Ebola Virus Disease: Are We Prepared?

E and re-emerging vira l diseases cause epidemics and as many of these have pandemic potential; they pose a threat to global health security. The notable ones in 2014 have been Middle East Respiratory Syndrome (MERS) due to Corona Virus (MERS-CoV) and Ebola Virus Disease (EVD). EVD continues to evolve since February 2014 in alarming ways, with no immediate end in sight. Guinea, Liberia, Nigeria, and Sierra Leone are affected. The Ministries of Health of Guinea and Liberia and the World Health Organization (WHO) have reported an outbreak of Ebola hemorrhagic fever in several Guinean and Liberian districts. The total cases have been1975 with 1069 deaths till August 14, 2014.1 Ebola Virus Disease first appeared in 1976 in Africa. Disease takes its name from Ebola River situated in the village where outbreak occurred. Ebola virus disease (EVD) outbreaks occur primarily in remote villages in Central and West Africa near rainforests.2 There are five sub species of Ebola virus four of which can cause human disease. It is a severe often fatal disease in humans. Ebola is a zoonotic virus. The natural reservoir host of Ebola viruses and the manner, in which transmission of the virus to humans occurs, remain unknown. Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola virus though 8-10 days is most common. Human to human transmission of the Ebola virus is through direct or indirect contact with blood and body fluids. Contact tracing is very important and is being done to the tune of 94%-98% as per WHO.1 Health care workers have frequently been infected while treating patients with Ebola virus disease. Clinical Features include sudden onset of fever, intense weakness, muscle pain, headache and sore throat followed by vomiting, diarrhoea, rash, impaired kidney and liver function and in some cases internal and external bleeding. The high mortality of 90% is attributed to underdeveloped immune response to the virus at the time of death. L a b o r a t o r y f i n d i n g s i n c l u d e leucopoenia and elevated liver enzymes. It is possible to diagnose Ebola virus definitely by antigen capture ELISA / RT-PCR assays, electron microscopy and virus isolation by cell culture. There is no vaccine yet available for clinical use. There is no specific treatment and patients need to be given intensive supportive care. Isolation of EVD patients from contact with unprotected persons can help in preventing its spread. Standard, contact and droplet precautions like hand hygiene, respiratory hygiene, use of gloves and personal protective equipment, safe injection and safe burial practices have been advocated to prevent spread of virus. A medical response unit which was set up in Liberia for EVD has been seriously compromised with the infection of its American director and an American aid worker. Increasingly there are reports of infection in close contacts of patients. Air, sea and land transport networks continue to expand in reach, speed of travel and volume of passengers and goods carried. Pathogens and their vectors can now move further, faster and in greater numbers than ever before. Thus each outbreak, including EVD poses a threat of crossing continents and becoming pandemic. The problems with any pandemic are as follows3 • Rapid Worldwide Spread: When a viral pandemic emerges, i t is expected to spread around the world. e.g. pandemic flu, making the entire world population susceptible. • The health care facilities get over