Ebola was first discovered in Africa in 1976, with two simultaneous outbreaks, one in a village near the Ebola River in the Democratic Republic of Congo (then called Zaire) and the other in a remote region of Sudan.1 The virus is rare, but can cause a very serious, often fatal haemorrhagic fever, known as Ebola virus disease (EVD). This can affect humans, chimpanzees, gorillas and monkeys. The actual origin of the virus is unknown, but fruit bats are thought to be the likely host.
Since December 2013, the World Health Organization (WHO) has reported 15,935 confirmed, probable and suspected cases of EVD in six affected countries: Guinea, Liberia, Mali, Sierra Leone, Spain and the United States of America) and two previously affected countries: Nigeria and Senegal. There have been 5,689 reported deaths (data as of 28 November 2014).3
This is the largest outbreak ever reported, with Guinea, Liberia and Sierra Leone currently the most severely affected countries.
The WHO declared Senegal Ebola free on 17 October 20145 and Nigeria Ebola free on 20 October 2014.
A separate, unconnected EVD outbreak has also been reported in an isolated part of the Democratic Republic of Congo.
While the United Kingdom (UK) may see cases of imported EVD, due to universal healthcare provisions, robust infection control procedures and disease control systems, the risk spread to the general UK population is considered very low. EVD causes most harm in countries with less developed healthcare facilities and poor public health capacity.
The natural reservoir host of the virus has not yet been identified. Scientists believe that an initial human case becomes infected through contact with the blood and body fluids of infected animal hosts, such as fruit bats, apes or monkeys. Person-to-person transmission then follows and can lead to large human outbreaks.
EVD is spread by direct contact (through the mucous membranes of the eyes, nose or mouth) with the blood and/or body fluids of an infected person or animal who has active symptoms or who has died from EVD.
People infected with EVD who do not have any symptoms cannot spread the virus to other people. Even if an infected person has symptoms, the virus is only transmitted by direct contact with their blood or body fluids.
Body fluids include: breast milk, saliva, semen, stools, urine and vomit. EVD can also be transmitted by direct contact with material heavily contaminated with infected blood or body fluids and by unprotected sexual contact with someone who has recently recovered from the disease.
EVD is not spread by ordinary social contact, such as shaking hands, travelling on a public transport (bus, plane or train) or
sitting beside someone who is infected and does not have any symptoms.
EVD is not generally transmitted by food. However, in Africa, EVD may be spread as a result of handling bushmeat. EVD is not spread through the air or in water, and there is no evidence that mosquitoes or any other insects can transmit the virus. Only apes, bats, humans and monkeys have shown the ability to become infected with and spread EVD to date.
Symptoms include: sudden fever, chills, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, stomach pain, rash and impaired kidney/liver function. Internal and external bleeding may occur. EVD is fatal in 50-90% of cases. The time from infection to the start of symptoms is from two to 21 days. People with EVD are only infectious once they have symptoms.
Currently there is no specific treatment for EVD. Preventive vaccines and drugs are being developed, but have not been fully tested for effectiveness or safety. Severely ill patients need intensive care. Early basic interventions, such as rehydration with intravenous fluids, electrolyte balance, maintenance of oxygen levels and blood pressure, and treatment of co-infection, can significantly improve the chance of survival. Some patients will recover, but may be left with long-term complications.
Advice for UK travellers
The WHO does not recommend general bans on travel or trade, or general quarantine of travellers arriving from Ebola-affected countries, as measures to contain the outbreak. The WHO does recommend exit screening of everyone departing affected countries through international airports, seaports and major land crossings. This is to reduce the number of people with symptoms travelling from countries with high levels of EVD.
The Foreign and Commonwealth Office (FCO) currently advise against all but essential travel to Guinea, Liberia and Sierra Leone, except for individuals involved directly in the emergency response, such as humanitarian aid workers. FCO will update their advice, as appropriate, and their website can be found in the Resources section for up-to-date information.
For travellers who travel to affected areas:
Avoid all contact with anyone with symptoms and their body fluids, with deceased persons and their body fluids and with any live or dead wild animals.
Follow strict hygiene and hand washing routines.
Wash and peel fruit and vegetables before eating.
Do not eat or prepare bushmeat.
Ebola virus has been found in semen for up to three months post infection. Avoiding sex (including oral sex) is recommended for at least three months. Those continuing to have sex should follow safe sexual practices, including the use of condoms.
Health workers travelling to affected areas should strictly follow WHO recommended infection control guidance.
Public Health England (PHE) has specific advice for humanitarian health workers travelling to affected areas, available in the Resources section.
PHE advice for anyone is worried about symptoms within 21 days of coming back from EVD risk areas is to stay at home and immediately telephone 111 or 999 - explaining they have recently visited West Africa.
There are other travel-related illnesses, such as typhoid and malaria, which have similar symptoms to EVD, so proper medical assessment is crucial to ensure correct diagnosis and treatment. It is also essential that medical services are expecting the patient’s arrival - calling 111 or 999 ensures this will happen. If necessary, the patient will be taken by ambulance to hospital, isolated and seen by healthcare staff wearing personal protective equipment. If required, blood samples will be taken for testing. If EVD is confirmed, the patient will be safely transferred to a specialist infectious disease centre.
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