Ebola Virus Disease (EVD) is a severe, infectious and deadly disease, which most commonly affects humans and nonhuman primates. It is caused by an infection with a group of viruses within the genus Ebolavirus. EVD is characterized by the sudden onset of fever and malaise, and usually accompanied by headache, muscle pain, diarrhea, vomiting, and abdominal pain (WHO Ebola Response Team. Ebola virus disease in West Africa: the first 9 months of the epidemic and forward projections. N Engl J Med 2014; 371:1481–95. ). In severe cases, multiorgan failure develops, as a result of shock, which eventually leads to death. Currently, there is no specific treatment for EVD, however supportive measures can be taken to increase chances of survival, which include early volume replacement, electrolyte resuscitation, treatment of associated infections, and symptom management (http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.851.2804&rep=rep1&type=pdf).
The disease takes its name from the Ebola River, which was near one of the villages in which EVD first appeared. The disease first appeared in 2 simultaneous outbreaks, in 1976, one in Yambuku, Democratic Republic of Congo and the other, approximately 500 miles away, in what is now, Nzara, South Sudan (cdc.gov). The largest and most complex outbreak, since the Ebola virus was first discovered, was the 2014-2016 West African outbreak, which began in a rural setting of southeastern Guinea. It began silently spreading on December 26, 2013, but was not identified as such until March 21, 2014. Within weeks, it spread to urban areas and then across borders, and within months became a global epidemic (https://www.cdc.gov/vhf/ebola/history/summaries.html). On March 31, 2014, Liberia had their first cases confirmed, in two different counties. On May 26, 2014 the World Health Organization reported the first cases and deaths in Sierra Leone. After a second wave of the outbreak and several countries stepping in with volunteers and as resources the Centers for Disease Control and Prevention (CDC) announced the first case of EVD in the United States on September 30, 2014 (SITE). The first transmission of EVD outside of West Africa was in Spain, on October 6, 2014 (https://www.bbc.com/news/world-europe-29514920). Ebola was first reported in Mali on October 23, 2014 and in December 2014 a healthcare worker returning from West Africa to Scotland, was diagnosed with Ebola. It wasn’t until January 14, 2016, West Africa was declared to be free of Ebola, officially marking the end of the epidemic (SITE).
Epidemics occur when an infected host is introduced into a susceptible population (SITE). It is estimated, in West Africa, that more than 28,000 people have contracted EVD, with a case fatality rate of 40% and between Central and Northeastern Africa an estimated 2,400 cases occurred (https://www.sciencedirect.com/science/article/pii/S0917504017300886). Between March 2014 and May 2015, in Guinea, Liberia, and Sierra Leone combined there were a total of almost 15,000 confirmed cases and just over 11,000 total deaths (https://www.sciencedirect.com/science/article/pii/S1201971215001848). Similar features are shared where recent and previous EVD outbreaks were found. Those similarities include poor personal hygiene and sanitation in the community or village and human contact with wild animals in remote areas, with close proximity to the forest, where bush meat is a favorite food. Other commonalities that contributed to the outbreak susceptibility are, but not limited to, damaged infrastructures, high population mobility across permeable borders, and a severe shortage of healthcare workers. Damaged infrastructures including road systems, transportation services, and telecommunications, especially in the rural settings, are lacking which greatly delayed patient’s treatment, communication of alerts, and public information campaigns. Border control measures are for the most part nonexistent in West Africa, making it easy for EVD to be spread across the countries. Prior to the outbreaks, it was estimated, that between Guinea, Liberia, and Sierra Leone, the ratio of doctors to population was 1 or 2:100,000. And by year-end nearly 700 healthcare workers were infected during the outbreaks and more than half of them died, contributing to the severe shortage of healthcare workers. (http://www.who.int/csr/disease/ebola/one-year-report/factors/en/)
Ebola, which originates in animals, and is then transmitted to humans, is considered a zoonotic virus (medicalnewstoday.com). The way Ebola is introduced into the human population is through close contact with the blood, secretions, organs or other bodily fluids of infected living or dead animals. Some of these animals include gorillas, fruit bats (which are thought to be natural Ebola virus hosts), chimpanzees, and porcupines. Human-to-human transmission occurs via direct contact with the secretions, blood, feces, or other bodily fluids of infected persons. Also contact with surfaces and/or materials, for example bedding or clothing, which are contaminated with these fluids would be a cause of human-to-human transmission. A major mode of transmission, especially in the early stages, was within hospitals. This occurred by having close contact with patients and not strictly practicing infection control precautions. The outbreak in 1976 in which the fatality rate was 88% was traced back to the use of contaminated needles (SITE). There were also numerous community-acquired cases, which meant person-to-person transmission also occurred outside of the hospital setting. (SITE) For example, burial ceremonies that involved direct contact with the deceased body. As long as ones blood contains the virus, they remain infectious.
The impact an Ebola outbreak would have in my community at a systems level would be that if the patient went through the emergency department (ED) at a local hospital, that particular ED, may go on diversion status, meaning they will divert any emergent cases coming in by ambulance to another ED. This may cause the surrounding facilities to reach capacity and be at risk for staffing issues. Also if the patient is treated on any of the units within the hospital they would need to be isolated, thus taking other hospital beds out of use. Likewise, all providers that came into contact with that patient would need to be monitored, again possibly creating staffing issues. The way that it would possibly affect schools would be if an infected person attended a particular school the potential that school would shut down would be greater due to the fear of EVD spreading.
The reporting protocol for an outbreak would be first to rapidly recognize and triage a patient with potential symptoms and relevant exposure history; the patient would then be isolated. The next step would be to immediately notify the hospital and/or facilities infection control program. They are then required to contact the state and the CDC. During the 2014 Ebola epidemic, The Florida Department of Health requested that all travelers returning from a country impacted by the EVD have their temperature and symptoms monitored for 21 days after potential exposure. Any fever or symptoms for a period of 21 days after departures from an EVD outbreak country should immediately by reported by phone to the county health department. Any persons that came into contact with a known or suspected EVD case in the past 21 days would be advised to voluntarily quarantine themselves for the duration of the monitoring period. Failure to do so will results in an involuntary quarantine by the County Health Officer (https://www.cdc.gov/phlp/docs/interim-ebolascreening.pdf) As of July 2017, the United States no longer recommends active monitoring for Ebola (https://www.cdc.gov/vhf/ebola/exposure/monitoring-and-movement-of-persons-with-exposure.html ).
Two strategies to prevent an outbreak in my community would be to 1) educate the public and 2) educate healthcare workers. I would educate the public on the ways that Ebola is transmitted and then educate them on ways to minimize their risk of potentially contracting EBV. Some of those ways would be to practice good hand hygiene, by washing hands frequently using soap and water, making sure fruits and vegetables are properly washed before consumption, avoid contact with anyone who presents with possible EBV symptoms, and don’t eat bush meat or handle dead animals. Since during the Ebola outbreak, the disease spread quickly though the healthcare system, due to close contact with the infected person, I think it is important to educate healthcare workers on the basic principles of using personal protective equipment (PPE). Making sure PPE’s are donned properly before, during, and after coming into contact with the patient or patient care area would help reduce and/or prevent the possibility of self-contamination, other exposure and most importantly transmission.