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EBOLA VIRUS DISEASE
Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans. EVD outbreaks have a case fatality rate(death rate) of up to 90% though said to be improving to up to 50% in the recent time.
EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.
The first cases was imported to Nigeria from Liberia by a Liberia born American Patrick Sawyer.
The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.
Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated the Ebola River, from which the disease takes its name.
Transmission
Ebola is introduce into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.
Ebola then spreads in the community through human-to-human transmission, with infection resulting from :
-Direct contact (through broken skin or mucous membranes)-This involve coming in contact with the blood, secretions, organs or other bodily fluids of infected people. Mucous membranes are moist lining of internal structure like mouth, throat or intestine.
Indirect contact-Involve coming in contact with objects or environment previously contaminated with infected fluids. e.g if someone touch infected secretion ,the hand could be a source of transmission to another person.
Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.
Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.
Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.
Among workers in contact with monkeys or pigs infected with Reston ebola virus, several infections have been documented in people who were clinically asymptomatic.
Signs and symptoms
EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
People are infectious as long as their blood and secretions contain the virus. Ebola virus was isolated from semen 61 days after onset of illness in a man who was infected in a laboratory.
The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days.
Diagnosis
Other diseases that should be ruled out before a diagnosis of EVD can be made include: malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers.The diseases could share the same symptoms and signs with EVD hence the need for proper investigation to differentiate it.
Ebola virus infections can be diagnosed definitively in a laboratory through several types of tests such as electron microscopy virus,isolation by cell culture and so on.
Samples from patients are an extreme biohazard risk; testing should be conducted under maximum biological containment conditions.
Vaccine and treatment
No licensed vaccine for EVD is available. Several vaccines are being tested, but none are available for clinical use.
Severely ill patients require intensive supportive care. Patients are frequently dehydrated and require oral rehydration with solutions containing electrolytes or intravenous fluids.
No specific treatment is available. New drug therapies are being evaluated.
Prevention and control
Controlling ebola virus in domestic animals
No animal vaccine is available. Routine cleaning and disinfection of pig or monkey farms (with sodium hypochlorite (jik) or other detergents) should be effective in inactivating the virus.Altenatively,out right avoidance of the animals and their carcasses is advised.Restricting or banning the movement of animals from infected farms to other areas can reduce the spread of the disease.
Reducing the risk of Ebola infection in people
In the absence of effective treatment and a human vaccine, raising awareness of the risk factors for Ebola infection and the protective measures individuals can take is the only way to reduce human infection and death.
During EVD outbreaks, educational public health messages for risk reduction should focus on several factors:
-Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat.For those who must touch the animals,they should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.
-Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their bodily fluids. Close physical contact with Ebola patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
Communities affected by Ebola should inform the population about the nature of the disease and about outbreak containment measures, including burial of the dead. People who have died from Ebola should be promptly and safely buried.
Pig farms can play a role in the amplification of infection. Appropriate biosecurity measures should be in place to limit transmission.
Controlling infection in health-care settings
Human-to-human transmission of the Ebola virus is primarily associated with direct or indirect contact with blood and body fluids. Transmission to health-care workers has been reported when appropriate infection control measures have not been observed.
It is not always possible to identify patients with EBV early because initial symptoms may be non-specific. For this reason, it is important that health-care workers apply standard precautions consistently with all patients regardless of their diagnosis in all work practices at all times. These include basic hand hygiene, respiratory hygiene, the use of personal protective equipment (according to the risk of splashes or other contact with infected materials), safe injection practices and safe burial practices.
Health-care workers caring for patients with suspected or confirmed Ebola virus should apply, in addition to standard precautions, other infection control measures to avoid any exposure to the patients blood and body fluids and direct unprotected contact with the possibly contaminated environment. When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).
Laboratory workers are also at risk. Samples taken from suspected human and animal Ebola cases for diagnosis should be handled by trained staff and processed in suitably equipped laboratories.
In conclusion, Ebola Virus Disease is fatal but not a death sentence. Taking precautionary and preventive measures is the key. Prevention is better than "NO CURE".
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