The Ebola virus is an infectious and fatal disease that is widely spread through various countries, scattering terror throughout. When traveling is areas with a high prevalence rate of infection one must equip themselves with a knowledge that will help them stay clear of infection. To create a thorough understanding of the disease it is important to look back in the history book to see where, how and when the infection came about, recognise the pathophysiological side of the condition and it’s modes of transmission.
By making sense of the severity of the disease, an individual is able to adopt safety precautions and preventative strategies such as incubation periods, treatment method including vaccinations. The World Health Organisation (WHO) have identified a three phase crisis plan that will assist in the dismantlement of the Ebola virus. Ebola first broke out in two different forms almost at the same time. One outbreak was in Sudan and the other in Zaire (Democratic Republic of Congo) in 1976. E. Sudan heavily affected ‘the towns of Nzara and Maridi’ (Pourrut, X et al. 2005 p. 1006).
Over the period of 4 months, 150 people died out of the 284 people infected bringing the mortality rate to 53%. The E. Zaire outbreak was much more severe. It hugely effect individuals in Yambuku as well as villages that lived off the river, Ebola. E. Zaire claimed 284 people lives out of the 318 infected from August to November, 1976. This high mortality rate of 89% aroused fear in the people of infected areas. Between 1994 – 1997, Ebola re-emerged with ‘a new subtype, E. Ivory Coast... (Pourrut, X et al. 2005 p. 1006). Over three years, 455 cases of E. Ivory Coast were presented and amongst them 351 deaths (mortality rate 77%).
Today there are 5 different strains of Ebola including; E. Zaire, E. Sudan, E. Tai Forest (previously known are E. Ivory Coast), Bundibugyo virus and E. Reston. (Pourrut, X et al. 2005 p. 1006). Ebola is a virus, ‘introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, fruit bats’ (World Health Organisation 2016a) infected with the disease. When the virus is transmitted to a human it first attacks the bodies immune system by destroying the individuals T-lymphocyte cells.
These cells help in the function of the immune system, attack and kill micro-organisms and suppress the helper and cytotoxic cells, therefore Ebola dismantles the bodies first line of defence. This causes the first symptoms of; increased body temperature, severe headaches, decreased appetite, and joint and muscle pain. As the immune system gets attacked small blood clots form throughout the blood stream causing blood vessels to burst and leak, which reduces blood and oxygen supply to the body’s vital organs, consequently causing them to shut down.
As the disease gets worse patient suffering experience severe diarrhoea and vomiting which contains blood. (Ross, P 2014). Within the World Health Organisation Situation report (2016b) they confirmed that out of a total of 28,616 individuals infected and suspected to have the virus in Guinea, Liberia and Sierra Leone, 11,310 have resulted in death, making the mortality rate 39. 5%. In April 2016, Guinea was reported to have a total of 3,814 suspected and morbid cases with 3,358 cases confirmed in a laboratory.
Out of the total (3,814) number of cases, 2,544 individuals died, making the mortality rate 66. %. Within the same report, Liberia was found to have a total of 10,678 suspected, probable and confirmed cases, with 3,163 cases confirmed in laboratory. Out of the 10,678 suspected cases, 4,810 died (mortality rate, 45%). According to BBC article ‘Ebola: Mapping the Outbreak’, (2016) ‘Liberia has been the worsthit….. reporting between 300 and 400 new cases every week’. Sierra Leone experience a large number of suspected, probable and confirmed cases coming to a total of 14,124.
Out of this 3,163 cases were confirmed through laboratory and 3,959 deaths were reported, bring the mortality rate to 28%. Centers for Disease Control and Prevention 2016a). It is seen that Guinea, Liberia and Sierra Leonie have been hugely affected by the Ebola virus but it is on a mend. On the 9th June 2016 the World Health Organisation declared ‘the end of the most recent outbreak of Ebola virus disease in Liberia’ and Guinea (World Health Organisation 2016c). This media release was accounted 42 days after the last confirmed Ebola patient. Both Liberia and Guinea are within a ’90 day period of heightened surveillance to ensure that any new cases are identified quickly’ (World Health Organisation 2016c).
This news was a breath of fresh air, as is demonstrated that the prevalence of Ebola in Guinea and Liberia are finally being reduced. (Centers for Disease Control and Prevention 2016a) When travelling to areas that have a high population of Ebola cases it is important to understand vaccinations, treatment methods and incubation periods. In July 2015, World Health Organisation announced that ‘Guinea Phase III efficacy vaccine trial show that VSV-EBOV’ (World Health Organisation 2016d), has a 100% success rate against Ebola.
The trial vaccine was given to all suspected individuals that may be at risk of the virus and due to the results Guinean Authorities ‘have approved continuation of the trial’ ( World Health Organisation 2016d). Though this drug has been 100% effective in Guinea, they have not licensed the vaccine due to human safety testing as they are ensuring the vaccine doesn’t present any risks to others before releasing it to the world. An incubation period begins when an individual becomes infected with the disease till they display signs and symptoms. The incubation period for Ebola is 2 to 21 days after infection.
During the incubation stage the patient can be either contagious or non-contagious, depending on the virus. Once the disease is diagnosed, treatment generally starts, however in the case of Ebola treatment is very limited with no proven cure available. When caring for an Ebola infected patient the main focus is to keep them hydrated, either orally or via intravenous fluids and treat specific symptoms to improve the individuals chances of survival. This can include medicating antipyretics or analgesia to tend to fevers and relieving head, muscle and joint pain. Other treatments being used to help people survive Ebola virus disease include, where available, kidney dialysis, blood transfusions, plasma replacement therapy. ‘ (World Health Organisation 2016e), (World Health Organisation 2016a), (Centers for Disease Control and Prevention 2016b), (Racaniello, V 2014).
In August 2014, World Health Organisation designed a strategy to eradicate Ebola reducing transmission of the virus and slow the ‘exponential increase in cases’ (World Health Organisation 2016f, p. 5). The First phase was called ‘rapid scale-up’ (United Nations 2016 p. ) which focused on ‘treatment beds, safe and dignified burial teams’ (World Health Organisation 2016g, p. 3). Phase two, referred to are ‘increase capacities’ (United Nations 2016a p. 2) which concentrated on ‘case finding… and community engagement (World Health Organisation 2016f, p. 4). Phase three is the final framework called ‘interruption of transmission’ (United Nations 2016a p. 2). The aim of this phase is to rapidly break the chain of transmission and respond to the after shock of Ebola within the affected communities. Phase three is broken into two objectives.
Objective one aims ‘to accurately define and rapidly interrupt all remaining chains of Ebola transmission’ (World Health Organisation 2016f, p. 4); while objective two aims ‘to identify, mange and respond to the consequences of residual Ebola risk’ (World Health Organisation 2016f, p. 4). To break the chain of transmission a multidisciplinary team must treat patients, identify’associated risks with each chain of transmission’ (World Health Organisation 2016f, p. 6), enhance the identification process and design incentives to promote preventative measures as well as engaging the local community.
Objective two centralise on; enhancing alert management, adopt protocols for preventative and re-emergence of Ebola, build clinical services and develop intervention such as vaccines. (World Health Organisation 2016f). “Phase 3 emphasises the importance of understanding and incorporating the concerns of affected communities, households and individuals and ensuring full community engagement in implementation’ (United Nations 2015b). Objective one of phase three refers to the interruption of transmission to reduce the spread of Ebola. Within objective one, there are three activities; Event management, Enhanced identification and local response.
These activities have been prioritised by the World Health Organisation to prevent the transmission of the Ebola virus. Activity one is ‘event management’. The goal of this activity is to; treating newly infected patients as soon as the infection has been identified (event), assess houses when a individual becomes infected t identify the associated risk, involve the locals in management of ‘events’ and quarantine, and confirm that all health facilities in the area are supported to ‘ensure appropriate infection prevention and control measures’ (World Health Organisation 20161, p. ). Activity two focuses of ‘Enhanced identification, incentivisation and management of cases & contacts’ (World Health Organisation 2016f, p. 6).
The goal of this activity is to; investigate ‘medical and social anthropology’ (World Health Organisation 2016f, p. 6), use genetic sequencing to determine the source of infection, implement vaccinations ‘in accordance with protocols established under the Ebola vaccine trial in Guinea and Sierra Leone’ (World Health Organisation 2016, p. ), improve clinical management to increase the patients chance of survival, and designing incentives for individuals and communities to promote preventative measures such as vaccinations. Activity three look upon involving the community in taking responsible for their care. This involves ‘giving local leaders… the responsibility and accountability… ensure all contacts are identified, missing contacts are found and followed, quarantined households are properly managed’ (World Health Organisation 2016f, p. 7). These three activity are the bases of objective one.
By adhering to the activities/plan, objective one will be implemented fast therefore reducing transmission of Ebola, bring the world one step closer to eradicating the disease. Ebola is vastly spreading across many countries including Guinea, Liberia and Sierra Leone. For travellers and people situated in areas where the disease has a high prevalence it can be scary. By gaining a knowledge of where Ebola originated from, how the disease effects the body and what the modes of transmissions are individual and ommunities will be able to minimise the fear fact and put in place actions to fight the disease.
Currently groups of people are working on a cure to stop the infection but haven’t yet been successful, however studies have been able to help formulate incubation periods, treatments to improve the patients survival as well as create a trial vaccine. The World Health organisation has all devised three phases to implement and sustain a ‘resilient zero’. To address these phases a team of varied disciplines including doctors, nurses, anthropologists and sanitation workers; must work together to interrupt the chain of transmission and respond to the consequences of the Ebola epidemic.