EBOLA virus disease, named after the Ebola river near the Democratic Republic of the Congo, where there was the initial outbreak in 1976, is an often fatal illness when contracted by humans. It causes a severe viral haemorrhagic disease in its sporadic outbreaks.

This virus dwells in wild animals such as fruit bats, chimpanzees, gorillas, monkeys, and porcupines and are transmitted to humans through close contact with their infected blood, secretions, organs, and bodily fluids, especially in villages near the tropical rainforests in Africa, more specifically Central and West Africa.

The Ebolavirus comes from the Filoviridae family (filovirus) and comprises five species. They are Zaire Bundibugyo, Sudan, Reston, and Tai Forest/Cote d’Ivoire ebolavirus. The first three are associated with outbreaks in Africa and the other two infects humans as seen in China and the Philippines, but no deaths have been reported.

The Ebolavirus is spread from human to human through direct contact with infected blood, secretions, organs, or bodily fluids, such as semen, through broken skin and mucous membranes.

Signs and symptoms

Once infected, within two to 21 days, the patient develops a high fever and starts to have viral symptoms such as chills, muscle aches and pain, weakness, headache, coughing, and sore throat, followed by nausea, abdominal pain, vomiting, diarrhoea, rash, along with impaired functions of the liver and kidney, and then some people suffer from low blood pressure as well as internal and external bleeding. The patient may have easy bruising, nosebleeds and bleeding at sites where veins are accessed, bleeding from the gastrointestinal tract, in urine or from the mucosa.

The patient will then have abnormalities in their complete blood count, such as low white blood cells and platelets. Their liver and kidney function tests will be elevated.

Diagnosis

Diagnosing the Ebolavirus is done through various tests which include the detection of antibodies from ELISA tests, antigen detection and isolating the virus through cell culture. This only occurs in specialised laboratories as the filoviruses are classified as biosafety level four pathogens, which provides the worker and the environment the highest protection.

Treatment

Treatment for the patient infected with the Ebola virus is supportive. Fluid resuscitation with oral and intravenous fluids is key. There is no cure at this time and no licensed vaccines are available. However, there are clinical trials under way.

Patients may progress to severe symptoms days after the onset of the disease, coma, and shock usually result in death. The survivors have detectable virus-specific antibodies while the non-survivors have higher levels of viruses in the blood and little detectable antibodies.

Survivors may suffer from a prolonged period of muscle and joint aches, muscle weakness, eye disease, hearing loss, or even psychosis.

Prevention

Prevention of this infection is paramount. Avoid contact with people infected with Ebola and handle their bodily fluids, such as blood, stool, saliva, semen, breast milk, or tears, with care if they are being treated, by donning protective clothing. Health care workers are particularly at risk and should observe precautionary and infection control measures including barrier nursing at all times. Regular hand washing by caregivers and relatives after hospital visits is necessary. The dead should be treated according to containment procedures and shoul be swiftly and safely buried.

In countries at risk, reducing the transmission from the wild life to humans can be done by handling the animals with protective clothing and not consuming raw meat, but cooking all meat thoroughly.

Jamaica and the Caribbean

Jamaica and the Caribbean would only be threatened with the Ebolavirus through bioterrorism or from an infected traveller or animal entering the region. Surveillance measures are employed to limit this occurrence.

Dr Romayne Edwards is a consultant emergency physician at the University Hospital of the West Indies and an associate lecturer at the University of the West Indies.