On October, 8, 2014, the world awoke to the news that Thomas Eric Duncan, the first patient diagnosed with Ebola virus disease (EVD) in the United States, had died of the disease. He had traveled from Liberia to Dallas, Texas, and developed symptoms of the disease four or five days after arriving in the states. This news—along with the information that a nurse had contracted the virus in Spain as a consequence of having been in contact with a patient diagnosed with the disease—has raised an alarm in the Western world, sweeping through the media in a matter of hours, unfortunately mixing facts and fiction, and creating a hysteria that frankly is not useful.
Because ChildVoice works in Africa, although not anywhere close to the affected region, we want to maintain a Frequently Asked Questions (FAQ) document with the most current facts, what is known about the disease, and what is being currently done to contain and treat the disease. We are diligently following the developments of this outbreak around the world and in the U.S. We are monitoring information from the leading health experts at the Centers for Disease Control (CDC), the World Health Organization (WHO), and the Ministries of Health in Uganda, South Sudan, and other countries in the East Africa region who are providing us with the latest information about this outbreak.
Since this is a dynamic situation, we will continue to update this FAQ with more facts and information as it is known.
What is Ebola?
The Ebola virus belongs to the family of filoviridae, which is capable of causing hemorrhagic fevers in a similar manner as does the dengue virus and other viruses.
Five different species of the Ebola virus have been identified, known under the names the Zaire, Sudan, Ivory Coast, Bundibugyo, and Reston agents. The virus was first recognized in 1976, and small outbreaks have been reported in different places with different mortality rates depending on the species of virus. The current outbreak in West Africa is being caused by the Ebola-Zaire species.
What happens to the body during an Ebola infection?
Like any disease, once the causative agent enters the body, it is followed by an incubation period during which the patient may not show any symptoms. In the case of the Ebola virus, the asymptomatic period varies from 6 to 10 days, with a range from 2 to 21 days in extreme cases. To our knowledge, patients do not appear to be infectious during this asymptomatic period.
The disease can start with symptoms common to other viral illnesses: fever, chills, malaise, headache, lack of appetite, muscle aches, cough, sore throat. Some patients may develop an erythematous rash over the whole body, accompanied by symptoms such as nausea, vomiting, and diarrhea. Other symptoms may appear later in the disease, such as bleeding in the areas of venipuncture (area where the veins are punctured for blood sample or placement of an IV catheter).
These findings may be accompanied by a decrease in white blood cells (leukopenia), decreased platelets count (thrombocytopenia), elevated liver enzymes, abnormal coagulation tests, and injury to the lungs and kidney. Patients who survive the disease usually improve after the tenth day.
What countries are presently experiencing Ebola cases?
The current outbreak of Ebola was identified first in March 2014 in Guinea. It has since spread to Liberia, Sierra Leone, Nigeria, and Senegal, though Nigeria and Senegal seem to have it under control. The outbreak in Liberia and Sierra Leone is severe and not yet under control. There is also a small concurrent outbreak in the Democratic Republic of Congo (DRC) but it is unrelated to the West African outbreak.
Why is this particular Ebola outbreak considered so serious?
This is the largest EVD outbreak ever identified and the first outbreak in West Africa. There is limited medical capacity in the affected countries, customs around the handling of dead bodies that put people at high risk, and there are inadequate infection control practices with under- and misinformation circulating around how to control the disease spread. In addition, the outbreak is in highly populated areas so there is a greater possibility for exposure and spread than was seen in previous outbreaks. The numbers of cases in Liberia and Sierra Leone are also increasing rapidly, which increases the chance of greater spread to more people and more countries.
When did the current crisis begin?
An outbreak of Ebola was reported in Guinea late last year and confirmed by the World Health Organization this past March. This was the first outbreak in West Africa, though previous outbreaks of lesser magnitude had been reported in Central Africa. Unfortunately, the disease was not contained. In recent months it has expanded to Liberia, Sierra Leone, Nigeria, and Senegal. It now appears to be contained in Nigeria and Senegal.
To date more than 4,000 deaths have been reported and more than 8,000 cases suspected or confirmed. This current mortality rate is about 50 percent. In previous outbreaks, mortality has ranged from 30 percent to 90 percent.
How is Ebola passed from person to person?
Ebola is transmitted through direct contact with the bodily fluids (such as blood, saliva, vomit, diarrhea, or sweat) of a person who is infected with Ebola virus disease (EVD). These secretions need to gain access to mucous membranes (conjunctiva, inside the lips and mouth or genitals) to cause infection. Transmission may also occur when these secretions are exposed to skin that has lost its integrity (wounds, abrasions, and so on).
Can Ebola be transmitted through the air?
No. To date there is no confirmation that the virus can be transmitted through the respiratory tract, as can the influenza virus.
How long does it take to become ill once you are infected?
Once exposed to the virus, it can take between 2 and 21 days to become ill, though most people become ill within 8–10 days. Compared to previous outbreaks, the spread of this EVD outbreak has been rapid. Previous outbreaks occurred in isolated rural populations with a smaller number of people, unlike this outbreak that has spread in urban centers. Knowing that previous outbreaks were contained by implementing basic infection control measures allowed us to understand that the disease is potentially containable through measures already known to medical science.
Can I get Ebola from contaminated food or water?
No, Ebola is not transmitted through eating or drinking contaminated food or water.
Who is at most risk for infection?
Families and health care staff who are in direct contact with individuals who are ill with EVD are most at risk. For the virus to be transmitted, a person has to have direct contact with the body fluids of a person infected with Ebola who is experiencing symptoms.
Can someone get Ebola from a person who is not showing any symptoms?
No. Individuals who do not have symptoms of Ebola virus disease are not contagious.
Is there a vaccine to prevent EVD?
There are currently no FDA approved vaccines for Ebola. The NIH’s National Institute of
Allergy and Infectious Diseases is working on developing an Ebola vaccine. NIH recently announced they are expediting their work and are launching Phase 1 clinical trials for humans of an Ebola vaccine.
Is there a treatment for EVD?
The treatment for Ebola consists of supportive care, such as managing a patient’s electrolytes, maintaining fluid levels and hydration, and treating any secondary infections. There is no known cure, but scientists are working hard to develop a treatment.
What are the reasons to be hopeful about the diseases containment?
- The causative organism has been known for about 40 years.
- Medical science could control previous outbreaks with known infection control measures, even when they were implemented in less sophisticated regions in terms of medical care.
- Even in the midst of this crisis, the outbreak that began in Nigeria and Senegal in August seems to be contained due to implementing infection control measures. In fact, it has been more than a month since Nigeria has reported a new case (September 5 being the last one), likewise in Senegal, which has not reported a new case since August 29.
- In 1998, a case of Ebola in South Africa was not recognized early and potentially exposed to about 300 people. However, only one of them was infected due to implementing infection-control measures. In the same country, 35 doctors and nurses were involved in the care of two patients with Marburg virus (from the same family as Ebola). Of those, only one became infected, although the two cases were not initially recognized.
- Multiple laboratories are working nonstop to find an effective treatment for the disease, and we know of at least two cases of American citizens who received monoclonal antibodies and responded favorably. One even improved significantly between 20 to 60 minutes after receiving the infusion of the medication. Two other cases were treated in Atlanta with positive outcomes. Obviously, every patient needs to be individualized, since we do not know if others will respond in the same way.
Is it safe to travel to Africa?
Map courtesy of About.com
So why does the size of Africa matter when we are talking about Ebola? Because there is a tendency on our part to generalize and assume that if there is an Ebola outbreak in Liberia in West Africa, that someone is likely to be exposed or infected in Uganda in East Africa. There is about 4,000 miles between these two regions, similar to the distance from Hawaii to the East Coast. The likelihood of exposure is highly remote given those distances.
The CDC has issued a Level 3 travel alert for Liberia, Sierra Leone, and Guinea, encouraging U.S. citizens to defer unnecessary travel to these countries. The recommendation to defer travel is to avoid contracting EVD and also because there is inadequate access to healthcare for any injury or illness, and these countries have experienced near-complete disruption of societal function because of this outbreak. As of the time of this FAQ, there is no similar travel alert for any of the other 52 countries of Africa.