Over a week ago, a traveler infected with Ebola virus boarded an airplane to Lagos, Nigeria, and became ill in flight. He died five days after landing. Could he have infected others on the aircraft and later in Nigeria? That depends …
First some background on Ebola virus:
— It is believed that Ebola exists naturally among certain species of fruit bats. The virus has also been found in wild antelope, porcupines, and primates. In 1989, an outbreak of Ebola occurred among monkeys imported to the United States from the Philippines.
— Five subtypes of Ebola virus are known to exist; four cause disease to humans.
— The incubation period varies between 2-21 days. Most infected patients show symptoms at 8-9 days after direct exposure to contaminated blood, vomit, body wastes, or secretions.
— The initial symptoms are sudden fever, intense weakness, sore throat, and headache. Profuse vomiting and diarrhea follow 1-2 days later.
— Bleeding from the nose and mouth, skin blisters containing blood, and signs of kidney and/or liver failure are dire developments that suggest severe internal bleeding. Patients with such fulminating courses die within 7-10 days.
— Ebola is NOT 100 PERCENT FATAL! Those who survive beyond two weeks have a better prognosis for survival.
The virus is transmitted whenever one has sufficient, unprotected, direct contact with the blood or secretions — saliva, vomit, diarrhea, sweat, tears, semen, any skin opening or healing wound — of an infected person. There are higher concentrations of virus in vomit, blood, and diarrhea compared to saliva, sweat, and tears. Risk of spreading the infection to others during the incubation period is low, yet it increases once symptoms commence and will become highest during the late stages of illness when the victim is vomiting, having diarrhea, or bleeding. Patients who acquire the infection through contaminated syringes and needles almost always die. And transmission even through semen has been reported to have occurred seven weeks after recovery.
In past Ebola epidemics, as well as the current one in Africa, those who have contracted the disease were primarily family members and health care workers caring for infected patients. Also, family members who handle corpses at the time of burial, and those who eat fruit bats or antelope could acquire the infection.
Public health measures such as screening all suspected patients, isolating those afflicted and tracing their contacts, and employing universal barrier precautions and strict equipment decontamination protocols will disrupt the spread of the virus. Authorities must not underestimate the worldwide mobility potential of people incubating the illness in African areas where Ebola outbreaks begin. Disinfection of public areas such as restrooms is imperative. Even sexual intercourse by recovered individuals should be restricted for three months or until semen can be shown to be free of virus.
Unfortunately, at this time a properly vetted vaccine — one proven in clinical trials to make a difference and result in more protective good than harm — is still under development. ZMAPP, a mixture of three antibodies harvested from tobacco plants, has been administered to two American health care workers in the hope it will aid their recovery. No one knows if the amounts of ZMAPP given were the correct dosages — even worse, could it make the recipients feel worse or die faster?
Utmost, the treatment of Ebola patients requires close supervision and intensive care. The challenge is to provide this support while minimizing the risk of infection to other patients and medical personnel. Patients require rapid hospitalization to access the around-the-clock attention that is geared toward preventing trauma to their fragile circulatory systems.
A treatment guideline not often mentioned in Ebola patient management is the enforcement of a restriction on air transportation of patients because of the effects of drastic changes in ambient air pressure on lung water balance when ascending from ground level into the diminished aircraft pressures of approximately 8,000 feet. This complication may have occurred to the passenger who had become symptomatic while on the flight to Lagos, Nigeria, and contributed to his death five days later.
A second management pearl to always keep in mind for Ebola caregivers is that secondary infections, especially malaria, are common and should be sought and aggressively treated.
So … did the ill passenger on the flight to Nigeria spread the infection to others on board or possibly at his destination later? Is Ebola virus in any community just a plane ticket and a toilet seat away?
Whenever humans are involved in potentially lethal situations, mistakes will happen.
For more examples on public health management strategies regarding epidemics such as HIV, SARS, polio, and Hepatitus C, please visit Spirit Made Smaller and look up how the character, Jennelle Daniels, managed those pathogens.