Ebola virus disease
Background
Ebola virus disease is a viral haemorrhagic fever (VHF) caused by the Filovirida family. VHFs are a group of illnesses that are caused by several distinct families of viruses: arena viruses, filo viruses, bunya viruses and flavi viruses. The natural reservoir for Ebola virus is not known, but it has been found in animals including non-human primates and bats.
Following an incubation period which could range from two to 21 days, the illness presents itself with the sudden onset of fever, headache, joint and muscle aches and weakness. As the infection progresses, nausea, vomiting and diarrhoea, shortness of breath, confusion and haemorrhage can occur. This can lead to multi-organ failure, shock and death.
Most human infections result from direct contact with bodily fluids or secretions from an infected human. The highest risks of infection are associated with caring for infected patients, particularly in hospital settings and associated with unsafe burial practices. Ebola has also been reported following contact with the tissues of infected animals such as non-human primates and bats].
Certain wildlife species, including fruit bats (usually consumed by some communities in West Africa) are thought to be the most likely reservoir species for Ebola.
CDC website: http://www.cdc.gov/vhf/ebola/
CDC website: http://wwwnc.cdc.gov/travel/yellowbook/2014/chapter-3-infectious-diseases-related-to-travel/viral-hemorrhagic-fevers
Advice for travellers
The World Health Organization does not recommend any travel restrictions to Guinea, Liberia or Sierra Leone at this time - WHO website: http://www.who.int/csr/don/2014_07_31_ebola/en/
South African Port Health authorities are on high alert for ill persons with EVD-compatible symptoms who have travelled from West Africa. An alert for healthcare workers is available on The National Institute for Communicable Diseases NICD website http://www.nicd.ac.za/ and is updated regularly; this alert includes recommendations for assessing ill persons who have travelled to West Africa.
For travel health advice – link to SANTHNET – South African Travel Health Network- collaboration between the NICD, South National Dept of Health (Communicable Diseases Directorate) and the South African Society of Travel Medicine (SASTM)
SANTHNET website: http://www.santhnet.co.za/
SASTM website: http://www.sastm.org.za/
How to prevent transmission
- Avoid contact with the blood or secretions of an infected patient.
- As with other infectious illnesses, one of the most important preventive practices is careful and frequent hand washing. Cleaning your hands often, using soap and water (or waterless alcohol-based hand rubs when soap is not available), removes potentially infectious materials from your skin and helps prevent disease transmission
- Avoid contact with dead animals, especially primates.
- Do not eat "bush meat" (wild animals, including primates, sold for consumption as food in local markets)
- To minimize the possibility of infection, observe barrier techniques when in close contact with a person or an animal suspected of having Ebola virus infection. These precautions include wearing protective gowns, gloves, and masks, in addition to eye protection (e.g., eye glasses) or a face shield. Sterilization and proper disposal of needles and equipment, and proper disposal of patient excretions are also important to prevent the spread of infection.
CDC website: www.cdc.gov/ncidod/dvrd/spb/mnpages/dispages/vhf.htm
Risk of Exposure
In Africa, confirmed cases of Ebola HF have been reported in:
- Guinea
- Liberia
- Sierra Leone
- Democratic Republic of the Congo (DRC)
- Gabon
- South Sudan
- Ivory Coast
- Uganda
- Republic of the Congo (ROC)
- South Africa (imported)
Signs and Symptoms
- Symptoms of Ebola HF typically include:
- Fever
- Headache
- Joint and muscle aches
- Weakness
- Diarrhea
- Vomiting
- Stomach pain
- Lack of appetite
- Some patients may experience:
- A Rash
- Red Eyes
- Hiccups
- Cough
- Sore throat
- Chest pain
- Difficulty breathing
- Difficulty swallowing
- Bleeding inside and outside of the body
Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola virus though 8-10 days is most common. Some who become sick with Ebola HF are able to recover, while others do not. The reasons behind this are not yet fully understood. However, it is known that patients who die usually have not developed a significant immune response to the virus at the time of death.
Transmission
When an infection does occur in humans, there are several ways in which the virus can be transmitted to others. These include:
- direct contact with the blood or secretions of an infected person
- exposure to objects (such as needles) that have been contaminated with infected secretions
The viruses that cause Ebola HF are often spread through families and friends because they come in close contact with infectious secretions when caring for ill persons.
Treatment
Standard treatment for Ebola HF is still limited to supportive therapy. This consists of:
- balancing the patient’s fluids and electrolytes
- maintaining their oxygen status and blood pressure
- treating them for any complicating infections
Timely treatment of Ebola HF is important but challenging since the disease is difficult to diagnose clinically in the early stages of infection. Because early symptoms such as headache and fever are nonspecific to Ebola viruses, cases of Ebola HF may be initially misdiagnosed.
However, if a person has the early symptoms of Ebola HF and there is reason to believe that Ebola HF should be considered, the patient should be isolated and public health professionals notified. Supportive therapy can continue with proper protective clothing until samples from the patient are tested to confirm infection.
Experimental treatments have been tested and proven effective in animal models but has not yet been used in humans.
CDC website: http://www.cdc.gov/vhf/ebola/treatment/index.html
Travel Insurance
It is always recommended that comprehensive travel and medical insurance are taken out before traveling.
