An outbreak of the deadly Ebola Virus Disease (EVD) in Guinea and Liberia in west Africa has spread alarm across the globe with international health agencies stepping up efforts to contain the disease.
The region has reported over 220 clinical cases of EVD, including 135 deaths since February. More than 100 are laboratory confirmed to be Ebola, according to the latest health alert put out by the World Health Organization (WHO). The international health agency is providing support to the governments of the two countries in clinical management of patients, contact tracing, disease surveillance, laboratory work, logistics, as well as information-sharing and social mobilisation and communication.
Ebola, characterised by sudden onset of fever, causes internal bleeding and organ failure and is fatal in up to 90 per cent of cases, depending on the viral strain. Ebola is introduced into the human population through close contact with the blood and secretions of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelopes and porcupines found ill or dead or in the rainforest. Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids.
WHO considers it one of the world’s most dangerous diseases.
There is no known cure or vaccine for Ebola, though some experimental vaccines have been developed.
Although this is not the largest outbreak (280 and 254 deaths were reported in Congo in 1976 and 1995 respectively) ever, given its spread across two countries, the current Ebola outbreak in Guinea and Liberia is one of the most challenging, says WHO. For example, tracing people who the ill have come in contact with requires following more than 640 people in six areas in Guinea and four in Liberia, and sometimes across the borders of the two countries, the world health agency adds. A total of 230 contacts are currently under medical observation and 53 have completed their 21 days of follow-up. Seven contacts who developed symptoms continue in isolation, says WHO.
“One of priority areas of work is to train health care workers in affected countries on how they can protect themselves as they provide care for the sick” says Pierre Formenty, one of WHO’s technical officers who specialises in Ebola. “So far in Guinea, 24 health workers have been affected including 13 deaths. Because Ebola outbreaks have not occurred in this area before, many health workers are not practised in caring for these patients. Protecting their health is crucial to succeeding in the control of this Ebola outbreak.”
Médecins sans Frontières (MSF/Doctors without Borders) is also helping Guinea in establishing treatment and isolation centres. Several other international agencies, like the International Red Cross (IRC), Pentecostal Mission Unlimited (PMU)-Liberia and the Samaritan’s Purse (SP) are aiding the Liberian government. IRC is supporting awareness campaigns among health care workers in a number of districts in Lofa County, and is working with PMU-Liberia and SP Liberia to provide preventive healthcare in 41 health facilities including 37 clinics, 3 health centres and the Curran Lutheran Hospital. Samaritan’s Purse is also providing logistics for the movement of response personnel medical supplies and fuel.
According to Mariano Lugli, coordinator of MSF's project in Guinean capital, Conakry, the epidemic is of a magnitude never before seen in terms of the distribution of cases. “MSF has intervened in almost all reported Ebola outbreaks in recent years, but they were much more geographically contained and involved more remote locations. This geographical spread is worrisome because it will greatly complicate the tasks of the organisations' working to control the epidemic,” Lugli says.
Not endemic to Guinea
The virus was first spotted in Guinea's remote south-eastern region of Nzerekore, where most of the deaths have been recorded. This is the first known outbreak in Guinea—most recent cases have been far away in the Democratic Republic of Congo and Uganda.
In Sierra Leone, there have been 12 suspected cases, 11 of which tested negative for the virus. It is not clear what the status is of the remaining case. In Mali, six cases were suspected, but also tested negative.
The Ebola virus in Guinea this year is a new strain, not imported from Central Africa, according to a group of scientists, who published their preliminary findings on the website of the New England Journal of Medicine.
Ebola is endemic to Congo, Uganda, South Sudan and Gabon, and scientists initially believed that Central Africa's Zaire strain of the virus was responsible for the outbreak. For the study, the researchers analysed blood samples from 20 patients in the current outbreak and found the strain was unique. The investigation continues to try to identify "the presumed animal source," the scientists write.
Guinea's Foreign Minister Francois Fall on April 14 claimed the country has brought the spread of the deadly haemorrhagic Ebola virus under control.
But MSF has a slightly different take. “From an epidemiological view it`s too early to say which way the outbreak is going. For us, every new case is a challenge. We will continue to admit new patients until this outbreak is over,” says Henry Gray, MSF emergency coordinator in Guinea, in the press communique issued by the organisation on April 18.
Senegal, meanwhile, has sealed its border with Guinea to keep the virus at bay. The move has annoyed Guinea. Its health minister, Remy Lamah, expressed serious reservations, saying closure of borders by any country poses more problems because, according to him, people who use illegal or unofficial point of entry would escalate the problem and they wouldn't be monitored.
There are many symptoms associated with Ebola, however, the sudden onset of fever, intense weakness, muscle pain, headache and sore throat are typical signs and symptoms.
This is often followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding, according to WHO.
Treatment and prevention
Severely ill patients require intensive supportive care. Patients are frequently dehydrated and require oral rehydration with solutions containing electrolytes, or intravenous fluids. Eight patients in Guinea have so far recovered. “We’ve learned from our previous experiences that we give patients 10 to 15 per cent more chance to survive with good medical support,” says Michel Van Herp, MSF epidemiologist in eastern Guinea. “But if they stay at home, the fatality rate reaches generally up to 90 per cent.”
Raising awareness of the risk factors for infection and the protective measures that should be taken is the only way to stop transmission and subsequent deaths, says WHO.
Close unprotected physical contact with Ebola patients should be avoided and those who have died from the disease should be promptly and safely buried.
Report : Emergence of Zaire Ebola Virus Disease in Guinea