Overview of the Ebola Virus: Symptoms, causes and treatments

Dr. Ajay KohliJun 23, 2024

Ebola virus disease, previously termed Ebola hemorrhagic fever, emerged in 1976 in the Democratic Republic of the Congo, marking the onset of sporadic outbreaks persisting to the present day. Symptoms typically encompass fever, body aches, diarrhoea, and occasionally bleeding, characterising the acute phase of the illness. 

Transmission primarily occurs through direct contact with an infected individual's blood or bodily secretions or via handling sick or deceased animals, particularly primates or bats known to harbour the virus. 

The virus's ability to spread rapidly within communities, coupled with its high fatality rate, poses significant public health challenges, needing surveillance, prompt containment measures, and widespread education to mitigate its impact and prevent future outbreaks.  Read ahead to know more about this disease.

Contents

• What is the Ebola Virus?
• Signs and symptoms of the Ebola virus
• What causes the Ebola virus?
• Long-Term Complications Of Ebola
• Treatment of the Ebola Virus
• What Is The History Of Ebola?
• The Major Outbreak
• Efforts Taken
• How to diagnose the Ebola Virus?
• How can I prevent the Ebola Virus?
• Research And Statistics
• Risk factors of the Ebola virus
• Related conditions
• Frequently Asked Questions (FAQs)

What is the Ebola Virus?

Ebola is a rare, contagious, and deadly virus that causes hemorrhagic fever, marked by iconic bleeding. During infection, when the virus lurks in the body for more than a week, it begins to wreck the immune system, blood vessels, and vital organs, resulting in multi-organ failure with excessive bleeding and shock, followed by death.  There are six known strains of the Ebola virus, and four affect humans. The Centres for Disease Control and Prevention (CDC) have graded the Ebola virus as a Category A agent, meaning the virus can be used as a bioterror tool owing to its human-to-human mode of transmissibility. 

Ebola is a hardy virus that can survive for several hours on inanimate surfaces like doorknobs, but the virus that is in the body fluids like blood can live much longer. 

Signs and symptoms of the Ebola virus

Symptoms appear 2 to 21 days after a person is infected with the Ebola virus and would feel like the flu or other viral illness early on. There is a sudden onset of the following.

• High fever

• Severe headache

• Joint pain and muscle pain

• Sore throat

• Rash

• Severe muscle weakness

Other symptoms that develop later as the infection progresses include the following.

• Nausea

• Diarrhoea

• Vomiting

• Organ failure (reduced function of liver and kidney)

• Unexplained bleeding from the eyes, ears, nose, and mouth 

Roughly 50% of Ebola patients die due to the rapid onset of diffuse bleeding and shock.

What causes the Ebola virus?

Ebola virus disease (EVD) is caused by the Ebola virus, a member of the filovirus family, which is believed to circulate among wild animals in Sub-Saharan Africa and spread to humans via bats. 

People get the Ebola virus often when they: 

• handle diseased animals (alive or dead) such as chimpanzees, gorillas, fruit bats, etc.  

• have unprotected direct contact with contaminated blood and body fluids (breast milk, urine, saliva, vomit faeces, and semen) during sex or burial ceremonies 

• touch Ebola virus-contaminated objects such as needles, gloves, and sheets 

• fail to undertake infection-control and personal protective equipment (PPE) measures such as masks, gloves, and gowns in healthcare settings 

Ebola does not spread through the air, water, or food. Even mosquito bites or causal contact are not theoretically known to transmit the virus.

Long-Term Complications Of Ebola

Surviving Ebola doesn't always mean complete recovery. Long-lasting effects like headaches, skin peeling, and vision issues such as blurred vision or light sensitivity can persist. Survivors may also suffer from peripheral neuropathy, leading to numbness and tingling, along with eye discomfort, muscle and joint pain, and stomach issues. These enduring symptoms significantly affect survivors' well-being, highlighting the need for continued medical attention and support. 

Comprehensive healthcare measures, including ongoing monitoring and management, are essential beyond the acute phase of the illness. Addressing the enduring health challenges faced by Ebola survivors requires vigilant healthcare practices to ensure their long-term well-being and quality of life.

Treatment of the Ebola Virus

With no cure, supportive hospital care is the cornerstone treatment for patients infected with the Ebola virus and those exhibiting symptoms (like other viral haemorrhagic fevers) to improve their odds of survival. It includes the following. 

• Oxygenation

• Fluid replacement and dialysis

• Maintaining stable blood pressure 

• Managing fever and pain

• Treating other comorbidities (i.e., other injuries or infections)

Recently, the US FDA has approved two monoclonal antibodies-based treatments that work by binding to the virus and blocking its entry into the person's cell. 

These include the following.

• Inmazeb (has three monoclonal antibodies: atoltivimab, maftivimab, and odesivimab-ebgn). 

• Ansuvimab-zykl (Ebanga) 

A study found that patients receiving either treatment have a very high survival rate. 

What Is The History Of Ebola?

The emergence of Ebola virus disease (EVD) in 1976 marked the beginning of a series of outbreaks and sporadic cases across various regions globally. Initially reported simultaneously in Yambuku, near the Ebola River in Zaire (now the Democratic Republic of the Congo), and Nzara, Sudan, subsequent eruptions and instances of asymptomatic cases have occurred due to outbreaks, laboratory accidents, and accidental exposures.

Since its initial identification, EVD has surfaced intermittently in numerous countries, including the Democratic Republic of the Congo (DRC), Sudan (including South Sudan), Senegal, the United Kingdom, the United States (U.S.), the Philippines, Italy, Spain, Gabon, Ivory Coast, South Africa, Russia, Uganda, Guinea, Liberia, Sierra Leone, and beyond.

The Major Outbreak

Among these, the 2014 Ebola outbreak stands as the largest in history, primarily affecting Guinea, northern Liberia, and Sierra Leone. The epidemic devastated communities, with the Centers for Disease Control and Prevention (CDC) estimating over 11,000 deaths, predominantly concentrated in West Africa. The outbreak's unprecedented scale underscored the urgent need for enhanced international cooperation, resources, and preparedness to combat such infectious threats effectively.

In the United States, there were reports of two imported cases and two locally acquired cases among healthcare workers during the 2014 outbreak. These incidents prompted heightened vigilance and response efforts to prevent further transmission within U.S. borders.

Efforts Taken

Despite the alarming toll of the 2014 outbreak, a collaborative global response led by public health authorities, international organisations, and local communities facilitated containment efforts. Prompt intervention, including enhanced surveillance, contact tracing, isolation protocols, and public awareness campaigns, played pivotal roles in limiting the outbreak's spread and mitigating its impact.

Moreover, a small number of cases were reported in Nigeria, Mali, and Senegal during the 2014 outbreak. However, due to swift and decisive public health responses, these countries successfully contained the spread of the virus, preventing widespread transmission and averting a larger crisis.

How to diagnose the Ebola Virus?

It is difficult to diagnose the Ebola virus shortly after infection. However, if your doctor suspects you have Ebola based on your symptoms and travel history, they will confirm the diagnosis by testing your blood and tissues in a laboratory.

The standard laboratory test for Ebola diagnosis is polymerase chain reaction (PCR), where a positive result confirms Ebola infection.Sometimes, antibody detection (ELISA) also helps in detecting exposure and infection by Ebola. 

How can I prevent the Ebola Virus?

Even though the likelihood of contracting the Ebola virus while travelling to Africa is considered very low, it's best to avoid paying visits to areas with active Ebola virus transmission. 

However, if this is not possible, you can still protect yourself from getting a potentially serious infection by following these basic precautions.

• Wash hands thoroughly and frequently with soap and water or alcohol-based hand sanitiser.

• Take care not to come into contact with possibly contaminated body fluids or other surfaces (e.g., clothes, medical equipment, needles).

• Make sure to stay away from funeral or burial rituals that involve handling infected bodies. 

• Avoid handling body fluids or raw meat of nonhuman primates and bats.

• Adhere to safe sex practices using condoms.

Since healthcare workers handling patients suspected or confirmed with the Ebola virus are also at greater risk of contracting Ebola, they must stick to the general principles of infection control, such as the following. 

• Wear protective clothing when exposed to patients.

• Exercise basic hand hygiene. 

• Dispose contaminated needles and other equipment, and sterilise other non-disposable equipment.

• Dispose infected patient's body fluids and tissues. 

• Follow safe injection and burial practices.

• Isolate suspected patients from each other and confirmed patients. 

In addition, the European Medicines Agency and WHO have recently authorised two vaccines for use in adults and children.

• Ervebo 

• Zabdeno-Mvabea (for individuals one year and above)

The Ervebo vaccine is administered in a single dose and solely protects against the Zaire virus strain. Meanwhile, Zabdeno-Mvabea is given in two doses: Zabdeno is delivered early, followed by Mvabea roughly eight weeks later. Both vaccines are preventative and are not intended for use during outbreaks.

Research And Statistics

The 2014–2016 West Africa Ebola outbreak was devastating, with the CDC documenting 28,616 cases and 11,210 deaths in Guinea, Liberia, and Sierra Leone. Outside these countries, there were 36 cases and 15 deaths. Despite its impact in sub-Saharan Africa, Ebola isn't currently deemed a threat beyond the region. Experts stress the importance of considering geographic risk factors rather than resorting to racial labelling. 

It's crucial to understand that anyone, regardless of race or ethnicity, can be susceptible to contracting the virus. This recognition underscores the need for global solidarity in addressing health crises, as infectious diseases like Ebola can transcend borders and affect diverse populations. 

By focusing on geographic risk factors and promoting inclusive approaches to public health, we can better prevent and respond to outbreaks while combating discrimination and stigma associated with disease transmission.

Risk factors of the Ebola virus

The risk of catching Ebola for the general population is generally low. But the threat is considerably larger for those who reside in or travel to Ebola risk zones. They acquire Ebola disease when they:

• handle or consume raw meat of wild animals (e.g., bush meat) infected with the Ebola virus. 

• clean the body fluids or touch the soiled clothes of a symptomatic Ebola patient without the proper protective equipment.

• live in the same residence and provide direct patient care to the infected individual while they exhibit symptoms.

• prepare burial for those infected with Ebola.

• process infected body fluids of an Ebola patient without the proper PPE or standard biosafety procedures.

Alternatively, a person's age, gender, and ethnicity do not make them susceptible to Ebola infection. 

Related conditions

The recurrence of Ebola outbreaks underscores the persistent threat posed by emerging infectious diseases and the critical importance of sustained preparedness and response mechanisms on a global scale. 

Efforts to strengthen healthcare systems, enhance surveillance capabilities, invest in research and development of vaccines and treatments, and promote international collaboration remain imperative in mitigating the impact of future outbreaks and safeguarding global health security.

• Several medical conditions exhibit signs and symptoms similar to Ebola, posing diagnostic challenges. 

• Among these, Marburg virus disease presents comparable symptoms such as fever, body aches, and hemorrhagic manifestations. Malaria, characterised by fever, chills, and fatigue, can mimic Ebola's initial presentation. 

• Additionally, typhoid fever, marked by high fever, abdominal pain, and diarrhoea, shares clinical features with Ebola. 

• Distinguishing between these diseases is crucial for accurate diagnosis and appropriate treatment, underscoring the importance of comprehensive medical evaluation, laboratory testing, and clinical judgement to differentiate between these potentially life-threatening conditions.

Frequently Asked Questions (FAQs)

Here’s a list of common queries and their answers related to Ebola.

How soon after exposure do the symptoms develop?

Symptoms can appear from 2 to 21 days after exposure, like a flu illness.

Is it possible to get Ebola from an infected person who doesn't have any symptoms?

No. Typically, a symptomless individual is not contagious. And for successful viral transmission, direct contact with a symptomatic individual is required.

How to stop the transmission of the virus if an outbreak happens?

To break the chain of transmission, isolate the suspected and confirmed patients first. In unison, people who have had close contact with patients should also be contacted and monitored for the development of possible Ebola symptoms.

How long does the Ebola virus remain in the body after a patient recovers?

The Ebola virus does not stay in the body after a patient fully recovers. However, the virus tends to persist in semen and breast milk for an extended period. Therefore, patients, including pregnant women, must take additional steps to avoid exposing others to these fluids.

If survived, does a person get immune to Ebola?

Evidence shows that patients who survive an Ebola illness are immune to the virus strain they contracted. However, the chance of subsequent infection from different strains remains.

References

1. http://www.ncbi.nlm.nih.gov/books/NBK560579/

2. https://www.who.int/news-room/fact-sheets/detail/ebola-virus-disease

3. https://www.nhs.uk/conditions/ebola/

4. https://www.cdc.gov/vhf/ebola/index.html

5. https://www.health.ny.gov/diseases/communicable/ebola/faq.htm

6. https://www.health.state.mn.us/diseases/ebola/basics.html

7. https://www.ecdc.europa.eu/en/ebola-and-marburg-fevers/facts/questions-answers

Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. Please consult a doctor before making any health-related decisions.

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