Ebola is Back

Actually it never left. Ebola is endemic in the Democratic Republic of Congo. The government has declared an outbreak after 17 people in the town of Bikoro are suspected of dying of the gruesome disease. The WHO statement says:

All cases were reported from iIkoko Iponge health facility located about 30 kilometres from Bikoro. Health facilities in Bikoro have very limited functionality, and rely on international organizations to provide supplies that frequently stock out…We know that addressing this outbreak will require a comprehensive and coordinated response. WHO will work closely with health authorities and partners to support the national response.

According to BBC News, “this is the ninth time an Ebola outbreak has been recorded in the DR Congo. The virus was first discovered there in 1976 (when the country was known as Zaire) and is named after the Ebola river.”

Ebola is thought to be transmitted to humans via contact with infected animals such as the fruit bat, or eating infected bushmeat. However, it is worth noting that scientists aren’t exactly sure how Ebola is spread, at least initially, so let that thought fester. Once a person is infected, the virus can be spread through blood or body fluids or objects contaminated with body fluids.

The biggest outbreak of Ebola occurred in West Africa from roughly 2014 to 2016 and killed over 11,000 people. According to the CDC, “Many of these survivors suffer from persistent medical conditions after recovery from Ebola, including joint pain, eye problems, headaches, and other chronic health issues.”

 

Ebola’s Friend: Lassa Fever

A large outbreak of Lassa fever in Nigeria has people worried. The area is observing an unusually high number of cases this year. As of February 18, there have been 913 cases and 73 deaths, compared to 733 cases and 71 deaths in all of 2017.

Like Ebola, Lassa fever is a hemorrhagic fever, though considered less serious than Ebola. According the WHO, Lassa fever usually starts with a fever and progresses to a headache, muscle pain, nausea, vomiting, and diarrhea. In severe cases there may fluid in the lungs, and bleeding from the mouth, nose or other areas. In the most advanced stage of the disease shock, seizures, and coma may occur. In fatal cases, death usually occurs within 14 days of the onset. The drug Ribavirin, given via IV, is considered an effective treatment for Lassa fever if given within 6 days of the onset of symptoms.

What’s causing such a large outbreak? According to Dr. Chikwe Ihekweazu, director of the Nigeria Centre for Disease Control, a couple things may be at play: Improved detection, and that Nigeria’s growing population has brought people closer to the disease host: the infamous rat.

According to NPR:

“West Africa’s dry winters push rodents closer to people to scavenge for food. Virus-carrying rats may defecate or urinate in grains and other food; people can pick up the virus from contact with contaminated products. The virus can also spread between people via bodily fluids. And there are a lot of rats – which means there’s a lot of potential for outbreaks.”

The WHO is scaling up its response to the outbreak, and heath officials are urging people to keep food in sealed containers, as well as limit the proximity of garbage to homes.

 

Lifelong Ebola Immunity?

Fourteen survivors from the first known Ebola outbreak in 1976 appear to have developed immunity against the disease, according to a study published this week in the Journal of Infectious Diseases. The study showed that the survivors blood contains antibodies that protect against, and in some cases even destroy, the Ebola virus.

An earlier study had shown that Ebola survivors have some immunity after 14 years, but this new study shows that protection lasts for at least 40 years. The Ebola virus is known for hanging around longer than anyone would like, frequently hibernating in eyes and semen. This “tenacity might explain why survivors continue to produce antibodies against it, long after they’ve finally cleared it from their bodies.”

All of the 14 people they studied still carry antibodies that recognize at least one of the Ebola virus’s proteins, and four had antibodies that could completely neutralize the virus. “Those are the kinds of responses you’d like to see in a vaccine—long-lasting and robust,” says Rimoin, “which means that these antibodies are of great value to science.”

A Way to Predict Ebola Outbreaks?

Researchers have identified a possible link between deforestation and the emergence of Ebola outbreaks. There is evidence that Ebola outbreaks are likely to occur within 2 years of forest loss.

This new research also suggests that preventing the loss of forests could reduce the likelihood of future outbreaks. “We have accumulated knowledge that removing forests causes problems not just to the functioning of the climate and ecosystems but also to humans, then we must see it as a threat to human livelihoods, health, security and everything else,” said Fa – a Senior Associate at CIFOR and a Professor of Human Development and Biodiversity at Manchester Metropolitan University in the United Kingdom.

When forests are destroyed, the animals that live in them are displaced. The Ebola virus is transmitted from wild animals, such as fruit bats or apes.

The forests should not be protected for the sake conservation alone but also for health reasons, according to Lutwama, a Virologist at the Uganda Virus Institute. “People should keep the forests,” he said.

 

 

Ebola’s Revenge

Ebola is a lingerer. It’s that guest at your party that stays even when everyone else is leaving, continuing to drink from leftover open bottles of wine. It’s that annoying friend who has overstayed their welcome even though you have made it perfectly clear you have very important, but very vague things to do and while you can’t quite bring yourself to physically usher them out, you are about to set off the fire alarm in a desperate attempt to “politely” get them to leave.

Ebola may linger in semen for 2 years, or more! No one really knows yet, because while Ebola has been happening since at least 1976 (WHO fact sheet), no one was invested in funding studies to better understand Ebola until 2014, when it seemed like the United States could possibly have a Hot Zone situation on their hands. Side note: The Hot Zone is one of my favorite books and I highly recommend it. I can also recommend the audio version of the book, especially if you are on a long trip driving more than 4 hours at a time. It will definitely keep you awake.

Other lasting Ebola effects occur in the eyes. Survivors in West Africa, many of them young children, have developed cataracts. The NY Times reports:

Cataracts usually afflict the old, not the young, but doctors have been shocked to find them in Ebola survivors as young as 5. And for reasons that no one understands, some of those children have the toughest, thickest cataracts that eye surgeons have encountered, along with scarring deep inside the eye…

There are about 17,000 Ebola survivors in West Africa, and researchers estimate that 20 percent of them have had a type of severe inflammation inside the eye, uveitis. It can cause blindness, but even if it resolves and sight returns, cataracts can quickly follow. Usually, just one eye is affected.

Many Ebola survivors have been found to have “major mobility, cognitive and visual limitations” as well as “higher levels of depression, anxiety, fatigue and pain. They also showed difficulties in concentrating and remembering and most of them suffered from blurred vision.”

Finally, what about the people tasked with gathering the bodies?

Not only did they stand a high chance of catching the virus themselves, they also risked beatings from mobs of hostile locals, who either refused to believe the virus existed, or blamed the health workers for spreading it…

But the masks, gloves and rubber boots were no protection against a contagion of a different sort.

For many of his colleagues, the horrors they saw every day have stayed in their minds ever since, driving some towards madness and others to drink and depression.

There is some good news, though. An experimental Ebola vaccine has been found to protect against Ebola for one year.  When the next outbreak happens the world will at least be better prepared.