Ebola outbreak in Guinea
The recent ‘unprecedented’ outbreak of Ebola haemorrhagic fever (Ebola) in the West African nation of Guinea stoked global fears about the deadly disease, which caused widespread panic in the 1990s and early 2000s after an outbreak in the Democratic Republic of Congo (formerly Zaire) in which 245 people died. Reports of the disease – which has a 90-per-cent fatality rate – were laboratory-confirmed by Guinean health officials on 23 March, and the World Health Organization (WHO) was subsequently notified. It marked the first time that the disease had been detected in Guinea.
As of 3 May, the Guinean outbreak was described by the UK’s National Travel Health Network and Centre (NaTHNaC) as ‘ongoing’, with a total of 231 cases, 155 of which resulted in the deaths of the patients, having been reported – although officially, only 127 of those cases had been laboratory-confirmed by the Guinea Ministry of Health. Cases were reported in Guinea’s capital city, Conakry, and in the districts of Dabola, Djingaraye, Guékédou, Macenta and Kissidougou. Most worryingly, the disease reportedly spread beyond Guinea’s borders to Liberia, Mali and Sierra Leone. Quarantine sites were set up in Guinea, and the country’s health minister Rene Lamah announced a ban of the sale and consumption of bats, a local delicacy that appears to have been ‘the main agent’ of the outbreak, according to a BBC report. It is thought that certain species of bat, while they do not show symptoms, are a natural ‘reservoir’ for Ebola.
Ebola was first documented in 1976, appearing in Sudan and the Democratic Republic of Congo; the latter case was near the Ebola River, which gave the disease its name. Caused by a virus of the Filoviridae family, and transmitted via bodily fluids, there are five distinct strains of the virus – Bundibugyo, Ivory Coast, Reston, Sudan and Zaire – three of which have been associated with the severe haemorrhagic fever. The incubation period for Ebola is approximately a week, although it is not unheard of for it to last up to 21 days, with the early stages characterised by chills, pain in the lower back, fatigue, headaches and diarrhoea. The illness then presents with severe nausea and vomiting, and individuals may experience bruised skin – caused by leaking blood vessels – and bleeding from the eyes, ears, nose and potentially mouth and rectum.
Blood loss, however, is generally not the cause of death – according to Dr Jay Keystone, a travel physician and professor with the University of Toronto’s department of medicine, victims suffer from a viremia, whereby a virus enters the bloodstream and is then able to access the rest of the body. “You start to get a breakdown of body function,” explains Dr Keystone. “The kidneys fail, you may get secondary pneumonia. But in this case, it’s an overwhelming infection which causes a breakdown of tissue, release of what we call antigens, and then essentially you get a total body failure.”
Currently, there is no known cure or even a vaccine for Ebola, and the relative quickness of the spread of the current outbreak, coupled with the virulent nature of the disease, have been a cause of arguably justifiable anxiety. However, Dr Keystone suggests that the terrifying reputation of the disease overshadows the actual threat that it presents – and its deadliness may actually have a positive aspect. Ebola has killed approximately 2,000 people since it first appeared in the late 1970s, and in terms of efficiency is vastly inferior to a virus such as HIV, which, as Dr Keystone says, ‘spreads quietly [and] silently, and millions get infected’. “All the people who get [Ebola] die,” he says, “within a matter of a few days.” This, while obviously of little comfort to the victims, prevents hosts from infecting more people, and makes containing the disease a more viable proposition than some alarming – and possibly irresponsible – headlines may suggest
In terms of guidelines for travellers, NaTHNaC suggests that the risk to travellers is considered to be ‘very low’. There have been no known imported cases of the disease to the UK, for example, and as transmission occurs when there is direct contact with infected bodily fluids, this can be avoided through scrupulous personal hygiene and common sense. Those providing medical care or evaluation services in infected areas should observe strict barrier precautions, and specialist guidelines have been prepared by WHO and the Centers for Disease Control and Prevention.