By Angela Grant
Engaged Environments FACTSHEET – Health: Ebola
So what exactly is Ebola?
Ebola is a highly fatal infection cause by a virus in the family Filoviridae, genus Ebolavirus.
The virus can cause disease in humans and non-human primates such as chimpanzees, gorillas and monkeys. Bats appear to be the primary reservoir for the virus.
There are 5 Ebola species, four of which cause disease in humans and one that causes disease in non-human primates.
The species are:
Ebola Virus (Zaire ebolavirus);
Sudan virus (Sudan ebolavirus);
Tai Forest (Tai Forest ebolavirus);
Bundibygyo virus (Bundibugyo ebolavirus);
and the fifth virus non-human is Reston virus (Reston ebolavirus).
How is Ebola transmitted?
Ebola is not airborne. That is a blessing and prevented an exponential number of deaths. Instead it is spread by direct contact from broken skin or mucous membranes (in the eyes, nose and mouth) with any of the following:
• blood or body fluids (urine, saliva, sweat, feces, vomit, breast milk and semen or a person with the disease or who died from Ebola;
• needles and syringes and other objects contaminated with body fluids from a person with Ebola or the body of a person who died from Ebola;
• infected fruits pats and primates (apes and monkey); and
• possibly sexual transmission from semen of a man who recovered from Ebola (where the virus can still be present for months and possibly even a year after recovery.) CDC advised men with virus in their semen be monitored and abstain from sex or practice safe sex by using a condoms.
Also, reports in some African countries show bushmeat was associated with Ebola outbreaks after exposure to contaminated bushmeat. So far bushmeat is the only food known to be associated with Ebola outbreaks.
What are the Symptoms?
The incubation period varies from 2-21 days, with the average duration after exposure to onset of symptoms being 8-10 days.
Early symptoms are nonspecific and include fever (87% of cases), fatigue (76%), muscle pain, headache, rash and sore throat. These early non-specific symptoms can progress in 5 days to GI (digestive) symptoms such as vomiting (68%), diarrhea (66%) and loss of appetite (65%). Bleeding, while a hallmark, is not always present and usually manifests later as bleeding diathesis such as easy bruising and petechiaes. Gross bleeding is not as common and occurs in 18% of patients, most often as bloody stool. Some patients may develop a generalized red maculopapular rash on neck, trunk and arms and some may have seizures due to brain swelling.
Patients with fatal disease present with severe symptoms early on and die of multi-organ failure or shock within 6-16 days of complications. While those with a non-fatal course present with milder symptoms of fever and then improve. Patients are contagious as long as they are symptomatic. However the virus can persist in the semen of men months after symptoms, being a carrier and spreading the infection. CDC recommends these men followed and counseled to abstain or practice safe sex using condoms.
The fatality rate varied widely and depended on the patient’s general health and immune system. In Guinea, Liberia and Sierra Leone the case fatality was 70% in non-hospitalized patients and 61% in those hospitalized. Actual mortality rate varies from 18.5-74% depending on if the patient was managed in Africa vs Europe or the USA.
Laboratory findings include low white cell count with low lymphocyte counts. Platelet counts are also decreased, as well as prolonged Prothrombin (PT) and partial thromboplastin times (PTT).
How is Diagnosis made?
The CDC defined a ‘Person Under Investigation’ (PUI) as anyone with symptoms and risk factors for exposure to the Ebola virus. If anyone with a fever, headache, fatigue, muscle pain, vomiting, diarrhea, or has unexplained hemorrhage and exposure to the virus within the past 21 days before the onset of symptoms, then the local or state health department should be notified and confirmatory laboratory testing performed by designated laboratory.
What is the Treatment?
Currently there is no FDA-approved treatment. Hospitalized patients are treated with supportive care, mostly intravenous fluids and careful monitoring and control of symptoms.
And also currently, there are no approved vaccines. However, in response to the outbreak in 2014, research into an effective vaccine was fast-tracked and concluded when trials in Guinea in 2015 appeared to show it worked. The vaccine, hastily produced and test, is manufactured by Merck ready to ship to the Democratic Republic of Congo.