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Understanding the Ebola virus disease

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By Agnes Kyotalengerire

Uganda is currently battling the Sudan Ebola virus for which there is currently no vaccine or medication.
This is the first time the virus was identified in Sudan.

Ebola was first reported in the districts of Kasanda and Mubende, in September this year.

These two districts are currently under lockdown. On September 20, the Ministry of Health declared an Ebola virus disease outbreak in the country.

This was after a team of experts from Uganda Virus Research Institute (UVRI) picked and tested samples of a 24- year-old man in Mubende district. He is now deceased.

Uganda has had four Ebola Virus Disease (EVD) outbreaks; in 2000, 2014, 2017 and 2018. The biggest and most deadly was in 2000 which registered 425 cases and 224 deaths.

Facts about Ebola. (Source/Ministry of Health)

Ebola status
By October 28, the number of people confirmed with Ebola stood at 109, the number of recoveries stood at 24 and those who had died stood at 30.

Dr Ivan Kimuli, a public health specialist supporting case management at the World Health Organisation (WHO), says Ebola virus is primarily found in wild animals, particularly fruit bats. It can infect monkeys and porcupines after getting in contact with bats.

Causes and spread
Dr Kimuli says the Ebola Sudan strain is caused by a virus; a disease-causing pathogen that is uncommon to the daily human community setting.

“Instead, the Ebola-causing virus stays far away from us and has got reservoirs amongst animals.

“So, if you go into the jungle and interact with animals, you can easily get into contact with Ebola,” he says.

However, it is important to note that not all animals are reservoirs of this virus.

The virus usually establishes its survival in specific hosts such as the fruit bat which normally harbours the virus.
The virus is easily spread when this bat interacts with other animals in the jungle.

Monkeys and porcupines are easily the most infected, and when humans get in close contact with these animals, they catch the virus.

From the records, most of the Ebola outbreaks have been originating from the DRC, implying that there is a lot of interaction between human beings and animals in the forests.

Incubation period
According to Dr Kimuli, the incubation period of the Ebola virus is from two to 21 days.

The incubation period is the time interval from infection with the virus to when symptoms begin to develop.

Worth noting, a person infected with Ebola cannot spread the disease until they develop symptoms.

He estimates that most patients, usually more than 60 per cent, develop Ebola symptoms by day 10 after being exposed to the virus.

It is therefore important that people who get into contact with infected people are put in isolation and monitored for close to 10 days.

Ebola manifests itself in various ways depending on the stage of infection one is in. (Source/UNICEF)

Signs and symptoms
According to Dr Kimuli, fever, fatigue, muscle pain, headache, or sore throat that cannot be explained by anything else are the first tell-tale signs of the Ebola Sudan variant.

In some cases, both internal and external bleeding (for example, oozing from the gums, nose, ears or blood in the stools) might occur.

Management
He says the Ebola Sudan strain does not have any proven treatment. Tentatively, treatment of the disease is largely supportive or non-specific.

“Because we know that a patient is likely to drift into organ failure as the disease progresses, we try our best to protect them from getting into organ failure. This results in increased chances of survival,” he says.

He urges health workers and caregivers to manage specific symptoms that Ebola patients experience.

For example, if the patient has pain, then try to manage the pain.

In case they have a fever, control it and if they are dehydrated, address it; if they are vomiting, then address the vomiting so that they do not lose more fluids or salts to make the organs deteriorate and fail to function.

A health worker disinfects a colleague after getting in contact with Ebola victims. (Photo/WHO)

Two drugs on trial
There is no approved treatment for the Ebola Sudan variant. However, the government is already trying out one re-purposed antiretroviral drug, Remdesivir, and the new Monoclonal antibody to treat Ebola patients.

“We are using the drugs under research on a compassionate basis to see if the patients respond well,” Dr Kimuli says.

He further explains that Remdesivir is an antiviral drug that works against viruses.

Therefore, since Ebola is caused by a virus, the drug could work.

He noted that the same drug was used to treat Covid- 19, and was given for six to ten days. The same duration can be used for Ebola Sudan strain.

Ebola vaccine is already available for some strains. (Photo/Reuters)

In addition, the new monoclonal antibody is given as a single dose based on the weight of an individual.

The earlier it is given to the patients the better-when the disease has not progressed to advanced stages.

By October 28, so far two patients from treatment units had been given the drug on a compassionate basis based on their health condition to give relief.

The use of the drug is also purely on voluntary basis.

Care for survivors
A number of medical complications have been reported in people who recovered from Ebola, including mental health issues.

Ebola virus may persist in some body fluids, including semen, pregnancy-related fluids and breast milk.

Ebola survivors need comprehensive support for the medical and psychosocial challenges they face and also to minimize the risk of continued Ebola virus transmission.

Are vaccines available?
Dr Kimuli says there are no approved vaccines for this Ebola strain (Sudan ebolavirus species).

The only available approved vaccine against Ebola is for another species like the Zaire Ebolavirus.

He adds that the vaccines have not yet been introduced in Uganda, although there are many vaccines to be tried.

Only those approved by the ministry of health will be allowed into the country, and will be used in a trial setting to see if they are effective or not against the Sudan variant.

“We have not yet started vaccinating people but preparations are well advanced. Once we have the vaccines in the country the trials will start,” he says, adding that scientists in Uganda are part and partial of this trial.

If the vaccines work, it will be Uganda’s gift to the world.

Safety measures Ebola
You can protect yourself from Ebola by observing the measures below.

  • Regular washing of hands.
  • Keeping a social distance of about two meters from an infected person or from a person who exhibits similar signs and symptoms.
  • Avoid contact with fluids such as vomit, blood, urine, sweat, semen and vaginal fluids of the people infected with the virus.
  • Avoid fist pumping as their skin may have the virus.
  • Avoid conducting burials rituals of washing, dressing and viewing bodies of people who have died of Ebola because they are highly infectious.
  • Avoid moving in congested or crowded public means, because then your bodies are likely to rub, hence increasing the risk of transmission from an infected person.
  • If you feel unwell or have been identified as a contact, avoid mingling with others.
We can control and end the spread of Ebola if we adhere to the control measures provided by government.

School safety measures
In the effort to contain the spread of Ebola, the Government has directed all schools to regularly check children’s temperature and observe all other standard operating procedures (SOPs) that were in place during the Covid-19 pandemic.

This follows the death of a pupil at a school in Rubaga division, Kampala, who was among the 170 contacts of a Nansana patient that infected pupils from three schools in Rubaga division.

Dr Diana Atwine, the permanent secretary at the Ministry of Health, has asked schools to reinstate the previous Covid-19 taskforces, which have been renamed Ebola taskforces.

The taskforces will enforce the SOPs, which also include setting up handwashing facilities or providing alcohol-based hand sanitisers to disinfect both hands and surfaces.

Dr Atwine also discourages parents from getting into physical contact with students, especially during visitation days and proposes that whatever they take for their children should be handed over to the teachers, who will then pass them over.

She urges organisations, workplaces and markets to reactivate the health SOPs, saying it only takes one individual to spread Ebola to the rest, thereby causing a catastrophe.

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