Travel to and from Ebola-affected countries: What you need to know

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Key facts OF Ebola virus disease

• Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
• The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
• The average EVD case fatality rate is around 50%. Case fatality rates have varied from 25% to 90% in past outbreaks.
• The first EVD outbreaks occurred in remote villages in Central Africa, near tropical rainforests, but the most recent outbreak in west Africa has involved major urban as well as rural areas.
• Community engagement is key to successfully controlling outbreaks. Good outbreak control relies on applying a package of interventions, namely case management, surveillance and contact tracing, a good laboratory service, safe burials and social mobilisation.
• Early supportive care with rehydration, symptomatic treatment improves survival. There is as yet no licensed treatment proven to neutralise the virus but a range of blood, immunological and drug therapies are under development.
• There are currently no licensed Ebola vaccines but 2 potential candidates are undergoing evaluation.

Introduction

A high-level emergency meeting, convened by WHO at the request of several governments and representatives of the pharmaceutical industry, was held on 23 October to look at the many complex policy issues that surround eventual access to experimental Ebola vaccines.

Ways to ensure the fair distribution and financing of these vaccines were discussed in an atmosphere characterized by a high sense of urgency. This sense of urgency was conveyed in many ways – from plans for the different phases of clinical trials to be performed concurrently rather than consecutively, to suggested partnerships for expediting clinical trials, to proposals for getting all development partners moving in tandem and at the same accelerated pace.

More than 90 participants, including some of the world’s leading scientists, came, on short notice, from national and university research institutions, also in Africa, government health agencies, ministries of health and foreign affairs, national security councils, and several offices of Prime Ministers and Presidents. Also represented were national and regional drug regulatory authorities, the MSF (Doctors Without Borders) medical charity, funding agencies and foundations, the GAVI alliance for childhood immunization, and development banks, including the African Development Bank, the European Investment Bank, and the World Bank Group.

Main conclusions reached

Impact of vaccines on further evolution of the epidemic

The meeting concluded that vaccines will have a significant impact on the further evolution of the epidemic in any scenario, from best-case to worst-case.

Financing of vaccine development, clinical trials, and vaccination campaigns

The meeting concluded that funding issues should not be allowed to dictate the vaccine agenda. The funds will be found.

Liability

The meeting concluded that neither affected countries nor industry should be left alone to bear the burden should lawsuits arise following possible adverse reactions to an Ebola vaccine. To respond to this potential problem, a proposal was made to establish a “club” of donors, in collaboration with the World Bank.

The timing and quantity of vaccine supplies

The meeting concluded that the timing and quantity of vaccine doses should not constrain the design of clinical trials. Industry confirmed that enough vaccine doses would be available.

GlaxoSmithKline’s monthly production capacity for purified bulk vaccine was expected to rise from the current figure of 24,000 doses to 230,000 by April 2015, if they can be filled for release. NewLink’s bulk vaccine manufacturing capacity for the Canadian vaccine was noted to vary, according to the dose selected, from 52,000 doses to 5.2 million doses anticipated for the first quarter of 2015.

Design of protocols for phase 2 and phase 3 clinical trials

The meeting concluded that randomized controlled clinical trials were the gold standard in terms of yielding reliable scientific data for the analysis and interpretation of efficacy. A stepped-wedge design could also yield useful and meaningful data during the special circumstances of the current epidemic.

WHO/M. Missioneiro

The 1st batch of experimental vaccines, VSV-EBOV, arrived in October 2014 in Geneva, Switzerland, and were stored at the Geneva University Hospital.

Priority uses of vaccine when supplies are limited

The meeting concluded that health care workers, including medical staff, laboratory staff, burial teams, and facility cleaners, should have first call on vaccine doses while supplies remain limited. Vaccination of health care workers in the three countries was judged feasible during the first quarter of 2015.

Regulatory requirements

The meeting concluded that the licensure and authorization requirements of regulatory authorities should be streamlined and harmonized, enabling the rapid introduction of vaccines for clinical trials and general distribution, yet with no compromise of scientific standards. In order to deliver the number of doses on the schedules proposed by the manufacturers, regulators must work closely with the manufacturers to find ways to overcome a number of regulatory hurdles.

Urgent measures to improve readiness for clinical trials and vaccines

The meeting concluded that two preparatory measures should be given the most urgent priority: community engagement and social mobilization to prepare populations to understand and accept clinical trials and vaccination campaigns, and the building of basic public health infrastructures, especially given the considerable logistical challenges facing health services in Guinea, Liberia, and Sierra Leone.

Coordination and alignment among multiple partners

The meeting concluded that a mechanism or framework must be urgently established, relying on WHO’s convening and coordination powers, to get all partners working in tandem, according to a single agreed plan and aligned with industry’s “critical paths” analysis.

Determination to finish the job

The meeting concluded that all efforts to develop, test, and approve Ebola vaccines must be followed through to completion at the current accelerated pace, even if dramatic changes in the epidemic’s transmission dynamics meant that vaccines were no longer needed.

• Read full meeting report: WHO high-level meeting on Ebola vaccines access and financing
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Ebola virus disease (EVD; also Ebola hemorrhagic fever [EHF]), or simply Ebola, is a disease of humans and other primates caused by ebolaviruses (EBOV). Signs and symptoms typically start between two days and three weeks after contracting the virus as afever, sore throat, muscle pain and headaches. Then, vomiting, diarrhea and rash usually follow, along with decreased function of the liver and kidneys. At this time some people begin to bleed both internally and externally.^[1] Death, if it occurs, follows typically six to sixteen days after symptoms appear and is often due to low blood pressure from fluid loss.^[2]

The virus spreads by direct contact with blood or other body fluids of an infected human or other animal.^[1] Infection with the virus may also occur by direct contact with a recently contaminated item or surface.^[1] Spread of the disease through the air has not been documented in the natural environment.^[3] EBOV may be spread by semen or breast milk for several weeks to months after recovery.^[1][4] Fruit bats are believed to be the normal carrier in nature, able to spread the virus without being affected by it. Humans become infected by contact with the bats or with a living or dead animal that has been infected by bats. After human infection occurs, the disease may also spread between people. Other diseases such as malaria, cholera, typhoid fever, meningitis and other viral hemorrhagic fevers may resemble EVD. Blood samples are tested for viral RNA, viral antibodies or for the virus itself to confirm the diagnosis.^[1]

Control of outbreaks requires coordinated medical services, along with a certain level of community engagement. The medical services include: rapid detection of cases of disease,contact tracing of those who have come into contact with infected individuals, quick access to laboratory services, proper care and management of those who are infected and proper disposal of the dead through cremation or burial.^[1][5] Prevention includes limiting the spread of disease from infected animals to humans.^[1] This may be done by handling potentially infected bush meat only while wearing protective clothing and by thoroughly cooking it before consumption.^[1] It also includes wearing proper protective clothing and washing hands when around a person with the disease.^[1] Samples of body fluids and tissues from people with the disease should be handled with special caution.^[1]

No specific treatment for the virus is available. Efforts to help those who are infected are supportive; they include giving either oral rehydration therapy (slightly sweetened and salty water to drink) or intravenous fluids as well as treating symptoms. This supportive care improves outcomes. The disease has a high risk of death, killing between 25 percent and 90 percent of those infected with the virus, with an average mortality rate of 50 percent. EVD was first identified in an area of Sudan (now part of South Sudan), and in Zaire (now theDemocratic Republic of the Congo). The disease typically occurs in outbreaks in tropical regions of sub-Saharan Africa.^[1] From 1976 (when it was first identified) through 2013, the World Health Organization reported a total of 1,716 cases.^[1][6] The largest outbreak to date is the ongoing epidemic in West Africa, which is centered in Guinea, Sierra Leone and Liberia.^[7][8][9] As of 25 October 2014, 12,008 suspected cases resulting in the deaths of 5,078 have been reported.^[10] Efforts are under way to develop a vaccine.^[1]

Unlike the common ailments that afflict human beings like flu or measles, Ebola’s transmission does not occur through the air. The disease is transferred if there is direct contact with various bodily fluids of an infected patient. Direct contact denotes fluids touching eyes, wounds, cut, opened skin or mouth, the disease is neither airborne nor does it spread by liquids like water. In this vein, the body fluids which spread Ebola’s virus include various secretions like saliva, urine semen, sweat, stool, mucus, breast milk, and breast milk.

Handshakes     

Shaking hands with a patient would unleash minimal risks; however, body fluids may exacerbate the conditions. Skin contact is not solely risky devoid of fluids. Patients become contagious if they are sick with symptoms. And at that juncture, the patients are hardly outdoors as they are very sick.

Surfaces

If you touch a surface that was in contact with a patient, contamination depends on the duration. The virus only survives few hours on surfaces, once it is desiccated, it is dead. Nevertheless, you can kill the virus using home-based bleach or organic sanitizers. On the other hand, if in body fluids, the viruses may stay alive at normal temperature while semen enables it to survive for a few months.

Coughs and Sneezes

First and foremost, if the victim is symptomatic, chances of viral transmission through a cough or sneeze are heightened. If they literally sneeze on an uninfected person, the contagion is communicable. Finally, the fluids in the cough like mucus and saliva if they land on eyes, nose, mouth or wounds; it is transmittable at that point. Coughs and sneezes do not suffice as symptomatic indications of the disease. Health experts have predicated the virus is wimpy and is poised to die if outside the body like the HIV/AIDS virus.

Animals and Organisms

Unlike the anopheles mosquito that spreads malaria, the virus does not have a microorganism that furthers or spreads it. However, various species like bats alongside monkeys have been identified as potential carriers.

Health Care Workers

Hospitals and quarantine areas where the patients of Ebola are restricted may pose a threat to the workers. Thus, needles and tools contaminated with the virus may suffuse the contagion, meticulous approach is imperative for doctors, nurses and co-workers in these settings. To keep the virus at bay, hospital staff should wear masks, protect eyes and gloves.

Medical equipment ought to be sterilized painstaking before re-use. Similarly, if not properly disposed, the virus can be communicable and amplify the outbreak.

Erstwhile Patients

When a patient infected with Ebola has convalesced fully, they cannot transfer the virus. Nevertheless, health experts have discovered the virus survives in semen for up to three months. Discernibly, abstaining from sex for not less than three months is recommended. Nevertheless, where abstinence is impossible, condoms are crucial to militate against spreading Ebola viruses.

In the view of the probable modes of transmission, body fluids of infected persons when in contact with uninfected people are the principal cause.

Ebola is a lethal disease that is communicable through humans and various animals, specifically a species of primates and bats. Once the virus contaminates the human body, its incubation time to the start of symptoms takes two to twenty one days. Humans are not contagious until the symptoms have bloomed.

Fore symptoms are the erratic onset of muscular pains, headaches, sore throat and fever fatigue. Next the patient starts to vomit, have diarrhea, internal or external bleeding, impaired kidney, rashes and liver malfunction. Laboratory results encompass diminished white blood cells and thrombocyte counts alongside heightened liver enzymes. Preempting Infections in Hospitals and Quarantine Settings Doctors and other medical assistants ought to undertake quintessential precautions when handling patients, despite any presumed pre-diagnosis. These encompass standard hand sanitization, respiratory hygiene, wearing shielding equipment, safe injections and protected burial practices.

Medical workers in interventions expatriated to hotspot areas ought to embrace holistic infection counter techniques to militate against touching with victim’s fluids or contaminated surfaces. If in proximate contact of victims afflicted with Ebola, medical officers must put on facial shield, masks and goggles, clean, anti-sterile lengthy-sleeved gowns and hand-wear gloves. In a similar vein, laboratory researchers are vulnerable to the Ebola virus. Thus, samples obtained from infected patients or animals for analysis of Ebola contamination ought to be dealt with by trained staff while processing in optimally equipped laboratories.

Pragmatic epidemic measures for control are founded on a wide array of interventions, viz. case organization, surveillance and trace of contacts, feasible laboratory services, sanitized burials and mobilizing communities. Societal engagement is imperative for success counter of outbreaks. Wakeup calls for awareness of biohazard risk factors related to Ebola and dissemination of information on the terminal ailment paired with protective techniques is effective to preempt human-to-human transmissions. In a similar vein, countering risks of animal-to-human communication, starting from touching contagious fruit bats or apes and consuming their meat is critical.

Animals must be handled with protective-wear like gloves and clothing. Thus, animal parts ought to be painstakingly cooked prior to consumption. Overcoming patients to uninfected persons spread is attainable if contact with bodily fluids is the hallmark of success. Appropriate protective wear must be provided to health workers and persons handling infectious victims in all settings.

You should clean your hands with organic fluids to keep the virus at bay. However, in case of an outbreak, there are counter-measures encompassing instantaneous and safe burials of victims who have succumbed to the ailment, pinpointing persons who have touched infected people, regulating the health of patients for twenty-one days, establishing quarantines to preempt transmissions, hygienic measures and keeping the environment clean. Supported care-rehydration including oral and bodily fluids, treating symptoms, heightens the survival chances of a victim.

At this juncture, there is no empirical treatment offered for EVD patients. Nevertheless, a wide spectrum of probable treatments encompassing blood packages, immune-based and drug therapeutic cure are undergoing analysis. Suffice to say, there are no approved vaccines provided, however, scientists have predicated twin potential vaccines going through cohort safety tests.

In 1976, Ebola (named after the Ebola River in Zaire) first emerged in Sudan and Zaire. The first outbreak of Ebola (Ebola-Sudan) infected over 284 people, with a mortality rate of 53%. A few months later, the second Ebola virus emerged from Yambuku, Zaire, Ebola-Zaire (EBOZ). EBOZ, with the highest mortality rate of any of the Ebola viruses (88%), infected 318 people. Despite the tremendous effort of experienced and dedicated researchers, Ebola’s natural reservoir was never identified. The third strain of Ebola, Ebola Reston (EBOR), was first identified in 1989 when infected monkeys were imported into Reston, Virginia, from Mindanao in the Philippines. Fortunately, the few people who were infected with EBOR (seroconverted) never developed Ebola hemorrhagic fever (EHF). The last known strain of Ebola, Ebola Cote d’Ivoire (EBO-CI) was discovered in 1994 when a female ethologist performing a necropsy on a dead chimpanzee from the Tai Forest, Cote d’Ivoire, accidentally infected herself during the necropsy.

Source: Stanford.edu