October 2019 I Tarrant County Physician I 15
border have also been found to have
Ebola, and there is a growing number
of cases in Gama, a large city on the
DRC-Rwanda border. Currently the WHO
reports 2,888 cases in DRC and 1,938
deaths (as of August 18, 2019).
Management of the current outbreak
has been hampered by its location—
urban conflict zones within the DRC—
which has significantly affected the
ability of the DRC government to deploy
assets and for personnel to respond.
During the current outbreak, more
than 180,000 doses of a experimental
Merck-manufactured glycoprotein
one-dose vaccine (rVSV-ZEBOV) have
been administered in a ring vaccination
approach (administering vaccines to
persons in concentric zones of exposure
to cases). But there is distrust of the
vaccine among some Congolese; many
exposed persons have refused the
vaccine or fled to avoid it, complicating
outbreak control. In neighboring Uganda,
a Johnson & Johnson experimental
two-dose
vaccine is in use to attempt to
control Ebola within Uganda.2
Ebola was first described in two
separate outbreaks in 1976, and so
far, six species have been identified.
Ebola is a zoonosis infection (one that
occurs in both humans and animals).
Host mammals are fruit bats, nonhuman
primates, forest antelope, porcupines,
and other small, normally sylvatic
mammals. Experts believe handling
of these Ebola reservoir animals, or
consumption of their meat, or contact
with their blood and fluids, results in
human infection with Ebola which can
then spread from human to human
through infected fluids, possibly during
burial ceremonies for Ebola victims.3
Ebola can be transmitted between
humans only through contact with the
body fluids of a symptomatic person or
an Ebola decedent. However, the initial
symptoms of Ebola human infection
are often nondescript (fever, headache,
myalgias, fatigue, sore throat) before
more serious symptoms manifest
(vomiting, diarrhea, bleeding, hepatorenal
dysfunction, vascular collapse). The case
fatality rate is variable but still reported
between 40 and 80 percent.
In healthcare settings, transmission
is prevented by use of gloves and other
personal protective equipment including,
gowns, masks/face shields, goggles,
respirators when indicated, and proper
handwashing.
We learned much during the October
2014 Ebola crisis and response five years
ago, and we as physicians are building on
the lessons from that time to be prepared
to meet the next Ebola challenge.
References
1) World Health Organization Ebola Virus
Disease-Democratic Republic of Congo
Disease Outbreak Update: 18 July 2019
2) K. Kupferschmidt. Science 365, Issue
6453, pp 526-527
3) https://www.cdc.gov/vhf/ebola/
history/2014-2016-outbreak/
AND NOW