he recent death of a Liberian Ebola victim in Nigeria has awakened a lot of interest and created fear among citizens about this new disease. For Nigeria, being a country with a high population, an outbreak of the disease would be very devastating, even as the citizens still question the country’s response to such threats and emergencies. However, details obtained from the United Nations Information Centre (UNIC), Lagos, and the World Health Organisation (WHO) provide a lot of insight to what the disease is all about and how to contain it. What is Ebola virus disease? Ebola is known formally as Ebola Virus Disease, or EVD. The Ebola strain in the Guinea outbreak is the most lethal of the five known strains of the virus. It is called Ebola Zaire and can kill up to nine out of 10 infected people. The fatality rate in this outbreak is around 60 per cent. The severity of the outbreak is a result of weaknesses in national health care systems, community fear, resistance and stigmatisation, inappropriate use of personal protective equipment and unsafe burial practices. During the current outbreak, much of the disease has spread through human-to-human transmission. ADVERTISEMENT What are the typical signs and symptoms of Ebola? It can take two to 21 days for symptoms to appear after a person is exposed to the virus. Symptoms include sudden onset of fever, intense weakness, muscle pain, headache, and sore throat, followed by vomiting, diarrhea, rash, impaired kidney and liver function and, in some cases, both internal and external bleeding. Men who have recovered from Ebola can still spread the virus to their partner through their semen for up to seven weeks after recovery. For this reason, it is important to either avoid sexual intercourse or to wear condoms during sexual intercourse for seven weeks after recovery. In the deceased, Ebola virus can live for several days after death. For this reason, it is important not to touch or kiss the body of a deceased person as this can contribute to continued disease spread. How does one get Ebola? A person is not contagious until he/she is acutely ill. When a person is showing symptoms, they are most likely to give the disease to others through direct contact and contact with objects contaminated with body fluids (for example, syringes). An infected person’s body fluids carry the virus. This means saliva, mucus, blood, urine, faeces, semen, vomit, breast milk, and sweat can transmit the virus. The virus is also very contagious from the bodies of people who have died of Ebola, which is why preparing their bodies for burial is dangerous and should be performed by medical care professionals. Some bush animals may also transmit the virus to humans if the humans handle infected animals or eat infected bush meat, especially from fruit bats and monkeys/apes. While the initial case of Ebola in this outbreak was the result of someone handling an infected animal, nearly all cases since have spread through human-to-human transmission. Health workers have frequently been exposed to the virus when caring for Ebola patients. This happened because they did not take simple measures, such as wearing personal protection gear, including gloves, when caring for an infected patient. Health care providers at all levels of the health system – hospitals, clinics and health posts – should strictly follow WHO recommended infection control precautions. What can be done to protect oneself from the Ebola virus? The virus is fragile and easily killed by contact with soap, bleach, sunlight or drying. Hand washing with soap and water is very effective and should be practised as much as possible. An alcohol-based solution/rub could be considered as an effective alternative. Regular bleach (1 per cent) is also very effective to disinfect surfaces potentially infected by bodily secretions. One is advised to listen to and follow directives issued by the country’s respective Ministry of Health or the UN Medical Officer(s). If you think someone close to one or in your community has Ebola virus infection, such a person should be encouraged and supported to seek appropriate medical treatment in a care facility. Those who have chosen to care for an ill person in their homes should also be encouraged to notify public health officials or the UN Medical Officer(s) so they can be trained and provided with appropriate gloves and personal protective equipment (PPE), as well as instructions on how to properly care for the patient, protect themselves and their family, and properly dispose of the PPE after use. When visiting patients in the hospital or caring for someone at home, hand washing with soap and water is recommended after touching a patient, being in contact with their bodily fluids, or touching his/her surroundings. People who have died from Ebola should only be handled using appropriate protective equipment and should be buried immediately. Households can consider extra precaution by buying a set of gloves and masks to keep at home for personal protection in case a family member gets sick. Keeping a thermometer at home to monitor temperature is also recommended. It is important to understand the nature of the disease, how it is transmitted and how to prevent it from spreading further. Is there any preventative medicine to keep one from getting Ebola? There is no preventive medicine or a specific cure for Ebola virus disease, nor a vaccine that would make you immune to the disease. The only treatments currently available for Ebola patients are supportive, such as intravenous fluids or oral rehydration for individuals who are dehydrated, or medicines for treating some of the symptoms, such as fever. This is why prevention is more important. Can one do anything to help stop the spread of Ebola? Yes. One can take a number of very simple actions. Ebola is not as contagious as most common viruses, such as colds, influenza or measles. Risk is negligible if one has not been in close contact with a person actively sick with the virus. It spreads to people by close contact with skin and bodily fluids. The key message is to minimise bodily fluid exposures. Because there is no treatment and no cure, raising awareness of the risk factors for Ebola infection and the protective measures individuals can take are the only way to reduce human infection and death. There are other diseases that have very similar symptoms. These include malaria, dengue, typhoid fever, shigellosis, cholera, plague, meningitis, hepatitis and other viral haemorrhagic fevers. The symptoms described above could be something else, so this is why people need to stay calm and call on medical officers in their areas so that the situation can be further investigated and managed properly. In addition to the information above, other simple measures one should take are: •Avoid contact with people who show signs of this illness, including the bodies of persons who have died after showing these symptoms, ideally at least one metre/ three feet away. Avoid contact with high-risk infected animals like fruit bats, monkeys or apes in the affected rainforest areas. If you suspect an animal is infected, do not handle it. Animal products (blood and meat) should be thoroughly cooked before eating. Share the reliable information you are receiving about Ebola with your friends and family. Why did Ebola epidemics end in past occurrences? Previous outbreaks of Ebola appear to have continued only as long as a steady supply of victims came in contact with bodily fluids from infected persons. The epidemics were resolved by teaching the local population about how to avoid spreading the disease and improving conditions at hospitals in impacted areas (for instance, unsterilsed needles and syringes were a major factor in the 1976 outbreak in Zaire). Ebola’s virulence may also serve to limit its spread: its victims die so quickly that they don’t have a chance to spread infection very far. Can Ebola recur in a survivor, that is, remain latent and then come back? No. Ebola cannot spontaneously recur: after recovery, the body becomes free of virus particles; the survivor can come down with the disease only by re-infection. Is vaccination required or recommended for travel to Ebola-affected areas, and what should I be aware of? There is no vaccine. If you are travelling, please check the most updated travel advisories that have been put out by the World Health Organisation at (http://www.who.int/ith/updates/en/ and http://who.int/csr/disease/ebola/en/) before you travel. Also adhere to any travel precautions put in place by your local UN administration, such as health checks needed upon exiting an area where Ebola is known to be occurring. Instructions released by the country’s Ministry of Health should also be strictly adhered to. In general, the risk of infection for travellers is very low since person-to-person transmission results from direct contact with the body fluids or secretions from an infected patient. WHO advises that if one is travelling to an Ebola-affected area, one should remember to avoid contact with infected patients, and be aware of the symptoms of infection so that one can seek medical attention at the first sign of illness. When seeking medical care, you should inform your medical practitioner that you have just returned from an Ebola-affected area, so that such a person can consider the possibility of Ebola virus disease. What about professional visits and private visits to affected areas during the outbreak? Should these be cancelled or postponed? This should be reviewed on a case-by-case basis. At present, there are no travel restrictions to or from affected areas. It may be prudent, however, to request your visitors to postpone their visit for a few weeks, if possible. The risk of infection for travellers is very low since person-to-person transmission results from direct contact with the body fluids or secretions of an infected patient. In general, WHO advises the following: Travellers should avoid all contact with infected patients. Health workers travelling to affected areas should strictly follow WHO-recommended infection control guidance. •Anyone who has stayed in areas where cases were recently reported should be aware of the symptoms of infection and seek medical attention at the first sign of illness. Clinicians caring for travellers returning from affected areas with compatible symptoms are advised to consider the possibility of Ebola virus disease. Should one tell one’s household help to take time off during the outbreak? That is up to you. You may keep your domestic help on as long as you are confident that they have been sensitised on how to prevent contagion. You can assist in this effort by talking to them and sharing the reliable information you are receiving on Ebola with them. However, one has to add that the WHO website contains detailed information on what Ebola virus disease is, a history of past outbreaks, symptoms, preventative steps that can be taken and the latest known information concerning the current outbreak. So, one is free to consult the following authoritative sources containing more detailed information regarding Ebola (known formally as Ebola Virus Disease or EVD) and the most updated status of suspected/confirmed cases in affected countries: WHO’s EVD website: http://who.int/csr/disease/ebola/en/ •CDC’s EVD website: http://www.cdc.gov/vhf/ebola/ •ECDC’s EVD website: http://www.ecdc.europa.eu/en/healthtopics/ebola_marburg_fevers/Pages/index.aspx •Local health authority.
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