A Comprehensive Overview Of Ebola Virus

Ebola. A name not familiar to those who have yet to see how an unwelcomed guest comes rearing its displeasing presence upon humanity. It was not until the outbreak of 2014, where the Ebola virus was introduced to the rest of the world, gaining peak notoriety for all the wrong and unpredictable reasons. In Western Africa, where the Ebola virus has gained infamy throughout the region, mainly in the countries of Liberia, Guinea, and Sierra Leone. It had the whole country-side in its grasp unwilling to show any signs of slowing down the spread of infection. Previously, this disease has had a history of small outbreaks in the remote regions of Central Africa, and the largest being in Zaire, now present day Democratic Republic of Congo, in 1976 with 319 cases of the disease. In 2013, what was seen was the worst outbreak of this disease. As it has spread through many West African countries it poses yet another emerging threat in 2019. Education about the Ebola virus may be the best course of action to further prevent the spread to other continents; threatening wellness across the planet.

The Ebola virus disease is an atypical and lethal disease that occurs in human and nonhuman primates (examples are monkeys, gorillas, and chimpanzees); other animals include those that could be carriers or reservoirs for Ebola. This disease is caused by a host of many viruses (belonging to the Filoviridae family) and are as followed: Ebola virus, Sudan virus, Tai Forest virus, Bundibugyo virus, Reston virus, and Bombali virus. Out of all of these filoviruses, only four (Ebola, Sudan, Tai Forest, and Bundibugyo viruses) are really able to cause the Ebola virus disease in humans (Wen-gang Li, et al., 2016). The structure of Ebola allows the virus to be highly pathogenic causing severe hemorrhagic fever leading to high mortality to those infected. Its assembly is done through heterogeneous, filamentous, enveloped virus particles that contain a negative-sense, single-stranded RNA and a genome packaged within a helical nucleocapsid. This information of its description is important as the virus has evolved to exploit the various defense mechanisms within body such as the many proteins and genes within the body’s cell. Figuring out how the virus affects the cell to infect, is a useful tool in preventing infection and further spread of the disease.

The symptoms of the Ebola virus disease are many and they may include the following: fever, severe headache, muscle pain, weakness, fatigue, sore throat, diarrhea, vomiting, and abdominal pain are all sudden onset symptoms. Late onset symptoms that occur are bleeding from the mouth, rectum, eyes, ears, and nose; and organ failure; leading to eventual death. Possible symptoms that may occur in some patients are rash, red eyes, hiccups, impaired kidney and liver function. This virus has an incubation period, that being the timeline in which the onset of symptoms is within the frame of two to twenty-one days. A person who has been infected with Ebola is not able to spread the disease unless they are symptomatic. Amongst the symptoms listed they might also be associated with other common illnesses (influenza or malaria) that may contain similar symptoms, making it hard to diagnose.

Diagnosing the Ebola virus disease can pose a challenge as it is not easily identifiable by symptoms alone. It may be similar to other infectious diseases such as malaria, typhoid fever, yellow fever, shigellosis, leptospirosis and meningitis. It is important to determine a diagnosis based on the information about a patients recent whereabouts of travel and history of exposure to other diseases that present similarly symptom-wise. There is clinical data in laboratory findings that can help determine how Ebola presents when suspected in a patient. In the presentation of this disease there is an incidence of leukopenia with lymphocytes and an increase percentages of granulocytes. Other findings that occur during disease progression include the development of leukocytosis with an increase of immature granulocytes in lab samples. A feature that may accompany a patient until death may often times be thrombocytopenia. While examining serum levels, there are mild elevations of alanine and aspartate aminotransferase detected. Other elevations of blood products are the serum total bilirubin levels either seen as normal or elevated in early progressions of Ebola. There are many more findings that are seen in laboratory work that may also include elevated blood urea nitrogen and creatinine due an excess loss in fluid during episodes of diarrhea and vomiting without treatment to replace lost of fluids. The prolonged prothrombin time, partial thromboplastin time, or bleeding and disseminated intravascular coagulation can also been seen within the diagnosis of this disease in laboratory findings (Ayten Kadanali, 2015). To confirm that the symptoms of Ebola are associated with the disease, there are diagnostic methods that are suggested in the following: antibody-capture enzyme linked immunosorbent assay or ELISA, antigen-capture detection tests, serum neutralization test, reverse transcriptase polymerase chain reaction assay, electron microscopy, or virus isolation by cell culture. The preferred substance of diagnosis are whole blood collected in ethylenediaminetetraacetic acid from those patients who are symptomatic and oral fluid specimens from those who are deceased or when blood samples are not possible to be obtained (those specimens are to be stored in universal transport medium used for viral collection, transport, maintenance and long term freeze storage of specimens). It is top priority that these specimens be handled with the utmost precaution necessary (Disease, 2019). The samples collected are a high-risk biohazard material to the handler; these samples that are to be tested should also be done so in a well-equipped laboratory with the biosafety level four-equivalent containment as it is classified by the World Health Organization as a Risk Group four pathogen. Transportation protocol with the use of triple packaging style and needs to be in place when specimens are transported nationally and internationally. Other characteristics of the transportation process pertaining to the packaging should include a watertight, leak-proof container with an outer shipping package and should be kept at temperatures of two to eight degrees Celsius or on ice packs.

With regards to treating this disease, the main strategies that are being provided to those infected with Ebola are with the use of supportive care that includes hydration, replacement of lost electrolytes, nutritional support for malnutrition, oxygen therapy for possible breathing complications, medications to support blood pressure, lessen vomiting and diarrheal episodes; as necessary, the treatment of other infections may be required (Disease, 2019).

There is no definitive vaccine available to treat for this disease or a standard of treatment for Ebola. Anything in development has not been licensed for use on humans, but there has been an effort made to develop drugs that stop the virus from replicating itself in the body’s cells. There has been possibilities that those who survive from the infection develop antibodies that show some hope as a treatment for Ebola. There are experimental vaccines (rVSV-ZEBOV) that have been shown to be protective against the virus. A trial of this vaccine was conducted by the World Health Organization and other international partners for the fight against Ebola in Guinea, in the year 2015, but licensure for this vaccine by the FDA has not be approved until the year 2019, but the vaccine was developed and stockpiled just in case an outbreak does occur prior licensure by the FDA (these vaccines have their own protocol to follow for emergency use only). Another vaccine that is receiving ongoing research is the recombinant adenovirus type-5 Ebola vaccine, whose affects were observed to present an immune response within twenty-eight days of vaccination, but later a decreasing response in six months post vaccination. The research for a vaccine to fight against the Ebola virus is an ongoing effort by the international health community.

The prognosis for this disease is relatively poor, as the average case fatality rate is about fifty percent. In recent outbreaks the other percentages seen have ranged from twenty-five to a high ninety percent.

Some facts to know about this disease, geographically speaking in relation to the United States, are that the Ebola virus disease if a very rare disease that has had cases occurred in the U.S. only by means of travel in countries where a chance of exposure was more prevalent. The reservoir that carries the disease is not available in the United States, but it is important to know that when living at or traveling to a region where risk for exposure to Ebola is more likely, there are precautionary steps to protect oneself from this disease and also prevent the possible spread of Ebola. While in a region that has a high prevalence for Ebola it is important for one to avoid any type of contact with the body fluids (blood, urine feces, saliva, sweat, vomit, breast milk, semen, or vaginal fluids) of any person that may present as infected. There are also other items to avoid in which an ill person may have come into direct contact with. Those items should avoid handling; including their clothes, bedding, needles, and/or medical equipment used on them. In relation to burial practices the body of someone who possibly passed due to Ebola must not be handled via traditional customs, but must otherwise be cremated or buried to prevent the spread of Ebola. There are contact with animals that one must avoid as they may possibly carry the disease and those animals might include bats or nonhuman primates (respectively the body fluids of them also) the meat of consumption of these animals (Disease, 2019). Other prevention practices do not end when leaving said area with a high prevalence of Ebola and returning individuals must be screened or possibly quarantined and monitored for twenty-one days if there are symptoms that develop. There are also precautions a health care professional caring for those infected should practice and understand. The Ebola virus is highly infectious and isolation of the infected individuals when treatment and care is to be administered should be done so in a single, secured, and sealed room that contains the individuals own bathroom and prepped bedding area. The personnel caring for the individual should follow proper donning and doffing techniques; understand contact information and be issued the proper personal protective equipment (PPE). The following should be included in the PPE: double gloves on each of the hands, an apron or front coverall, face mask, eye protection (goggles and face shield combination suggested), head cover (hood of protective suit), and boots. There are procedures that can produce aerosol from body fluids so a respirator of N95 standards or higher should be worn. Prior to handling the patient and other items that the patient has come into contact with, wash with soap an water or an alcohol based hand sanitation should be used in PPE. If exposure occurs, healthcare workers should be decontaminated and the exposed area should be cleaned with soap and water. There are even more precautions to take heed of when performing diagnostic or laboratory work of specimens of an ill patient. If there is an incident of fluids that are at an area risking others for exposure the proper protocol for decontamination would be to use one to ten ratio dilution of household bleach on environment related surfaces and a one to one-hundred dilution of bleach on surfaces for a duration of ten minutes for full effect (Ayten Kadanali, 2015).

In conclusion, the vast amount of information and knowledge needed to be able to identify, treat, and prevent further spread of Ebola virus disease is important for the further safety of the international community and of areas of higher prevalence. This virus poses a high-risk threat to humanity as a whole if an outbreak where to lose control and/or the genetic information of this disease mutates to possibly be more difficult and dangerous to prevent and treat. The future holds much hope and potential for a better tomorrow, but with a future it also brings undecided and unpredictable circumstances we need be ready and prepared for.

References

• Bharat, T. A., Noda, T., Riches, J. D., Kraehling, V., Kolesnikova, L., Becker, S., Kawoaka, Y., Briggs, J. A. (2012, March 13). Structural dissection of Ebola virus and its assembly determinants using cryo-electron tomography. Retrieved from https://www.pnas.org/content/109/11/4275
• Ebola Virus Disease. (2019, August 2). Retrieved from https://www.iamat.org/risks/ebola-hemorrhagic-fever#
• Ebola (Ebola Virus Disease) | CDC. (2017, May 20). Retrieved from https://www.cdc.gov/vhf/ebola/index.html
• Ebola virus disease. (2019, May 30). Retrieved from https://www.who.int/en/news-room/fact-sheets/detail/ebola-virus-disease
• Ebola virus disease: MedlinePlus Medical Encyclopedia. (2017, October 18). Retrieved from https://medlineplus.gov/ency/article/001339.htm
• Ebola: Overview, history, origins and transmission. (2019, July 29). Retrieved from https://www.gov.uk/government/publications/ebola-origins-reservoirs-transmission-and-guidelines/ebola-overview-history-origins-and-transmission#symptoms
• Ebola Virus Disease Outlook / Prognosis. (2014, October 24). Retrieved from https://my.clevelandclinic.org/health/diseases/15606-ebola-virus-disease/outlook-- prognosis
• Kadanali, A., & Karagoz, G. (2015, April 24). An overview of Ebola virus disease. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175058/
• Li, W., Chen, W., Li, L., Ji, D., Ji, Y., Li, C., Goa, X., Wang, L., Zhao, M., Duan, X., Duan, H. (2016, May 10). The etiology of Ebola virus disease-like illnesses in Ebola virusnegative patients from Sierra Leone. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053697/