Ebola

Ebola Virus Disease is an rare and commonly fatal viral hemorrhagic fever caused by ebolaviruses mostly in sub-Saharan Africa with occasional spread elsewhere with the largest outbreak in West Africa from 2014 to 2016.

Ebola was first discovered in 1976 after two consecutive outbreaks in the Democratic Republic of Congo in a village near the Ebola River (hence the name) and another 850km away in what is now South Sudan. Genetic testing subsequently found they were caused by two different ebolavirus variants: Zaire ebolavirus and Sudan ebolavirus.

The average case fatality rate is assumed to be around 50%, but has varied from 25% to 90% in previous outbreaks.

Transmission:
The Ebola virus is transmitted to humans from wild animals and then spreads in the human population through human-to-human transmission. The natural reservoir or host at this stage is unclear, however, the fruit bat is considered the most likely at this stage. In humans, it can be transmitted to others via direct contact with the blood or secretions of an infected person and exposure to objects, such as needles and syringes that have been contaminated with infected secretions.

Clinical Features:
The onset of symptoms is usually 4-10 days but can vary from a few days to 21 days following infection.
There is usually an abrupt onset of flu like symptoms most commonly with fatigue, fever, weakness, loss of appetite, muscular and joint pains, headache, and a sore throat – these are non-specific to Ebola, so a positive lab test is needed to determine diagnosis (ELISA; PCR; IgM and IgG antibodies).
This is often followed by severe vomiting and diarrhoea that can often lead to a severe dehydration.
The next stage may be characterized by a shortness of breath and chest pain
Half may develop a maculopapular skin rash, 5-7 days after the first symptoms.
There is decreased blood clotting and bleeding issues may develop such as the vomiting of blood and blood in the stools.

Recovery will typically start around 7 and 14 days after first symptoms appear.
Fatalities are usually due to shock from fluid loss and can occur 6-16 days after the first symptoms.

Differential diagnosis:
Early features are similar to other diseases that are common in Africa such as malaria, dengue fever, yellow fever and other viral haemorrhagic fevers.

Management:
There are no approved or specific treatments for Ebola. Periodically there are fraudulently advertised products and extraordinary claims made for fake treatments.
The use of monoclonal antibodies (Inmazeb and Ebanga) can improve outcomes.
Treatment is mostly supportive with rehydration and pain management with other treatments for the nausea and fever. Intensive care is usually needed.

In those that recover there are often a number of lingering health issues (Post-Ebola Syndrome) that most commonly include: fatigue, headaches, eye and vision problems, muscle and joint pain, weight gain, stomach pains and sometime a loss of appetite.

Public Health Measures:
Contact tracing and community engagement is crucial to help contain an outbreak.
Most public health authorities worldwide have border identification and management policies in place.
The CDC (USA) has guidelines for health care worker for PPE when working with suspected Ebola cases. The Communicable Diseases Network (Australia) has guidelines for public health units.

Prevention:
The Food and Drug Administration in the USA has approved the Ebola vaccine, Ervebo. The European Medicines Agency authorised the use of Zabdeno and Mvabea.
In regions that Ebola is present, prevention is by avoiding contact with blood and body fluids of those who are sick and with items that they have been in contact with.
Hand hygiene is extremely important.

External Links:
CDC Health Advisory on Ebola issued for health professionals (Podiatry Arena)

Other viral haemorrhagic fevers:

Arenaviridae:	Bunyaviridae:	Filoviridae:	Flaviviridae:
Chapare hemorrhagic fever	Crimean-Congo hemorrhagic fever	Ebola	Dengue fever
Venezuelan hemorrhagic fever	Hemorrhagic fever with renal syndrome	Marburg hemorrhagic fever	Kyasanur forest disease
Argentine hemorrhagic fever	Rift Valley fever		Omsk hemorrhagic fever
Lassa fever	Hantavirus pulmonary syndrome		Yellow fever
Lujo hemorrhagic fever	Severe fever and thrombocytopenia syndrome
Lymphocytic choriomeningitis

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