Ebola virus disease, formerly described as Ebola hemorrhagic fever, refers to a severe illness that is usually deadly in humans. Wild animals transmit the virus to human populations where it spreads through direct contact with infected bodily fluids. Typically, the disease has a fatality rate of nearly 50% with past outbreak cases recording fatality rates ranging between 25% and 90% (World Health Organization (WHO), 2016). For example, an Ebola epidemic in West Africa reported in 2014 caused global panic because it was “the largest and most complex Ebola outbreak since the Ebola virus was first discovered” (WHO, 2016). In the present study, Ebola is examined with the aim of understanding its epidemiology. Accordingly, the paper hypothesizes that if community engagement and supportive care are initiated early, Ebola containment and improved patient survival can be achieved.
Past Incidences
The first recorded Ebola cases occurred in 1976 in northern Zaire (present-day Congo) and southern Sudan. Researchers noted additional cases in 1979 and 1977 in Sudan and Zaire, respectively. Although the virus became inactive after the 1970s outbreaks, its subtypes scared researchers in Virginia in 1989. The incident in Virginia occurred in Reston where cynomolgus monkeys infected four laboratory technicians. In 1995, another deadly outbreak was reported in Congo. Despite the fact that the outbreak’s source remains unknown, researchers believe that an infected laboratory technician spread the disease. As the epidemic began to subside, twenty Ebola cases were reported in Gabon triggering new concerns. Nonetheless, Ebola’s natural history is not clearly understood because researchers have not determined the virus’ ability to survive in nature and remain dormant between outbreaks.
Pathophysiology and Disease Symptoms
Ebola’s viral genome comprises a single nineteen kb RNA strand with seven viral genes transcribed by RNA polymerase in the viral particle. The single RNA strand has a cover consisting of helical viral nucleoproteins (Itaki, 2015). Infected fluids that contact breaks in a healthy person’s skin can transmit the virus and cause tissue invasion. During initial infections, filoviruses prefer replication sites such as dendritic cells, macrophages, and monocytes (Itaki, 2015). The infected cells then relocate to the spleen, liver and lymph nodes where they disseminate the infection. In essence, the virus possesses the striking ability to regulate gene expressions associated with the immune response of a host. Consequently, the modulation causes lymphocyte apoptosis, in addition to weakening interferon’s protective effects (Itaki, 2015). Since the immune responses of the host dictate disease outcome, the viral triggering of various pro-inflammatory cytokines causes Ebola to progress to fatal stages. In turn, the progression leads to endothelial activation, reduction of vascular integrity, tissue factor release, and the development of hypotension due to an increase in the levels of nitric oxide (Itaki, 2015). Furthermore, infection results in lymphocyte depletion and neutrophil inhibition. Subsequently, platelet disappearance leads to hepatic impairment and disseminated intravascular coagulation that predispose patients to severe bleeding (Itaki, 2015). Other disease complications include pancreatitis, hepatitis, and kidney injury. Shock also develops due to factors such as hemorrhage and disseminated intravascular coagulation. According to WHO (2016), Ebola’s incubation period is two to twenty-one days. In humans, the infectious stage is marked by the development of symptoms like a sore throat, headache, muscle pain, fatigue, and fever. Subsequently, the patient begins to show severe symptoms like external and internal bleeding, rash, diarrhea, and vomiting, as well as signs of liver and kidney failure (WHO, 2016). Positive laboratory tests indicate increased liver enzymes and reduced counts of platelets and leucocytes.
Epidemiologic Triangle
On eighth August 2014, WHO declared the Ebola epidemic witnessed in several West African countries “a Public Health Emergency of International Concern (PHEIC)” (Goeijenbier et al., 2014, p. 442). As such, the organization stressed the urgent need for the international community to collaborate in containing the outbreak. By September of 2014, about 5,335 cases had been recorded with over 2,600 deaths being reported in Sierra Leone, Liberia, and Guinea (Goeijenbier et al., 2014). Several imported cases caused relatively smaller outbreaks in Nigeria, Spain, and the US.
The virus that caused the recent epidemic in West Africa was identified as Zaire Ebolavirus (EBOV). According to Goeijenbier et al. (2014), EBOV is in “the genus Ebolavirus, which together with the genus Marburgvirus forms the family of Filoviridae” (p. 442). Ebola disease is zoonotic with each outbreak being introduced into humans by certain infected animals, particularly when humans consume contaminated bush meat. Species that were implicated in the introduction of Ebola into West Africa were duikers, gorillas, chimpanzees, and particular fruit bat species, which were infected with EBOV. Due to the absence of overt Ebola disease, researchers considered bats as the most probable reservoir host (Goeijenbier et al., 2014). After introduction into human populations, Ebola spreads quickly owing to the rapid and uncontrolled rates of virus shedding in the victims’ body fluids. In the case of poor personal hygiene and inadequate protective measures, the risk of disease transmission intensifies significantly, especially in exposed healthcare workers.
Evidence-Based Management
The first step in managing the disease involves identifying patients that present Ebola symptoms. Such patients require rapid isolation and identification of their contacts. Moreover, medical personnel should immediately institute appropriate preventive and containment measures. Qualified medical practitioners should then obtain blood samples and submit them to a certified clinical laboratory for diagnosis. At present, treatment modalities include the use of various supportive care techniques and the management of a patient’s hemostasis and hemodynamics (Goeijenbier et al., 2014). In particular, healthcare workers utilize fluid replacement therapies because they increase survival rates drastically when initiated during the early stages of the malady. Experimental drugs like ZMapp, which show considerable efficacy in animal models, have also been employed sparingly to treat Ebola patients (Goeijenbier et al., 2014).
Disease Status as Compared with Healthy People 2020’s Goals and Objectives
Healthy People 2020 presents ten-year national targets and tasks aimed at improving the health of every American. The goals of the agenda are released every ten years and undergo various updates before being launched (“About Healthy People,” 2016). Healthy People 2020 reflects recent environmental, political, and epidemiological episodes of national or global significance. Its principal objectives include recognizing domestic priorities in health improvement and enhancing public understanding of important health issues. Its primary goal involves establishing longer and high-quality lives that are exempt from premature deaths and preventable injuries or diseases (“About Healthy People,” 2016). Since global health threats like the recent Ebola outbreak in West Africa can affect the health of Americans, improving public health at the international level is crucial to ameliorating public health in the US. Furthermore, fostering economic growth, diplomacy, and political stability worldwide can support global and national security interests. Accordingly, US government “agencies are harnessing $5 billion to address Ebola preparedness overseas and at home” (“Global Health,” 2016). In addition, the agencies continue to cooperate with other countries in order to build the capacity required to detect, prevent, and address emerging threats associated with Ebola.
Conclusion
The present study supports the theory that if community engagement and supportive care are initiated early, Ebola containment and improved patient survival can be achieved. After introduction into humans, Ebola spreads quickly because the virus sheds uncontrollably in the victims’ body fluids. Hence, healthcare workers dealing with Ebola patients should maintain high personal hygiene and employ adequate protective measures to minimize the risk of contracting the disease. Infected people should be quarantined quickly and offered appropriate supportive care, as well as fluid replacement therapies. Experimental drugs like ZMapp have also been used sparingly to treat patients. Nevertheless, supportive care and community engagement are still the primary approaches to managing the disease.
References
About Healthy People. (2016). Retrieved from https://www.healthypeople.gov/2020/About-Healthy-People
Global Health. (2016). Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/global-health
Goeijenbier, M., van Kampen, J. J. A., Reusken, C. B. E. M., Koopmans, M. P. G., & van Gorp, E. C. M. (2014). Ebola virus disease: A review on epidemiology, symptoms, treatment and pathogenesis. Journal of Medicine, 72(9), 442-448.
Itaki, R. (2015). Pathophysiology of Ebola virus infection: A review of current literature. Pacific Journal of Medical Sciences, 14(1), 41-45.
World Health Organization (WHO). (2016). Ebola virus disease. Retrieved from http://www.who.int/mediacentre/factsheets/fs103/en/
