Ebola outbreak declared a public health emergency by World Health Organization

Ebola outbreak declared a public health emergency by World Health Organization

Stes de Necker

LONDON –  The World Health Organization on Friday (8/8/2014) declared the Ebola outbreak in West Africa to be an international public health emergency that requires an extraordinary response to stop its spread.

It is the largest and longest outbreak ever recorded of Ebola, which has a death rate of about 50 percent and has so far killed at least 932 people. WHO declared similar emergencies for the swine flu pandemic in 2009 and for polio in May.

The WHO chief, Dr. Margaret Chan, said the announcement is "a clear call for international solidarity" although she acknowledged that many countries would probably not have any Ebola cases.

"Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own," Chan said at a news conference in Geneva. "I urge the international community to provide this support on the most urgent basis possible."

The agency had convened an expert committee this week to assess the severity of the continuing epidemic.

The current outbreak of Ebola began in Guinea in March and has since spread to Sierra Leone and Liberia, with a suspected cluster in Nigeria. There is no licensed treatment or vaccine for Ebola.

The impact of the WHO declaration is unclear; the declaration about polio doesn't yet seem to have slowed the spread of virus.

"Statements won't save lives," said Dr. Bart Janssens, director of operations for Doctors Without Borders. 

"For weeks, (we) have been repeating that a massive medical, epidemiological and public health response is desperately needed. ... Lives are being lost because the response is too slow."

In the United States, the Centers for Disease Control and Prevention have already elevated their Ebola response to the highest level and have recommended against travelling to West Africa. On Thursday, CDC director Dr. Tom Frieden told a Congressional hearing that the current outbreak is set to sicken more people than all previous outbreaks of the disease combined.

"I don't know what the advantage is of declaring an international emergency," said Dr. David Heymann, who directed WHO's response to the SARS outbreak and is now a professor at the London School of Hygiene and Tropical Medicine.

"This could bring in more foreign aid but we don't know that yet," he said.

Other experts hoped the declaration would send more health workers to West Africa.

"The situation is very critical and different from what we've seen before," said Dr. Heinz Feldmann, chief of virology at the U.S. National Institute of Allergy and Infectious Disease. "There are so many locations with transmission popping up and we just need more people on the ground."

WHO did not recommend any travel or trade bans but said people who had close contact with Ebola patients should not travel internationally. For countries with Ebola, WHO issued various recommendations, including exit screening at international airports and border crossings to spot potential cases. It also discouraged mass gatherings.

WHO said countries without Ebola should heighten their surveillance and treat any suspected cases as a health emergency.

This week, two of the worst-hit Ebola countries -- Liberia and Sierra Leone -- brought in troops to enforce quarantines and stop people infected with the disease from travelling. Liberian President Ellen Johnson Sirleaf said no one with a fever would be allowed in or out of the country and warned some civil liberties could be suspended if needed to bring the virus under control.

Chan said while extraordinary measures might be necessary to contain the outbreak, it is important to recognize civil rights.

"We need to respect the dignity of people and inform them why these measures are being taken," she said.

Important facts about the current outbreak (2014)

It’s the worst Ebola virus outbreak in history. West Africa is in a state of panic and paranoia. More than 1,201 people have been infected and 672 have died since the outbreak started more than four months ago. With up to a 90% fatality rate, the virus terrorizes residents of countries where breakouts occur, and terrifies the rest of us worried that it will spread. Preventing its spread is the primary goal of medical personnel.

Biology

Ebola is categorized as a member of the filoviridae family of viruses, one of three negative-stranded RNA viruses (Marburg, Ebola, and Reston) that often take on a “U” shape. Although it’s not yet known how it enters the cell, once inside, the RNA of the ebola virus is transcribed and replicated inside the cytoplasm, thereby infecting the cell. The Niemann-Pic C1 (NPC1) is a cholesterol transporter protein that is required for the ebola virus to permeate a cell, infect it, and replicate. The mutation of NPC1 is believed by many scientists to be key to finding a cure — perhaps through its mutation. As viruses are a-cellular, they do not replicate into other cells, but use the interior makeup of the host cell to multiply and assemble within the cell.

First cases and primary virus species

Ebola takes its name from the DRC’s Ebola River, where the virus first broke out in what was then Zaire in 1976. The original species was called Ebola-Zaire (considered the most lethal subtype), and the first outbreak occurred in the Yambuku region. With 318 reported cases, it resulted in an 88% death rate (280 people). The second Ebola subtype, Ebola-Sudan, was introduced to the world that same year, spreading quickly around the Nzara and Maridi areas of the Sudan. There, 53% of the 284 reported cases resulted in death (151 people).

The Infamous Marburg Outbreak

In 1967, the Filoviridae virus Marburg made its first appearance during outbreaks in three European cities: Marburg and Frankurt, Germany, and Belgade, former Yugoslavia. The source was said to be from labs where imported green monkeys from Uganda were being analyzed. A total of 31 cases of infections were documented when lab workers starting showing similar violent symptoms, and seven of these workers died.

Other species of the virus

There are three other known types of the virus: ebola Côte d’Ivoire , ebola Bundibugyo (BDBV) and the Reston type. The former virus is also known as the Tai’ Forest virus and first surfaced in 1995 after a Swiss ethologist was infected from doing a necropsy on a chimpanzee in the Côte d’Ivoire  forest. BDBV first surfaced in Uganda in 2007, and is as lethal as its cousin, the EBOV (classic ebola virus). The latter virus, Reston, is found in China and the Philippines, and while it can infect humans, has not killed one to date–instead causing the death of scores of monkeys and pigs.

Transmission

Ebola can be transferred from animal to animal, from animal to human and from human to human. The infection travels via fluid secretions (blood, urine, semen, mucus), usually orally or through broken skin. In many cases, contaminated victims’ vomit has been a primary catalyst for the virus to travel, or burial ceremonies where improper handling methods infected community members. In Africa, contact with animals infected with the virus such as pigs, monkeys, bats, and porcupines inflicted humans. Many healthcare and hospital workers have died from the disease through lack of knowledge or environmental exposure.

The source

Studies throughout the decades have led researchers to believe that one of the greatest sources for ebola is the fruit-eating bat. Three different bat species — hypsignathus monstrosus, epomops franqueti, and myonycteris torquata carry RNA sequences, proof that their bodies carry mutations from the ebola virus. This suggests that these bats may have lived with the virus for a long time, and that they could be the source. The often wide range of area a single outbreak can cover also implies that the source could be a mammal that can travel great distances very quickly. A proposed chain of events by many scientists is: bat droppings are eaten by terrestrial animals; the animals die, and then their carcasses are handled by a human. Keep in mind, not only the human race is at risk: approximately one third of gorillas in protected areas have perished from the virus in the last 15 years.

Symptoms

Ebola and Marburg viruses start to show symptoms after approximately five days after infection. Chills, sore throat, a typical-feeling fever, sore joints — all common symptoms that would not necessarily send a victim to the doctor. Days later, vomiting, bloody diarrhea, body rashes and red eyes begin, and increase in severity. Many cases result in internal hemorrhaging or external bleeding from the mouth, nose, ears, and rectum.

Containment

Early symptoms of the virus do not look much different from the common flu, fever, or stomach viruses. Therefore, the disease usually is unreadable until there are multiple cases, which is why containment is difficult. In most outbreaks, isolation wards in hospitals or medical centers have been established. In many cases, isolating victims and tracking their contacts has helped prevent the disease from becoming more widespread. The World Health Organization (WHO), Red Cross, Doctors Without Borders, and many disease control prevention workers descend on areas as soon as an breakout has been reported. In light of the current West African outbreaks, Senegal has closed its borders with Guinea, and many airports are taking the temperatures of arriving travellers before allowing them to enter the country.

Safety

“Barrier nursing techniques” are crucial for the safety of medical personnel during an Ebola outbreak. Basically, they get suited up–goggles, gloves, face mask, gown, and protection for the shoes. In the common event of an Ebola patient hemorrhaging or projectile vomiting, this helps to ensure that transmission does not occur. Many cases of hospital workers becoming infected are from early incidents of an outbreak before the actual disease has been diagnosed.

Treatment

While there is not a known cure, the ebola virus can be mollified and often eliminated if discovered in a timely fashion. In 2012, groundbreaking scientific findings were published in Science Translational Magazine, claiming that two leukaemia drugs showed signs of halting ebola virus replication. Intensive care treatment is necessary, and many drug therapies are in the process of being validated. Further work on finding a definitive vaccine continues; in many cases, electrolyte and nutritional management have aided in rehabilitating infected patients.

Early 2014 Outbreaks

As of late February, 2014, West Africa has seen an alarming outbreak of the Ebola virus. In Guinea, the epidemic started with five confirmed cases in the capital of Conakry. By March, cases were proliferating, with 60 deaths by hemorrhagic fever reported in three other districts. On May 15, the number of cases in Guinea totalled to 248, with 171 dead. The borders between Guinea and Liberia were closed when Liberia reported 35 cases and 11 deaths. Sierra Leone reported its first-ever outbreak of the virus, with five deaths initially. This has grown. The W.H.O. confirmed that the cases were along the country’s border with Guinea.

The New Outbreak: 1,000 and More Infected

Sierra Leone is now being called the epicentre of this continued, intensified outbreak, which cut a swath across three countries in West Africa–Liberia, Guinea, and Sierra Leone. More than 1,201 cases have been reported by the World Health Organization, with 672 deaths documented. A Liberian man held in quarantine in Lagos, Nigeria, died Friday after travelling from Monrovia on a business trip, illustrating how easily the virus can hop national borders. Hysteria is on the rise; many who feel symptoms of even a common cold will not admit to it, on account of becoming stigma. There are two infected U.S. citizens being treated in intensive care in Liberia.

The Fight to Contain this Outbreak

The rush to quarantine all areas in West Africa where the virus may spread has been intense. In Liberia, all public gatherings are banned and nearly every border has been shut down. Police forces as well as medical personnel are in a state of emergency, and work to enforce quarantines. The hospital in Lagos–Africa’s most populated city– where the Liberian Patrick Sawyer died of ebola, has been entirely shut down. Officials are tracing his contacts over the last few days, including fellow airline passengers and airport personnel. Airports in Liberia are screening all international passengers for symptoms.

Bioterrorism

In East Africa especially, where terrorist cells have been the culprits of serious acts of violence against the public, it may be a reasonable concern to fear a situation where the ebola virus surfaces as a deliberate outbreak. While security in containment sites is always very high and areas always heavily monitored with surveillance, there is an increased need for policymakers to take measures against bioterrorism ever becoming a possibility. Following the chain of transmission with every outbreak is a high priority, in order to root out the source.