Ebola

……….why should we
fear?

Fabian Pitkin MT, MPH

 What is Ebola?
Ebola, previously known as Ebola haemorrhagic fever, is
a rare and deadly disease caused by infection with one of
the Ebola virus strains. Ebola can cause disease in humans
and non-human primates (monkeys, gorillas, and
chimpanzees).
Ebola is caused by infection with a virus of the family
Filoviridae, genus Ebolavirus. There are five identified
Ebola virus species, four of which are known to cause
disease in humans: Ebola virus (Zaire ebolavirus); Sudan
virus (Sudan ebolavirus); Taï Forest virus (Taï Forest
ebolavirus, formerly Côte d’Ivoire ebolavirus); and
Bundibugyo virus (Bundibugyo ebolavirus). The fifth,
Reston virus (Reston ebolavirus), has caused disease in
nonhuman primates, but not in humans.
Ebola viruses are found in several African countries.
Ebola was first discovered in 1976 near the Ebola River in
what is now the Democratic Republic of the Congo. Since
then, outbreaks have appeared sporadically in Africa.
The natural reservoir host of Ebola virus remains
unknown. However, on the basis of evidence and the
nature of similar viruses, researchers believe that the virus
is animal-borne and that bats are the most likely reservoir.
Four of the five virus strains occur in an animal host
native to Africa.
 Overview
The 2014 Ebola epidemic is the largest in history,
affecting multiple countries in West Africa. There were a small
number of cases reported in Nigeria and a single case reported
in Senegal; however, these cases are considered to be
contained, with no further spread in these countries.
One travel-associated case was diagnosed in the United States
on September 30, 2014. On October 12, 2014, a healthcare
worker at Texas Presbyterian Hospital who provided care for
the index patient tested positive for Ebola. Confirmation
testing at CDC’s laboratory is being performed.
 Signs and Symptoms
 Fever (greater than 38.6°C or 101.5°F)
 Severe headache
 Muscle pain
 Weakness
 Diarrhoea
 Vomiting
 Abdominal (stomach) pain
 Unexplained haemorrhage (bleeding or bruising)
 Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola,
but the average is 8 to 10 days.
 Recovery from Ebola depends on good supportive clinical care and the
patient’s immune response. People who recover from Ebola infection
develop antibodies that last for at least 10 years.
 Transmission
 When an infection does occur in humans, the virus can be spread in several
ways to others. Ebola is spread through direct contact (through broken skin
or mucous membranes in, for example, the eyes, nose, or mouth) with:
 blood or body fluids (including but not limited to urine, saliva, sweat, feces,
vomit, breast milk, and semen) of a person who is sick with Ebola
 objects (like needles and syringes) that have been contaminated with the
virus
 infected animals
 Ebola is not spread through the air or by water, or in general, by food.
However, in Africa, Ebola may be spread as a result of handling bushmeat
(wild animals hunted for food) and contact with infected bats. There is no
evidence that mosquitos or other insects can transmit Ebola virus. Only
mammals (for example, humans, bats, monkeys, and apes) have shown the
 Risk
Healthcare providers caring for Ebola patients and the
family and friends in close contact with Ebola patients are
at the highest risk of getting sick because they may come
in contact with the blood or body fluids of sick patients.
People also can become sick with Ebola after coming in
contact with infected wildlife.
 Prevention
 There is no FDA-approved vaccine available for Ebola.
 If you travel to or are in an area affected by an Ebola outbreak, make sure
to do the following:
 Practice careful hygiene. For example, wash your hands with soap and
water or an alcohol-based hand sanitizer and avoid contact with blood and
body fluids.
 Do not handle items that may have come in contact with an infected
person’s blood or body fluids (such as clothes, bedding, needles, and
medical equipment).
 Avoid funeral or burial rituals that require handling the body of someone
who has died from Ebola.
 Avoid contact with bats and nonhuman primates or blood, fluids, and raw
meat prepared from these animals.
 Diagnosis
 Diagnosing Ebola in an person who has been infected for only a few
days is difficult, because the early symptoms, such as fever, are
nonspecific to Ebola infection and are seen often in patients with more
commonly occurring diseases, such as malaria and typhoid fever.
 However, if a person has the early symptoms of Ebola and has had
contact with the blood or body fluids of a person sick with Ebola,
contact with objects that have been contaminated with the blood or
body fluids of a person sick with Ebola, or contact with infected
animals, they should be isolated and public health professionals
notified. Samples from the patient can then be collected and tested to
confirm infection.
 Time line of infection and Diagnostic tests
 Within a few days after symptoms begin-Antigen-capture enzyme-linked
immunosorbent assay (ELISA) testing
 IgM ELISA
 Polymerase chain reaction (PCR)
 Virus isolation

 Later in disease course or after recovery- IgM and IgG antibodies

 Treatment
 No FDA-approved vaccine or medicine (e.g., antiviral drug) is available for
Ebola.
 Symptoms of Ebola are treated as they appear. The following basic
interventions, when used early, can significantly improve the chances of
survival:
 Providing intravenous fluids (IV)and balancing electrolytes (body salts)
 Maintaining oxygen status and blood pressure
 Treating other infections if they occur
 Experimental vaccines and treatments for Ebola are under development, but
they have not yet been fully tested for safety or effectiveness. (e.g. Zmapp)
 Ebola and Jamaica…..what do we
know?
 According to the Ministry of Health, “There are no reported cases of the
Ebola virus in Jamaica at this time. ”
 Dr. DuCasse, International Health Regulations (IHR) Focal Point and
Director, Emergency, Disaster Management and Special Services,
declares that while Jamaica does not at this time fall into the
category of at risk countries, “we continue to ensure that our
systems are strengthened so that we can have an effective response if
the need arises. Our surveillance system has already been heightened,
we will be sensitizing staff and undertaking training specific to the
Ebola virus and continue with our monitoring of the situation.”
 “Ebola is an unprecedented infectious disease that knows no
borders…..” Pitkin, 2014
 Are we prepared to Handle the
Ebola? What do the expert say…
Chief Public Health Inspector for St Mary, Paul Brown
speak of the Ebola says, “We are nowhere ready for this”.

Medical Officer of Health for the parish of St Mary, Dr San

San Win highlights that Jamaicans should be vigilant to
stop persons who may be carrying the disease, from
entering the country. (The Jamaica Observer, October 12,
2014)
 What plans are in place?
 According to Dr Kevin Harvey, Acting Permanent Secretary in the Ministry
of Health, “We are not intending to treat and manage Ebola cases long-term
at all our hospital facilities. It will simply be a short-term holding space
with planned transfer to the main isolation treatment site,” He also noted
that the aim of the ministry is to have two days’ supply of protective gear at
hospitals, with a significant stock at the main isolation facility.
 He informed that the ministry will be presenting guidelines for the
management for funeral homes and mortuaries “and this will tell you a little
bit more on how to manage the dead bodies”.
 The Government will also carry out a public education campaign on the
Ebola virus. (The Jamaica Observer, October 9, 2014)
According to Ferguson, surveillance at the nation's points
of entry is already in place and "we will be continuing
with training and sensitisation of our health workers, as
part of measures to increase our vigilance and
preparedness for this disease". (The Gleaner, August
2014)
You heard there’s a possible cure?
Where is your evidence?
 Do you have an silver?
One could respond as saying “mi nah no silva”
 What is Nanosilver? Also called Colloidal nano silver is nanometer-
sized silver particles suspended in water. It has been used by people to
self-medicate innumerable conditions for around a century now. .
 According to Andrew Maynard, Director of the is Risk Science
Center at the University of Michigan School of Public Health, studies
carried out on nanosilver provide valuable insights into silver
nanoparticle-virus interactions, and indicate that, with significantly
more research, silver nanoparticles may have some role to play in
preventing or managing infections. But the research does not support
clinical applications at this stage. Even if there was proof that silver
nanoparticles are effective in humans in suppressing viral activity (and
there is not), there are critical questions over dose and delivery.
To be effective, there would need to be systemic uptake of
nano silver within the body at doses that are sufficient to
inhibit the Ebola virus, but low enough to prevent
unacceptable harm. Currently, scientists have no ideas
what an appropriate dose is. (Maynard, 2014)
 Resources
World Health Organisation
Centres for Disease Control and Prevention
WHO Frequently asked questions on Ebola virus disease
WHO Ebola Virus Disease
Jamaica Information Service
Dixon, Renae. 2014. “Jamaica not prepared to handle Ebola
— health official” Sunday Observer. Sunday, October 12,
2014
Ebola Articles and information from the Risk Science
Center