Ebola Virus

Human beings are constantly exposed to several microorganisms that can either be pathogenic,

non-pathogenic, or opportunistic. One of the non-living categories of microorganisms we are

vulnerable to are viruses, where some can even cause death. Recently, an outrageous outbreak

was recorded in different parts of the world, and it was identified as Ebola virus after a thorough

investigation of the symptoms and the recorded results. What is Ebola? Where did it originate?

What are its symptoms and effects? How can it be diagnosed? Millions of questions intrigue our

thoughts every time we hear about a new kind of danger which can colonize our body and

generate damage to our organs. According to the WHO, Ebola virus disease (EVD), formerly

known as Ebola hemorrhagic fever, is a severe, often fatal illness in humans. The virus is

transmitted to people from wild animals and spreads in the human population through human-to-

human transmission. The average EVD case fatality rate is around 50%. Case fatality rates have

varied from 25% to 90% in past outbreaks. The first EVD outbreaks occurred in remote villages

in Central Africa, near tropical rainforests, but the most recent outbreak in West Africa has

involved major urban as well as rural areas.

The Ebola virus causes an acute, serious illness which is often fatal if untreated. Recorded by the

WHO (April,2015), the Ebola virus disease (EVD) first appeared in 1976 in 2 simultaneous

outbreaks, one in Nzara, Sudan, and the other in Yambuku, Democratic Republic of Congo. The

latter occurred in a village near the Ebola River, from which the disease takes its name.

The WHO confirms the fact that the current outbreak in West Africa, (first cases notified in

March 2014), is the largest and most complex Ebola outbreak since the Ebola virus was first

discovered in 1976. There have been more cases and deaths in this outbreak than all others

combined. It has also spread between countries starting in Guinea then spreading across land
borders to Sierra Leone and Liberia, by air to Nigeria and USA, and by land to Senegal and Mali.

The main source of transmission was travelers moving across the countries mentioned. The most

severely affected countries, Guinea, Liberia and Sierra Leone, have very weak health systems,

lack human and infrastructural resources, and have only recently emerged from long periods of

conflict and instability. On August 8, the WHO Director-General declared the West Africa

outbreak a Public Health Emergency of International Concern under the International Health

Regulations (2005).

“The virus family Filoviridae includes three genera: Cuevavirus, Marburgvirus, and Ebolavirus.

There are five species that have been identified: Zaire, Bundibugyo, Sudan, Reston and Taï

Forest. The first three, 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.”(WHO, April, 2015).

Many Ebola survivors are likely to face further health issues including eye and joint problems,

the World Health Organization has warned. It was also discovered by experts in the field that a

recent case may have caught Ebola through sexual contact with someone who had recovered.

The WHO has decided the crisis still constitutes as a public health emergency of international

concern. However, it is asserted that progress in the ability to control the outbreak is increasing.

Transmission:

Unlike what most people perceive or think, transmission of the virus does not occur via normal

social contact such as shaking hands, travelling on public transport, or sitting near someone
infected by the virus but not revealing the symptoms. It is also unlikely to catch the virus from

the sweat left on gym equipment. Airborne transmission occurs at a lower rate; one should be in

direct contact with the source of infection, meaning body fluids as a primary source of infection.

Most people are infected when taking care of the diseased individuals since they are more likely

to touch the victim’s body or clean the latter’s body fluids (stool, urine, vomit) that carry

infectious blood. According to NHS, traditional African burial rituals have also played a part in

its spread. The Ebola virus can survive for several days outside the body, including on the skin of

an infected person, and its common practice for mourners to touch the body of the deceased.

They only then need to touch their mouth to risk becoming infected. Moreover, touching the

soiled clothing of an infected person followed by contact with one’s mouth, having sex with an

infected person without the use of a condom knowing that the virus is present in the semen up to

7 weeks after the person has recovered, in addition to handling unsterilized medical equipment

also constitute other sources by which the virus can be transmitted.

However, the way in which the virus first appears in humans is unknown at the start of the

outbreak because the natural reservoir of the Ebola virus remains unknown. Yet, scientists

believe that the first patient becomes infected through contact with an infected animal, such as a

fruit bat or primate (apes and monkeys), which is called a spillover event. Person-to-person

transmission follows and can lead to large numbers of affected people. In some past Ebola

outbreaks, primates were also affected by Ebola and multiple spillover events occurred when

people touched or ate infected primates.

Ebola is not spread through the air, by water, or in general, by food. However, in Africa, Ebola

may be spread as a result of handling wild animals hunted for food and contact with infected

bats. There is no evidence that mosquitoes or other insects can transmit Ebola virus. Only a few
species of mammals (e.g., humans, bats, monkeys, and apes) have shown the ability to become

infected with and spread Ebola virus.

Healthcare providers caring for Ebola patients and family and friends in close contact with

Ebola patients are at the highest risk of getting sick because they may come in contact with

infected blood or body fluids. During outbreaks of Ebola, the disease can spread quickly within

healthcare settings (such as a clinic or hospital). Exposure to Ebola can occur in healthcare

settings where hospital staff is not wearing appropriate personal protective equipment.

Symptoms:

 According to the WHO, symptoms of the Ebola virus disease are characterized by the

sudden onset of fever fatigue, muscle pain, headache and sore throat followed by

vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some

cases, both internal and external bleeding (e.g. oozing from the gums, blood in the

stools). Humans are not infectious until they develop the symptoms. The incubation

period, that is, the time interval from infection with the virus to onset of symptoms is 2 to

21 days, and laboratory findings include low white blood cell and platelet counts and

elevated liver enzymes. It is seen that signs and symptoms begin abruptly within five to

ten days of infection with Ebola virus. Early signs and symptoms include: Fever, Severe

headache, Joint and muscle aches, Chills, Weakness. Over time, these symptoms become

more dangerous and harder to treat and include: Nausea and vomiting, Diarrhea (may be

bloody), Red eyes, Raised rash, Chest pain and cough, Stomach pain, Severe weight loss,
Bleeding, usually from the eyes, and bruising (people near death may bleed from other

orifices, such as ears, nose and rectum), Internal bleeding. (Mayo Clinic Staff).

How does it work?

According to Servick (August, 2014), Ebola outbreak that occurred in West Africa was

due to a species with an incredible power to overtake its host. Zaire ebolavirus and the

family of filoviruses to which it belongs owe their virulence to mechanisms that first

disarm the immune response and then dismantle the vascular system. The virus

progresses so quickly that researchers have struggled to tease out the precise sequence of

events, particularly in the midst of an outbreak. Much is still unknown, including the role

of some of the seven proteins that the virus’s RNA makes by hijacking the machinery of

host cells and the type of immune response necessary to defeat the virus before it spreads

throughout the body. But researchers can test how the live virus attacks different cells in

culture and can observe the disease’s progression in nonhuman primates—a nearly

identical model to humans.

“Once the virus enters the body, it targets several types of immune cells that represent the

first line of defense against invasion. It infects dendritic cells, which normally display

signals of an infection on their surfaces to activate T lymphocytes—the white blood cells

that could destroy other infected cells before the virus replicates further. With defective

dendritic cells failing to give the right signal, the T cells don’t respond to infection, and

neither do the antibodies that depend on them for activation. The virus can start

replicating immediately and very quickly.

Ebola, like many viruses, works in part by inhibiting interferon—a type of molecule that

cells use to hinder further viral reproduction. In a new study published today in Cell Host

& Microbe, researchers found that one of Ebola’s proteins, called VP24, binds to and

blocks a transport protein on the surface of immune cells that plays an important role in

the interferon pathway.

Curiously, lymphocytes themselves don’t become infected with the virus, but a series of

other factors—a lack of stimulation from some cells and toxic signals from others—

prevent these primary immune cells from putting up a fight.

As the virus travels in the blood to new sites, other immune cells called macrophages eat

it up. Once infected, they release proteins that trigger coagulation, forming small clots

throughout the blood vessels and reducing blood supply to organs. They also produce

other inflammatory signaling proteins and nitric oxide, which damage the lining of blood

vessels, causing them to leak. Although this damage is one of the main symptoms of

infection, not all patients exhibit external hemorrhaging—bleeding from the eyes, nose,

or other orifices.

Ebola triggers a system-wide inflammation and fever and can also damage many types of

tissues in the body, either by prompting immune cells such as macrophages to release

inflammatory molecules or by direct damage: invading the cells and consuming them

from within. But the consequences are especially profound in the liver, where Ebola

wipes out cells required to produce coagulation proteins and other important components

of plasma. Damaged cells in the gastrointestinal tract lead to diarrhea that often puts

patients at risk of dehydration. And in the adrenal gland, the virus cripples the cells that
 make steroids to regulate blood pressure and causes circulatory failure that can starve

organs of oxygen.

Damage to blood vessels leads to a drop in blood pressure, and patients die from shock

and multiple organ failure.” (Servick, August, 2014).

Diagnosis:

Diagnosing Ebola in individuals who have been infected for only a few days is difficult because

the early symptoms, such as fever, are nonspecific to Ebola infection and often are seen in

patients with more frequent diseases including malaria and typhoid fever. However, if the patient

shows the early symptoms of Ebola, samples can be taken from these infected people and tested

to confirm the presence of the infection.

 Tests include: Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing,

IgM ELISA, Polymerase chain reaction (PCR), and Virus isolation (within a few days

after the symptoms begin), IgM and IgG antibodies (later in disease course or after

recovery), and Immunohistochemistry testing, PCR, Virus isolation (in deceased

patients).

“Although there are no approved specific therapies for Ebola virus disease, it is essential to make

the diagnosis as early as possible, in order to initiate supportive measures before the

development of irreversible shock and to institute infection control procedures. Thus, providers

should ask patients who present with fever and/or other symptoms consistent with Ebola virus

disease if they have travelled to the epidemic area or had contact with a patient with possible

Ebola virus disease within 21 days prior to the onset of symptoms.” (Bray, M. & Chertow, D.

(2015).UpToDate.)
Treatment and Vaccines:

No FDA-approved vaccine or medicine (e.g., antiviral drug) is available for Ebola.

Symptoms of Ebola and complications are treated according to severity and as they appear. The

following basic interventions, when used at an early stage, can significantly improve the chances

of survival:

 Providing intravenous fluids (IV) and balancing electrolytes (body salts).

 Maintaining oxygen status and blood pressure.

 Treating other infections if they occur.

Experimental vaccines and treatments for Ebola are under development, but they have not yet

been fully tested for safety or effectiveness.

Recovery from Ebola varies from patient to patient depending on the immune response. People

who recover from Ebola infection develop antibodies that last for at least 10 years, possibly

longer. It is not known if people who recover are immune for life or if they can become infected

with a different species of Ebola. Some people who have recovered from Ebola have developed

long-term complications, such as joint and vision problems.

According to the WHO, Novavax, a biotech company in the US, is developing a recombinant

protein Ebola vaccine candidate based on the Guinea 2014 Ebola virus strain and is currently

beginning Phase I human clinical trials in Australia. Moreover, of the pre-existing medicine that

were considered for re-purposing to treat Ebola, several are either being tested or considered for

testing in patients with EVD or have already been used in patients with EVD. A few other
therapies have also been considered for use in treatment, but have been deemed not to be

appropriate for further investigation.

Prevention and control:

Centers for Disease control and Prevention recommends staff members to use standard, contact,

and droplet precautions to care for a PUI or patient with confirmed EVD. These staff members

might need to take additional infection control steps if a PUI or patient with confirmed EVD has

other conditions or illnesses, such as tuberculosis, or requires care involving aerosol-generating

procedures.

Healthcare personnel can be exposed to Ebola virus by touching a patient’s body fluids,

contaminated medical supplies and equipment, or contaminated environmental surfaces.

Splashes to unprotected mucous membranes (for example, the eyes, nose, or mouth) are

particularly hazardous and can stimulate the spread of the disease.

There’s no vaccine to prevent Ebola. The best way to avoid catching the disease is by not

traveling to areas where the virus is found.

Health care workers can prevent infection by wearing masks, gloves, and goggles whenever they

come into contact with people who may have Ebola.

The World Health Organization asserts that raising awareness of the risk factors for infection

and the protective measures that should be taken is the only way to reduce human infection and

subsequent deaths. Close unprotected physical contact with Ebola patients should be avoided

since contact with bodily fluids can be easily stimulated. Appropriate use of gloves and personal

protective equipment (including hand hygiene before putting on, and especially after taking off

personal protective equipment) should be practiced 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.

Almost all transmission of the virus to health-care workers has been reported when basic

infection control measures have not been observed. Health-care workers caring for any patient

should practice standard precautions. When caring for patients with suspected or confirmed

Ebola virus infection, health-care workers should apply infection control measures and standard

precautions to avoid any exposure to patients’ blood and body fluids and with possibly

contaminated environments.

Preparation for burial of the bodies of persons who have died from Ebola virus disease also

carries high risks of transmission of the virus. Those who have died from the disease should be

promptly and safely buried.

WHO response:

“The response by WHO and its partners to stop transmission of the Ebola virus is accelerating by

scaling up effective outbreak control measures and preventing its further spread, as urged by

Health Ministers from 11 West African countries in a new strategy approved in July. Health

authorities are concerned because Ebola continues to be transmitted in communities and in

health-care settings, and it has appeared in cities as well as rural and border areas.” (As cited in

“Accelerating WHO emergency response to Ebola outbreak in Liberia: Contact tracing, 2014).

WHO, the Global Alert and Response Network (GOARN), and its partners are in constant

motion, providing guidance and support and have deployed teams of experts to West African

countries, including epidemiologists to work with the countries in surveillance and monitoring of

the outbreak, and laboratory experts to support mobile field laboratories for early confirmation of
Ebola cases. Furthermore, clinical management experts were sent too to help health-care

facilities treat affected patients, infection and prevention control experts to help the countries

stop community and health-care facility transmission of the virus, and logisticians to dispatch

needed equipment and materials.

WHO works with national governments and leads the international community to provide

emergency health services in countries with widespread Ebola transmission as well as prevent

outbreaks in countries that are unaffected.

The WHO aims to stop transmission in all affected countries by:

 Identify and trace people with Ebola

 Care for persons with Ebola

 Safe and dignified burials

 Infection prevention and control