Ebola Virus
The Ebola virus, also known as Ebola Hemorrhagic Fever, is one of the most deadliest diseases known to man. Ebola is a member of RNA viruses, known as filoviruses. There are four different types of the Ebola Virus: Zaire, Sudan, Reston, and Tai. Marburg is also a filovirus virus and is a sister of Ebola. Ebola Reston only causes disease to monkeys, while the other four attacks humans. The name "Ebola," comes from the Ebola River in Zaire where one of the most fatal of all Ebola outbreaks took place. In 1976, the virus appeared from an unknown place and killed many people. Many of the sick and dying waited outside clinics hoping for treatment for the disease, but there was no medicine for their illness. A cure was unable to be found, mainly because scientists could not find a host that the virus was living in, without hurting them. Families were forced to watch their loved ones die, while hoping that their own lives would be saved.
Symptoms
The initial symptoms of this virus begin within four to fourteen days after infection. These symptoms include: fever, weakness, muscle pain, headache, and sore throat. At this point, it is not known of the strength of this virus. The symptoms are followed by vomiting, diarrhoea, rashes, limited kidney functions, limited bodily functions, and internal as well as external bleeding. The host's blood also fails to clot.
Effects
The Ebola virus attacks every organ and tissue in the human body except the skeletal muscle and bone. As the host progresses in their sickness, small blood clots begin to appear in the bloodstream, and the blood thickens and slows, and clots begin to stick to the walls of blood vessels. The blood thickens even more and then clots form in the capillaries, where they get stuck. This shuts off the blood supply to varies parts of the body, causing dead spots to appear in the brain, liver, kidneys, lungs, intestines, testicles, breast tissue, and all throughout the skin. The skin develops red spots, called petechiae, which are hemorrhages under the skin. The skin bubbles up into a bunch of tiny white blisters mixed with red spots. This is know as a maculopapular rash. This rash highly resembles tapioca pudding. Soon, a numerous amount of rips appear in the skin, and a flow of blood flow from them. The skin becomes soft and delicate. A piece can be ripped off if it is touched with any kind of pressure. The mouth bleeds, and it bleeds around the teeth. Hemorrhages can also be found on the salvery glands. The surface of the tongue turns bright red and soon falls off. It may be torn off during tremendous heaves of black vomit. The back of the throat and the lining of the wind pipe may also get torn off. The dead tissue will then slide down into the lungs, later to be coughed up. The heart drowns itself. The heart muscle softens and has hemorrhages into its chambers. The blood is squeezed out of the heart as it beats and fills the chest cavity. The brain is clogged with dead blood cells. The eyeballs are also effected. The eyes may fill up with blood, and the host usually goes blind. In some cases the host may go into a hemispherical stoke, in which one whole half of the body is completely paralyzed. At this point of the disease, blood flows freely from every opening in the body, no matter how small it is. The blood has been striped of its clotting factors. Its red cells are broken and dead. During this horrible illness, Ebola kills a tremendous amount of tissue, while the host is still alive. The liver swells, turns yellow, begins to liquify, and finally splits apart. The liver soon dies after that. The kidneys become jammed with blood clots and dead cells. This forces them to cease functioning. As the kidneys fail, the blood becomes toxic with urine. The spleen turns into a huge blood clot the size of a baseball. The intestines fill up completely with blood. The lining of the gut dies and falls off into the bowels and is defecated along with large amounts of blood. Victims of Ebola often go into epileptic fits during the final stages. The whole body shakes with the evil death and the bloodied eyes roll far back into the head. After death, the host suddenly deteriorates. The internal organs, have already begun to dissolve. It is resembled as a bodily meltdown. The corpse's skin and organs begin to liquify. The fluids, swarmed by the black virus, will wait patiently for a new victim.
Outbreaks in Zaire, Reston, and Sudan
In May, of 1976, an outbreak of the Ebola virus generated global panic after becoming known to the media in Kinshasa, Zaire. The disease is believed to have spread to humans from green velvet monkeys, but where, when, and how is unknown. Fifteen days after the disease was known, there were 76 confirmed cases with 64 dead. Most of the deaths took place in Kitwit, a town of 500,00, and about 300 miles from Kinshasa, the nations capital. Three other towns were affected, including Kenge, less than 125 miles from Kinshasa, which has five million people but limited medical and sanitation facilities. As a form of filovirus, the Ebola disease family was founded in 1967 when surgical workers at a polio vaccine production laboratory in Marburg, Germany, were exposed to the blood and saliva to a batch of infected green velvet monkeys imported from Uganda. This case caused the U.S. to impose a quarantine on imported monkeys, for the first time, but that didn't prevent an outbreak of a similar kind of disease in 1989, Ebola Reston, at the Hazleton Research animal import site in Reston, Virginia. A quick response by the Center for Disease Control included killing all 400 monkeys at the Reston site, and also did the same at several other sites. The virus strain is believed to have come with crab-eating macaques imported from the Philippines. The Ebola Sudan came between the Zaire and Reston Epidemics. This disease hit parts of both Sudan and Zaire. It took its name from the river in the northern Zaire near the epicenter of the 1976 outbreak. "The death rate in some villages of the Sudan topped 90%" (Deborah Blum). "Ebola killed patients, nurses, doctors, wiped out entire hospital staffs. By the end, anybody left alive was fleeing. The virus destroys the body's blood system, ripping apart blood cells until they leak as if punctured by a thousand tiny needles. In the end, the membranes that contain the body's fluid are destroyed. The body is awash in disintegrated blood, the skin mushy and oozing," (Deborah Blum). There is no known vaccine or cure. The incubation period is believed to range from two to 21 days. "Another outbreak may have killed 200 people in the Nzara district of war-torn southern Sudan last year," (Father Julio Albanesi of the Comboni Missionaries in Nairobi, Kenya). "Nobody issued an official statement, but the symptoms of the people who got sick and died were those of Ebola," (Father Julio Albanesi of the Comboni Missionaries in Nairobi, Kenya). At this point, many people were dying. "The people there were so afraid they burned down the villages." (Father Julio Albanesi)
Outbreak in Switzerland
On February 20, 1996 in GENEVA, Switzerland experts believe they have identified the source of a deadly outbreak of Ebola which has killed 13 people in the West African nation of Gabon. "If this epidemic is like previous ones, and the signs are that it is, we are going to see a very rapid drop in cases shortly," (Dr. Ralph H. Henderson). Nineteen men from the remote village of Mayibout are believed to have contracted the virus from a dead chimpanzee which they found and brought back to their village for food. In addition to those it killed, the virus has infected at least seven other people in Gabon, a country of 1.2 million on the west coast of Africa. So far, all the victims are from Mayibout, a village of 150 inhabitants on the Ivindo River, 200 miles east of the capital, Libreville. In two neighboring villages, seven more people with fevers are suspected Ebola cases. Health experts are concerned the virus may spread through those who came in contact with the men who found the chimpanzee. There are already concerns the disease may have spread to Makokou, capital of Ogooue-Ivindo province, about 100 miles away, where the sick were hospitalized, he said. "Typically the real explosion occurs in hospital settings. Once you stop that, it tends to die out," (Dr. Ralph H. Henderson). One of the deadliest viruses known to man. The outbreak in Gabon is the third time the disease has struck the African continent in a year. People in Gabon are being warned not to touch dead or sick animals in the forest, to cover hands when attending to the sick or the dead and to avoid any contact with a sick person's blood. The Gabonese government has launched a public information campaign to advise the population on how to protect themselves from the disease. Others at risk are the medical staff at the hospital that treated those were infected with the virus. Scientists have learned more about the Ebola virus since the outbreak in Zaire.
How People Get Infected
Ebola jumps from victim to victim due to close personal contact. The disease is passed through the persons body fluids - blood, sweat, saliva, semen, vaginal secretions, and possibly by breathing infected respiratory droplets. Person-to-person infections take place when someone is tending to the infected person. Reusing hypodermic needles, also helps the virus get around. This is a common practice in Zaire and Sudan. Fortunately, a patient that has recover from the virus do not appose a serous threat of spreading it. "This virus is spread a lot like another virus-- Hepatitis B which is spread through mainly contact with blood. We also know that the virus does attack chimpanzees and kills chimpanzees as well as in humans. But we still don't know where the virus hides in nature," (WHO spokesman Valery Abramov).
Facts
Incubation: 2 to 21 days.
Diagnosis: Specialized laboratory tests on blood specimens (which are not commercially available) detect specific antigens or antibodies and/or isolate the virus. These tests present an extreme biohazard and are only conducted under maximum containment conditions.
Therapy: No specific treatment or vaccine exists for Ebola hemorrhagic fever. Severe cases require intensive supportive care, as patients are frequently dehydrated and in need of intravenous fluids. Experimental studies involving the use of hyperimmune sera on animals demonstrated no long-term protection against the disease after interruption of therapy.
Prevalence: The Ebola virus was first identified in a western equatorial province of Sudan and in a nearby region of Zaire in 1976. An isolated case occurred in Tandala, Zaire in 1977, a second outbreak occurred in Sudan in 1979, and an epidemic in the Bandundu Region of Zaire in 1995 caused 245 deaths. Two isolated cases of Ebola hemorrhagic fever were also identified in Côte d'Ivoire in 1994-95. The most recent outbreak was in rural Gabon in February 1996.
Natural Reservoir: The natural reservoir of the Ebola virus is not known. Extensive ecological studies are currently underway in Côte d'Ivoire, Gabon and Zaire to identify the reservoir. Ebola-related filoviruses were isolated from cynomolgus monkeys (Macacca fascicularis) imported into the United States of America from the Philippines in 1989. A number of the monkeys died and at least four persons were infected, although none of them suffered clinical illness.
Transmission: The Ebola virus is transmitted by direct contact with the blood, secretions, organs or semen of infected persons. Transmission through semen may occur up to 7 weeks after clinical recovery, as with Marburg hemorrhagic fever. Transmission of the Ebola virus has also occurred by handling ill or dead infected chimpanzees, as was recently documented in Côte d'Ivoire. Health care workers have frequently been infected while attending patients. In the 1976 epidemic in Zaire, every Ebola case caused by contaminated syringes and needles died.
Containment: Suspected cases should be isolated from other patients and strict barrier nursing techniques practiced. All hospital personnel should be briefed on the nature of the disease and its routes of transmission. Particular emphasis should be placed on ensuring that high-risk procedures such as the placing of intravenous lines and the handling of blood, secretions, catheters and suction devices are done under barrier nursing conditions. Hospital staff should have individual gowns, gloves and masks. Gloves and masks must not be reused unless disinfected. Patients who die from the disease should be promptly buried or cremated.
Contacts: As the primary mode of person-to-person transmission is contact with contaminated blood, secretion or body fluids, any person who has had close physical contact with patients should be kept under strict surveillance, i.e. body temperature checks twice a day, with immediate hospitalization and strict isolation recommended in case of temperatures above 38.3 C (101 F). Casual contacts should be placed on alert and asked to report any fever. Surveillance of suspected cases should continue for three weeks after the date of their last contact. Hospital personnel who come into close contact with patients or contaminated materials without barrier nursing attire must be considered exposed and put under close supervised surveillance.
Opinion
The Ebola Virus can probably be stopped if the United States spent more money on research. The American government doesn't think we should spend so much money on this disease since it doesn't oppose a real threat to the U.S.. However, this is where they are wrong. If we do not help poorer, less fortunate countries reach our high standards, then they will threaten danger among our country and the world. The reason is that they will not have the proper equipment and medical facilities to deal with and contain the virus. Thus, this disease may escape. Also, leading nations should buckle down on airline industries. If a person with the Ebola virus gets on a plane, they could go around the world and spread the virus within 48 hours worldwide. Most airports today do not have containment procedures for any people who show signs of unusual illness.
Interview
Dr. Donald Francis is currently doing research to develop a vaccine for HIV at Genentech, Inc. In February of 1992 he retired after 2 years in the U.S. Public Health Service. At the time of his retirement he was the Centers for Disease AIDS Advisor to the State of California and Special Consultant to Mayor Art Agnos in San Francisco. In the latter capacity he served as the Chair of the Mayor's HIV Task Force. Dr. Francis is a Californian having done his undergraduate studies at the University of California at Berkeley. He received his M.D. from Northwestern University and his Doctor of Science from Harvard. Before beginning his work on AIDS, Dr. Francis was involved in epidemic control around the world. He was instrumental in eradicating smallpox from Sudan, India and Bangladesh. He was also on the front line of the cholera epidemic in Nigeria in the early 1970's and the Ebola epidemic in Sudan in 1976. Dr. Francis also did some of the early developmental work on the hepatitis B vaccine, both in the United States and in the People's Republic of China. He began his work on AIDS in 1981. He was one of the first scientists to suggest that AIDS was caused by an infectious agent. As director of CDC's AIDS Laboratory Activities, he worked closely with the Institute Pasteur to prove that HIV was the cause of AIDS. He was also one of the earliest scientists to realize the impact HIV would have on the United States and has been an indefatigable advocate for a logical public response. This transcript was taken from an online discussion sponsored by Access Excellence that occurred on America Online on May 15, 1995.
Q: What exactly is Ebola?
A: "Ebola is a virus named after a river in Zaire, its first site of discovery. A usually fatal filovirus which affects monkeys, apes and humans, it is a cause of viral hemorrhagic fever -- there are others. Filoviruses are string-shaped, often with a little hook or loop at one end. Another, somewhat less deadly filovirus is the Marburg virus. "
Q: How is the virus transmitted?
A: "Ebola virus is spread through close personal contact with a person who is very ill with Ebola. In previous outbreaks, person-to-person spread frequently occurred among hospital care workers or family members who were caring for an ill person infected with Ebola virus. Blood and body fluids contain large amounts of virus, thus transmission of the virus has also occurred as a result of hypodermic needles being reused in the treatment of patients. Reusing needles is a common practice in developing countries, such as Zaire and Sudan, where the health care system is underfinanced. Medical facilities in the United States do not reuse needles."
Q: Is this virus airborne?
A: "There is no evidence of airborne transmission of Ebola between humans. There have been no clinically proven cases of airborne transmission between monkeys however there was a recent report in ProMED that two control monkeys cage across the room from monkeys infected with Ebola Zaire died of Ebola Zaire [5] . The Reston strain appears to have been transmittable by airborne means, but that strain is not harmful to humans. See Ebola section news for more information on the ongoing research into airborne transmission."
Q: Is there any cure or vaccine?
A: "No."
Q: Are there past illnesses of unknown cause that have since been identified as Ebola?
A: "We know of at least one case, a doctor who was working in Tandala, Zaire in 1972 who contracted it while doing an autopsy. He was tested in 1976 after Ebola was identified and was found to carry antibodies to the virus."
Q: Where has Ebola been known to occur?
A: "In Central Africa, initially in Zaire and Sudan. A new strain, Ebola Tai, was discovered recently in Cote d'Ivoire (Ivory Coast), West Africa. A Swiss researcher apparently caught Ebola Tai from a chimpanzee during her autopsy of it. There's also the open question of how monkeys from the Philippines came to be infected with Ebola (the Ebola Reston strain of "Hot Zone" fame.)"
Q: What are the chances of the Ebola virus coming to the US?
A: "Given the short incubation period, it is unlikely that an individual would come to the U.S. However, given the relative smallness of the world, every health care worker and hospital should treat any traveler from Zaire with fever with suspicion. If caution in hospitals (isolation) is instituted, transmission even if a case were introduced should be minimal."
Q: Many people are terrified that this virus will enter the US. How confident are we that we have it contained?
A: "From our previous experience with the other two outbreaks, rather simple isolation procedures stop the spread in hospitals and communities. So the same procedures should contain it this time. We will know from the case count as intensive surveillance for new cases has been instituted."
Q: Can an immune system treatment, such as an antibody, be effective on a virus that acts so quickly ?
A: "Sure it can."
Q: Have there been any attempts to do this?
A: "I don't know. If there were, they must be extremely small efforts."
Q: From what I understand, the Marburg was a different type of Ebola virus, not as lethal, in that effect because they found a vaccine that worked against it. What is the difference between the Ebola Zaire and the Marburg. Why won't the vaccine work?
A: "I know of no vaccine for Marburg. The mortality was slightly less of this sister virus. But in the big picture, they are almost identical."
