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Ebola

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March 26, 2014 the Zaire ebolavirus(EBOV) was confirmed to be the cause of the outbreak in West Africa. Up until 2014 this species had only been located in Gaban, Republic of the Congo, Central Africa, and Democratic Republic of the Congo. EBOV is considered the most deadly of the five known species of Ebola, holding true with approximately 11,000 deaths of approximately 28,000 reported cases from the start of the outbreak in March of 2014 to the present. Unfortunately there is no magic pill or cure that will destroy the Ebola virus, however with rapidly advancing technology a vaccine may be available within the year.
The Ebola virus “was first identified in 1976 by Professor Peter Piot.” (Boulton, 2014, p. 988) Sudan cotton workers contracted the Ebola virus presumably from bats and when treated at the local hospital infecting many health care workers and then spreading the disease to nearby villages. This species was labeled the Sudan ebolavirus (SUDV). During the same year a few months later, in Zaire, a teacher was infected by eating bush meat, once treated at a neighboring hospital the disease spread due to re-using of contaminated needles. This species was labeled Zaire ebolavirus (EBOV). In 1989 another species was discovered, Reston ebolavirus (RESTV). Monkeys imported from the Philippines’ arrived in Virginia infected with the virus. Yet another species emerged in 1994. During a necropsy, an anthropologist was infected with Tai Forest ebolavirus (TAFV). The last species discovered was Bundibugyo ebolavirus (BDBV). During a funeral ritual where visitors touch the corpse they became infected. Once hospitalized the virus spread to surrounding villages due to poor precautions of health care workers. Three out of the five species will infect humans, Zaire ebolavirus, Sudan ebolavirus and Bundibugyo ebolavirus. Not known to cause infection to humans but pose a threat is the Reston ebolavirus . Tai Forest ebolavirus appears more likely to affect animals however there was one human case reported who survived.
“The definition of Ebola virus is any of several single-stranded RNA viruses of the family Filoviridae (especially species Zaire Ebola virus) of African origin that cause an often fatal hemorrhagic fever.” ("Ebola Virus | Definition of Ebola virus by Merriam-Webster," n.d.) Being Ebola virus is zoonotic means the virus can be passed for animal to human. Modes of transmission range from direct contact with infected person to eating tainted meat. In many villages of third world countries such as Africa, killing, butchering and consuming bush meat is a common way to contract the Ebola virus. The animal would be tainted with the virus and due to direct contact of bodily fluids during butchering or ingestion, the virus could be acquired. A common food source, the fruit bat, appears to be a natural carrier of the Ebola virus. Bodily fluids of an infected person, such as sweat, blood, semen, emesis, tears, or stool are another way to contract the virus. There must be direct contact as well as an entrance way for the virus to enter such as a break in the skin. Ebola virus contaminated tables, door knobs, bedding, and other surfaces can survive for several hours or if contaminated with blood for several days generating an alternative way to contract the virus.
Once the virus penetrates the body’s natural defense mechanisms, skin, mucosa, saliva, tears, or stomach acids, our immune system detects the invader and starts an immune response. Dendritic cells release a surface signal, which stimulates white blood cells, T-lymphocytes. These T-cells kill the invading virus before it can replicate. When the Ebola virus infects the dendritic cells, they become futile. No longer having the ability to signal the T-cells, the virus replicates rapidly. Another signaling protein, interferon, boosts the immune response by signaling other cells to generate their signal and activate their own resistive mechanisms, and activates other immune cells, like macrophages, which kill the invading virus. Viral protein 24 of the Ebola virus blocks the interferon signaling process; therefore crippling the immune response. Macrophage cells that do arrive eat the Ebola virus but become infected with the virus, producing inflammatory signaling proteins and nitric oxide. The lining of blood vessels is wounded by the nitric oxide causing seepage. Clots in blood vessels are also formed by triggering proteins released by the infected macrophages which will decrease the blood supply to organs. Once the virus is in the blood it travels to other organs, targeting liver cells. As liver cells are taken over by the Ebola virus, clotting factor which is formed by the liver is no longer being manufactured. The body has no way to clot causing hemorrhage. Hormones that regulate blood pressure in the adrenal gland are impaired causing oxygen deprived organs due to circulatory failure. The cells in the gastrointestinal tract are damaged causing diarrhea leading to dehydration. There are still many unknowns as to the actual progression through the body.
Making Ebola virus difficult to identify quickly is that its early symptoms, fever, chills, muscle aches, and severe malaise, mirror many other viral infections like the flu. An algorithm can be used to identify a patient’s possible exposure to the virus. Should there be sufficient suspicion and symptoms, quarantine is certain. Once exposure occurs, symptoms can begin at day two to twenty-one. As the disease progresses vomiting, diarrhea, low blood pressure, headache, and anemia arise, followed by confusion, bleeding, coma, and death. The average length of symptoms is eight to ten days. Should survival transpire, the immune system will have built antibodies that can last up to 10 years, according to the Center for Disease Control. Semen has been found to contain the Ebola virus for up to 61 days post disease. Testing will need to continue until clear. Spinal column fluid and tears are another site for the virus to linger post disease.
Diagnosis is accomplished by an “antibody-capture enzyme-linked immunosorbent assay (ELISA), antigen-capture detection tests, serum neutralization test, reverse transcriptase polymerase chain reaction (RT-PCR) assay, electron microscopy, and by virus isolation by cell culture,” ("WHO | WHO's contribution to the Ebola response," ) which can be obtained a few days after symptoms commence. Should the disease have already progressed into later stages an antibody test can be performed. The Ebola virus falls under biosafety level 4, where there are only a small amount of laboratories in the United States and around the world that can handle this level of safety.
Treatment of the disease is supportive at best, volume repletion with intravenous fluids; medications to maintain blood pressure, oxygen supplementation, pain control, nutrition, and treatment of secondary infections. A few drugs that are being studied for treatment of Ebola virus are RNA inhibitor based agent (TKM-Ebola,) monoclonal antibodies (ZMapp,) and favipiravir. ZMapp targets the expression phase of viral replication. Favipiravir prevents viral replication. Statins commonly used to treat high cholesterol are being considered for their ability to encourage immunity. The previously mentioned medications and a few more are being considered but are still being evaluated.
Vaccines are currently being developed with several in clinical trials. Two promising vaccines that were tolerated in humans are ESV-EBOV developed by Merck and ChAd3-ZEBOV developed by Glaxon Kline Smith. Merck has ESV-EBOV in phase two and three in Sierra Leone and Guinea which have started vaccinating front line health care workers. Johnson and Johnson also has a vaccine in the making, Ad26-EBOV and MVA-EBOV. This two dose vaccine has phase one completed. Another that achieved phase one, is safe for humans, was based on the recent outbreak in 2014, and is a recombinant protein Ebola vaccine which is made of inactive Ebola virus. There are many others in progress and more to come with technological advances.
Cleaning instructions have been created by the CDC for villagers of West African countries to teach them how to clean properly should a family member become infected with the Ebola virus. ”Key points are Only one person should be responsible for cleaning the house after someone in the household with symptoms of Ebola is transferred to an Ebola Treatment Unit (ETU) or Ebola Community Care Center (CCC). Do not touch body fluids or anything that was used by the sick person including bed covers, plate, cup and utensils without wearing appropriate protective gear. ("Interim Recommendations for Cleaning Houses Safely in West Africa Ebola-Affected Areas after Persons with Symptoms of Ebola are Transferred to Ebola Treatment Units or Community Care Centers| Ebola Hemorrhagic Fever | CDC,") These pamphlets explain ways to make the proper bleach solutions, what protective equipment should be worn, what in the hut should be disinfected, and how to remove the protective gear as not to contaminate them. Time frames of how long the solution should be left on the contaminated items is listed as well as should the surface be soiled how to clean then disinfect. Hopefully by teaching others these techniques, the Ebola virus will not spread to other household members.
Hospitals in West Africa in dire need of repair, walls crumbling, windows broken, only a few working bathrooms or sinks, make it difficult to treat the thousands of people infected with the Ebola virus. Healthcare workers donned with gowns, gloves, and masks to ensure transmission will not occur while attempting to take care for the ill the best they can with the resources available to them. The country is underdeveloped and areas that are developed are in poor conditions related to poor upkeep and civil war. The WHO, World Healthcare Organization, play a large role in outbreaks like the one in West Africa last year, by “providing curricula for multiple partners on trainings in the field on case management, contact tracing, safe and dignified burials and social mobilization; providing trainings on contact tracing; working with partners (the Governments of France, United Kingdom, USA) to train thousands in the classroom and in simulation.” ("WHO | WHO's contribution to the Ebola response,") They work with the communities to recognize the symptoms so they can get their ill family member moved to a treatment center. Ebola treatment centers (ETC) and community care centers (CCC) providing facilities for the diseased individuals a better chance of survival are built by WHO workers with fellow partners. On the data side of the disease, the WHO tracks countries with Ebola virus outbreaks paying close attention to “those with widespread and intense transmission; those with or that have had an initial case or cases, or with localized transmission; those countries that neighbor or have strong trade ties with areas of active transmission.” ("WHO | WHO's contribution to the Ebola response,") The CDC, Center for Disease Control and Prevention, another organization which sends helping hands before, during and after a deadly disease outbreak. Using the latest technology and most up to date science, the CDC attempts to prevent deadly disease before outbreaks occur. The CDC educates healthcare workers working the front lines so that they can teach their know-how to the community members of villages and towns like the ones in the West Africa Ebola outbreak. Medical teams are formed specializing in deadly disease like Ebola virus to help take care of the ill. After an outbreak the CDC will track new and old disease that pose a threat. Doctors without Borders also play a great role in battling the Ebola virus. They have teams located in the heart of the villages that administer medical care as well as educate the citizens of the towns regarding signs and symptoms of the disease. Without the World Health Organization, Doctors without Borders, and Center for Disease and Prevention health threats could overwhelm the world by causing uncontrolled disease and death.
Outbreaks of the Ebola virus continue in many countries of Africa. Death tolls are changing frequently with new data being attained during continued investigation of the disease outbreak. Organizations like WHO, CDC, and Doctors without Borders spend countless numbers of hours helping the sick, building make shift hospitals, predicting the next outbreak, investigating current outbreaks, and research new species of the disease. The work is demanding and rewarding with hopes of preventing outbreaks and in the near future using vaccines to eradicate Ebola virus altogether.

References
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CDC LC Quick Learn: Recognize the four Biosafety Levels. (n.d.). Retrieved from http://www.cdc.gov/training/QuickLearns/biosafety/
Ebola Virus. (2015). In The Columbia Encyclopedia. New York, NY: Columbia University Press. Retrieved from http://vlib.excelsior.edu/login?url=http://search.credoreference.com.vlib.excelsior.edu/content/entry/columency/ebola_virus/0 ebolavirus. (2015). In Encyclopaedia Britannica. Retrieved from http://academic.eb.com.vlib.excelsior.edu/EBchecked/topic/177623/ebolavirus
Galán-Huerta, K., Arellanos-Soto, D., Rivas-Estilla, A. M., Bravo-de la Cruz, V., & Ramos-Jiménez, J. (2014). Ebola virus disease 2014. Medicina Universitaria, 16(65), 207-215.
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A History of Ebola in 24 Outbreaks - The New York Times. (n.d.). Retrieved from http://www.nytimes.com/interactive/2014/12/30/science/history-of-ebola-in-24-outbreaks.html?_r=0
Interim Guidance for Environmental Infection Control in Hospitals for Ebola Virus| Ebola Hemorrhagic Fever | CDC. (n.d.). Retrieved from http://www.cdc.gov/vhf/ebola/healthcare-us/cleaning/hospitals.html
Judson, S., Prescott, J., & Munster, V. (2015). Understanding Ebola Virus Transmission. Viruses, 7(2), 511-521. doi:10.3390/v7020511
Kekulé, A. S. (2015). Learning from Ebola Virus: How to Prevent Future Epidemics. Viruses (1999-4915), 7(7), 3789-3797. doi:10.3390/v7072797
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Mission, Role and Pledge| About | CDC. (n.d.). Retrieved from http://www.cdc.gov/about/organization/mission.htm
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Ebola

...Ebola Kelly Minefield SCI/163 December 7, 2015 Bryn Van Patten Ebola The Ebola epidemic is the largest in history affecting multiple countries in West Africa. Two imported cases including one death and two locally acquired cases in healthcare workers have been reported in the United States. The risk of an Ebola outbreak affecting a large number of people in the U.S is very low. It is important to be educated about Ebola and other epidemics so that we can take every step to lessen the chances of an outbreak. Infectious Agents Ebola is an elongated filamentous virus, which can vary between 800 - 1000 nm in length, and can reach up to 14000 nm long ("Pathogen Safety Data Sheet - Infectious Substances", 2014).. The pleomorphic viral fragment may take on several distinct shapes, and are contained within a lipid membrane. Each virion contains a single-strand of non-segmented, negative-sense viral genomic RNA ("Pathogen Safety Data Sheet - Infectious Substances", 2014).. Ebola virions enter host cells through endocytosis and replication occurs in the cytoplasm. When infected, the virus affects the host blood coagulative and immune defence system and leads to severe immunosuppression ("Pathogen Safety Data Sheet - Infectious Substances", 2014).. Early signs that you are infected are flu-like. ......

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