Research on Ebola

Abstract

In the United States of America there was an outbreak in 2014. Many of the hospitals and staff members were unaware of the symptoms and transmission of this virulent virus until it was too late and it spread among patients and staff members. This paper serves as an overview of the virus, including symptoms, diagnosis, and treatments. Also, including how health care has changed to accommodate treating Ebola, and other viruses similar in severity.

Introduction

Viruses can be very dangerous considering how microscopic they are.

They consist of only nucleic acid enclosed by a capsid which may have small protein spikes surrounding it. They are not considered living organisms since they are unable to replicate on their own. They require a host cell to replicate by the Lytic cycle or the Lysogenic cycle. By replicating they can produce hundreds to thousands of new cells, and they can either keep the host cell alive (Lysogenic) or kill the host cell and move on to another one (Lytic cycle). Viruses can be found on almost any surface, or environtment. They only begin to become a danger when the chain of infection is inacted and it finds a suitable host to wreak havoc.(7).

The Ebola Virus Disease is a rare but deadly disease that affects humans and primates including monkeys and gorillas. It was discovered in 1976 near the Ebola river, today it is known as the Democratic Republic of Congo. Due to the randomeness of those becoming infected it is not clear to reasearchers where this disease came from. From what they have gathered they believe that it is an animal borne virus. There are five strains of the Ebola Virus, of which four can infect humans. Those strains are: Ebola virus (Zaire ebolavirus), Sudan Virus (Sudan ebolavirus), Taï- Forest Virus (Ta-Forest ebolavirus), Bundibugyo virus (Bundibuygo ebolavirus), and lastly Reston virus (Reston ebolavirus). The Reston virus causes disease in primates and pigs, but not humans. (1)

Origination and Spread of disease

As stated above the Ebola virus was discovered near the Ebola river in the Democratic Republoc of the Congo, in Africa. Much of what is known about the Ebola virus is theoretical, including the origination place and how someone becomes initially infected. Scientists believe that humans become initially infected with this virus by coming in direct contact with another person or animal that is infected. This can include blood or body fluids (such as urine, saliva, breast milk...) from someone who is sick with the virus or has died from this illness. Objects contaminated with body fluids from a person who is sick or from someone who has died. The virus can also spread from health care workers who are treating patients, but also from burial ceremonies that have direct contact with the dead body which can still spread the disease.(11) Infected nonhuman primates, and lastly semen from a man who has recovered from the Ebola Virus. Ebola cannot spread when someone does not show the symptoms. Once a person has recovered from the Ebola Virus, the virus can still lay dormant or undetected in the body. These areas of the body can include Semen (as mentioned above), breast milk, eye fluid, and spinal column fluid. Also, the virus can be found in the placenta, and amniotic fluid in women. (11)

This virus can spread very quickly from person to person especially in the helath care setting. Therefore, handwashing is so crucial in the heatlh care profession. (Practicing standard precautions are also curial to prevent the spread of disease. When health care workers are caring for patients with suspected Ebola virus they should take extra prevention methods. This includes preventing contact with blood, body fluids, and contaminated surfaces. When in close contact health care providers should don personal protective equipment such as a face shield, a long-sleeved gown, and gloves. (2)

When men become infected with Ebola virus it also affects their sperm. Once the person recovers from the infection they must be wary about spreading the virus to their sexual partners. To ensure safe sex men must make sure their semen has tested negative twice before sex with out condoms. Testing occurs every three mints after the onset of the disease, testing becomes once a month for those who test positive until they test negative twice one week apart. Between the time of testing negative those Ebola survivors and sexual partners must either abstain from all forms of sex, or participate in safe sex by use of condoms. Even after semen testing is negative, it is recommended for the survivors and sexual partners to use good hand and personal hygiene after any physical contact with semen. This practice is to ensure the Ebola virus will not spread from person to person. (11)

Signs and Symptoms

The Ebola Virus may take anywhere between two and twenty-one days after initial contact with the virus. The symptoms are presents with are like influenza or malaria. The symptoms that people appear with are fever, headache, muscle pain, weakness, fatigue, diarrhea, vomiting, abdominal pain, unexplained hemorrhage which included bleeding or bruising.(3) The bleeding can occur from the gums, and in the stool. (11) It is considered a member of the hemorrhagic fever family of diseases, yet the hemorrhaging does not occur until the disease has progressed more.(8)

Diagnosis

Ebola virus can be difficult to identify as causing disease in humans. Many of the first symptoms that appear are not characteristic to Ebola. Fever, headache, and weakness can fall under many other viral infections as symptoms. The one-way to confirm a diagnosis of Ebola is to conduct blood samples from the patient. Other tests that can be used to identify the virus will be Antibody- Capture enzyme-linked immunosorbent assay (ELISA), Antigen-capture detection test, serum neutralization test, reverse transcriptase polymerase chain reaction (RT-PCR) assay, electron microscopy, virus isolation by cell structure. For each of these tests consideration must be made to choose the correct test for the situation of the patient. For testing for the virus blood collected in ethylenediaminetetraacetic acid

(EDTA). If the patient has died and researchers are testing for the cause of death the body fluids that must be used is oral fluid specimen which must be stored on a transport medium. This is used instead of blood since blood cannot be collected from a deceased body.(11)Once it is a confirmed diagnosis this person must be isolated, and authroties must be notified.(5)

Treatment

There is no cure for Ebola, one can only treat the symptoms as they occur. According to the U.S Food and Drug Administration there is no drug that is liscenced by them that is able to cure the virus. There are other non liscences drugs that are being developed. However, there is a treatment that is being used for more recent Ebola infections. This is performing a blood transfusion from a survivor of Ebola to a person currently fighting the illness. This transfers the survivor's antibodies to the person fighting the infection. (6)

There is one vaccine that is experimental for Ebola that is being tested in Guinea. The vaccine is called rVSV-ZEBOV and has been tested on about 12,000 people and about 6,000 no Ebola case was recorded. This vaccine is a trial to help prevent the spread of disease in areas where there are high risk of outbreaks.(11).

Post Ebola Syndrome

Patients who have survived from Ebola continue to have to face health problems after their initial flight. These symptoms have been named Post- Ebola Syndrome. The symptoms are a collection of physical and psychological symptoms. They span range from muscle and joint pain, extrema fatigue, clouded vision, hair loss and deafness. These symptoms can extend from 12 months to over 14 months. About half of the Ebola survivors from Sierra Leone have Post-Ebola Syndrome. These symptoms make it very difficult for the survivors to go back to the lives they lead before becoming ill. There was a study that was conducted that took Ebola survivors and evaluated their Post Ebola symptoms. What was found was that the most common symptoms were unusual tiredness, sleep disorders, and pain spread across the body in many different places (chest, muscle, abdominal) In the future researchers will be trying to improve the Ebola survivor's quality of life. They will try to do this by hiring specialists for the most common reported symptoms to help treat them to the best of the ability. Also, WHO has set up a guide for follow up visits for survivors. These visits help ensure that the Ebola survivors are not suffering from Post Ebola Syndrome. In the end will help improve these survivor's quality of life.(10).

What was learned from the past outbreak

There have not been many Ebola outbreaks in the United States of America. There is protocol for when specific diseases outbreak in hospitals, such as influenza. But when patients come in to the hospital with primary stages of Ebola they are very like other diseases or viruses. In the hospital setting it is crucial to prevent further spread of disease. More recently the United States and the Center for Disease oControl and Prevention have created a National Ebola Training and Education Center, to help hospitals know how to prevent the spread of Ebola further around the hospitals. Patricia Abbott who is on the national panel who reviews hospitals response to Ebola outbreaks. She believes that health care workers need improved ""situational awareness. This means that health care workers need to become more aware of the symptoms that patients are showing and think of all the possibilities of diseases it could relate to, instead of jumping to conclusions on a diagnosis. Abbott explains how hospitals routinely prelates for active shooters, fires, and other natural disasters that involve casualties. Few hospitals train for an infectious disease outbreak. If more hospitals practice this then the pervious 2014 Ebola outbreak would have been handled much better. There are some new basement hospitals, which as the name states assess patients with potential infectious diseases, evaluates them and then transfers that patient to an either a state designed treatment center or a regional treatment center. During the 2014 outbreak hospitals believed they could contain the outbreak by just isolation. This turned out to continue to spread the disease. Even though the patients were in isolation and health care workers were wearing personal protective equipment the virus could infect the health care workers. This is where the ""vital sign zero concept has been enacted in a few hospitals. This concept ensures that the patient shows no risk of infecting another person before going in and taking their vital signs. Kristi Koenig San Diego County in California and professor emeritus of emergency medicine and public health at the Center for Disaster Medical Sciences at the University of California, Irvine has established this concept. Koenig explains how many health care workers who work in the emergency department just jump into help that patient before donning personal protective equipment, which in the end can harm them instead of helping the patient. Ashwell as the creating the ""vital sign zero she also has created the 3-1 tool, which is an acronym for Identify, Isolate, and Inform. It makes the health care worker ask themselves these three questions ""You have to look at the disease characteristics, so if it is something contagious from person to person, then how is it transmitted? Is it something that can be transmitted prior to symptom onset (Koeing, 2017) This was originally created for any future Ebola outbreaks but it has been adapted for Zika and other infectious diseases. All of these listed new protocols listed above have been developed after the 2014 Ebola outbreak. They are not only used for Ebola, they can be adapted to other infectious disease, such as the 3-1 tool. (9)

Education for the Future

More and more virulent viruses are evolving and will cause infection. The Special Clinical Studies Unit (SCSU) at the National Institute of Health (NIH) has developed a protocol for nursing staffs around the country to follow in case of a virulent virus outbreak, which includes Ebola. Beginning with the staffing model, it enforces the buddy system where 2 nurses enter the patients room. One nurse performs direct patient contact, and the other is there for observation only. They are there to step in if the other nurse dons or doffs personal protective equipment incorrectly, or if they see any other possible was for the infection to spread. There is also another nurse who is known as the circulating nurse who runs around the floor to gather supplies, answer phones and assist as needed. Zones of transmission of Ebola has been created so the nurses can report the level of how contagious the patient may be. Hot zone is immediate area within infected patients room where most contagion could exist (Eckes). Warm zone is the area within an anteroom of a hallway between the patient and a clean area. (Eckes) Lastly the Cold zone an area considered clean with no direct contact with a patient (Eckes). With the continuation of training and monitoring staff members will be as prepared to care for Ebola Virus patients as well as other virulent patients (8)

Conclusion

While writing this research paper it was very eye opening. I learned so much about the Ebola Virus than my previous understanding from watching the news. Previously I had not read too much into the virus and the long-lasting effects of it. I had no clue that there is a such thing as Post- Ebola Syndrome and that the symptoms can last up to and over 2 years. For me going into the health field I will take what I have learned about this virus seriously since I may be exposed to it in the future. Especially since there are not definitive symptoms of the virus, which makes it very difficult to diagnose as Ebola Virus.

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