Perhaps no virus strikes as much fear in people as Ebola, the cause of a deadly outbreak in West Africa.

afp20030501p1927-f3The World Health Organization (WHO) reports more than 2,400 confirmed or suspected cases of Ebola in the countries of Guinea, Liberia, Nigeria, and Sierra Leone as of Aug. 20. More than 1,300 people have died in the largest Ebola outbreak ever recorded.

On Aug. 8, the WHO declared the Ebola outbreak in West Africa to be a “public health emergency of international concern.” It said “a coordinated international response is deemed essential to stop and reverse the international spread” of the virus.

 

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Two Americans were among those infected. Kent Brantly, MD, working in Liberia with the relief organization Samaritan’s Purse, arrived in the United States on Aug. 2 and was treated in a special isolation unit at Atlanta’s Emory University Hospital.

He was released from the hospital Aug. 21. “Today is a miraculous day. I’m thrilled to be alive, to be well, and to be reunited with my family,” he said.

Nancy Writebol, a missionary for the Christian mission organization SIM, arrived in Atlanta on Aug. 5. She was in Liberia on a joint team with Brantly and was also being treated in Emory’s isolation unit.

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Writebol was released from Emory on Aug. 19 after tests showed she no longer had the virus, SIM said in a statement Aug. 21. “She and her husband, David, have gone to an undisclosed location to rest and spend time with one another.”

“After a rigorous course of treatment and testing, the Emory Healthcare team has determined that both patients have recovered from the Ebola virus and can return to their families and community without concern for spreading this infection to others,” says Bruce Ribner, MD, director of Emory’s Infectious Disease Unit.
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hqdefaultIn his Aug. 15 statement, Brantly wrote: “Thank you for your prayers for Nancy and me. Please continue to pray for and bring attention to those suffering in the ongoing Ebola crisis in West Africa.”

In an earlier statement on Aug. 8, Brantly wrote that while treating those with Ebola in Liberia, he “held the hands of countless individuals as this terrible disease took their lives away from them. I witnessed the horror firsthand, and I can still remember every face and name.”

He said when he began feeling ill, he immediately isolated himself until a test confirmed he had the virus three days later.

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Ebola was first identified in 1976, when it appeared in outbreaks in Sudan and the Democratic Republic of the Congo. It is named for the Ebola River, which runs near the Congolese village where one of the first outbreaks happened.

WebMD asked Amesh Adalja, MD, about the virus and efforts to contain it. Adalja is an infectious disease doctor at the University of Pittsburgh.

Q. How deadly is Ebola?

A. The Ebola strain in the current outbreak is the most lethal of the five known strains of the virus. It is called Ebola Zaire and usually kills up to 9 out of 10 infected people. But the high death rate might be due to a lack of modern medical care, Adalja says. “It’s hard to say exactly what the [death] rate would be in a modern hospital with all of its intensive care units.”
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On July 28, the CDC said the Ebola death rate in the West African outbreak is actually about 6 in 10, rather than 9 in 10. That indicates early treatment efforts have been effective, says Stephan Monroe. He’s the deputy director of the National Center for Emerging and Zoonotic Infectious Diseases at the CDC.

On July 31, the CDC issued a travel advisory recommending against non-essential travel to Guinea, Liberia, and Sierra Leone, said CDC Director Tom Frieden, MD, MPH.

Q. What are the symptoms?

A. At first, the symptoms are like a bad case of the fluhigh fever, muscle aches, headache, sore throat, and weakness. They are followed quickly by vomiting, diarrhea, and internal and external bleeding, which can spread the virus. The kidneys and liver begin to fail.

Ebola Zaire kills people quickly, typically 7 to 14 days after symptoms appear, Adalja says.

A person can have the virus but not show any symptoms for as long as 3 weeks, he says. People who survive can still have the virus in their system for weeks afterward.

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The virus has been detected in semen up to 7 weeks after recovery, according to the WHO. But this is very rare, says Thomas Geisbert, PhD, a professor of microbiology and immunology at the University of Texas Medical Branch. Geisbert has been studying the Ebola virus since 1988.

Q. How does the virus spread?

A. Ebola isn’t as contagious as more common viruses, such as colds, influenza, or measles, Adalja says. It spreads to people by close contact with skin and bodily fluids from infected animals, such as fruit bats and monkeys. Then it spreads from person to person the same way.

“The key message is to minimize bodily fluid exposures,” A

dalja says.

Q. What precautions should people take if they’re concerned they might come in contact with someone infected with Ebola?

A. “Ebola is very hard to catch,” Adalja emphasizes. Infected people are contagious only after symptoms appear, by which time close contacts, such as health care workers and family members, would use “universal precautions.” That’s an infection control approach in which all blood and certain body fluids are treated as if they are infectious for diseases that can be borne in them, Adalja says.

imagesEven though the virus can be transmitted by kissing or sex, people with Ebola symptoms are so sick that they’re not typically taking part in those behaviors, he says.

Q. Is there a cure or a vaccine to protect against it?

A. No, but scientists are working on both. There is no specific treatment for Ebola. The only treatments available now are supportive kinds, such as IV fluids and, if available, medications to level out blood pressure, a respirator, and transfusions, Adalja says.

nnnnnnnn-300x225Q. Why do some people survive the virus?

A. That’s hard to say. Adalja thinks several things might play a role, such as a person’s age and genetic makeup, and whether they have other medical conditions. Those aren’t proven reasons, though.

Q. How can the outbreak be stopped?

A. Simple steps to control infection, such as gowns, gloves, and eye protection, can help halt the spread of Ebola, Adalja says. Public health officials will have to wait 6 weeks after the last case is reported before declaring the outbreak over, he says.

Keys to stopping Ebola include identifying patients; providing treatment, preventing the spread, and protecting health care workers, including following patients’ contacts and monitoring them for symptoms; and preventing future cases through education and urging people to avoid close contact with sick people or bodies, Frieden said July 31.

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The CDC is sending an additional 50 epidemic intelligence service officers, epidemiologists, and health communication experts to the area over the next month, he said.

But, he said, turning the tide in Western Africa is “not going to be quick or easy. Even in a best-case scenario, it would take 3 to 6 months or more.”

Q. Could an Ebola outbreak happen in the United States?

Since the virus was first identified, all of the outbreaks in people have happened in Africa. It’s possible that an infected person who appeared to be healthy could board a plane in Africa and fly to the U.S., Adalja says. But “it’s not something that we’ve ever seen before.” The outbreaks generally have happened in poor, isolated communities, so those infected didn’t have the resources to travel far.

illnessConcerns were raised after an Ebola-infected man from Liberia flew to the Nigerian capital of Lagos, only to die on July 25, soon after arriving. He was identified in media reports as Patrick Sawyer, 40, a naturalized U.S. citizen making his way home to Minnesota.

But most flights between West Africa and the U.S. require one or more stops in other countries, making it unlikely a sick person could travel the entire distance, Marty Cetron, director for Global Migration and Quarantine at the CDC, said on July 28.

The CDC says Ebola poses little risk to the general U.S. population.

“We are confident that we will not have significant spread of Ebola, even if we were to have a patient with Ebola here,” Frieden told reporters July 31. “We work actively to educate American health care workers on how to isolate patients eyeand how to protect themselves against infection. In fact, any advanced hospital in the U.S., any hospital with an intensive care unit, has the capacity to isolate patients. There is nothing particularly special about the isolation of an Ebola patient other than it’s really important to do it right.”

“Because it’s not airborne, it would take very close contact with someone who is at an advanced stage of illness to become infected,” Ebola expert Geisbert tells HealthDay. 

One of the five Ebola virus strains caused an outbreak in laboratory monkeys in Reston, VA, outside Washington, DC, in 1989. People who were exposed to that strain of Ebola virus did not get sick. But they developed antibodies to it.

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