This educational program will review the current Ebola outbreak, discuss epidemiology pathophysiology, signs and symptoms, patient assessment, prevention, and supportive care for Ebola victims. We will concentrate specifically on the 2014 Ebola virus (EBOV) (Zaire Ebolavirus) epidemic currently raging in the West African countries of Guinea, Liberia, Nigeria, Senegal and Sierra Leone.
After completing this course, the learner will be able to meet the following 30 objectives:
As of August 2014, the World Health Organization (WHO) also reported an outbreak of Ebola Virus Disease in the Democratic Republic of the Congo (DRC) which lies in Central Africa. The WHO confirmed that the current strain of the virus is the Zaire Ebola species, which is common in the DRC. The virology results and epidemiological findings indicate no connection to the current epidemic in West Africa (i.e. the index case and her contacts had no history of travel to the Ebola ravaged countries in Western Africa or history of contact with individuals from the affected areas). This is the DRC's seventh Ebola outbreak since 1976.
Ebola virus disease (EVD) or Ebola hemorrhagic fever (Ebola HF) is the human disease caused by the Ebola virus-one of numerous Viral Hemorrhagic Fevers. It is a severe, often fatal disease in humans and nonhuman primates such as monkeys, gorillas, and chimpanzees.
Basic understanding of these countries may help to facilitate understanding of the roadblocks faced in undertaking the eradication of these Ebola outbreaks.
|Countries||Religion||Ethnic Groups||Official Language||Main Industries||GDP||Population|
|24||French but 24 Indigenous languages||Petroleum, fishing, sawmilling, natural gas||$10.41 million||10.5 million|
0.5% Indigenous religions
|16||English but 30 indigenous languages||Rubber processing, palm oil processing, timber, diamonds||$2.719 billion||4 million|
|500||English||Crude oil, coal, tin, columbite, uranium; palm oil, peanuts, cotton, rubber, wood; hides and skins, textiles, cement and other construction materials, food products, footwear, chemicals, fertilizer, printing, ceramics, steel, small commercial ship construction and repair, entertainment, machinery, car assembly||$522 billion||174 million|
|7||French but 24 Indigenous languages||Food processing, mining, cement, artificial fertilizer, chemicals, textiles, refining imported petroleum, tourism. Fishing, chemicals, cotton, fabrics, groundnuts, and calcium phosphate.||$13.864 billion||13.5 million|
|Sierra Leone||Islamic, Christian||16||English|
(Krio language generally spoken)
|Diamond mining, small-scale manufacturing (cigarettes, beverages, textiles, footwear), petroleum refining, commercial ship repair||$8.412 billion||6 million|
|Demographic Republic of Congo (DRC)||1.5-10% Islamic, 80% Christian, 1.8-10% Indigenous beliefs||200||French but 242 Indigenous languages||Mining (copper, cobalt, gold, diamonds, coltan, zinc, tin, tungsten), mineral processing, consumer products (including textiles, plastics, footwear, cigarettes, processed foods, beverages), metal products, lumber, cement, commercial||$55 billion||75 million|
In general, there are inherent problems with containing and controlling the Ebola epidemics in the affected countries.
West Africa, also called Western Africa and the West of Africa, is the westernmost subregion of the African continent. West Africa is inhabited by West Africans, and in line with the current membership of the Economic Community of West African States (ECOWAS), established in May 1975, West Africa has been defined in Africa as including fifteen states Benin, Burkina Faso, Island of Cape Verde, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone, and Togo. (Diagram 1).
Situation map of the outbreak
|Date December 2013 – present|
Location Liberia, Sierra Leone, Guinea, Nigeria, Senegal
Reported Cases / Deaths (as of 25 September 2014)
Total: 6,808 / 3,159
Liberia: 3,564 / 1,922
Sierra Leone: 2,120 / 564
Guinea: 1,103 / 668
Nigeria: 20 / 8
Senegal: 1 / 0
The Democratic Republic of the Congo, also known as DR Congo, DRC, Congo, Congo-Kinshasa, DROC, or RDC, is a country located in Central Africa. (Diagram 2)
Ebola virus disease (EVD) or Ebola hemorrhagic fever (Ebola HF) is caused by four of five identified subspecies of Ebolavirus classified in the genus Ebolavirus, family Filoviridae, order Mononegavirales. The four identified subspecies of the Ebolavirus that have caused disease in humans are:
The fifth virus, Reston virus (RESTV) (Reston ebolavirus), has caused disease in nonhuman primates such as monkeys, gorillas and chimpanzees but is not thought to cause disease in humans. A host of similar species are probably associated with Reston virus, which was isolated from infected cynomolgous monkeys that were imported to the United States and Italy from the Philippines. Several workers in the Philippines and in US holding facilities became infected with the virus, but did not become ill.
The International Committee on Taxonomy of Viruses currently recognizes four subspecies of the Ebolavirus: Zaire ebolavirus (EBOV), Sudan ebolavirus (SUDV), Reston ebolavirus (RESTV), and Taï Forest ebolavirus (TAFV). The World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) added an additional subspecies of Ebola, the Bundibugyo ebolavirus (BDBV) or Ebola-Bundibugyo, following an outbreak in Uganda in 2007.
Ebola outbreaks have been restricted to Africa with the exception of the Reston ebolavirus. (Table 2)
The first Ebolavirus subspecies was discovered in 1976 in what is now the Democratic Republic of the Congo (DRC), formerly Zaire, near the Ebola River. Since then, outbreaks have appeared sporadically.
|Comments: First recognition of EVD. Disease was spread by close personal contact and by use of contaminated needles and syringes in hospitals/clinics.|
|Comments: EVD was spread mainly through close personal contact within hospitals. Many medical care personnel were infected.|
|Comments: Noted retroactively in the village of Tandala.|
|Comments: Occurred in Nzara, Maridi. Recurrent outbreak at the same site as the 1976 Sudan epidemic.|
|Comments: RESTV was introduced into quarantine facilities in Virginia and Pennsylvania by monkeys. The monkeys were imported from the Philippines.|
|RESTV was introduced once again into quarantine facilities in Virginia and Texas by monkeys imported from the Philippines. Four humans developed antibodies but remained asymptomatic.|
|Comments: High mortality among crab-eating macaques in a primate facility responsible for exporting animals in the USA. Three workers in the animal facility developed antibodies but remained asymptomatic.|
|Comments: RESTV was introduced into quarantine facilities in Siena by monkeys imported from the same export facility in the Philippines that was involved in the episodes in the United States. No humans were infected.|
|Comments: Occurred in gold-mining camps deep in the rain forest. Initially thought to be yellow fever; identified as EVD in 1995.|
|Comments: First and thus far only recognition of TAFV. Approximately one week after conducting necropsies on infected western chimpanzees in Taï National Park, a scientist contracted the virus and developed symptoms similar to those of dengue fever. She was discharged from a Swiss hospital two weeks later, and fully recovered after six weeks.|
|Comments: Occurred in Kikwit and surrounding area. Traced to index case-patient who worked in forest adjoining the city. Epidemic spread through families and hospitals.|
|Comments: Occurred in Mayibout area. A chimpanzee found dead in the forest was eaten by people hunting for food. Nineteen people involved in the butchery of the animal became ill; other cases occurred in family members.|
|Comments: A medical professional traveled from Gabon to Johannesburg, South Africa, and was exposed to the virus after having treated Ebola virus-infected patients. He was hospitalized, and a nurse who took care of him became infected and died.|
|1996 Mar.||Philippines, USA||RESTV||0||0||n/a|
|Comments: RESTV was introduced into a quarantine facility in Texas by crab-eating macaques from a monkey export facility in the Philippines. No human infections were identified.|
|Comments: Occurred in Booué area with transport of patients to Libreville. Index case-patient was a hunter who lived in a forest camp. Disease was spread by close contact with infected persons. A dead chimpanzee found in the forest at the time was determined to be infected.|
|Comments: Occurred in Gulu, Masindi, and Mbarara districts of Uganda. The three greatest risks associated with EVD were attending funerals of EVD case-patients, having contact with case-patients in one's family, and providing medical care to EVD case-patients without using adequate personal protective measures.|
|2001–2002 Oct.-Jul.||Gabon, DRC||EBOV||122||96||79%|
|Comments: Occurred over the border of Gabon and the Republic of the Congo. This was the first time that EVD was reported in the Republic of the Congo.|
|Comments: Occurred in the districts of Mbomo and Kéllé in Cuvette Ouest Département.|
|Comments: Occurred in Mbomo and Mbandza villages located in Mbomo district, Cuvette Ouest Département.|
|Comments: Occurred in Yambio County in Western Equatoria of Southern Sudan. This outbreak was concurrent with an outbreak of measles in the same area, and several suspected EVD cases were later reclassified as measles cases.|
|Comments: Occurred in Kasai-Occidental Province. The outbreak was declared over on November 20. Last confirmed case was on October 4 and last death on October 10.|
|Comments: First recognition of BDBV. Occurred in Bundibugyo District in Western Uganda.|
|Comments: First recognition of RESTV in pigs. Strain closely similar to earlier strains. Six workers from the pig farm and slaughterhouse developed antibodies but did not become sick.|
|Comments: Occurred in the Mweka and Luebo health zones of the Province of Kasai-Occidental.|
|Comments: Occurred in the Kibaale District.|
|Comments: Occurred in Province Orientale.|
|2013–2014 Dec.-present||Guinea, Liberia, Sierra Leone, Nigeria, Senegal, DRC||EBOV||2,127||1,145||64%|
|Comments: An outbreak of Ebola virus disease (EVD) began in Guinea in December 2013, leading to an epidemic in West Africa. The outbreak was not detected until March 2014. It then spread to Sierra Leone, Liberia, Nigeria and Senegal. The outbreak is caused by the Zaire ebolavirus, known simply as the Ebola virus (EBOV). It is the most severe outbreak of Ebola in terms of the number of human cases and fatalities since the discovery of the virus in 1976.|
December 2013: Researchers believe that a 2-year-old boy was the index case of the current EVD outbreak. He died on 28 December 2013 in the village of Meliandou, Guéckédou Prefecture, Guinea. His mother, sister, and grandmother then became ill with similar symptoms. All died. People infected by those victims spread the disease to other villages. Although Ebola represents a major public health issue in sub-Saharan Africa, no cases had ever been reported in West Africa and the early cases were diagnosed as diseases more common to the area. Thus, the disease had several months to spread before it was recognized as Ebola.
The following countries have reported imported cases since the 2014 Ebola outbreak in West Africa:
American aid worker Kent Brantly, a physician, became infected with Ebola while working in a Monrovia treatment center as medical director for the aid group Samaritan's Purse; Nancy Writebol, one of Brantly's missionary co-workers, became infected at the same time. Both were flown to the United States at the beginning of August for further treatment in Atlanta's Emory University Hospital, near the headquarters of the Centers for Disease Control. Both survived. Both survived.
A Boston physician, Rick Sacra, was airlifted from Liberia to be treated in the United States. He is the third US missionary, working for Serving in Mission (SIM), who had tested positive for the disease. Sacra was being treated in Omaha at the Nebraska Medical Center. The doctor did not get infected while treating Ebola patients, but was exposed to the virus while delivering babies at a hospital in Liberia. On 9 September, it was reported that Sacra had received an experimental therapy (not ZMapp) and it was later announced that he had received a blood transfusion from Kent Brantly, the American physician who had recovered from the disease. It has been theorized that transfusing blood products from former Ebola patients may assist a diseased person's immune system to fight the disease. He survived a fourth U.S. citizen who contracted the Ebola virus arrived at Emory University Hospital in Atlanta for treatment. The patient was airlifted from Sierra Leone and landed at Dobbins Air Reserve Base. The identity of the patient, a male doctor working for the WHO in Sierra Leone, has not been released. According to doctors at the hospital, he will not be receiving any experimental treatment and will only receive supportive care to boost his immune system. The patient exited the ambulance and was assisted into the hospital while walking on his own. Thomas Eric Duncan, a Liberian national, flew to Dallas, Texas to visit family. He left Liberia on September 19, 2014 and arrived in Dallas on September 20th. On September 24th he developed symptoms and sought medical care at Texas Health Presbyterian Hospital and was discharged from the Emergency Department on antibiotics. He returned to the same hospital via EMS on September 28th and was admitted. On September 30th the CDC confirmed Ebola.
Thomas Eric Duncan, a Liberian national, flew to Dallas, Texas to visit family. He left Liberia on September 19, 2014 and arrived in Dallas on September 20th. On September 24th he developed symptoms and sought medical care at Texas Health Presbyterian Hospital and was discharged from the Emergency Department on antibiotics. He returned to the same hospital via EMS on September 28th and was admitted. On September 30th the CDC confirmed Ebola.Ashoka Makpo, an NBC cameraman, tested positive for Ebola in Liberia. He began feeling achy and tired on October 1, 2014. He will be flown back to the USA on October 10, 2014. Medical institution unknown.
The natural reservoir host of ebolaviruses remains unknown. However, on the basis of available evidence and the nature of similar viruses, researchers believe that the virus is animal-borne with bats, particularly fruit bats, being considered the most likely natural reservoir of the Ebola virus (EBOV).
In the 1976 and 1979 outbreaks in the cotton factory where the first cases of EBOV were employed, bats were known to roost. Only bats became infected when 24 plant species and 19 vertebrate species were experimentally inoculated with EBOV. The absence of clinical signs in these bats is characteristic of a reservoir species. In a 2002–2003 survey of 1,030 animals including 679 bats from Gabon and the Republic of the Congo, 13 fruit bats were found to contain EBOV RNA fragments. As of 2005, three types of fruit bats (Hypsignathus monstrosus, Epomops franqueti, and Myonycteris torquata) have been identified as being in contact with EBOV. They are now suspected to represent the EBOV reservoir hosts. Antibodies against Ebola Zaire and Reston viruses have been found in fruit bats in Bangladesh, thus identifying potential virus hosts and signs of the filoviruses in Asia.
Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians, and arthropods sampled from outbreak regions, no ebolavirus was detected apart from some genetic traces found in six rodents (Mus setulosus and Praomys) and one shrew (Sylvisorex ollula) collected from the Central African Republic. Traces of EBOV were detected in the carcasses of gorillas and chimpanzees during outbreaks in 2001 and 2003, which later became the source of human infections. However, the high lethality from infection in these species makes them unlikely as a natural reservoir.
Because the natural reservoir of ebolaviruses has not yet been proven, the manner in which the virus first appears in humans at the start of an outbreak remains unknown. EVD outbreaks are usually traceable to a single individual who has handled an infected animals body fluids while skinning the carcass of a gorilla, chimpanzee, or duiker.
Bats drop partially eaten fruits and pulp onto the ground then land mammals such as gorillas and duikers feed on these fallen fruits. This chain of events forms a possible indirect means of transmission from the natural host to animal populations, which has led to research towards viral shedding in the saliva of bats. Fruit bats are also eaten by people in parts of West Africa where they are smoked, grilled or made into a spicy soup. (Diagram 3).
Fruit production, animal behavior, and other factors vary at different times and places that may trigger outbreaks among animal populations.
Human-to-human transmission of EVD infections is considered low as the disease is only spread by direct contact with the secretions from an individual who is showing the signs and symptoms of infection. EVD is spread by:
The quick onset of symptoms makes it easier to identify sick individuals and limits an infected individual's ability to spread the disease by traveling. Because dead bodies are still infectious, some doctors dispose of them by cremation, despite local traditional burial rituals.
Healthcare workers have also contracted EVD. In these cases, transmission has occurred because:
Airborne transmission has not been documented during previous EVD outbreaks. The Ebola virus is, however, infectious as breathable 0.8–1.2 micrometre laboratory generated droplets. Because of this potential route of infection, ebolaviruses have been classified as Category A biological weapons.
Healthcare workers, family and friends in close contact with Ebola patients are at the highest risk of contracting EVD because they may come in contact with infected blood or body fluids.
The average time between exposure to the Ebola virus thus contracting EVD and the onset of symptoms may range anywhere from 2 to 21 days, although 8-10 days is most common.
Signs and symptoms of EVD usually begin suddenly with a flu-like stage characterized by (Diagram 4):
Less common symptoms include the following: sore throat
Skin manifestations may include a maculopapular rash (in about 50% of cases). Not all infected individuals show hemorrhagic symptoms.
All infected individuals show some symptoms of circulatory system involvement, including impaired blood clotting. In 40–50% of cases, bleeding from puncture sites and mucous membranes (e.g. gastrointestinal tract, nose, vagina and gums) have been reported.
In the bleeding phase, which typically starts 5 to 7 days after first symptoms:
In general, the development of bleeding symptoms often indicates a worse prognosis and this blood loss can result in death. If the infected individual does not recover, death due to multiple organ dysfunction syndrome occurs within 7 to 16 days (usually between days 8 and 9) after the onset of first symptoms.
Some who become sick with EVD recover. Why this occurs is unknown. However, individuals who die usually have not developed a significant immune response to the virus at the time of death.
Endothelial cells, mononuclear phagocytes, and hepatocytes are the main targets of the Ebola virus. After infection, a secreted glycoprotein (sGP) known as the Ebola virus glycoprotein (GP) is synthesized. Ebola replication overwhelms protein synthesis of infected cells and host immune defenses. The GP forms a trimeric complex, which binds the virus to the endothelial cells lining the interior surface of blood vessels. The sGP forms a dimeric protein that interferes with the signaling of neutrophils, a type of white blood cell, which allows the virus to evade the immune system by inhibiting early steps of neutrophil activation. These white blood cells also serve as carriers to transport the virus throughout the entire body to places such as the lymph nodes, liver, lungs, and spleen.
The presence of viral particles and cell damage resulting from budding causes the release of cytokines (to be specific, TNF-a, IL-6, IL-8, etc.), which are the signaling molecules for fever and inflammation. The cytopathic effect, from infection in the endothelial cells, results in a loss of vascular integrity. This loss in vascular integrity is furthered with synthesis of GP, which reduces specific integrins responsible for cell adhesion to the inter-cellular structure, and damage to the liver, which leads to coagulopathy. (Diagram 5).
The medical history including travel (country, dates of travel), work history and exposure to wildlife are clues which should lead the healthcare worker to suspect the diagnosis of EVD.
The diagnosis is confirmed by isolating the virus itself, detecting its RNA or proteins, or detecting antibodies against the virus in a person's blood. Isolating the virus by cell culture, detecting the viral RNA by polymerase chain reaction (PCR) and detecting proteins by enzyme-linked immunosorbent assay (ELISA) is effective early and in those who have died from the disease. Detecting antibodies against the virus is effective late in the disease and in those who recover.
During an outbreak, virus isolation is often not feasible. The most common diagnostic tests are therefore real time PCR and ELISA detection of proteins, which can be performed in field or mobile hospitals. Filovirions can be seen and identified in cell culture by electron microscopy due to their unique filamentous shapes, but electron microscopy cannot tell the difference between the various filoviruses despite there being some length differences.
|Timeline of Infection||Diagnostic Tests Available|
|Within a few days after symptoms begin|
|Later in disease course or after recovery|
|Retrospectively in deceased patients|
Early symptoms of EVD may be similar to those of dengue fever, Marburg virus disease, viral hemorrhagic fever, falciparum malaria, typhoid fever, shigellosis, rickettsial diseases such as typhus, cholera, gram-negative septicemia, borreliosis such as relapsing fever or EHEC enteritis.
Other infectious diseases that should be included in the differential diagnosis include: leptospirosis, scrub typhus, plague, Q fever, candidiasis, histoplasmosis, measles, trypanosomiasis, visceral leishmaniasis, hemorrhagic smallpox, and fulminant viral hepatitis.
Non-infectious diseases that can be confused with EVD include: acute promyelocytic leukemia, hemolytic uremic syndrome, snake envenomation, clotting factor deficiencies/platelet disorders, thrombotic thrombocytopenic purpura, hereditary hemorrhagic telangiectasia, Kawasaki disease, and even warfarin poisoning.
Ebola viruses are contagious after the onset of symptoms so preventing the spread of EVD is paramount. Healthcare providers caring for individuals with EVD, as well as, family and friends in close contact with individuals with EVD are at the highest risk of contracting the disease. Behavioral changes include:
Due to lack of proper equipment and hygienic practices, large-scale epidemics have occurred mostly in poor, isolated areas without modern hospitals or well-educated medical staff. Airline crews who fly to these areas of the world are taught to identify potential Ebola victims and isolate anyone who has symptoms.
No vaccine is currently available for humans. The most promising candidates are DNA vaccines or vaccines derived from adenoviruses, vesicular stomatitis Indiana virus (VSIV) or filovirus-like particles (VLPs) because these candidates could protect nonhuman primates from ebolavirus-induced disease. DNA vaccines, adenovirus-based vaccines, and VSIV-based vaccines have entered clinical trials.
Vaccines have protected nonhuman primates such as crab-eating macaques and mice but the development and rigorous testing and trials on humans remains a long way off.
No proven ebolavirus-specific treatment exists. Treatment is primarily supportive in nature and includes:
Early treatment may increase the chance of survival. Timely treatment of EVD is important but challenging because the disease is difficult to diagnose clinically in the early stages of infection. Because early symptoms, such as headache and fever, are nonspecific to Ebola viruses, cases of EVD may be initially misdiagnosed.
The lack of treatments in the most-affected regions has spurred controversy. Some individuals are demanding that experimental drugs be made more widely available in Africa on a humanitarian basis. Other individuals warn that making unproven drugs widely available would be unethical, especially in light of past experimentation conducted in developing countries by Western drug companies. As a result of the controversy, on August 12, 2014 an expert panel of the WHO endorsed the use of interventions with as-yet-unknown effects for both treatment and prevention of EVD. The WHO expert panel also stated that deciding which treatments should be used and how to distribute them equitably were matters that needed further discussion.
Subsequently the WHO Assistant Director-General for Health Systems and Innovation said on September 5, 2014 that transfusion of whole blood or purified serum from Ebola survivors is the therapy with the greatest potential to be implemented immediately on a large scale in West Africa, although there is little information on the efficacy of such treatment.
In mid-September the sale of black market blood from survivors of the disease had become a new trend in the Ebola-affected regions. Serum derived blood from surviving victims has been used under strict control in certain cases. This trend in an uncontrolled manner could potentially lead to other infectious diseases. This treatment must be properly implemented as a medical treatment under strict control and screening of possible donors. Margaret Chan of the WHO has criticized the use of this practice in a black market environment, noting concerns over "storage and collection methods".
A number of experimental treatments are being studied or will undergo trials:
It is important to remember that vaccines are usually given to individuals before they are exposed to a virus that causes a disease. A vaccine stimulates the immune system to generate antibodies and cellular immunity that can fight off an infection should it occur. Typically, therapeutics are provided to individuals who are already infected with a virus. As can be seen, prevention of EVD is the best route to take while waiting for the development and rigorous testing of vaccines and other therapeutic treatments.
The disease has a high mortality rate: often between 50 percent and 90 percent. April 2014 information from the WHO across all occurrences to date puts the overall fatality rate at 60%-65%. There are indications based on variations in death rate between countries that early and effective treatment of symptoms (e.g., supportive care to prevent dehydration) may reduce the fatality rate significantly.
If an infected individual survives, recovery may be quick and complete. Prolonged cases are often complicated by the occurrence of long-term problems, such as:
EBOV and SUDV may be able to persist in the semen of some survivors for up to seven weeks, which could give rise to infections and disease via sexual intercourse.
The basic reproduction number is a statistical measure of the number of people who are expected to be infected by one person who has the disease in question. If the rate is less than 1, the infection will die out in the long run and if the rate is greater than 1 the infection will continue to spread in a population.
Using data supplied by the WHO, several studies have estimated the reproduction number of the EVD epidemic in West Africa between 1.2 and 2.5, with variations between countries and time during the outbreak. The basic reproduction number of EVD together with its generation time, which is the time between initial infection and transmission to others, cause the cumulative number of infected cases to double every two to three weeks in some affected areas.
On 28 August, the WHO released its first estimate of the possible total cases (20,000) from the outbreak as part of its roadmap for stopping the transmission of the virus. The WHO roadmap states "This Roadmap assumes that in many areas of intense transmission the actual number of cases may be two- to fourfold higher than that currently reported. The WHO acknowledges that the aggregate case load of EVD could exceed 20,000 over the course of this emergency. The Roadmap assumes that a rapid escalation of the complementary strategies in intense transmission, resource-constrained areas will allow the comprehensive application of more standard containment strategies within 3 months." It does not provide details of how it made this total casualty estimate or a more detailed projection of how Ebola casualty statistics might evolve over time. It includes an assumption that some country or countries will pay the required cost of their plan, estimated at half a billion dollars.
A number of epidemiologists have highlighted that the WHO projection of a total of 20,000 cases might be an underestimate. On August 31, the journal Science quoted Christian Althaus, a mathematical epidemiologist at the University of Bern in Switzerland, as saying that if the epidemic were to continue in this way until December, the cumulative number of cases would exceed 100,000 in Liberia alone.
According to a research paper released in early September, in the hypothetical worst-case scenario, if a reproduction number of over 1.0 continues for the remainder of the year we would expect to observe a total of 77,181 to 277,124 additional cases within 2014.
Writing in the NYT on 12 September, Bryan Lewis, an epidemiologist at the Virginia Bioinformatics Institute at Virginia Tech, said that researchers at various universities who have been using computer models to track the growth rate say that at the virus's present rate of growth, there could easily be close to 20,000 cases in one month, not in nine.
On 3 September, Thomas Kenyon, Director of the U.S. CDC's Center for Global Health said, "The highly virulent disease, which has claimed more than 1,900 lives so far, is spreading faster than health workers in Guinea, Liberia, Nigeria and Sierra Leone can manage".
Similar comments were made by Anthony Fauci, Director of the US NIH's National Institute of Allergy and Infectious Diseases, who said that 42 percent of the cases have occurred in the last month and that the outbreak is "completely out of control". He further noted that the rate of infection is exponential: "The number of cases per unit time is dramatically increasing."
On 8 September, the WHO warned that the number of new cases in Liberia was increasing exponentially, and would increase by "many thousands" in the following 3 weeks.
On 9 September, Jonas Schmidt-Chanasit of the Bernhard Nocht Institute for Tropical Medicine controversially announced that the containment fight in Sierra Leone and Liberia had already been "lost" and that the disease will "burn itself out" after eventually infecting nearly the entire population, with half of them, around five million, dying.
In addition to the loss of life, the outbreak is having a number of significant economic impacts:
International Organizations which have responded to the Ebola Epidemic in West Africa and the Democratic Republic of the Congo include the:
Charitable Organizations, Foundations and Individuals include:
It would be fair to say that most countries circling the globe have responded with:
Anxiety and fear now has struck the United States and other countries of the world since EVD is no longer being viewed as "just an African problem". Despite all the best intentions and best efforts the Ebola epidemic in West Africa continues to spread exponentially. The Ebola epidemic in the DRC is just beginning to pick up speed. Now the whole world feels threatened, so much so, that most average everyday people feel at risk.
Instead of feeling afraid and becoming paranoid use common sense: wash your hands, pay attention to those who seem to "have the flu", ask questions about recent travel, to what country, exposure to bushmeat etc. Remember, despite what you may think, African "bushmeat" is illegally sold here in America.
The Centers for Disease Control and Prevention offer protocols for diagnosis/testing, transportation/monitoring/movement, protecting healthcare workers, EVD information for clinicians in U.S. healthcare settings and other very valuable information for caring for the Ebola patient and keeping all others safe.
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"First British volunteer injected with trial Ebola vaccine in Oxford". Guardian. Retrieved 17 September 2014.
"An Ebola vaccine was given to 10 volunteers, and there are 'no red flags' yet". Washington Post. Retrieved 17 September 2014.
"Ebola Outbreak Still Not Under Control: Officials". US News & World Report. Retrieved 18 September 2014.
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This course is applicable for the following professions:
Advanced Registered Nurse Practitioner (ARNP), Clinical Nurse Specialist (CNS), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Registered Nurse (RN)
CPD: Practice Effectively, Infection Control/Disease, Medical Surgical