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A REVIEW ON FATAL DISEASE- EBOLA VIRUS DISEASE (EVD)
Posted: 20 September 2014

Mr. Ratnadeep Vaman Ghadage

ratnadeepghadage@gmail.com

Ratnadeep Ghadage (1*) & Prof. Satyanand Tyagi (2)

(1*) Drug Safety Associate, Pharmacovigilance, inVentiv Health Clinical, Pune, Maharashtra-411006 (India); Associate Editor, Tyagi Pharmacy Association (TPA), Chattarpur, New Delhi, India-110074.

(2) Founder, President, CEO & Manuscript Reviewer, Tyagi Pharmacy Association (TPA) & Scientific Writer (Pharmacy), Chattarpur, New Delhi, India-110074.

Abstract

Ebola Virus Disease (EVD), formerly known as Ebola Haemorrhagic Fever, often fatal illness, with a death rate of up to 90%. The illness affects humans and non-human primates (monkeys, gorillas, and chimpanzees). Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Severely ill patients require intensive supportive care. Signs and symptoms of Ebola usually begin suddenly with an influenza-like stage. There's currently No specific treatment is available. New drug therapies are being developed and evaluated. While there is no specific drug against Ebola, the best treatment is intensive supportive treatment provided in the hospital by health workers using strict infection control procedures. WHO strongly recommends that people seek credible health advice about Ebola virus disease from their public health authority.

Key Words

Ebola Virus Disease (EVD), Ebola Hemorrhagic Fever (EHF), BSL-4 positive pressure suit, ELISA, Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) assay, Body Fluid.

Description

Introduction:

Ebola Virus Disease (EVD) or Ebola Hemorrhagic Fever (EHF) is a disease of humans and other primates caused by an Ebola Virus, named after a river in the Democratic Republic of the Congo (formerly Zaire) in Africa, where it was first recognized. It is a severe, often fatal disease in humans and nonhuman primates (such as monkeys, gorillas, and chimpanzees) that has appeared sporadically since its initial recognition in 1976.

Ebola Virus:

The virus is one of two members of a family of RNA viruses called the Filoviridae. There are five identified subtypes of Ebola virus. Four of the five have caused disease in humans: Ebola-Zaire, Ebola-Sudan, Ebola-Ivory Coast and Ebola-Bundibugyo. The fifth, Ebola-Reston, has caused disease in nonhuman primates, but not in humans. There are no licensed specific treatments or vaccine available for use in people or animals.

The incubation period of Ebola Virus disease (EVD) varies from 2 to 21 days, with an observed average of 8 to 10 days. Following the introduction of Ebola Virus in the human population through animal-to-human transmission, person-to-person transmission by direct contact body fluids/secretions of infected persons is considered the principal mode of transmission. Indirect contact with environment and fomites soiled with contaminated bodily fluids (e.g. needles) may also occur. Airborne transmission has not been documented during previous EVD outbreaks.

There is no risk of transmission during the incubation period. The exact origin, locations, and natural habitat (known as the "natural reservoir") of Ebola Virus remain unknown. However, on the basis of available evidence and the nature of similar viruses, researchers believe that the virus is zoonotic (animal-borne) with four of the five subtypes occurring in an animal host native to Africa.

Signs and Symptoms:

Signs and symptoms of Ebola usually begin suddenly with an influenza-like stage characterized by fatigue, fever, headaches, joint, muscle and abdominal pain. Vomiting, diarrhea and loss of appetite are also common. Less common symptoms include the following: sore throat, chest pain, hiccups, shortness of breath and trouble swallowing. Early symptoms of EVD may be similar to those of malaria, dengue fever or other tropical fevers, before the disease progresses to the bleeding phase. In 40–50% of cases, bleeding from puncture sites and mucous membranes (e.g. gastrointestinal tract, nose, vagina and gums) has been reported. Symptoms may appear anywhere from 2 to 21 days after exposure to ebola virus though 8-10 days is most common.

Transmission:

Infections with Ebola virus are acute. There is no carrier state. Because the natural reservoir of ebolaviruses has not yet been proven, the manner in which the virus first appears in a human at the start of an outbreak is unknown. However, researchers have hypothesized that the first patient becomes infected through contact with an infected animal.

When an infection does occur in humans, there are several ways in which the virus can be transmitted to others. These include:

   (1). Direct contact with the blood or secretions of an infected person.

   (2). Exposure to objects (such as needles) that have been contaminated with infected secretions.

  (3). During outbreaks of EHF, the disease can spread quickly within health care settings (such as a clinic or hospital). Exposure to ebolaviruses can occur in health care settings where hospital staffs are not wearing appropriate protective equipment, such as masks, gowns, and gloves. Without adequate sterilization of the instruments, virus transmission can continue and amplify an outbreak. 

Diagnosis:

Other diseases that should be ruled out before a diagnosis of EVD can be made include: malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers. Samples from patients are an extreme biohazard risk; testing should be conducted under maximum biological containment conditions. If Ebola is considered a possibility on this basis, then a person would be tested for the disease.

Prevention:

There's currently no specific treatment or licensed vaccine for Ebola Virus Disease, although potential new vaccines and drug therapies are being developed and tested. A researcher working with the Ebola virus while wearing a BSL-4 positive pressure suit to avoid infection.  No ebola virus-specific treatment exists. And Standard treatment for Ebola HF is still limited to supportive therapy.

a.  Infection Control

Ebola Viruses are contagious, with prevention predominantly involving behavior changes, proper full-body personal protective equipment, and disinfection. Recommended measures when caring for those who are infected include isolating them, sterilizing equipment, and wearing protective clothing including masks, gloves, gowns, and goggles. Hand washing is important but can be difficult in areas where there is not even enough water for drinking. The Ebola virus can be eliminated with heat (heating for 30 to 60 minutes at 60 °C or boiling for 5 minutes).

b.    Quarantine

Quarantine, also known as enforced isolation, is usually effective in decreasing spread. Governments often quarantine areas where the disease is occurring or individuals who may be infected. In the United States, the law allows quarantine of those infected with Ebola.

c.     Vaccine

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.

d.    Treatments and Medications:

No ebola virus-specific treatment exists. And Standard treatment for Ebola HF is still limited to supportive therapy. Treatment is primarily supportive in nature and includes minimizing invasive procedures, balancing fluids and electrolytes to counter dehydration, administration of anticoagulants early in infection to prevent or control disseminated intravascular coagulation, administration of procoagulants late in infection to control bleeding, maintaining oxygen levels, pain management, and the use of medications to treat bacterial or fungal secondary infections. As of Aug 14, 2014, the FDA has approved no medications or vaccines to treat or prevent Ebola and advises people to watch out for fraudulent products. On 12 August the WHO released a statement that the use of not yet proven treatments is ethical in certain situations in an effort to treat or prevent the disease. In July 2014, an experimental drug, ZMapp, was first tested on humans. It was administered to two Americans who had been infected with Ebola. Both people appeared to have had positive results. Favipiravir looks like it may be useful in a mouse model of the disease. Both small interfering RNAs (siRNAs) and phosphorodiamidatemorpholino oligomers (PMOs) targeting the Zaire Ebola Virus (ZEBOV) RNA polymerase L protein could prevent disease in nonhuman primates.

Raising awareness and communication:

All institutions at different levels of the health care system and all health care workers (clinical, public health professionals, laboratory, janitorial staff, etc.) must be constantly informed.

Based on the areas of expertise, health care personnel should be trained to respond to the situation, prioritizing the implementation of infection prevention and control of infections and the systematic and comprehensive collection of comprehensive patient travel history.

Conclusion

Ebola Virus Disease (EVD) is a disease of humans and other primates caused by an ebolavirus. The virus may be acquired upon contact with blood or bodily fluids of an infected animal. It is not entirely clear how Ebola is spread. No specific treatment for the disease is yet available. Efforts to help those who are infected are supportive and include giving either oral rehydration therapy (slightly sweet and salty water to drink) or intravenous fluids. The disease has a high risk of death, killing between 50% and 90% of those infected with the virus. Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.  Anyone who cares for an infected person or handles their blood or fluid samples is at risk of becoming infected. Hospital workers, laboratory workers and family members are at greatest risk. Patients need to be placed in isolation in intensive care.

Journal/Book/Web Reference(s)

1.     http://www.who.int/mediacentre/factsheets/fs103/en/

2.     http://www.nhs.uk/Conditions/ebola-virus/Pages/Ebola-virus.aspx#treated

3.     http://www.webmd.com/a-to-z-guides/ebola-fever-virus-infection

4.     www.cdc.gov/vhf/ebola/pdf/fact-sheet.pdf

5.     www.who.int/csr/disease/ebola/ebola-faq.pdf

6.     en.wikipedia.org/wiki/Ebola_virus_disease

7.     http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=26416&Itemid‎

    Ebola Virus Click Image To Enlarge
    Symptoms of Ebola Click Image To Enlarge
    Ebola: Fighting A Killer Disease Click Image To Enlarge
Ankit shukla (TPA scholer)
Posted on: 11/05/2017

Good papee

Prof Dr Dhrubo Jyoti Sen (Professor & HOD Pharmaceutical Chemistry)
Posted on: 13/10/2016

TPA is the isomer of ATP which constantly gives energy to the authors through INNER CONCEPT, INNER STRENGTH via INNER EYE.

Dr D J Sen (Professor)
Posted on: 20/07/2015

TPA is Tremendous Pharmaceutical Aspiration......and this coin has been practically proved

Ishita D. Mangukia (associate editor)
Posted on: 18/07/2015

great work.....

Dhruv Mangukia (associate editor)
Posted on: 18/07/2015

great work.....keep it up

Prof Dr Dhrubo Jyoti Sen (Professor of Medicinal Chemistry)
Posted on: 20/10/2014

EVD is really deadly virus. The article of Ratnadeep is really a brilliant job to focus about Ebola in public which is now in hot topic in every news bulletin...

Jony Mallik (TPA scholar)
Posted on: 07/10/2014

Very informative. As Ebola is a recent health risk, this work would be essential for understanding Ebola aspects. Thanks

Amandeep Kaur (Assistant Professor and TPA Scholar)
Posted on: 04/10/2014

Great work and latest news....GlaxoSmithKline is working to fight against this disease...thanks to provide such a required information in detail.....All the best...

Prof. Satyanand Tyagi (Founder, President & CEO-: Tyagi Pharmacy Association-TPA, Chattarpur, New Delhi, India-110074)
Posted on: 21/09/2014

Nice attempt by Mr. Ratnadeep- TPA Associate Editor. Presentation is nice and give deep information about Ebola Virus Disease (EVD).

Amitava Sinha Ray (Scientific writer & TPA Associate editor)
Posted on: 20/09/2014

Excellent paper ..Mr. Ratnadeep...keep it up...

chirag patel (Editor in chief)
Posted on: 20/09/2014

Great work....TPA Rocks....

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