Transmission
Ebola Virus Disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans. It is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals.
In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.
Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids.
Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to seven weeks after recovery from illness.
Healthcare workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.
Among workers in contact with monkeys or pigs infected with Reston Ebola virus, several infections have been documented in people who were clinically asymptomatic.
Thus, RESTV appears less capable of causing disease in humans than other Ebola species.
However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of RESTV are needed before definitive conclusions can be drawn about the pathogenicity and virulence of this virus in humans.
Signs and symptoms
EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
People are infectious as long as their blood and secretions contain the virus. Ebola virus was isolated from semen 61 days after onset of illness in a man who was infected in a laboratory.
The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is two to 21 days.
Diagnosis
Other diseases that should be ruled out before a diagnosis of EVD can be made include: malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers.
Ebola virus infections can be diagnosed definitively in a laboratory through several types of tests:
•Antibody-capture enzyme-linked immunosorbent assay (ELISA)
•Antigen detection tests
•Serum neutralisation test
•Reverse transcriptase polymerase chain reaction (RT-PCR) assay
•Electron microscopy
•Virus isolation by cell culture.
Samples from patients are an extreme biohazard risk; testing should be conducted under maximum biological containment conditions.
Controlling infection in healthcare settings
Human-to-human transmission of the Ebola virus is primarily associated with direct or indirect contact with blood and body fluids. Transmission to healthcare workers has been reported when appropriate infection control measures have not been observed.
It is not always possible to identify patients with EBV early because initial symptoms may be non-specific. For this reason, it is important that healthcare workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices at all times.
These include basic hand hygiene, respiratory hygiene, the use of personal protective equipment (according to the risk of splashes or other contact with infected materials), safe injection practices and safe burial practices.
Healthcare workers caring for patients with suspected or confirmed Ebola virus should apply, in addition to standard precautions, other infection control measures to avoid any exposure to the patient’s blood and body fluids and direct unprotected contact with the possibly contaminated environment.
When in close contact (within 1 metre) of patients with EBV, healthcare workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).
Laboratory workers are also at risk. Samples taken from suspected human and animal Ebola cases for diagnosis should be handled by trained staff and processed in suitably equipped laboratories.
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