By Dr. Peter Kopling,MD
September 4, 2014 (SSNA) — Ebola virus is among the 30 known viruses capable of causing bleeding fever attacks. The genus Ebolavirus is currently classified into 5 separate species: Sudan ebolavirus, Zaire ebolavirus, Tai Forest (Ivory Coast) ebolavirus, Reston ebolavirus, and Bundibugyo Ebolavirus.
What made me write this piece is our region had a run with this deadly virus before, indeed the Sudan ebolavirus is perhaps to be called, South Sudan ebolavirus, because in the former Sudan, the ground zero was in our territories! Thus it is imperative that we raise awareness of this deadly virus sweeping through West Africa. This is one condition we do not want to wait until it punches us but rather the people must be actively made aware of how to prevent this from entering our country and be aware of the signs and symptoms of this deadly virus! The environment is ripped in our country and it will have a devastating effect if this was allowed to reach our already-ravaged country, which has no capabilities to handle such a disease! The question then is how is South Sudan preparing itself and her people? As we can see, as far away is America from West Africa, they now have registered their first case and will not be the last! Must we sleep until we are surprised awake by this deadly virus?
Below is some basic awareness everyone should have about Ebola Virus.
The primary host of this virus seems to be the fruit bats, which passes it to the Monkeys and chimpanzees! The eating or handling of Monkeys leads to this virus jumping to humans thus people must not eat Monkeys and their related kin!
The following 2 types of exposure history are recognized:
- Primary exposure – This typically involves travel to or works in an Ebola-endemic area.
- Secondary exposure – This refers to human-to-human exposure (e.g., medical caregivers, family caregivers, or persons who prepared deceased patients for burial), primate-to-human exposure (e.g., animal care workers who provide care for primates), or persons who collect or prepare bush meat for human consumption.
Modes of transmission:
An infected person who does not have symptoms, not necessarily can pass the virus to others but a person who is Vomiting, having diarrhea or bleeding from any parts of his body, essentially this person is passing the infection through any body liquid that comes out of him/her to include saliva.
SIGNS AND SYMPTOMS:
Physical findings depend on the stage of disease at the time of presentation. There is an incubation period (time it takes to multiply in the body before causing illness typically 3-8 days in primary cases and slightly longer in secondary cases).
Early findings may include the following:
- Fever
- Sore throats
- Severe constitutional signs and symptoms (just feeling terrible, unwell)
- May see skin rashes.
- Both eyes may become red.
Later findings may include the following:
- Expressionless facies (Persons displays no emotions).
- Bleeding from intravenous (IV) puncture sites and mucous membranes, like mouth and anus.
- Myocarditis and pulmonary edema (Inflamation in the heart muscles and water in the lungs)
- In terminally ill patients, rapid heartbeats, low blood pressures, thus lightheadedness, inability to make urine and to urinate, and coma and death.
Survivors of Ebola virus disease have developed the following late manifestations:
- Myalgias (Muscle aches).
- Asymmetric and migratory arthralgias (alternating joint pains).
- Headache
- Fatigue
- Bulimia (eating disorders)
- Amenorrhea (Absence of menstrual periods)
- Hearing loss
- Tinnitus (ringing in the ears)
- Unilateral orchitis (One sided testicular swelling or pain)
- Suppurative parotitis (one side of the jaw near the ear becoming swollen due to bacterial infections)
Management:
- Supportive therapy with attention to intravascular volume, electrolytes, nutrition, and comfort care is of benefit to the patient; this to be done only by trained health care provider which we terribly lack in our country.
- Such therapy must be administered with strict attention to barrier isolation; all body fluids contain infectious virions and should be handled with great care only by healthcare professionals.
- No specific therapy is available that has demonstrated efficacy in the treatment of Ebola hemorrhagic fever, essentially most if not all deadly.
- There are no commercially available Ebola vaccines;
- At present, no specific anti-Ebolavirus agents are available. In those patients who do recover, recovery often requires months, and delays may be expected before full resumption of normal activities. Weight gain and return of strength are slow. Ebola virus continues to be present for many weeks after resolution of the clinical illness.
Recommendations:
Anyone who presents with diarrhea vomits and or with bleedings should alert the authority very quickly and do not handle the bodily liquids and when such a person dies the body must not be transported for burials from one town or village to another. Even if it is not Ebola, it could be Cholera. In other words before you go for a funeral ask what the person die of, If diarrhea, vomits and or bleeding is involved then relatives must be kept away. Mourners must not surround such dead bodies as is customary. Such dead body must not be touched and left for the authorities to burry speedily! Those exposed should not return to the families and isolate themselves where possible for at least 10 days.
Given our country is home to many foreigners coming and going, not only Africans but also Europeans and Americans who may be working for Medical team that fights the deadly disease in West Africa, the Virus may come through them! The health officials at the airport must screen for not only African but also Europeans and Americans! The attentions must not be solely at the airport but also boarder entries like Nimule etc.
Our healthcare setting and capabilities are Zero, the authorities must be vigilant indeed should consider not allowing entry to those coming from Ebola region! In addition Monkey eating must be discouraged. In our case prevention is better cure, where none exists and poor health care and sanitary facilities this is even more so! We must be preemptive! If the world does not arrest this in West Africa, which is just a country or two away from us, it is then a matter not if but when this deadly virus with terrible consequences hits us!
Dr Peter Kopling Josep, MD, lives in the Republic of South Sudan. He can be reached at [email protected].