let me take this opportunity to create awareness to my fellow kenyans on deadly EBOLA VIRUS. The current outbreak in west Africa, (first casesnotified in March 2014), is the largest and mostcomplex Ebola outbreak since the Ebola virus wasfirst discovered in 1976. There have been morecases and deaths in this outbreak than all otherscombined. It has also spread between countriesstarting in Guinea then spreading across landborders to Sierra Leone and Liberia, by air (1traveller only) to Nigeria, and by land (1 traveller) toSenegal.The most severely affected countries, Guinea, SierraLeone and Liberia have very weak health systems,lacking human and infrastructuralresources, havingonly recently emerged from long periods of conflictand instability. On August 8, the WHO Director-General declared this outbreak a Public HealthEmergency of International Concern.A separate, unrelated Ebola outbreak began inBoende, Equateur, an isolated part of the DemocraticRepublic of Congo.The virus family Filoviridae includes 3 genera:Cuevavirus, Marburgvirus, and Ebolavirus. There are5 species that have been identified: Zaire,Bundibugyo, Sudan, Reston and Taï Forest. The first3, Bundibugyo ebolavirus, Zaire ebolavirus, andSudan ebolavirus have been associated with largeoutbreaks in Africa. The virus causing the 2014 westAfrican outbreak belongs to the Zaire species.TransmissionIt is thought that fruit bats of the Pteropodidae familyare natural Ebola virus hosts. Ebola is introducedinto the human population through close contact withthe blood, secretions, organs or other bodily fluids ofinfected animals such as chimpanzees, gorillas, fruitbats, monkeys, forest antelope and porcupinesfound ill or dead or in the rainforest.Ebola then spreads through human-to-humantransmission via direct contact (through broken skinor mucous membranes) with the blood, secretions,organs or other bodily fluids of infected people, andwith surfaces and materials (e.g. bedding, clothing)contaminated with these fluids.Health-care workers have frequently been infectedwhile treating patients with suspected or confirmedEVD. This has occurred through close contact withpatients when infection control precautions are notstrictly practiced.Burial ceremonies in which mourners have directcontact with the body of the deceased person canalso play a role in the transmission of Ebola.People remain infectious as long as their blood andbody fluids, including semen and breast milk, containthe virus. Men who have recovered from the diseasecan still transmit the virus through their semen forup to 7 weeks after recovery from illness.Symptoms of Ebola virus diseaseThe incubation period, that is, the time interval frominfection with the virus to onset of symptoms is 2 to21 days. Humans are not infectious until theydevelop symptoms. First symptoms are the suddenonset of fever fatigue, muscle pain, headache andsore throat. This is followed by vomiting, diarrhoea,rash, symptoms of impaired kidney and liverfunction, and in some cases, both internal andexternal bleeding (e.g. oozing from the gums, bloodin the stools). Laboratory findings include low whiteblood cell and platelet counts and elevated liverenzymes.DiagnosisIt can be difficult to distinguish EVD from otherinfectious diseases such as malaria, typhoid feverand meningitis. Confirmation that symptoms arecaused by Ebola virus infection are made using thefollowing investigations:antibody-capture enzyme-linked immunosorbentassay (ELISA)antigen-capturedetection testsserum neutralization testreverse transcriptase polymerase chain reaction(RT-PCR) assayelectron microscopyvirus isolation by cell culture.Samples from patients are an extreme biohazardrisk; laboratory testing on non-inactivatedsamplesshould be conducted under maximum biologicalcontainment conditions.Treatment and vaccinesSupportive care-rehydration with oral or intravenousfluids- and treatment of specific symptoms,improves survival. There is as yet no proventreatment available for EVD. However, a range ofpotential treatments including blood products,immune therapies and drug therapies are currentlybeing evaluated. No licensed vaccines are availableyet, but 2 potential vaccines are undergoing humansafety testing.Prevention and controlGood outbreak control relies on applying a packageof interventions, namely case management,surveillance and contact tracing, a good laboratoryservice, safe burials and social mobilisation.Community engagement is key to successfullycontrolling outbreaks. Raising awareness of riskfactors for Ebola infection and protective measuresthat individuals can take is an effective way toreduce human transmission. Risk reductionmessaging should focus on several factors:Reducing the risk of wildlife-to-humantransmission from contact with infected fruit batsor monkeys/apes and the consumption of theirraw meat. Animals should be handled with glovesand other appropriate protective clothing. Animalproducts (blood and meat) should be thoroughlycooked before consumption.Reducing the risk of human-to-humantransmission from direct or close contact withpeople with Ebola symptoms, particularly withtheir bodily fluids. Gloves and appropriatepersonal protective equipment should be wornwhen taking care of ill patients at home. Regularhand washing is required after visiting patients inhospital, as well as after taking care of patients athome.Outbreak containment measures includingprompt and safe burial of the dead, identifyingpeople who may have been in contact withsomeone infected with Ebola, monitoring thehealth of contacts for 21 days, the importance ofseparating the healthy from the sick to preventfurther spread, the importance of good hygieneand maintaining a clean environment.Controlling infection in health-care settings:Health-care workers should always take standardprecautions when caring for patients, regardless oftttheir presumed diagnosis. These include basic handhygiene, respiratory hygiene, use of personalprotective equipment (to block splashes or othercontact with infected materials), safe injectionpractices and safe burial practices.
Posted on: Fri, 31 Oct 2014 19:19:56 +0000
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