Wednesday, October 8, 2014

The Truth About Ebola

By Ed Dominguez, MD, FACP, FIDSA
Medical Director, Organ Transplant Infectious Diseases
Methodist Transplant Physicians
Methodist Healthcare System
Dallas

It is said that the first casualty of war is the truth. Although the American health community is always involved in battles — most recently against enterovirus D68 and chikungunya virus — the arrival of Ebola virus in the United States poses different challenges. In West Africa, Ebola has spread more extensively than in previous outbreaks dating back to 1976. We see the images of suffering and loss wrought by this in various media reports throughout each day. These tragic stories of families and communities decimated by Ebola are rapidly accumulating. The influence of this evolving narrative became clear with the report of the first patient diagnosed with Ebola in the United States, and the response of the community to him and his family. This morning, Ebola claimed its first domestic victim; it is critical that the scientific truth about this disease not be its second.

To begin with, for an infection of this significance, it is worth repeating how Ebola is spread and how it isn’t. Ebola is acquired from an infected individual who exhibits symptoms. According to an Oct. 3 alert from the Centers for Disease Control and Prevention (CDC), these may include “fever, muscle ache, severe headache, abdominal pain, vomiting, diarrhea, and unexplained bleeding or bruising.” However, such symptoms only suggest Ebola infection if the affected individual has been in a region with reported Ebola within the last 21 days or closely associated with someone else who has. The contact required for transmission is direct contact with bodily fluids or secretions from such individuals. Importantly, the virus is not spread through the air or through the food and water supply.

A major advantage that the United States experiences in response to Ebola is the availability and use of disposable medical equipment. Countries with fewer resources initially had to sterilize and reuse medical equipment. While Ebola is not as transmissible as other viruses like influenza, it is not forgiving, either. A single breach of infection control and isolation precautions may be enough to lead to disease in a caretaker. It is not surprising that professional and lay medical personnel are among those at highest risk in West Africa. U.S. hospitals and health care workers are equipped with and trained in the proper use of personal protective and single-use equipment. According to CDC, one experimental study showed the virus may survive up to six days on contaminated surfaces or items but only under ideal conditions. Standard environmental disinfection protocols used in all U.S. hospitals are capable of eradicating the virus. Consequently, there has not been a hospital-acquired case of Ebola in Atlanta, Omaha, or Dallas, cities where Ebola patients have been treated.

The survivors of Ebola — and about 40 percent of symptomatic individuals survive — may hold the key to our understanding of the disease as well as the treatment of it. What determines survival is already a question of intense investigation. However, the survivors’ immunity might be transferrable to others early in the course of illness. This approach of passive immunization has been shown to alter the course of a number of other infections, including rabies. This approach is still being refined for Ebola.

What You Can Do

As citizens of the United States, we have become comfortable with the vigilance that our public health infrastructure employs to protect us from diseases like Ebola, SARS (Severe Acute Respiratory Syndrome), and the like. However, with so many battles against microbes raging simultaneously, as citizens we can participate in this effort by employing simple and effective measures. These include washing our hands and restricting our public activity and travel if we have a fever. As importantly, keeping abreast of public health recommendations ensures that we have a shared knowledge of the disease. We may not yet be able to cure it, but we can contain it, and that is the truth.

4 comments :

  1. my concern is what about mosquitoes carrying the disease?

    ReplyDelete
    Replies
    1. To be transmitted by a mosquito, a virus (like Dengue or West Nile) has to be able to survive in the mosquito. The various Ebola strains do not appear to have that characteristic and thus, have only been found to be transmissible between mammals.

      Edward A. Dominguez, MD, FACP, FIDSA

      Delete
  2. If a person is infected with Ebola and sneezes, can the Ebola strain be transmitted by the droplets coming from the persons mouth?

    ReplyDelete
    Replies
    1. Sneezing and coughing are not considered routes of transmission.
      The virus is present in various secretions, including saliva. However, the amount of virus is lower in sneezes unless there is blood in the saliva. The concern with respiratory secretions is not inhaling them but rather having them infect the eyes, which may be a portal of infection.

      Dr. Dominguez

      Delete

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