Ebola virus, the Environmental Conflict

N Munal Meitei *

Signs and symptoms of Ebola virus:: Pix - Wikipedia

Medical relief workers fighting a burgeoning Ebola outbreak in West Africa since March, 2014 have not been welcomed with open arms by their family members. Death was all that the hazmat-suited visitors seemed to bring. Most patients who entered the makeshift hospitals died, their families forbidden to handle their bodies. So people scattered, making a bad situation worse.

The cascades are in much dreaded appearance with bloody scratches. Doctors have no cure to offer the infected. The WHO is organizing a two day meeting to declare a global health emergency. On Wednesday, a man suspected to have contracted Ebola died in Saudi Arabia after coming back from a business trip to Sierra Leone. If confirmed, this will be the first Ebola-related death outside of Africa.

The outbreak, the biggest recorded in Ebola history, has so far killed more than 900 people in West Africa, and it shows no sign of abating. The affecting Sub-Saharan Africa countries are Democratic Republic of the Congo, Guinea, Sierra Leone, Liberia and Nigeria. British Airways has temporarily suspended all flights from Liberia and Sierra Leone until 31, August because of the health crisis.

In these affecting countries, about 45000 Indians are working and hence the country is prone to such a deadly challenge. The Hon’ble Health Minister Mr. Harshbvardhan told on Parliament that the country has also taken up all possible efforts to face any eventualities. The World Bank is allocating $200m as the emergency assistance for countries battling to contain Ebola.

Ebola virus disease (EVD) or Ebola hemorrhagic fever (EHF) is the human disease caused by the Ebola virus which is classified in the genus Ebolavirus, family Filoviridae, order Mononegavirales. There are four Ebola viruses which are Bundibugyo virus (BDBV), Ebola virus (EBOV), Sudan virus (SUDV), Tai Forest virus (TAFV). The name Ebola originates from a place first recorded outbreaks in 1976 in Yambuku which lies on the bank of River Ebola in Democratic Republic of the Congo. Ebola virus disease is really a deadly challenge to humanity.

Signs and symptoms

The disease has a high mortality rate: often between 50 percent and 90 percent. Most dreaded part of Ebola is in the bleeding phase, internal and subcutaneous bleeding through reddening of the eyes and bloodily vomit. Bleeding from puncture sites and mucous membranes e.g. gastrointestinal tract, nose, vagina and gums is reported in 40–50% of cases. Due to impaired blood clotting, blood in stool and coughing is also very common.

In general, the development of bleeding symptoms often indicates a worse prognosis and this blood loss can result in death. At the initial stage, the signs and symptoms of Ebola usually begin with a flu-like stage characterized by fatigue, fever, headaches, sore throat and joint, muscle, and abdominal pain. Vomiting, diarrhea and loss of appetite are also common. The average time between contracting the infection and the start of symptoms is 8 to 10 days, but can occur between 2 and 21 days.

Transmission

It is not entirely clear how Ebola is spread. EVD is believed to occur after an Ebola virus is transmitted to an initial human by contact with an infected animal’s body fluids. Human-to-human transmission can occur via direct contact with blood or bodily fluids from an infected person including embalming of an infected dead person or by contact with contaminated medical equipment, particularly needles and syringes. Semen is infectious in survivors for up to 50 days and hence it transmits through sexual relationship also.

Fruit Bats drop partially eaten fruits and pulp, then land mammals such as gorillas and duikers feed on these fallen fruits. This chain of events forms a possible indirect means of transmission from the natural host to animal populations and then to human being.

Reservoir

Bats are considered the most likely natural reservoir of the Ebola virus. The three types of fruit bats, i.e. Hypsignathus monstrosus, Epomops franqueti, and Myonycteris torquata have been identified as the EBOV reservoir hosts. These Fruit bats are eaten by people in some parts of West Africa where they are smoked, grilled or made into a spicy soup thus it pave the way to transmit the virus from natural host to the human being.

Prevention

For Ebola, there is no cure, only prevention. Ebola viruses are contagious, with prevention predominantly involving behavior changes, proper full-body personal protective equipment, and disinfection. Techniques to avoid infection involve not contacting infected blood or secretions, including from those who are dead. This involves suspecting and diagnosing the disease early and using standard precautions for all patients in the healthcare setting. Recommended measures when caring for those who are infected include isolating them, sterilizing equipment, and wearing protective clothing including masks, gloves, gowns and goggles.

Due to lack of proper equipment and hygienic practices, large-scale epidemics have occurred mostly in poor, isolated areas without modern hospitals or well-educated medical staff. Traditional burial rituals, especially those requiring embalming of bodies, should be discouraged or modified. Airline crews who fly to these areas of the world are taught to identify Ebola and isolate anyone who has symptoms.

Vaccine

No vaccine is currently available for Ebola virus disease. But many-DNA vaccines are trying at various levels such as adenoviruses, vesicular stomatitis Indiana virus (VSIV) or filovirus-like particles (VLPs). These vaccines could protect nonhuman primates from ebolavirus-induced disease. Though proved on clinical trials on nonhuman primates, the immunization takes six months. So for a Pandemic, it will be too long to wipe out the whole population. A vaccine based on attenuated recombinant vesicular stomatitis virus (VSV) vector carrying either the Ebola glycoprotein or the Marburg glycoprotein in 2005 protected nonhuman primates, opening clinical trials in humans. The study completed on the first human trial, over three months giving three vaccinations safely shows inducing an immune response. However, actual EBOV infection could never be demonstrated without a doubt.

Treatment

No ebolavirus-specific treatment exists. Treatment is primarily supportive in nature and includes minimizing invasive procedures, balancing fluids and electrolytes to counter dehydration, administration of anticoagulants early in infection to prevent or control disseminated intravascular coagulation, administration of procoagulants late in infection to control bleeding, maintaining oxygen levels, pain management, and the use of medications to treat bacterial or fungal secondary infections. Early treatment may increase the chance of survival.

2014 outbreak

In March 2014, the outbreak of the Ebola virus occurred in the Western African nation of Guinea. As of 10 April, 157 suspected and confirmed cases and 101 deaths had been reported in Guinea, 22 suspected cases in Liberia including 14 deaths, 8 suspected cases in Sierra Leone including 6 deaths, and 1 suspected case in Mali. By late June 2014, the death toll had reached 390 with over 600 cases reported. By 23 July 2014, the World Health Organization had reported 1201 confirmed cases including 672 deaths. On 31 July 2014, WHO reports the death toll has reached 826 from 1440 cases since the epidemic began in March.

Conclusion

Given the lethal nature of Ebola, and since no approved vaccine or treatment is available, it is classified as a biosafety level 4 agent, as well as a Category A bioterrorism agent by the Centers for Disease Control and Prevention. It has the potential to be weaponized for use in biological warfare. The most challenging part also comes while mutation takes place. While mutation takes place, then to find out a vaccine, it will take at least three to four months and by the time there is the great chance for wiping out of the whole living beings.

Main outbreaks of EVD among human populations result from handling and taking the affected wild animals and their carcasses. It is again doubtful that due to the deadliness of the Ebola, it seems that human may pressurized on the already declined wild life population. We sometimes forget that due to our discriminate killing and wrongful handling of the wild-animals has caused the outbreak. It is really a challenge for them also. In general, declines in animal populations precede outbreaks among human populations. Since 2003, Ebola have resulted in the deaths of 5,000 gorillas. Outbreaks of EVD may have been responsible for an 88% decline in chimpanzee populations in 420 square kilometer Lossi Sanctuary between 2002 and 2003. These are some of the available data but how many of other wild animals might have been affected are yet to be ascertained. Therefore in the name of a human challenge, we should never forget the right of another living friend.