Ebola Virus Disease

On July17, 2019, the Emergency Committee of the World Health Organization (WHO) declared the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of Congo (DRC) a Public Health Emergency of International Concern (PHEIC). This declaration came almost a year after the outbreak started in the DRC in August 2018 and five years after the last Ebola outbreak in West Africa.

A Public Health Emergency of International Concern is defined in the International Health Regulations (IHR, 2005) as an extraordinary event which constitute a public health risk to other States through the international spread of disease; and potentially require a coordinated international response. This definition implies a situation that is serious, unusual or unexpected; carries implications for public health beyond the affected State’s national border; and may require immediate international action.

Ebola Virus Disease, formerly known as Ebola haemorrhagic fever, is a rare, but severe, often fatal illness in humans. The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission. The average EVD case fatality rate is around 50 percent. That is, on average, half the persons who would have contracted the disease have died. This case fatality rate has varied from one outbreak to another and ranged from 20 to 90 percent.

Ebola then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes), through blood or body fluids of a person who is sick with or has died from Ebola. Objects that have been contaminated with body fluids (like blood, feces, vomit) from a person sick with Ebola or the body of a person who died from Ebola can also transmit the virus.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This occurs through close contact with patients when infection control precautions are not strictly practiced.

Burial ceremonies that involve direct contact with the body of the deceased can also contribute in the transmission of Ebola.

People remain infectious as long as their blood contains the virus.

The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is from 2 to 21 days. A person infected with Ebola cannot spread the disease until they develop symptoms.

The symptoms of EVD can be sudden and include; fever, fatigue, muscle pain, headache and sore throat. This is then followed by vomiting, diarrhoea, rash and symptoms of impaired kidney and liver. In some cases, both internal and external bleeding (for example, oozing from the gums, or blood in the stools and vomit) may occur.

Supportive care – rehydration with oral or intravenous (IV) fluids – and treatment of specific symptoms improves survival. There is as yet no proven treatment available for EVD. However, a range of potential treatments, including blood products, immune therapies and drug therapies, are currently being evaluated, including an experimental vaccine.

• Dr. Rosmond Adams, MD; MSc (Public Health); M.S (Bioethics) is a medical doctor and a public health specialist with training in bioethics and ethical issues in medicine, the life sciences and research. He is a lecturer of medical ethics and Research Methods.

He is the Head of Health Information, Communicable Disease and Emergency Response at the Caribbean Public Health Agency
(CARPHA). He is also a member of the World Health Organization Global Coordination Mechanism on the Prevention and Control of NCDs.

•  (The views expressed here are that of the writer and not of any organizations). You may contact him at adamsrosmond@gmail.com