The recent outbreak of cases of ebola fever in West Africa has become a matter of international concern. Health care workers including foreign nationals have also been affected and some of these returning home have alarmed the people there for fear of outbreak in their respective countries. The current outbreak started in March 2014 and was declared a public health emergency by W.H.O in August. Ebola outbreak first occurred in 1976, in the tropical rain forests of Central Africa near Ebola River from which it derived its name.
Ebola virus disease (EVD) formerly known as ebola hemorrhagic fever causes severe often fatal sickness in human beings. Fruit bats are said to be the natural reservoirs of ebola virus. Other animals like antelopes, gorillas, monkeys, etc. can be infected with this virus. Humans acquire infection by touching, handling the carcass of an infected animal or consuming raw or inadequately cooked meat. Man to man spread occurs through physical contact with an infected person or even by touching objects like beddings, clothes, phones or any object contaminated by body fluids of the infected individual.
After being exposed to the virus one can develop the sickness between 2 to 21 days. A person becomes infectious after he develops symptoms. One develops high fever, muscle and joint pains, flu like symptoms, followed by nausea, vomiting and diarrhea. This may be associated with bleeding from any site in the body.
Diagnosis is mainly made by excluding other diseases with similar presentations. Confirmed diagnosis is made by detecting the virus strands by specific tests but transportation and handling of the infected body fluids is extremely hazardous.
Currently there is no specific treatment available for this disease. Treatment is palliative where the sick person is given fluids, painkillers and other medicines to relieve suffering. Vaccines for prevention of ebola are under trial but none has proved successful yet.
Therefore prevention becomes much more important in case of EVD. People handling animals should be motivated to use gloves and adopt good hand hygiene while doing so. Meat should be thoroughly cooked before it is consumed.
Avoid direct physical contact with a suspected person with ebola. Greeting with a bow or with folded hands and palms together instead of a handshake is advisable. Thorough hand washing after coming in contact with a suspected individual will help to avoid infection.
The body fluids like urine, stool, sputum, e.t.c of the sick person should be disinfected thoroughly before being disposed of. The bedding and soiled clothes are soaked in antiseptic solution first, then washed and dried in strong sunlight or hand dried by hot iron. Individuals strongly suspected of EVD should be immediately put in isolation. Persons nursing them are supposed to wear protective mask, goggles, cap, gown, gloves and shoes to prevent any direct contamination through body fluids of the sick person. W.H.O. has issued guidelines on how to put on and remove this protective clothing.
In case of death, the body should be handled with gloves as it is also potentially infectious. It should be washed thoroughly, people should be discouraged from coming close to it, only those directly working on it should be allowed to touch it. After washing it should be wrapped in plastic cover and then buried as deep as possible.
Eventually there will be preventive vaccination, drugs and successful treatment for EVD as has emerged for so many diseases. Till then, people have to be sensitized to be vigilant about EVD and how best they can prevent it. Ministry of Health, Government of Rwanda is taking very good initiative regarding sensitizing people in communities and medical personnel down to level of health centers regarding preventive measures for EVD. In spite of its close proximity to DRC, there have been no documented cases here so far.
The author is Specialist internal medicine at Ruhengeri District Hospital