Ebola virus disease: A natural disaster

Ebola virus disease causes, symptoms and treatment.

Ebola virus disease: A natural disaster 

-Yogesh Kumar & Ashwini K. Dubey 

What is Ebola?

Ebola is a rare, acute and severe disease caused by Ebola virus, also known as Ebola hemorrhagic fever or Ebola virus disease. It could be fatal if not treated. It spreads in humans and non-human primates, viz., monkeys, chimpanzee, and gorillas. The Ebola virus belongs to Filoviridae family. Its genome contains single-stranded RNA. When the virus particle attaches to a specific cell surface receptor (a glycoprotein) of a cell membrane, it releases its nucleocapsid (protein shell along with the nucleus) into the cytoplasm and replicates its genetic material. The newly formed nucleocapsids and envelope proteins associate with the host cell’s plasma membrane. Its budding occurs and destroys the cell.

Ebola virus disease symptoms
There are three genera of Filoviridae: Cuevavirus, Marburgvirus, and Ebolavirus. Out of the five types of Ebola virus, four have been reported to cause disease in humans and one in non-human primates only. Zaire ebolavirus (Ebola virus), Sudan ebolavirus (Sudan virus), Bundibugyo ebolavirus (Bundibugyo virus), and Tai forest ebolavirus (Tai forest virus) cause infection in humans and Reston ebolavirus (Reston virus) in non-human primates. The three Ebola viruses, namely Zaire ebolavirus, Bundibugyo ebolavirus, and Sudan ebolavirus have been associated with large outbreaks in Africa.

The disease infects humans through close contact with infected animals including chimpanzees, fruit bats and forest antelope. Later it spreads by direct contact with infected blood, body fluids or with contaminated environments.

Why is Ebola so dangerous?

The Ebola virus disease typically occurs in Sub- Saharan Africa, the ongoing outbreaks affecting Guinea, Liberia, and Sierra Leone. It may spread to other countries by persons who have recently visited the affected areas. The deadly outbreak of Ebola virus has spread fear to other continents.

History of Ebola fever

Ebola virus disease (EVD) first appeared in 1976 in two simultaneous outbreaks. The first outbreaks occurred in Nizara, Sudan and the other in Yambuku, Democratic Republic of Congo. The names Ebola comes from the latter outbreak, which occurred in a village near the Ebola River. The current case of Ebola outbreak in March 2014 in West Africa is the largest and most complex outbreak since 1976. This deadly virus belongs to the Zaire species that caused more deaths in this outbreak than all others combined. The World Health Organization (WHO) declared this outbreak a public health emergency of international concern. There were a total of 1,716 cases reported by WHO till 2013, but the current outbreak has already led to 5,078 deaths and 12,008 suspected cases.

Symptoms of Ebola virus disease

The symptoms of Ebola fever are similar to other diseases common in Africa, including malaria, dengue fever, Marburg virus disease and viral hemorrhagic fevers. The incubation period is 2 to 21 days. Humans become infectious after the development of symptoms. The initial symptoms include a sudden fever, muscle pain, intense weakness, headache and sore throat. Later stages include diarrhea, vomiting, rash, symptoms of impaired liver and kidney function and in some cases internal and external bleeding. There is also a decrease in WBC count and platelet count and increased level of liver enzymes

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Reservoir of Ebola virus

The natural reservoir of Ebola virus has yet to be confirmed; however, on the basis of evidence and the nature of similar viruses, bats are considered to be the most likely reservoir. Three types of fruit bats were found to possibly carry the virus without any falling sick. These are: Hypsignathus monstrosus , Epomops franqueti , and Myonycteris torquata.

Transmission

It is not entirely clear how Ebola initially spread from animals to humans, but it is believed to be contact with infected wild animals or bats. It spreads in humans by direct contact with blood or body fluids (mucus, saliva, sweat, tears, vomit, urine, semen, breast milk) of the infected persons. Entry points of the virus include the nose, eyes, mouth, wounds, cuts and abrasions. Men who have recovered from the disease can still transmit the virus through their semen via sexual intercourse for up to seven weeks. Ebola may also occur in the breast milk of women after recovering from the disease and it is not known when it is safe to breastfeed again. Evidence indicates the dogs and pigs can be infected with Ebola virus, but dogs don’t appear to develop symptoms while carrying the virus and pigs appear to transmit the virus to some primates. Domestic dogs that dwell in the area where outbreaks happened have been found to contain antibodies to Ebola virus, but their role in spreading the disease to people is unclear. So far there is no report of involvement of mosquitoes or other insects in spreading the disease.

Diagnosis

As the symptoms of the disease are not easily distinguishable from malaria, typhoid and meningitis, there are non-specific, specific and differential tests for the Ebola fever. Non-specific tests include low platelet count, increased level of liver enzymes and abnormality in blood clotting. Tests that confirm the Ebola virus includes: • Antibody-capture enzyme-linked immunosorbent assay (ELISA) • Antigen-capture detection tests • Serum neutralization test • Reverse transcriptase polymerase chain reaction (RT-PCR) assay • Electron microscopy • Virus isolation by cell culture.

Treatment and vaccines

There is no specific treatment approved for the Ebola virus disease so far; however, supportive oral or intravenous fluids and treatment improve survival. Treatments for the Ebola virus disease are being evaluated, but there are no vaccines available yet. Favipiravir (also known as T-705 or Avigan) and Brineidofovir (CMX001) are antiviral drugs currently being used for the treatment of Ebola virus disease. Zmapp is an antibody vaccine comprising three chimeric monoclonal antibodies and is under development. Although some individuals have recovered, the outcome is not considered statistically significant.

Prevention and control

As there is no satisfactory cure for Ebola virus disease and treatments are still being evaluated. So there is a great need to do the following measures to prevent the infection of Ebola virus:

• Surveillance and contact tracing
• Safe burial or cremation of the dead
• Raising awareness among people about the risk factors for Ebola infection
• Use of protective gloves and clothing for safety while handling the animals
• Avoiding direct contact with any kind of bodily fluids such as saliva, vomit, urine, blood, semen, sweat, etc., of Ebola infected people and notifying health officials if there is direct contact
• Washing hands with proper disinfectants after visiting patients in hospital
• Isolating the sick from healthy persons
• Avoid contact with bats or other non- human primates and raw meats from these animals
• Monitoring of health for 21 days after returning from an Ebola affected area
• Seeking medical care immediately after getting symptoms like Ebola fever
• Avoiding contact with virus contaminated objects like needles and syringes, etc.
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