that require handling a body that has died from Ebola
- Avoid contact with bats and nonhuman primates or blood as well as fluids and raw meat that have been made from these animals
- Avoid any facilities in West Africa where Ebola patients are being treated
- After returning from a trip, monitor your health for 21 days
- Get medical attention right away if you start noticing symptoms
- Wear protective equipment
- Practice proper infection control
- Isolate patients with Ebola from other patients
- Avoid direct contact with diseased people who contracted Ebola
- Notify health officials if you have had direct contact with blood or body fluids such as:
- Feces
- Saliva
- Urine
- Vomit
- Semen
Disease Outlook: Future Of Disease
Current Outlook for Disease
Future Outlook for Disease
- The most affected countries from the Ebola outbreak (Guinea, Liberia and Sierra Leone) still continue to be afflicted with the disease with reports of Ebola patients being in all three of the countries capitals.
- Trends of disease transmission, as of mid-January of 2014, seem positive as the number of recorded cases in each country falls under 100 cases-- the lowest its been since June of 2014
- However, the last week of January showed a slight rise of disease in the countries.
- Guinea began to see a sharp rise in cases as of February and Sierra Leone continues to have widespread transmission of the disease.
- None of the countries have implemented safe burials or patient/case tracking to limit transmission of the disease
- Liberia saw slight increase in cases at the end of January of 2015 as well.
- Overall, transmission and contraction of the Ebola virus has gone down incredibly so to the point where WHO (World Health Organization-- health group in charge of controlling Ebola outbreak) have moved to their “second phase” where they are done slowing down the disease and are now working to completely eradicate it.
- Although the cases in these countries have diminished immensely, the countries will continue to be seen as risks to re-igniting Ebola outbreaks in Western Africa.
Future Outlook for Disease
- Dr. Thomas Freiden, head of the US CDC, stated mid-December 2014 that the threat of the outbreak now is that it never gets completely contained
- Scientists are less afraid of its spreading and much more afraid of its prevalence in the Western African region.
- UN Ebola Coordinator David Nabarro said the outbreak has passed its “tipping point” and transmission/contraction of the disease will most likely continue to fall through 2015.
- Study completed in the US indicated outbreak could be under control by 2015.
- Novavax Inc has begun early-stage human trials for Ebola vaccine-- cannot only be taken in smaller amounts than other Ebola vaccines tested but can also be refrigerated and has the potential to hit multiple strains of the virus (can protect people from more than just the Zaire Ebola)