Ebola Virus Disease With a Recent Outbreak in West Africa, a Review of Literature by Gunwant S Dhaliwal, MD @ Primary Care Walk in Clinic, New Port Richey, Florida

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Ebola Virus Disease also called Ebola Hemorrhagic Fever, a deadly disease is transmitted through close contacts, so far there has been no Vaccine or Treatment available, Personal Protective Equipment while taking care of the infected patients and / or investigating for vaccine and treatment of this deadly disease is recommended.

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Ebola Virus Outbreaks occur in East and West Africa near Tropical Rainforests, initial one being in a village near Ebola River thereby getting its name. Recent outbreak is in Guinea, Sierra Leone and Liberia with over 700 people has dead.
Fatality Rate: It has fatality rate of 90% i.e., 90% of the individuals infected with this virus will die from the disease or its complications.
Transmission: Ebola virus is transmitted through close contact with the blood, secretions, organs or other bodily fluids of infected animals. Subsequently it spreads in the community by direct contact through broken skin or mucus membranes with the blood, secretions or other bodily fluids of infected people. Men can transmit the disease through semen for up to 7 weeks after recovery from the disease. Healthcare workers have high incidence of infection when precautions are not strictly practiced.

Signs & Symptoms: Ebola virus disease is an acute viral illness characterized by sudden onset of fever, intense weakness, muscle aches and pains, headache and sore throat followed by diarrhea, vomiting and rash. It is complicated by kidney and liver failures as also internal and external bleeding. Labs show low white cell count and platelet count, elevated liver enzymes.

Incubation Period: The time interval from infection with the virus to onset of symptoms is 2 to 21 days.

Differential Diagnosis: Other diseases that present similar to Ebola virus disease include; Malaria, Typhoid, Cholera, Plague, Relapsing Fever, Leptospirosis, Meningitis, hepatitis and other viral hemorrhagic fever.

Definitive Diagnosis: Ebola Virus can be diagnosed through labs with

  •     Antibody-capture enzyme linked immunosorbant assay (ELISA)
  •     Antigen Detection Test
  •     Serum Neutralization Test
  •     Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) assay
  •     Electron Microscopy
  •     Virus isolation by Cell Culture.

Due to extreme biohazard risk, testing should be conducted under maximum biological containment conditions.

Vaccine: Several vaccines are being tested but none are available for clinical use.

Treatment: Severely sick patients require intensive supportive care in the form of oral rehydration with electrolytes or intravenous fluids. New drug therapies are being investigated but no specific treatment is available as of now.

Prevention & Control: Routine cleaning and disinfection of pig and monkey farms with Sodium Hypochlorite or other detergents are effective in inactivating the virus. If an outbreak is suspected quarantine the premises immediately. Culling of infected animals with close supervision of burial or incineration of carcasses may be necessary to reduce the risk of animal to human transmission. An active animal health surveillance to detect new cases is essential in providing early warning for animal and human public health authorities.

In the absence of effective treatment and / or human vaccine, raising awareness of risk factors for Ebola virus infection and protective measures individuals can take, is the only way to reduce human infection and death.

Risk Reduction Message: Reduce the risk of wildlife to human transmission from contact with infected fruit bats or monkeys and consumption of their raw meat by handling animals with gloves and other protective clothing, animal products are thoroughly cooked before consumption. Reducing risk of human-to-human transmission in the community arising from direct or close contact with infected patients particularly their bodily fluids. Close contact with Ebola patients should be avoided otherwise protective equipment should be worn along with regular and frequent hand washing.
Communities affected by Ebola should inform the population about the disease and outbreak measures including prompt and safe burial of the dead.

Health care workers should apply standard precautions consistently with all patients that include hand washing, use of personal protection equipment, safe injection and safe burial practices. When in close contacts within one meter of patients with Ebola virus, they should wear face shield, clean long sleeved gown and gloves.

Samples from suspected human and animal cases should be handled by trained staff and processed in suitable equipped labs.

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Gunwant S Dhaliwal, MD

Gunwant S Dhaliwal, MD
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