20 things to know about the Ebola outbreak

What hospitals need to know about the current Ebola outbreak

Ebola overview
1. Ebola, as it is commonly refereed to, is short for Ebola virus disease, a form of haemorrhagic fever, that causes severe illness and is often fatal.

2. Symptoms include fever, extreme weakness, muscle pain and sore throat, often with sudden onset. After these initial symptoms, infected individuals may suffer experience, vomiting, diarrhea, rash and bleeding

3. Ebola has a death rate of "up to 90 percent," according to the World Health Organization. However, the rate varies by outbreak; averaging the death rate across all outbreaks since 1976 results in a death rate of 65 percent. Some virologists argue the rate is likely to be lower than that given that a number of those infected by the disease were likely never diagnosed.

4. Ebola is often known for its horrific disease course. Richard Preston, author of the 1994 book. "The Hot Zone," on the disease's origins, describes the end stages of Ebola in one of its first known victims, Charles Monet: 

"Monet maintains silence, waiting to receive attention. Suddenly he goes into the last phase. The human virus bomb explodes. Military biohazard specialists have ways of describing this occurrence. They say that the victim has 'crashed and bled out'. Or more politely they say that the victim has 'gone down'.

He becomes dizzy and utterly weak, and his spine goes limp and nerveless and he loses all sense of balance. The room is turning around and around. He is going into shock. He leans over, head on his knees, and brings up an incredible quantity of blood from his stomach and spills it onto the floor with a gasping groan. He loses consciousness and pitches forward onto the floor. The only sound is a choking in his throat as he continues to vomit while unconscious. Then come a sound like bedside being torn in half, which is the sound of his bowels opening and venting blood from sloughed his gut. The linings of his intestines have come off and are being expelled along with huge amount of blood. Monet has crashed and is bleeding out."

5. Despite the graphic nature of the disease course, most Ebola patients die before this stage. Only 20 percent of victims will experience such extreme symptoms, says Nahid Bhadelia, MD, associate hospital epidemiologist at Boston Medical Center and director of Infection Control at Boston University's National Emerging Infectious Disease Laboratories, in a report.

6. Ebola attacks its victims quickly. Symptoms generally occur 8-10 days after exposure, and most patients recover or pass away within 6-10 days of symptoms appearing.

7. The majority of patients who die from Ebola succumb from an extreme drop in blood pressure, known as hypovolemic shock.

Origins of Ebola
8. Ebola was discovered in 1976 when it appeared during two simultaneous outbreaks, both in West Africa. In Sudan, 284 people were infected and 151 died, giving the virus a death rate of 53 percent for that particular outbreak. In the Democratic Republic of Congo, 318 were infected and 280 died — a death rate of 88 percent.

9. From 1976 to 2014, there have been 25 separate Ebola outbreaks, all in West Africa. Since 1976, 2,621 people have died from Ebola.

10. Before this summer's outbreak, the last known outbreaks occurred in 2012 in Uganda and the Democratic Republic of Congo.

2014 outbreak
11. The most recent outbreak was formally announced on March 25th when the World Health Organization and the Ministry of Health of Guinea reported an outbreak of Ebola in four southeastern districts of the country. At the time, suspected cases in the neighboring countries of Liberia and Sierra Leone were being investigated. In March, a total of 86 suspected cases, including 59 deaths (case fatality ratio: 68.5 percent), had been reported.

12. In spring, Doctors Without Borders joined with the Ministry of Health of Guinea to establish treatment centers in affected regions, and the CDC and WHO began educational efforts to help contain the spread of the disease.   Ebola

13. Yesterday, the WHO reported the death count of the current outbreak, which has now been documented in Sierra Leone, Guinea, Liberia and Nigeria, at 932.

14. Despite efforts to protect healthcare workers in West Africa from the virus, many have been infected, including the two American aid workers who were flown to the U.S. for treatment. In Liberia, 15 percent of deaths to date were attributed to physicians and other healthcare workers who contracted the disease while treating affected patients. In Sierra Leone, healthcare workers account for 9 percent of deaths, according to a Wall Street Journal

Emory's role in treating infected Americans
15. The two American victims, Kent Brantly, MD, 33, and Nancy Writebol, 59, are currently being treated at Emory University Hospital in Atlanta. Dr. Brantly was in Liberia completing a general medicine fellowship with Christian international relief organization Samaritan's Purse. Ms. Writebol was a personal coordinator for Christian missionary group SIM.

16. Emory University Hospital was selected to treat the two Americans, in part, because it has a special isolation unit physically separate from other patient areas. The unit was created in collaboration with the CDC, which is also based in Atlanta. "This unit has unique equipment and infrastructure that provides an extraordinarily high level of clinical isolation with very different capabilities than are normally provided to isolate patients in other hospitals. It is one of only four such facilities in the country," according to an Emory statement on its involvement in treating the infected patients.

17. A third American, Patrick Sawyer, died in late July from the virus. A Liberian-American, Mr. Sawyer lived in Minnesota but worked as a consultant for the Liberian finance ministry. Before succumbing to the disease, he had traveled by air to Nigeria for a conference. A Nigerian nurse who treated him has since died, and a Nigerian doctor who treated him has been infected.

Experimental treatment
18. The Americans who were flown to the U.S. were treated with an experimental drug, ZMapp, being developed by Mapp Biopharmaceutical, based in San Diego. Both showed signs of improvement after receiving the drug, though the WHO points out that spontaneous-seeming improvement can occur in regular disease course. According to Mapp Biopharmaceutical, "ZMapp is the result of a collaboration between Mapp Biopharmaceutical Inc, LeafBio, Defyrus Inc., the US government and Public Health Agency of Canada." ZMapp was first identified as a drug candidate in January 2014, according to the company.

19. Use of the experimental treatment was arranged privately by Samaritan's Purse, the humanitarian organization that employed Dr. Brantly. Samaritan's Purse contacted the CDC, who referred them to the National Institutes of Health. NIH was able to provide the organization with the appropriate contacts at the private company developing this treatment. The World Health Organization is currently convening in Geneva, Switzerland, to discuss Ebola response efforts and the potential use of the drug, which has not been tested yet in humans.

20. On August 1, the CDC issued guidelines for hospitals treating patients with Ebola.

Guidelines for hospitals
According to the CDC guidelines, healthcare providers should evaluate patients for EVD if they have the following risk factors:

  • Clinical criteria of a fever greater than 101.5 degrees Fahrenheit, severe headache, muscle pain, vomiting, diarrhea, abdominal pain, hemorrhage
  • Epidemiologic risk factors like contact with an infected person, travel to an area where EVD is active or direct contact with bats, rodents or primates in an area where Ebola is endemic.

The CDC also issued recommended infection control measures for patients with known or suspected EVD. They include the following (see the full recommendations here):

  • Patients should be placed in a single patient room, with a private bathroom, with the door closed
  • Healthcare workers should wear gloves, gowns, shoe covers, eye protection and face masks
  • Workers should avoid aerosol-generating procedures
  • Environmental cleaning should be performed with the appropriate disinfectants, which include 10 percent sodium hypochlorite solution or hospital-grade quaternary ammonium or phenolic products
  • Potentially contaminated materials like blood, sweat, emesis, feces and body secretions should be safely handled


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