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LETTER TO EDITOR
Year : 2015  |  Volume : 28  |  Issue : 3  |  Page : 789-790

West Africa Ebola outbreak 2014: the world's largest Ebola outbreak so far


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu, India

Date of Submission02-Oct-2014
Date of Acceptance19-Dec-2014
Date of Web Publication22-Oct-2015

Correspondence Address:
Raja Danasekaran
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Thiruporur - Guduvanchery Main Road, Ammapettai Village, Sembakkam post, Chengalpattu Taluk, Kancheepuram District 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.165830

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How to cite this article:
Danasekaran R, Mani G, Annadurai K. West Africa Ebola outbreak 2014: the world's largest Ebola outbreak so far. Menoufia Med J 2015;28:789-90

How to cite this URL:
Danasekaran R, Mani G, Annadurai K. West Africa Ebola outbreak 2014: the world's largest Ebola outbreak so far. Menoufia Med J [serial online] 2015 [cited 2020 Apr 4];28:789-90. Available from: http://www.mmj.eg.net/text.asp?2015/28/3/789/165830

Ebola virus is one among the 30 known viruses that can cause haemorrhagic fever syndromes. The genus Ebola has five species - namely, Sudan, Zaire, Tai Forest (Ivory Coast), Reston and Bundibugyo strains [1]. Outbreaks of Ebola occur in parts of sub-Saharan Africa, and the ongoing West Africa Ebola outbreak is the largest one so far. The disease has a mortality rate of up to 90%; so far 15935 cases and 5689 deaths have been reported during this outbreak. Currently, no specific therapy or vaccines are available for the management and prevention of the disease. Healthcare workers are at a very high risk of contracting the disease, and strict precautions need to be followed so as to reduce the secondary person-to-person transmission [2].

Ebola cases were first reported during the year 1976 in Democratic Republic of the Congo. Until 2013, Ebola outbreaks have caused around 1500 cases. The current outbreak has involved the following countries in West Africa: Guinea (2134 cases and 1260 deaths), Liberia (7168 cases and 3016 deaths), Sierra Leone (6599 cases and 1398 deaths), Nigeria (20 cases and eight deaths), Mali (eight cases and six deaths) and Senegal (one case). Cases are also being reported from the USA (four cases and one death) and Spain (one case). This outbreak is unprecedented in many ways, including the high proportion of healthcare workers who have been infected (301 cases and 144 deaths) [3]. Zaire ebolavirus has been implicated as the strain involved in the ongoing outbreak on the basis of genetic analysis. Fruit bats are considered to be the natural reservoir of the virus in Africa, and transmission occurs from them to humans or nonhuman primates through direct contact with body fluids such as saliva or blood or other infected tissues [4].

The disease manifests itself after an incubation period of 2-21 days, and the person remains infective up to 7 weeks after infection. Severe headache, arthralgias or myalgias, fever with or without chills, anorexia and asthenia occur early in the disease. The initial phase is followed by vomiting, diarrhoea, skin rashes, impaired liver functions and severe bleeding [1]. The infection can be diagnosed by detecting the viral RNA using polymerase chain reaction, detecting proteins with enzyme-linked immunosorbent assay (ELISA) or by virus isolation using culture. Immunoglobulin M-capture ELISA uses Zaire ebolavirus antigens grown in Vero E6 cells to detect immunoglobulin M antibodies to this strain, which can be used to diagnose acute Ebola infections [5].

Currently, there is no specific therapy for Ebola disease. The treatment is primarily supportive and includes isolation of the patient, correction of dehydration, prevention of disseminated intravascular coagulation using anticoagulants, pain relief and antibiotics in case of any secondary bacterial infections. Early treatment increases the chances of survival. However, the disease has high mortality, often between 50 and 90%. The disease closely resembles Marburg virus disease, and other diseases that have to be ruled out include malaria, typhoid, leptospirosis, shigellosis, rickettsiosis and other viral haemorrhagic fevers [2]. In the absence of any specific treatment for Ebola, clinical trials are being planned in three Ebola treatment centres in West Africa by the medical charity association Medecins Sans Frontieres from December 2014. These three trials will test the effectiveness of:

  1. Antiviral drugs brincidofovir and,
  2. Favipiravir and,
  3. Convalescent blood and plasma therapy, using blood from Ebola patients who have survived, which contains antibodies that successfully fought off the virus, to boost sick patient's immune system [6].


To date, no vaccines have been licensed for prevention of Ebola, but several vaccines are under trials. Several promising candidate vaccines have been shown to protect nonhuman primates (usually macaques) against Ebola infection. These include replication-deficient vaccine (cAd3-EBO Z), replication-competent vesicular stomatitis (VSV-EBOV) vaccine, etc. Currently, these vaccines are under phase 1 clinical trials among healthy adults who are not infected with Ebola virus to determine whether the vaccine is safe and whether it induces an adequate immune response. The pace of human safety testing for experimental Ebola vaccines has been expedited in response to the ongoing Ebola virus outbreak in West Africa [7].

Because of the absence of any effective treatment or vaccine, the only way to control the disease is to raise awareness about the risk factors and follow protective measures to reduce human infection and mortality. The disease transmission can be prevented by avoiding contact with infected body fluids of animals and humans. Healthcare workers should follow standard precautions such as basic hand hygiene, respiratory hygiene, the use of personal protective equipment, safe injection practices and safe burial practices [3]. Level 3 alert has been given for travelers to affected countries, advising them to avoid nonessential travel to the affected countries [8]. To conclude, the current outbreak of Ebola can be effectively controlled by following strict aseptic precautions both in the community as well as in the healthcare settings.


  Acknowledgements Top


The authors thank the Head of the Department Dr. Jegadeesh Ramasamy for his encouragement and support in preparing this article.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
King JW, Khan AA. Medscape - Ebola virus infection. Available at: http://emedicine.medscape.com/article/216288-workup. [Last accessed on 2014 Sep 16].  Back to cited text no. 1
    
2.
World Health Organization. Ebola virus disease - Factsheet. Available at: http://www.who.int/mediacentre/factsheets/fs103/en/. [Last accessed on 2014 Sep 16].  Back to cited text no. 2
    
3.
Centre for Disease Control and Prevention. Ebola hemorrhagic fever - 2014 Ebola outbreak in West Africa. Available at: http://www.cdc.gov/vhf/ebola/outbreaks/guinea/index.html. [Last accessed on 2014 Sep 16].  Back to cited text no. 3
    
4.
Pourrut X, Délicat A, Rollin PE, Ksiazek TG, Gonzalez JP, Leroy EM. Spatial and temporal patterns of Zaire ebolavirus antibody prevalence in the possible reservoir bat species. J Infect Dis 2007; 196 (Suppl 2):176-183.  Back to cited text no. 4
    
5.
Grolla A, Lucht A, Dick D, Strong JE, Feldmann H. Laboratory diagnosis of Ebola and Marburg hemorrhagic fever. Bull Soc Pathol Exot 2005; 98 :205-209.  Back to cited text no. 5
    
6.
First trials for Ebola treatments to start at MSF sites in December. Available at: http://www.msf.org/article/first-trials-ebola-treatments-start-msf-sites-december. [Last accessed on 2014 Nov 20].  Back to cited text no. 6
    
7.
National Institute of Allergy and Infectious Diseases. NIH to Launch Human Safety Study of Ebola Vaccine Candidate. Available at: http://www.niaid.nih.gov/news/newsreleases/2014/Pages/EbolaVaxCandidate.aspx. [Last accessed on 2014 Nov 20].  Back to cited text no. 7
    
8.
Centre for Disease Control and Prevention. Traveler′s health - Travel health notices. Available at: http://wwwnc.cdc.gov/travel/notices. [Last accessed on 2014 Sep 16].  Back to cited text no. 8
    




 

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