Ebola Virus Disease

What is Ebola Virus Disease?

Ebola is a deadly and highly infectious disease caused by Ebola viruses. It was once known as Ebola hemorrhagic fever, and it can cause symptoms such as bleeding, black stool, bloody diarrhea, and bloody vomit. However, such symptoms are seen less than half of the time. More common initial symptoms include fever, a general feeling of discomfort, headaches, and muscle aches. As the disease advances, it may cause serious diarrhea, nausea, and vomiting.

The disease can worsen quickly, causing multiple organs to fail, leading to shock and death. Ebola has a fatality rate of about 40% to 50%. Early identification of the disease and access to healthcare play a crucial role in survival, along with the patient’s health status, genetic differences, and their attitude towards seeking medical treatment. Ebola is known for causing large outbreaks and worldwide epidemics, such as the Western African epidemic from 2013 to 2016, which affected several countries beyond Africa. It can greatly impact global healthcare, economy, and society. While the main treatment is supportive care, innovative treatments continue to be researched.

Ebola viruses were discovered in The Democratic Republic of Congo in 1976. Belonging to the Filoviridae family, these viruses have a distinctive thread-like shape. Filoviridae are a type of RNA virus and are believed to use bats as their natural carriers. The viruses can infect humans and primates.

Because of the high infection rate and mortality of Ebola, it’s paramount to suspect and diagnose the disease early to reduce deaths and the risk of an outbreak. Over the past few years, advances in diagnosing, treating, and vaccinating against Ebola have improved survival rates and reduced spreading. Rapid implementation of infection prevention measures is necessary to prevent spreading in healthcare facilities. Early reporting of suspected cases is critical for public health authorities to carry out contact tracing, surveillance, and other measures.

Continuous research aims to improve diagnostic tests, treatments, and vaccines in order to reduce the threat of Ebola epidemics and the possibility of the virus being used as a biological weapon.

What Causes Ebola Virus Disease?

The Ebola viruses first emerged in 1976 and are named after the Ebola River. They tend to appear in animal populations near the African equator from time to time. These viruses can easily spread between humans and primates, such as chimps, apes, and gorillas. We’ve also found Ebola virus antibodies in bats, but the bats don’t seem to develop symptoms. While we’ve found these antibodies in bats during outbreaks, we’ve yet to confirm that they actually cause human illness.

Ebolavirus is part of the Filoviridae family, which also includes the extremely dangerous Marburgvirus in humans and the Cuevavirus, which to our knowledge, has only been found in bats in Spain and Hungary. There are five subtypes of Ebola virus that can harm humans; these are named after the places they were discovered – Zaire/Ebola (EBOV), Bundibugyo (BDBV), Sudan (SUDV), Tai Forest (TAFV), and Bombali (BOMV). All of these subtypes seem to be equally harmful, even though the specific subtype triggering the outbreak can vary. We’ve identified other filoviruses, but so far they haven’t caused harm to humans.

The naming of Ebola viruses has been changed over time, which has made their classification a bit confusing. Since 2018, the terms ‘Ebola virus’, ‘Ebola virus disease (EVD)’, and ‘EBOV’ are used to refer specifically to the Zaire strain of Ebola. This strain has been the culprit behind most Ebola outbreaks and thus is the most studied type.

Microscopic examination of blood samples has shown us the structure of the Ebola virus. The virus particle is enclosed in an envelope, with spike-like structures made of glycoproteins. Inside this capsule, there’s a single-strand of RNA, together with four proteins. These proteins and glycoproteins play a key role in how the Ebola virus affects the body and our immune reaction to it.

Risk Factors and Frequency for Ebola Virus Disease

Since it was discovered, there have been over 25 outbreaks of Ebola Virus Disease (EVD) mainly in rural areas of certain African countries. This deadly virus has taken the lives of over 15,000 people. It’s believed that contracting the virus can occur from hunting and eating certain wild animals. The virus also spreads easily within communities from infected patients to their family or during funerals.

There have been over 25 outbreaks of EVD.
The outbreaks primarily occurred in Sudan, the Democratic Republic of Congo, Gabon, the Republic of the Congo, and Uganda.
Over 15,000 people have died from EVD.
It’s believed that the virus can be contracted through hunting and consumption of certain wild animals.
The virus spreads quickly within close communities, especially during funerals.

The most recent outbreak took place in the Democratic Republic of the Congo from April to September 2022. The largest and longest outbreak between late 2013 and 2016 extended to Western Africa with some cases also identified in Europe and the United States. Health care systems in certain nations were stretched beyond their limits showing a lack of readiness for such large-scale outbreaks. Most reported cases outside of Africa were health care workers who were aiding in regions with an outbreak. These workers had strict travel restrictions and quarantine strategies in place, with only a handful of travelers being infected following direct human contact.

Without proper care, Ebola virus disease can be lethal in up to 90% of cases. However, with increased awareness, better education about seeking medical help promptly, and early detection, the mortality rate has dropped to about 50%. It’s important to note that people are only infectious when they show symptoms such as fever, chills, nausea, or vomiting or when people touch infected objects or deceased persons.

The most recent Ebola outbreak transpired in the Democratic Republic of the Congo in 2022.
The largest outbreak occurred from late 2013 to 2016, affecting Western Africa, Europe, and the United States.
There is a high mortality rate of up to 90% without the proper care; this has reduced to about 50% with better awareness and early detection.
People with Ebola are only infectious when symptoms appear.

Transmission of Ebola virus occurs via direct contact with bodily fluids of infected humans and animals or with contaminated objects. The virus typically enters the new host through their mucosal membranes or skin. The virus can live in body fluids for an extended time, for example, it has been found in semen up to 82 days and detected up to 101 days after initial symptoms. Infection can also occur from a pregnant mother to their fetus. After entering the body, the virus remains undetectable and non-contagious for several days to weeks before symptoms start to show. The time a virus can survive outside the body is not precisely known. Typically, objects such as bedding, clothes and medical equipment used by patients are burned or disposed of as medical waste to prevent further spread. Traditional funeral practices in affected countries, such as touching the deceased’s body and personal items, can also contribute to the spread of the disease.

Ebola is transmitted through direct contact with bodily fluids from infected individuals or wildlife, or through contaminated objects.
The virus can live in body fluids for a prolonged period.
Persons are not contagious until they start showing symptoms.
Personal contact during traditional funerals can aid in spreading the virus.

Signs and Symptoms of Ebola Virus Disease

People who are infected with the Ebola virus usually suffer from sudden fever, fatigue, headache, loss of appetite, and body aches. These symptoms are often followed by nausea, stomach pain, vomiting, and diarrhea. Other symptoms such as red eyes, sore throat, and hiccups could also develop. As the disease progresses, the person might develop a rash, bleeding from eyes, ears, nose, or skin, shortness of breath, cough, and neurological symptoms like confusion.

Medical evaluations of patients with these symptoms usually focus on the recording of vital signs and their fluid volume/levels, with a special attention to signs of dehydration such as dry mucous membranes and poor skin elasticity. Patients might experience severe fluid loss – with an average of 3 to 5 litres per day, but it could go as high as 10 litres per day. Those with early-stage Ebola may show only the initial symptoms and still seem fairly stable, while others in later stages might be gravely ill and could even be in shock.

Not all people with these symptoms will have Ebola, but medical authorities should be alert if the World Health Organization has declared an Ebola outbreak, especially in areas where Ebola is known to occur.

Diagnosis would require the patient to have traveled to an Ebola-stricken area within the past 2 to 21 days or have had contact with a person who was ill with suspected or confirmed Ebola, or any thing that might’ve come in contact with body fluids within the same timeframe. Contact with semen from anyone who’s survived Ebola is also a risk, as is any break in infection prevention practices when caring for someone with suspected or confirmed Ebola. Participating in activities like funeral preparations, working or visiting healthcare facilities or laboratories, visiting traditional healers, contact with bats or animals, or working or visiting a mine or cave while in an active outbreak region, raises the risk of infection.

Any person who matches these risk factors and displays the Ebola-like symptoms should be immediately isolated in a single room with a private bathroom. Local or state health authorities should be informed immediately, and the hospital’s Infection Prevention and Control team needs to be alerted. If Ebola is confirmed, the patient should be stabilized and treated immediately, and a thorough contact tracing needs to be done for all who might’ve come in contact with the patient for prompt follow-up.

Testing for Ebola Virus Disease

If a patient is diagnosed with Ebola virus disease, or is suspected to have it, there are several laboratory tests that the doctor might order. Tests such as complete blood count, comprehensive metabolic panel, and arterial blood gas are essential. A complete blood count test looks at elements like the number of red blood cells, white blood cells and platelets. This is important because Ebola can cause severe bleeding and bacterial infections which these tests can help detect.

The comprehensive metabolic panel test checks kidney function, balances of body salts, liver enzymes, and sugar levels. All of these can be affected by Ebola. The arterial blood gas test is done to check for disturbances in the acid-base balance of the body, which can be another symptom of the disease.

Doctors may also test for rhabdomyolysis, a breakdown of muscle tissue that can harm the kidneys. This is done by checking creatine kinase levels. They may also do tests to check how well the kidneys and blood clotting system are working, as well as testing blood types in case a transfusion is needed. Another crucial test is the one that detects the presence of the Ebola virus itself.

For diagnosing Ebola, there are molecular tests like RT-PCRs that detect the presence of certain proteins related to the virus. These tests are highly sensitive but also require a lot of safety precautions and specialist equipment, which can make them difficult to use in areas with limited resources. An alternative could be automated tests which are easier and quicker. These tests have been found to agree with the results of RT-PCRs about 85% of the time.

There are also rapid tests that can give results faster than PCR testing. These tests have been found to be 85% sensitive and 95% specific in comparison. Even though they aren’t as sensitive or specific, they are still powerful tools when dealing with an outbreak in rural areas where resources are limited. There are also serologic tests that check for antibodies to the virus, but these can only be detected 6 days after the onset of the illness.

Finally, x-rays may be done to check for fluid in the lungs due to capillary leak syndrome, a potential effect of Ebola virus disease.

Treatment Options for Ebola Virus Disease

It’s crucial to control the spread of the Ebola virus in a timely and effective manner. When a person gets infected, they can potentially cause 1 to 3 additional infections. In areas where Ebola is a common issue, patients are often directed to specialized Ebola Treatment Units for tests and isolation. However, if a person believes they have Ebola, they might go to a random healthcare facility or not get treatment at all, which can result in the virus spreading even more.

If there isn’t proper infection control in these facilities, the virus can spread rapidly, which is what happened in the West African Ebola epidemic from late 2013 to 2016. During this time, over 800 healthcare workers died from Ebola, mostly in areas that didn’t have proper infection control measures. To control the disease, it’s crucial to screen patients, train healthcare workers, isolate patients, and quickly report suspected cases to health authorities.

The first Ebola case in the U.S was in a hospital in Dallas, Texas, in 2014, where two nurses got infected. Afterward, they added measures like fabric walls to show where protective equipment was needed and a one-way entry and exit system to avoid contaminating that equipment. The use of protective equipment is a key part of preventing the spread of Ebola, however, it’s been difficult for some affected areas to get this equipment.

Different options are being researched for the best protective equipment, as it’s crucial to be both effective and comfortable. However, it’s still not clear what’s best. It might be helpful to give spoken instructions while removing the equipment, use double gloves and disinfect them, and follow guidelines from Centers for Disease Control and Prevention.

Health officials will monitor anyone who has been in contact with an Ebola patient for 21 days. Travel bans and screenings at airports from countries with Ebola have been used to prevent the spread. However, these measures might make it harder for help to reach these countries and could decrease the effectiveness of disease prevention efforts.

The key treatment for patients with Ebola is supportive care, like fluid replacement and addressing any electrolyte abnormalities. It’s also recommended to have enough staff to monitor changes in patients, keep families informed, relieve pain, and give antibiotics to those with severe illness since bacterial infections often occur alongside Ebola.

Vaccines and treatments such as ansuvirimab and REGN-EB3 have been identified and approved for treatment of Ebola. The vaccine r-VSV-ZEBOV, which gives partial protection after 3 days and full protection after 7 days, has been approved for use in patients over 12 months old. Another vaccination, Ad26.ZEBOV, which is usually followed by a dose of MVA-BN-FILO, is also available.

Ebola virus disease needs to be distinguished from other illnesses that can cause bleeding in a patient with a fever and common viral diseases that have similar early symptoms and gastrointestinal problems.

When a patient has a high temperature and bleeding, the following diseases should also be considered:

Marburg virus
Crimean-congo hemorrhagic fever
Lassa fever
Rift Valley fever
Dengue
Bunyavirus

Also, conditions with similar early signs:

Malaria
Typhoid fever
Measles
Leptospirosis
Influenza
COVID-19 infection

For patients presenting with stomach and intestinal issues, the health provider should consider the following infections:

Shigella
Rotavirus
Norovirus

What to expect with Ebola Virus Disease

The chances of recovering from the Ebola virus hinge largely on early treatment and access to proper healthcare, which includes consistent care and frequent check-ups. This care often includes measures to correct dehydration and anemia, as well as respiratory support if required.

Even with the best treatment, though, the death rate remains high. The fatality rates can differ depending on the specific outbreak. For instance, during the first recorded outbreak in 1976, the Ebola virus had an 88% fatality rate, and the Sudan virus variant had a 60% fatality rate. Recent outbreaks, however, have shown death rates as low as 40%. This change may be due to improved care provided to patients.

Possible Complications When Diagnosed with Ebola Virus Disease

The Ebola virus primarily causes significant dehydration, bleeding, and the failure of multiple body systems, which can eventually lead to shock and death. Survivors of Ebola are commonly affected by psychological disorders, due to the traumatic experience of witnessing deaths in Ebola Treatment Units. Moreover, the perceived hesitation of healthcare workers to provide care, stemming from their fear of getting infected, can further contribute to these psychological impacts.

The World Health Organization advises that due to the prolonged presence of the Ebola virus in semen, which can be sexually transmitted, regular tests should start three months after infection. These tests should be conducted every month until two successive tests show negative results a week apart. It is recommended to either use protection or abstain from sexual activity until these tests confirm that the virus is no longer present.

Preventing Ebola Virus Disease

People who are closely associated with an infected person should be taught about several things. These include the warning signs and symptoms of the disease, how it typically progresses, and the essential guidelines to follow when quarantined. They also need to be educated on the importance of Ebola treatment units and when to go to a hospital. Critical information about the need to isolate sick family members and the risks associated with viral shedding through semen after recovery is also necessary. In this regard, practicing safe sex or abstaining until the semen is confirmed virus-free is vital.

Public engagement and education play a key role in keeping the disease from spreading in communities. Public health education should focus on being able to recognize Ebola’s symptoms and knowing how it spreads. For instance, this could be through bodily fluids, sexual contact, objects, or even deceased bodies. In the African countries where the disease is common, especially rural areas, the community must also be informed about the risk of eating wild game. Plus, they should be taught how to report sightings of dead or ill animals and they should be encouraged to take sick family members to healthcare facilities.

Adopting these preventive measures will only work if the community trusts the authorities. This can be established by actively engaging with the community, explaining what the interventions entail, and comprehensively answering their questions.

Frequently asked questions

Ebola Virus Disease is a deadly and highly infectious disease caused by Ebola viruses. It can cause symptoms such as bleeding, black stool, bloody diarrhea, and bloody vomit, but more common initial symptoms include fever, discomfort, headaches, and muscle aches. It can quickly worsen, leading to organ failure, shock, and death.

There have been over 25 outbreaks of EVD.

The signs and symptoms of Ebola Virus Disease include: - Sudden fever - Fatigue - Headache - Loss of appetite - Body aches - Nausea - Stomach pain - Vomiting - Diarrhea - Red eyes - Sore throat - Hiccups - Rash - Bleeding from eyes, ears, nose, or skin - Shortness of breath - Cough - Neurological symptoms like confusion It is important to note that not all people with these symptoms will have Ebola, but if the World Health Organization has declared an Ebola outbreak, medical authorities should be alert, especially in areas where Ebola is known to occur. Diagnosis of Ebola requires the patient to have traveled to an Ebola-stricken area within the past 2 to 21 days or have had contact with a person who was ill with suspected or confirmed Ebola. Other risk factors include contact with body fluids, semen from Ebola survivors, or any break in infection prevention practices. If a person matches these risk factors and displays Ebola-like symptoms, immediate isolation in a single room with a private bathroom is necessary. Local or state health authorities should be informed, and the hospital's Infection Prevention and Control team needs to be alerted. If Ebola is confirmed, the patient should be stabilized and treated immediately, and contact tracing should be done for all who might have come in contact with the patient for prompt follow-up.

Ebola Virus Disease can be transmitted through direct contact with bodily fluids from infected individuals or wildlife, or through contaminated objects.

Marburg virus, Crimean-congo hemorrhagic fever, Lassa fever, Rift Valley fever, Dengue, Bunyavirus, Malaria, Typhoid fever, Measles, Leptospirosis, Influenza, COVID-19 infection, Shigella, Rotavirus, Norovirus.

The types of tests that are needed for Ebola Virus Disease include: 1. Complete blood count (CBC) test: This test looks at the number of red blood cells, white blood cells, and platelets in the blood. It can help detect severe bleeding and bacterial infections caused by Ebola. 2. Comprehensive metabolic panel: This test checks kidney function, balances of body salts, liver enzymes, and sugar levels. These can be affected by Ebola. 3. Arterial blood gas test: This test is done to check for disturbances in the acid-base balance of the body, which can be a symptom of Ebola. 4. Creatine kinase levels: This test is done to check for rhabdomyolysis, a breakdown of muscle tissue that can harm the kidneys. 5. Kidney and blood clotting system tests: These tests are done to check how well the kidneys and blood clotting system are working. 6. Blood typing: This test is done to determine the blood type in case a transfusion is needed. 7. Molecular tests like RT-PCRs: These tests detect the presence of certain proteins related to the Ebola virus. They require safety precautions and specialist equipment. 8. Rapid tests: These tests provide faster results than PCR testing and are useful in areas with limited resources. They are 85% sensitive and 95% specific. 9. Serologic tests: These tests check for antibodies to the virus and can only be detected 6 days after the onset of the illness. 10. X-rays: These may be done to check for fluid in the lungs due to capillary leak syndrome, a potential effect of Ebola virus disease.

The key treatment for patients with Ebola is supportive care, which includes fluid replacement and addressing any electrolyte abnormalities. It is also recommended to have enough staff to monitor changes in patients, keep families informed, relieve pain, and give antibiotics to those with severe illness since bacterial infections often occur alongside Ebola. Additionally, vaccines and treatments such as ansuvirimab and REGN-EB3 have been identified and approved for the treatment of Ebola. The vaccine r-VSV-ZEBOV and Ad26.ZEBOV, followed by a dose of MVA-BN-FILO, are also available for use in patients over 12 months old.

The side effects when treating Ebola Virus Disease include: - Significant dehydration - Bleeding - Failure of multiple body systems - Shock - Death Survivors of Ebola may also experience psychological disorders due to the traumatic experience of witnessing deaths in Ebola Treatment Units. Additionally, the perceived hesitation of healthcare workers to provide care, stemming from their fear of getting infected, can further contribute to these psychological impacts.

The prognosis for Ebola Virus Disease (EVD) depends on early treatment and access to proper healthcare. With consistent care and frequent check-ups, the chances of recovery increase. However, even with the best treatment, the death rate remains high. The fatality rates can vary depending on the specific outbreak, with recent outbreaks showing death rates as low as 40%.

You should see an infectious disease specialist or a healthcare provider experienced in treating Ebola Virus Disease.