Photo taken of care providers in Nigeria for the Center of Disease Control in the United State by Sally Ezra
Ebola was first described in 1976 when the disease struck a village along the Ebola River, a tributary of the Kongo River. Since the disease was first recognized, it is only known to have struck people in Africa, but diseases caused by similar viruses have struck elsewhere. One milder form of the disease exists in the Philippines and in 1967 monkeys imported to the US from there were found to have the disease.
Ebola is a RNA virus that affects primates including humans. Almost everything we know about how the virus affects the body is derived from studies in monkeys. Similarly, the potential treatments with blocking RNA or with antibodies are being studied in monkeys with promising results. Along with the Marburg virus, which once struck Germany, Ebola is part of the filovirus family of viruses and there are 5 species of it. By testing the genetic sequence of the virus in an affected individual one can derive the geographical region from which the infection came. Such studies have shown that the current Ebola strain is a distant relative of the one that has been recurring in the Kongo. This tells us that the disease in Guinea was not the result of human migration from the Kongo. This same type of study also shows that the epidemic in Guinea, Liberia, Sierra Leone, Senegal and Nigeria all arose from a common source and got spread by human to human contact.
Ebola is suspected to live in fruit bats and in some other wild animals. It appears that the virus is passed to humans from wild sources as well as from humans to humans. The recent outbreak in Guinea is believed to have started when a bat bit a young boy. The disease was previously unknown in Guinea and so when the boy developed symptoms, no one suspected. The disease usually involves fever, pain, generalized malaise, diarrhea, vomiting and internal as well as external bleeding. Once a person contracts the infection, the chance of dying from it ranges from 30 to 90% depending on the strain of virus and the availability of supportive care.
As Haiti continues to struggle under the burden of the newly introduced cholera, it must be aware of the potential threat posed by Ebola. To help limit its spread, health care workers worldwide must become familiar with its symptoms so that they can immediately recognize suspected cases and isolate them. The disease is transmitted by contact with body fluids and through open skin lesions. It is among the most contagious viruses known. For this reason, the place where people are treated must be de-contaminated so as to avoid infected people who come in contact with infected clothing, bedding or other surfaces. The bodies of those who have died from the disease can also contaminate people who come in contact with the corpse. In the Kongo as well as in Guinea, it is the custom for people to wash the deceased before burial. This practice continues in Haiti. Perhaps this is done to honor the dead as well as to symbolically purify the demise for the trip to the expected life hereafter. Should such practice continue in the face of a contagious disease, than the bathing should only be done by a person who is immune to the disease because of having survived a prior exposure. Haiti's cultural link to Africa makes many of the lessons learned from that region applicable to Haiti should this or another similar disease were to afflict our population.
The disease can come to Haiti haphazardly or by malicious intent. As a highly contagious and potentially lethal virus, the Ebola virus is highly attractive to potential bio-terrorists. For this reason, numerous governments are concerned about the introduction of this virus to their country by terrorists.
Fortunately, the virus can be killed with common products like soap, detergent or bleach. Since there is no known cure, the disease has to be controlled by limiting its spread. This can be done by observing for 21 days those who have had contact with an infected person. This is because after exposure to Ebola, a person develops symptoms within 2 to 21 days. Once a suspected case develops fever they should be isolated and tested for the virus. Although the virus can cause bleeding, in some cases, it does not always manifest itself in this manner. As a diarrhea disease, its symptoms can be confused with cholera. When bleeding does occur, that symptom can be confused with yellow fever or with dengue fever. Since the early symptoms of the disease are fever, muscle aches, and generalized malaise, early infection can be confused with Chikungunya, a mosquito born infection. The disease also causes liver and kidney abnormalities.
Once a person has recovered from the disease and has been demonstrated to no longer have the virus in their blood, they are no longer contagious and can integrate fully in the community. However, men can still harbor the virus in their semen for 7 weeks after the virus is no longer in their blood. For this reason, they should avoid intercourse for at least 7 weeks following disease recovery. In one case, the virus was present in a man's semen 82 days after it could no longer be recovered in his blood.
Meticulous attention to infectious disease control is important for limiting the spread of Ebola. In fact, lack of attention to these principles aggravated the spread of Ebola in the Kongo when the disease was first noted in 1976. At that time, a missionary group in the city of Yambuku treated approximately 100 people for malaria by soaking a syringe in a bowl of water and then reusing it. One unsuspected patient had Ebola and the disease was spread to all the others treated with the reused syringe. The medical staff also succumbed to the disease.
Today, even though Haiti has not been affected by Ebola, it is important to continue to practice handwashing, proper sanitation, vaccination, and isolation of people with contagious diseases because it is those measures that will help guard the population against the constant threat of infectious diseases.
It is vital that this education be done to contain Ebola and to prevent intolerant Christians from using it as justification to scapegoat Vodou as a cause of illness. Hopefully, a better understanding of disease transmission will enable us to take a more sensible approach to disease prevention. We must recognize that we live in a tropical rain forest, and it is in such places that Ebola tends to emerge. Hopefully with advanced warning, we will be ready to limit its impact if ever it were to come to our shores.
Mike Bray, Martin S Hirsch, Jennifer Mitty: Diagnosis and treatment of Ebola and Marburg virus disease. Uptodate. September 12, 2014
Mike Bray, Martin S Hirsch, Jennifer Mitty: Epidemiology, pathogenesis and clinical manifestations of Ebola and Marburg virus disease. Uptodate. September 12, 2014
Thomas R Frieden, Inger Damon, Beth P. Bell and others. Ebola 2014-New challenges, new global perspective and responsibility. New England Journal of Medicine
Sylvie Briand, Eric Bertherat, Paul Cox, Pierre Formenty and others. The International Ebola Emergency. New England Journal of Medicine. August 20, 2014
Sylvain Blaize, Delphine Pannetier, Lisa Oestereich, Toni Rieger and others. Emergence of Zaire Ebola Virus Disease in Guinea- Preliminary Report
Heinz Feldmann, M.D. Ebola — A Growing Threat? New England Journal of Medicine. May 7, 2014
Joel G. Breman, Karl M. Johnson. Ebola Then and Now. New England Journal of Medicine.
September 10, 2014 ( funeral practices)
World Health Organization, website publication on Ebola, accessed on September 16, 2014