Ebola Virus

What is Ebola?

Ebola is a disease caused by a virus that causes hemorrhagic fever, but contrary to popular belief, fewer than half the people who get hemorrhagic fever suffer from internal bleeding. The virus, however, is deadly; some strains rapidly kill 50 to 90 percent of all those infected. And worse yet, the Ebola virus is highly transmissible from person to person.

In the 1990s, the virus caused such alarm that books and movies were based on the horrors of the disease. Primates can be infected by the same virus, and fruit bats are suspected of being the natural reservoir of the virus, meaning the bats may be a safe harbor for the virus and allow it to survive.

What Causes Ebola?

The Ebola virus includes four subtypes: Zaire, Sudan, Cote d'Ivoire and Reston. The Reston serotype only produces infection without any symptoms.

Symptoms of Ebola

Ebola strikes quickly and patients quickly decline. Symptoms include:

• Sudden onset of fever and chills
• Intense weakness
• Muscle pain
• Headache
• Sore throat
• Dry cough
• Nausea, vomiting
• Diarrhea and abdominal pain
• Hemorrhagic signs in nose, gums, digestive or internal bleeding. Contrary to popular belief, bleeding usually only happens at the end of the illness. The first sign in most people is red eyes, bruising and difficulty with blood clotting after taking blood samples.

Diagnosing Ebola

The test for Ebola can be done in blood, saliva or urine, but requires a specialized laboratory with the capacity to do viral cultures or PCR for hemorrhagic fevers. Body fluid samples are a biohazard and need special packaging for transportation to prevent accidental transmission. For this reason, it is difficult to quickly diagnose Ebola in remote parts of Africa because adequate laboratories are not readily available and transporting samples to external laboratories for testing is highly dangerous. The Unites States Naval Mobile Research Unit (NAMRU), and the CDC often set up mobile laboratories in remote regions of the world when granted permission by the host country. NAMRU and CDC labs facilitate testing for highly infectious diseases, like Ebola.

Could Ebola Arrive to Other Parts of the World?

The risk of an Ebola outbreak due to natural transmission outside of Africa is very low. The most probable causes of Ebola outside of Africa would be transmission by accident from an experimental laboratory or by bioterrorism. In fact, the Ebola virus is a category A bioterrorism agent. Accidental transmission in laboratory settings happened with a virus similar to Ebola in Marburg, Germany, giving that new virus its name, the Marburg virus.

How Is Ebola Treated?

There is no specific treatment for Ebola: no vaccines, no drugs. However, basic supportive care is very important. This includes:

• Treatment of fever (with NSAIDs, not aspirin)
• Good hydration (like ORS)
• Treatment of other diseases like malaria or respiratory infections

With basic supportive care and proper treatment, half of the patients who would have died from Ebola can be saved.

How Can Ebola Be Prevented?

• Prevent any unprotected contact with Ebola patients.
• Monitor everyone who has had direct contact with Ebola patients.
• Ebola patients need to be hospitalized in an isolation room and be managed by trained health staff.
• Health staff need to use special protection materials like gloves, goggles, masks and protective clothing, and these items need to be disinfected before disposal or reuse.
• All patients secretions (saliva, stools, urine) need to be disinfected with a 2% active chlorine solution (bleach) and disposed of safely.
• People who have died from Ebola should be promptly and safely buried.
• There is a new drug (rNAPc2) tested in the laboratory that has shown good results against Ebola, but this drug needs to go through clinical trials.
• One experimental vaccine tested by the U.S. National Institute of Allergy and Infectious Diseases protected monkeys after one month of giving the shot. This vaccine has not yet been tested in humans.

Getting Closer to Ebola

CNN has some Ebola quicktime video clips showing Ebola patients and conditions at a hospital where Ebola patients were treated in Kikwit, Zaire in 1995. 50 people died, including 3 Italian nuns who were caring for the sick.

Ebola and Popular Culture

The media had a heyday with the Ebola virus because it is deadly and because Ebola can cause internal hemorrhaging. The reality is that people do not die from such dramatic deaths, but die from weakness and shock.

Films like Ebola Syndrome (1996) and Outbreak (1995) were themed around Ebola or Ebola-like viruses. Books like Richard Preston's The Hot Zone (1994) were bestsellers, feeding largely off the Ebola media circus. Other fiction books based on Ebola are Tom Clancy's Executive Orders and Robert Liparulo's Germ.

Ebola News

News events surrounding Ebola occasionally pop up. The following are links to Ebola-related outbreak news in recent years. For the complete list of Ebola outbreaks in past years, see the World Health Organization's Epidemic and Pandemic Alert and Response Site for Ebola.

• Ebola Hemorrhagic Fever in the Democratic Republic of Congo September 11, 2007. World Health Organization. Epidemic and Pandemic Alert and Response.
• Ebola Hemorrhagic Fever in the Republic of Congo June 16, 2005. World Health Organization. Epidemic and Pandemic Alert and Response.
• WHO Annouces the End of Ebola Outbreak in Southern Sudan August 7, 2004. World Health Organization. Epidemic and Pandemic Alert and Response.
• Ebola hemorrhagic Fever in the Republic of Congo. World Health Organization. Epidemic and Pandemic Alert and Response. January 6, 2004.

Sources:

Heymann, David (2004.) Control of communicable diseases manual. Washington D.C.: American Public Health Association.

Bernal, Oscar. Personal communication. August 15, 2007.

Medicins Sans Frontieres. (2004.) Clinical Guidelines for Curative Programmes in Hospitals and Dispensaries. Paris, France.