Ebola – a global health problem?

I will be hosting this week’s ENB twitter chat on Wednesday the 20th of August between 8-9pm focusing on ‘Ebola viral disease – a global health problem?’ Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc @EBNursingBMJ, or better still, create a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ and add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets.

This past week, the Ebola outbreak in Africa has been reported extensively. Ebola viral disease is a severe, often fatal illness caused by the Ebola virus, with a 90% fatality rate. Transmission of the virus to humans is by contact with blood or bodily fluids from infected animals most commonly monkeys or fruit bats (thought to be the natural host for the Ebola virus); once in the population human-human spread rapidly occurs. Outbreaks primarily occur in tropical rainforests such as the remote villages in Central and West Africa. Ebola viral disease is named after the Ebola River in Zaire, where the first outbreak in Sudan and Zaire was reported in 1976; over 284 people were infected and 53% of infected people died. A second outbreak followed a few months later in Yambuku, Zaire with a different virus strain (Ebola-Zair or EBOZ) which had a higher mortality rate (88% of the 318 infected people died). There have been other strains of the Ebola virus, the last known being Ebola Cote d’Ivoire (EBO-CI) identified in 1994. The current outbreak of Ebola viral disease is the largest to-date affecting  Guinea, Sierra Leone, Liberia and Nigeria with more than 1,750 suspected cases reported.

Symptoms of Ebola viral disease occur two days to three weeks after being in contact with the virus and include fever, sore throat, muscle pain, headache, nausea, vomiting, and diarrhoea, which can result in decreased liver and kidney function, and can cause internal and external haemorrhaging (hence it was formerly known as Ebola haemorrhagic fever). There are currently no licensed treatments or vaccines available for Ebloa viral disease; care is supportive and symptom management, with severely ill patients requiring intensive supportive care. Several experimental treatments for Ebola viral disease are in development (Zmapp and Tekmira) and although results are encouraging have only undergone animal testing and testing on a small number of healthy human volunteers. A number of prototype vaccines again are in early development and potential vaccines may be available as early as 2016.

Stigma and victimisation are features of Ebola epidemics, with reports of infected individuals and health workers being ostracised by the community, unable to find work, abandoned by their partners and the possessions and homes of some survivors burned. In this current outbreak there have been reports that a quarantine centre for suspected Ebola patients in the Liberian capital of Monrovia have been attacked.

The World Heath Organisation has issues two statements this month in relation to viral disease:

Ethical considerations for use of unregistered interventions for Ebola viral disease (EVD) 12 August 2014

Panel identified areas that need more detailed analysis and discussion, such as:

  • Ethical ways to gather data while striving to provide optimal care under the prevailing circumstances;
  • Ethical criteria to prioritize the use of unregistered experimental therapies and vaccines;
  • Ethical criteria for achieving fair distribution in communities and among countries, in the face of a growing number of possible new interventions, none of which is likely to meet demand in the short term.

WHO Statement on the Meeting of the International Health Regulations Emergency Committee Regarding the 2014 Ebola Outbreak in West Africa 8 August 2014

The Committee advised that:

  • The Ebola outbreak in West Africa constitutes an ‘extraordinary event’ and a public health risk to other States;
  • The possible consequences of further international spread are particularly serious in view of the virulence of the virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries;
  • A coordinated international response is deemed essential to stop and reverse the international spread of Ebola.

Questions for consideration:

  • Malaria, tuberculosis and measles (measles caused 122,000 deaths in 2012 http://www.who.int/mediacentre/factsheets/fs286/en/) remain worldwide killer diseases, is the current media focus on Ebola justified?
  • Does the Ebola epidemic highlight that vaccination uptake for infectious diseases, such as measles, rubella and pertussis which are increasing, should be a public health priority?
  • What role should developed countries take in relation to Ebola viral disease, if any?
  • What ethical and research principles, such as informed consent, apply when faced with a health crisis and in different cultures?
  • How will the media and world health community respond and what are the consequences of introducing a ‘trial’ drug, particularly if the drugs are ineffective or cause harmful reactions?  What are the implications of not offering these ‘trial’ drugs?
  • While Ebola remains a genuine concern in West Africa, would the outcome in terms of mortality be similar in countries with well developed healthcare systems?

Sources of information

http://www.who.int/mediacentre/factsheets/fs103/en/

http://www.who.int/mediacentre/news/statements/en/

Joanna Smith, Senior Lecturer Children’s Nursing, University of Huddersfield, Associate Editor EBN.   Tweet me @josmith175

Join in the twitter chat #ebnjc@EBNursingBMJ

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