Professor of Molecular Biology and Genomics and Director, African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Christian Happi, tells ARUKAINO UMUKORO how Nigerians can protect themselves from the Ebola virus What is Ebola virus disease and how is it transmitted? The Ebola virus causes a viral haemorrhagic fever, a set of severe illnesses that is “multisystem” in that it affects several of the body’s regulatory systems. These viral diseases damage the circulatory system and may be accompanied by bleeding or haemorrhaging. The virus causing the disease was named after the Ebola River in the Democratic Republic of Congo, where the disease claimed its first known victims in 1976. A separate strain broke out simultaneously in Nzara, Sudan. The Ebola virus is a ribonucleic acid (RNA) virus. There are five known species of Ebola virus: Bundibugyo Ebola virus; Zaire Ebola virus; Reston Ebola virus; Sudan Ebola virus; and Taï Forest Ebola virus. All but the Reston strain can be fatal to humans and are found in Africa. Something peculiar to RNA viruses is that they (the RNA viruses) produce acute infections, severe for a short time and then gone. Either they soon disappear or they kill you. The virus can spread to primates and humans who handle infected meat – a risk given the informal trade in “bush meat” in forested central and West Africa. Ebola is thought to be a zoonotic or animal-borne virus. The virus survives in a “reservoir” host – an animal or insect that carries the virus at no cost to itself – and is passed on to other animals or humans through contact with the bodily fluids, secretions or organs of the host animal. The fruit bat is considered to be the natural host or “reservoir” of the Ebola virus. The exact manner in which Ebola enters human cells remains a mystery. Transmission to humans and primates is thought to occur through direct contact with the animal host, or through contact or consumption of the meat, bodily fluids or secretions of animals that have become infected by contact with the host. Once it has presented in humans, Ebola is transmitted through direct contact, where broken skin or mucous membranes come into contact with the blood or secretions of the infected person. It may also be transmitted indirectly “through exposure to objects (such as needles) that have been contaminated with infected secretions”, according to the US Centres for Disease Control and Prevention. This means that health care workers, family and friends of those infected with the virus are at a higher risk of infection. The diagnosis of the Ebola virus on the Liberian’s sample was successfully carried out in the laboratories at the Lagos University Teaching Hospital and ACEGID. How was the diagnosis reached? Yes, it is true that the tests were conducted at the laboratories of the African Centre of Excellence for Genomics of Infectious Diseases in Redeemer’s University and Professor Sunday Omilabu’s laboratory in LUTH. We received blood and urine samples from the patient at 8:40 pm at the Redeemer’s University on Wednesday, July 23. Samples processing and testing started the next day in the morning. We were able to detect and confirm the presence of the Ebola Zaire strain in both blood and urine obtained from the patient on Friday, July 25, at 6:10 am in our laboratory at ACEGID. According to information that was given to us, we were told that the World Health Organisation reference laboratory in Dakar corroborated our findings. What does this correct diagnosis say about the capacity of Nigeria’s medical practitioners in handling such cases? The correct diagnosis is a clear indication that the virus can be diagnosed in Nigeria, unlike what happened in Guinea when the outbreak started. There was no capacity to diagnose the virus, while the virus was ravaging the local population. In Guinea, samples had to be sent out for confirmatory diagnosis. Usually in such situation, the case fatality will be high because the clinicians do not know how to manage the patients. Since they do not know what the patient is suffering from. What are the symptoms of Ebola and how long is the incubation period? Patients will begin to show symptoms anywhere from two to 21 days after exposure to the virus, mostly between eight and 10 days. The symptoms are: fever, weakness, muscular pain, headaches and sore throat. Unfortunately, the symptoms at this stage make it difficult to distinguish Ebola from various other diseases, including malaria, typhoid fever, meningitis or cholera. However, as the disease develops, Ebola sufferers may experience vomiting, diarrhoea, a red rash, difficulty in breathing and swallowing. The virus severely compromises the immune system, and affects liver, kidney and respiratory function, as well as the skin and blood. Blood clots may form and patients may experience haemorrhaging, bleeding internally and externally. How true is it that Ebola has no cure but can be treated if detected early? Yes, there is no vaccine or drug/cure for the Ebola virus, though several vaccinations are currently being tested. Treatment is thus limited and merely supportive of the body’s immune function: providing fluids, electrolytes and oxygen; keeping blood pressure constant; and treating additional infections with antibiotics. It is however, unclear why some people infected with the virus survive where so many do not, but it is thought to relate to the strength of the individual’s immune system, the strain of the virus and the viral dose the person has been exposed to. In addition to supportive and symptomatic treatment, health workers can only really control the spread of the virus: isolating those infected, raising awareness of the virus and how it is spread in affected communities, ensuring appropriate protective gear is worn by all in contact with Ebola sufferers and ensuring the quick and safe burial of those who have succumbed. The Lagos State government claimed to have identified 59 people who had contact with the Liberian, what does this portend for the country? It means that efforts are being made. However, the question is, are all the 59 people presently in quarantine? I don’t think so. We should fish out all these individuals and put them under observation in quarantine for at least three weeks. What should the Federal Government and health authorities do to check the disease in the country? We need mass education to create awareness. This is not just the duty of the Federal Government and health authorities. The media have a very important role to play in the campaign. We are all stakeholders and all hands should be on deck educating the masses, reporting new cases if they occur and reassuring our people. What are the precautionary measures to be taken to prevent being infected by Ebola? I believe that Ebola is not particularly easy to catch. One needs really close contact with an infected individual in order to get infected. The virus spreads from direct contact, for instance through broken skin or mucous membranes, with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. In order not to get infected, direct contact with either suspected Ebola patients or infected individual should be avoided. More important, people should avoid contamination through process of burial of their loved ones. What we observed in Sierra-Leone is the fact that the first cases of Ebola in the country was through people who attended the burial ceremony of their relative that died of Ebola virus infection. So, if your loved one or relative dies of Ebola virus diseases, please let it be buried by health authorities who will know how to handle the dead body. Individuals should avoid handling “bush meat” and especially fruit bats. Through contact, processing or consumption of the “bush meat” and bats bodily fluids or secretions one can become infected. What should be done in Nigeria and the West African region to arrest the spread of the virus? This is an epidemic characterising dysfunctional health systems. If the disease surveillance systems in West African countries were very active, we would have prevented the spread of the virus once the epidemic started in Guinea in December, 2013. Now, this epidemic can no longer be considered as a West African problem. Remember that the ASKY flight carrying nationals from many African countries came from Liberia through Togo and landed in Lagos. This same aircraft flew through many other African countries prior to confirmation of the Ebola case in Nigeria. So, you can see that there is the potential that people from many African countries could have come in close contact with the Liberian that was infected with Ebola. Therefore, the risk of epidemic in other African countries cannot be ruled out. In this regard, African countries have to come together and develop an agenda for surveillance in this emergency situation. There is a need for collaboration and cooperation between all health agencies in the African regions for diseases surveillance. There is also a need for mass education and awareness campaign in the African region on Ebola virus and prevention of infections. I understand that the Federal Government and the Lagos State government are making a lot of efforts to contain the current situation. However, I don’t know how really prepared we are in case of major outbreak. We are very fortunate that we have the diagnostic capability in country, but I am not sure if the laboratories have enough reagents and supplies in case of a major outbreak. I believe that the government has a small window of opportunities now to really stock these reference laboratories with equipment, supplies and reagents in order to face the epidemic. The government should quickly refurbish some medical facilities and dedicate them for the management of viral haemorraghic fevers as a major step towards preparing for a major Ebola outbreak if it occurs. Copyright PUNCH. All rights reserved. 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Posted on: Tue, 05 Aug 2014 22:16:21 +0000
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