Ebola. It's something that everyone is talking about and alot of information is getting thrown about it in the media. The other day I was chatting to some 1st year students on placement about infection control and contact precautions, they didn't understand what I meant when I was chatting to them about infection precautions used in conditions such as MRSA, TB and C-Diff and other infectious diseases, but as soon as I mentioned Ebola they knew instantly what I was talking about.
This just goes to show how much the news impacts on our meaning of events and conditions, in this case our understanding of the Ebola virus. Its seems that everyone has a different opinion on all areas of this disease, and I guess as it is not something that nurses in Australia have been exposed to so it's no wonder we're getting confused! Consequently I thought it would be interesting to do a post on Ebola, so here we go!
Number 10 - Where did it start?
The Ebola virus is named after the Ebola River near a small village called Yambuku in the Democratic Republic of Congo. This was where the Ebola virus first appeared in 1976 and killed 280 people whilst infecting 318 people. This gave the first Ebola outbreak a case fatality of 88%.
Number 9 - Fatality rates
Speaking of fatality rates, this current outbreak which began in March 2014 in Guinea and is the largest and most complex outbreak since it was discovered. It has been hard to find exact numbers of people infected and consequently fatalities, but as from October 23rd, the Ebola outbreak has reached 10,141 people with nearly 5,000 of these individuals now deceased. This is a huge increase from their August numbers in which there were 3685 cases and of these cases 1841 deaths. It currently has an unconfirmed fatality rate of between 50% and 70%. . The Centres for Disease Control and Prevention in America (CDC) delves into these numbers more and has more specific information regarding the location of the outbreak and numbers of people affected in each area. Pretty shocking stats! You can see them here.
Number 8 - Transmission
One of the questions that everyone is asking is 'how is it transmitted?' The main school of thought is that fruit bats of the Pteropodidae are natural Ebola virus hosts. So these naturally infected bats then transmit the virus through close contact with their blood, secretions, organs and other bodily fluids to other animals like chimpanzees, monkeys and sometimes humans.
Once a human is infected, human to human transmission occurs in the same way via direct contact through broken skin or mucous membranes with the blood secretions and other bodily fluids of infected people and also with surfaces and materials (like bedding) contaminated with these fluids. So you can see how especially health care workers can become infected by not following strict infection control precautions.
Number 7 - Symptoms
You might be asking yourself what are the symptoms of Ebola? It generally has non-specific symptoms initially such as fever, vomiting and severe diarrhoea. Patients can also complain of headaches, muscle pain, general weakness and abdominal pain. Visible haemorrhage then occurs in approximately less then half the infected individuals. Symptoms can appear between 2 - 21 days after being transmitted but generally occur on days 8-10. And you must always remember that the person becomes infectious once they begin to display symptoms.
Number 6 - Diagnosis and Treatment
An individual is commonly diagnosed with Ebola following a blood test. There is currently no licensed treatment or prophylaxis treatment for the Ebola Virus. Once an individual has contracted Ebola, supportive treatment is offered to the patient in order to keep them comfortable. This includes intravenous fluid administration and maintaining blood pressure and oxygen saturation levels. However there have been cases treated with anti-bodies which need further testing to determine their success in the treatment of Ebola.
"Recent intense media coverage of experimental medicines and vaccines is creating some unrealistic expectations, especially in an emotional climate of intense fear. The public needs to understand that these medical products are under investigation. They have not yet been tested in humans and are not approved by regulatory authorities, beyond use for compassionate care."
Quoted from WHO (see website at the end of the post)
Number 5 - Prevention
Prevention begins with elimination the transmission of the virus. The most effective way of preventing contracting the virus by personal means is by avoiding high risk areas, knowing the symptoms of the virus and reporting for early detection of the virus. Research has shown that early supportive treatments of the virus can help with survival.
The Ebola virus is highly contagious but only in specific situations such as when in contact with an infective persons bodily fluids. Therefore demonstrating the importance of adhering to contact precautions. Most cases of Ebola have been transmitted through the individuals home, funeral practices or in health facilities.
Number 4 - Ebola for healthcare workers?
We have seen lately in the news a few health care workers who have been helping with the crisis in West Africa contracting this disease, in conjunction with 2 nurses who cared for a patient in the USA with Ebola. This displays the importance of ensuring health care workers are not exposed to the virus. The Centers for Disease Control and Prevention (CDC) has recently completed a guidance protocol for caring for patients with the Ebola Virus in the health care setting. It focuses on the use of effective personal protective equipment (PPE) and can be found in this link here.
We also need to be proactive in our assessment and evaluation of patients, especially if they have been travelling. Once again the CDC has a great resource where they actually have made an Ebola checklist found below and by following the link here.
Number 3 - When the patient survives
Great! Our patient has survived the Ebola virus! But what now? Our thoughts are generally on making sure they get through the virus but not many people actually think about what happens after they survive. Generally they will have antibodies in their system which should protect them for the next 10 years or so or maybe even their lifetime against Ebola, but more research needs to be done in this area as it is also unknown if the patient is immune against other strands of Ebola.
Some people who have survived have gone on to develop chronic joint and vision problems, but once again more research is needed in this area. Implications for males also include the virus being able to survive in sperm for a short time following the recovery from the virus, therefore education is essential to these individuals.
Number 2 -Different types of Ebola
As mentioned in on the previous sections, there are different types of Ebola and each different type has different survival rates. As quoted directly from the WHO website, below are the different types of Ebola:
"The virus family Filoviridae includes 3 genera: Cuevavirus, Marburgvirus, and Ebolavirus. There are 5 species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï Forest. The first 3, Bundibugyo ebolavirus, Zaire ebolavirus, and Sudan ebolavirus have been associated with large outbreaks in Africa. The virus causing the 2014 west African outbreak belongs to the Zaire species."
Number 1 - The future...
At the moment there is no outcome or finale to this latest outbreak and there seems to be no sign of it slowing down. No one can predict the future (although sometimes it would be nice, especially when trying to plan your tea break during a busy shift!), and i'm sure that everyone has different theories on what will eventually happen with regards to the Ebola virus. My theory is that we will eventually find a vaccine or some type of treatment that will decrease the mortality rate of this virus, but I think this will be a long time coming... but I guess we'll all just wait and see! I would love to know what some others think the future will bring in regards to the Ebola virus.
Most of the information I've mentioned can be found on the WHO website which you can access here. I have also sourced information from a great article in The New England Journal of Medicine, Ebola - A Growing Threat.
And what is Australia doing during this Ebola threat? The ABC news has broken it down for us in an article in the news today, see it here.