*From Forbes, contributed by an MD.
Could Ebola Virus Become A Threat In The U.S.?
As the Ebola virus continues to spread throughout West Africa, with increasing concern among both health officials and the public alike, recent media reports about a death of a man who traveled to Lagos, Nigeria having been in an area rife with Ebola Virus, recently caught the world’s attention–and for good reason.
As we live in an interconnected world–and not just by the internet- we have to come to grips with the fact that hopping on a plane may potentially spread any virus–not just Ebola–to another country.
Thus, the importance of enforcing proper infectious screening procedures of those who plan to board an aircraft in an endemic area such as West Africa becomes critical to containing the spread of the Ebola virus. Enforcing a “Do Not Board List” would be critical to preventing any spread of such a virus.
While the Ebola virus could potentially be transported by travelers to another country by a plane ride, according to officials at the CDC, the actual chance of this developing in a serious public health risk to those living in the US is small.
One of the main reasons, officials believe, that the virus has a low public health risk is related to the conditions which would be favorable to allow spread of the virus. Poor and crowded living conditions, along with improper sanitation seem to be an important element that contribute to the spread of the virus. Such are not the living conditions, in general, throughout most modernized countries in the Western world
[caption id="" align="" width="670"]English: Transmission Electron Micrograph of t... English: Transmission Electron Micrograph of the Ebola Virus. Hemorrhagic Fever, RNA Virus. Français : Virus Ebola. Italiano: Fotografia al microscopio elettronico della trasmissione del virus Ebola. Русский: Изображение вируса Эбола полученное с помощью просвечивающей электронной микроскопии. 中文: 電子顯微鏡下的伊波拉病毒結構. Türkçe: Ebola virüsü. Føroyskt: Ebola virus, eitt (-)ssRNA virus, undir elektronmikroskopi. (Photo credit: Wikipedia)[/caption]
Ebola, comprised of 5 strains, was first identified in 1976 in the Western Democratic Congo along the Ebola river. Four of the strains can be spread to humans. The fifth resides only in primates. The fruit bat, considered a delicacy in West Africa, is typically considered a natural reservoir of the Ebola virus.
Ebola is spread directly, human-to-human, by secretions such as saliva, sweat, but also by blood and feces. It can be spread directly by a break in the skin or mucous membranes or indirectly after touching your nose, mouth or eyes after having contact with the virus. It is not transmitting by coughing or sneezing (droplet spread)- as would be the case for someone with influenza or measles.
Ebola virus, a member of the family of filoviruses, is one of the most deadly viruses known to man, owing to its ability to constantly undergo changes or mutations in its viral proteins. Symptoms begin suddenly–often with an intense headache and fatigue, sore throat and chills–followed by vomiting, and diarrhea with onset of a hemorrhagic rash in the upper roof of the mouth and the skin that appears to be blister-like. The virus attacks the immune system, releasing inflammatory mediators, which lead to collapse of the coagulation pathway, ending in massive external and internal bleeding.
While the virus incubates from 2-21 days, its important to know that only those who are symptomatic–generally after 8-9 days–having fever along with diarrhea, vomiting and potentially a hemorrhagic rash can transmit the virus to others.
As a result, if someone on a plane with active symptoms–including vomiting and diarrhea –soils a restroom, another person who is not aware could theoretically touch a contaminated area, and then acquire the virus.
That said, its important to know that the majority of those who have become infected with the Ebola virus have been primarily healthcare workers in close contact with patients as well as family members caring for sick family members. In addition, the risk of transmission from family members touching an infected corpse prior to burial represents another potential mode of transmission.
As a caveat, its also important to know that early on its course, persons with Ebola may have symptoms that are nonspecific (headache, chills fever) making identification of the virus nearly impossible. It could be easily be mistaken for other illnesses including malaria, cholera or even typhoid fever. Only many days into the illness–after the onset of profuse vomiting and diarrhea–will a patient exhibit the telltale signs of Ebola with bleeding from the mouth and nose along with rectal bleeding concurrent with shock, liver and renal failure, followed by continued bleeding and fulminant cardiovascular collapse.
As a result, a heightened awareness, proper education, and a recent travel history from West Africa are vital for for healthcare providers who are on the front lines.
The public should be assured that medical providers in all US emergency departments are on high alert for persons with active symptoms and who have a concerning travel history. Prompt isolation using universal precautions, (gown, gloves, mask, eye protection) by providers is essential to preventing spread of the virus.
At this time, there is no vaccine or antiviral medication available to treat the disease. Only supportive care, with intravenous fluids, platelet and blood transfusions are available to patients. While there have been some promising experimental treatments in animal models,(monoclonal antibodies), there are no treatments that are currently available for humans.
With obvious technical issues regarding the high mutability of the virus–related to the proteins on its surface—preventing researchers from being able to produce a vaccine or viable antiviral medication, larger issues such as the danger of handling the virus (Biosafety Level 4) often have prevented more intense efforts to aggressively pursue research. With few patients having the disease and far fewer surviving, research efforts have likely been compromised.
However, one recently discovered compound, BCX 4430, reported by researchers in a paper in Nature (April, 2014), may hold promise for not only treating Ebola, but other deadly viruses such as Marburg, as well as MERS, SARS, dengue and measles.
Developed by US Army’s highly specialized biolaboratory in Fort Detrick, Maryland, the compound is a RNA dependent RNA polymerase that has shown promise in nonhuman primate models, as well as some in vitro activity against the virus in human cells. In their experiment, 18 Macaque monkeys who were exposed to the deadly Marburg virus, but then given post exposure treatment (1, 24, and 48 hrs) with BCX4430 exhibited near complete survival. 17 of the 18 treated monkeys survived based on results of the trial. There have been no human trials reported to date.