Author: Dr Simon Worrell, Global Medical Director
Dr Worrell has over 20 years of experience in the delivery of international medical assistance and emergency care, and has significant specialist expertise in immunology and communicable diseases. Simon leads Collinson’s medical team and provides expert advice on medical issues including pandemics from Ebola to Zika, helping to keep travellers and expatriates safe as they work and holiday internationally.
The on-going outbreak of Ebola virus in the eastern Democratic Republic of Congo (DRC), is the second largest in history. At the time of writing, approaching 2,000 people have been infected so far, proving fatal for well over 1,000 individuals. This particular outbreak has been confounded by militia activity that has disrupted the work of the WHO health workers in the field: efforts to identify cases, vaccinate contacts and quarantine and treat sufferers, have all needed to be halted regularly. As case number continue to rise, it is clear that this outbreak will continue for some time to come.
The natural host of the Ebola virus is the fruit bat. This bat suffers few effects of Ebola infection, allowing the virus to be circulated within bat colonies. However, this relatively benign situation is far from the case when Ebola spills over into other environments. When Ebola infects humans, in around 60-70% of cases, death rapidly follows within a few weeks. This has led to reports of a killer virus, intent on decimating villages and cities. This is not true, however. Ebola and humans are simply a truly catastrophic match. With effective quarantining to limit further transmission of the virus, control of outbreaks can be rapidly obtained. The challenge is to identify the ways that the virus is being spread, to separate those affected from the healthy, and to educate the population to reduce the risk of transmission. As Ebola epidemics usually occur in communities that understand little of viruses and medicine, are distrustful of the outsider, follow cultural practices that facilitate the transmission of the virus, and become understandably fearful when loved ones become seriously ill, engaging the local people is central to controlling outbreaks. As this current epidemic in the DRC is also occurring in an area of significant military activity, halting the spread of the Ebola virus will possibly be more difficult than ever before.
The initial symptoms of Ebola are shared by many viral diseases, making diagnosis difficult in the early days of the illness. After being infected from 2 to 21 days (the incubation period), individuals become unwell with a fever, headache, tiredness and muscle ache – the so called ‘flu-like symptoms’. In the only 6-16 days, however, severe illness can follow during which many organs of the body become affected. Uncontrolled bleeding often results as the clotting systems are overwhelmed, giving rise to the description of Ebola as a ‘haemorrhagic’ fever.
For those who have survived an infection with Ebola, there might be continued difficulties as the virus often causes prolonged inflammation in neurological and other tissues. Meningitis, deafness and eye problems are often reported as are long-lived joint pains and lethargy.
There are specific tests for Ebola that are able to detect either the genetic make-up of the virus, or the antibodies that we make in response to the disease. Both are important, but in the early stages of the disease, genetic testing is particularly crucial.
How can I catch Ebola?
Although eating meat infected with Ebola can start off an epidemic, the Ebola virus is generally caught following close contact with infected patients. There are three settings that are especially risky for catching Ebola. Attending local funerals has been associated with increasing the transmission of the disease during previous outbreaks. This is because the ritual cleansing of the body that occurs during the ceremony is particularly perilous for those carrying out the ritual. Caring for Ebola-infected family members has also proven to be highly likely to transmit the viral disease to the carers. In a similar way, healthcare workers looking after Ebola sufferers in hospital are at prolonged risk of acquiring the illness. Although there is personal protective equipment that the healthcare worker can wear to reduce the likelihood of infection, it often only takes one mistake in its use to make the nurse or doctor susceptible to Infection.
Lastly, as the Ebola virus has been found to persevere in certain parts of the body despite the infection being cleared from most of the body, other forms of transmission can occur. In men, the virus can persist in semen for several months making sexual transmission of the illness possible: safer sex practises should be followed.
The mainstay of treatment for Ebola is supportive: fluids are given directly into the veins to keep the patient hydrated, and simple analgesics can be administered. Recently several medications have been used to see if they improve the outcome in Ebola virus disease but at the time of writing, it is not certain whether they are effective. Such medications include compounds that might disrupt the way the Ebola virus replicates.
Control of the Outbreak
Quarantine underpins the approach taken to control Ebola epidemics. The first step is for rapid, accurate diagnosis to be made of the disease in infected individuals. As Ebola outbreaks often occur in rural areas, there can be significant delays in several steps involved with the quarantine process: the notification of a potential sufferer, reaching the patient, testing of blood samples, and the quarantining of the patient, can all take time during which further transmission can occur. A recent addition to the process has been the vaccination of contacts of an Ebola patient with novel, Ebola immunisations, tested during the West African Ebola outbreak of 2014-16. At present the most evaluated vaccine is the VSV-ZEBOV, Ebola vaccine, which has received good results in the field so far.
Our Travel Risk Management Solutions
Solutions that put travellers at the heart of the proposition and provide peace of mind for any organisation looking to mitigate organisational risk and safeguard their travellers’ wellbeing wherever they are.