Communicable Diseases: Ebola 

Communicable Diseases: Ebola

Introduction

Communicable disease is the illness that is caused by bacteria or viruses which are carried people and spread to one another through contacts with contaminated bodies, surfaces, air, insect bites, body fluids. In the current medical field, there are numerous communicable diseases which include but not limited to HIV, Chickenpox, TB, Influenza, Hepatitis B, Ebola Measles, and Polio. The epidemiology of infectious diseases tries to understand the distribution mechanisms and the determinants of these diseases in a defined population and its application to the control of these disease and other health-related problems. In this assignment, I would wish to talk about Ebola which is one of the deadliest communicable diseases in the world.

Ebola

The Ebola Virus Disease (EVD) formerly known as Ebola hemorrhagic fever is a deadly communicable disease which was first diagnosed in Africa, in Democratic Republic of Congo in a village near River Ebola thus the name in 1976 (Gatherer, 2018). Initially, when the outbreak occurred, the public health officials made assumptions that the outbreaks were single events associated with an infected individual who traveled between two locations. Later the spread was numerous which called for immediate medical interventions.

Causes, Symptoms, Mode of Transmission, Complications, and Treatment

The first cause of Ebola outbreak occurs when the virus is transmitted from an infected animal to humans then the then the virus is now spread among humans. Wild animals such as bats, gorillas and chimps may have the virus and spread to humans through contact. A particular type of a bat called the fruit bat is believed to be the natural host of the virus when it first broke out in Central Africa (Norris et al, 2018). The EVD transmission occurs between people through direct contact of the open wounds or the mucous membranes. It is also transmitted through body fluids as well as secretions from infected persons. Such secretion includes blood, sweat, breast milk, semen, urine, stool or vomit. If transmitted through semen the virus may take up to two months to manifest. Additionally, the virus can also be transmitted through contacts with contaminated objects or the bodies of the casualties of the virus (Reddy et al, 2018). Therefore, safe burial practices must be enhanced to contain more outbreaks. Moreover, the cultural burial practices in some communities around the world such as ritual washings must be prohibited to contain further spread of the virus.

The EVD usually targets the host’s blood and the immune system. Consequently, the effect can lead to a weak immune system and severe bleedings. After an incubation period of about two weeks, there is the onset of rapid flu-like symptoms which include fever, muscle pains, sore throat, general body weakness and headache (Gatherer, 2018). The advanced symptoms of EVD include diarrhea, vomiting, and measles-like rashes on the skin and reduced kidney and liver functions. Such signs usually lead to both external and internal bleedings due to the damaged blood vessels after five days of the symptom onset. The other complications may include death due to shock as a result of body organ failures. Additionally, the EVD results in severe dehydration which is caused by extensive vomiting and diarrhea.

Treatment and prevention of EVD typically involve restricted nutrition, supportive care-rehydration with either intravenous or oral fluids and medication that suppresses the symptoms (Reddy et al, 2018). This approach is taken because currently, EVD has no cure or any available vaccines. Moreover, early supportive treatment is critical to prevent severe dehydration. EVD essential treatment and prevention lies in limiting the transmission from animals to humans. Such key measures include rapid quarantine, wearing gloves when handling animals, safe injection practices, sanitation and sterilization of the environment and instruments, isolation of the infected persons and animals, and thorough cooking of animal products before eating (Reddy et al, 2018). In 2015, medical experts in Guinea tried to come up with experimental Ebola vaccine called rVSV-ZEBOV which provide quite effective in controlling the spread of the deadly virus.

Demographic of Interest

In the year 2014, USA reported four cases of the Zaire Ebola virus with one death case and a case fatality of 25% according to the survey by the World Health Organization. In the same study, same year, DRC led the other countries with 66 cease of the virus reported and 49 deaths resulting in 74% case fatality (World Health Organization, 2018). Nevertheless, Mali led in the overall case fatality at 75% after reporting eight cases and six deaths of the virus. Besides the research by the WHO, several types of research have been done to show the morbidity and the mortality rates of EVD. In separate research, between March 2014 and July 2015, Liberia reported more than 10,500 cases of Ebola virus and over 4,800 deaths (World Health Organization, 2018). In the DRC for example, the prevalence rates as at 30th May 2018 reports 25 deaths and with case fatality ratio of 56%. The various statistics indicate that EVD is most prevalent in West African counties such as Guinea, Sierra Leone, Liberia, and Nigeria.

The latest reports on the virus incidence is that of the WHO of 1st August 2018 which indicated the DRC declared fresh outbreaks in the Province of North Kivu (World Health Organization, 2018). As of 18th December 2018, the latest incidences included a total of 549 total cases with 501 confirmed. The deaths from this number were 326 with confirmed deaths totaling to 2718 and 48 probable deaths (World Health Organization, 2018). With the recent cases of the EVD fresh outbreaks, this disease is reportable. Every government across the globe responded to the calls to send medical doctors to Italy in collaborative medical research for the EVD vaccine. The fact that several doctors from all over the world US included indicates the disease is reportable. If any cases of Ebola virus is suspected to have encroached a population, the first reports should be done to the respective healthcare organizations so that the medical teams could respond promptly and prevent any further spread (World Health Organization, 2018). After which, the individual is isolated for the rest of the population before case reports are channeled to the respective governments. The EVD must be reported immediately upon signs showing in an individual.

Health Determinants and EVD

Health Care Workers

The social determinants of health for a particular disease are complex. The determinants of the spread of Ebola are based on the past evidence when the disease broke put in most parts of the world. These determinants include health care and community-related risks factors. Health workers are one of the significant determinants of health in any community. The presence of health care professionals leads to prompt response if any strange disease is reported. The severe shortage of health care workers in most parts where the EVD was reported led to the development of EVD. Before the outbreaks of the EVD in DRC, Sierra Leone, Liberia, and Guinea, the ratio of patients to doctors was one to two doctors per 100,000 population (Norris et al, 2018). The outbreaks further resulted in the unprecedented number of health care workers falling victims to the deadly virus outbreak. More than 700 doctors were infected and close to half died by the end of 2016 (Norris et al, 2018). The condition worsened since there were inadequate healthcare workers and those who were left were gripped in intense fear.

Health Infrastructures

Health infrastructures such as clinics, public and private hospitals form a crucial part in the determination of healthcare providence. Areas which lack health care facilities or areas with inadequate facilities is likely to impact negatively on the population of such areas. The four counties which received high rates of EVD outbreak, most of them had damaged healthcare facilities (Norris et al, 2018). Guinea, Liberia, and Sierra Leone are among the poorest countries in West Africa with poor road systems leading the few health facilities and poor telecommunication networks. When such outbreaks were reported in the rural areas, it was difficult for the few health care professionals to reach out to the affected persons. EVD is a highly contagious disease, spread so fats among those who lacked the background knowledge about the virus and came into contact with the infected individuals. The virus thus spread rapidly and killing many (Norris et al, 2018). Poor roads linking the healthcare faculties culminated by the poor status of the healthcare facilities themselves resulted in more spread.

Epidemiology Triangle of Ebola

Epidemiology triangle is a model used by the scientist for studying health problems. The triangle consists of the agent at the epitome, the host and the environment at the bases. Concerning EVD, the agent which causes the disease is the Virus in the group of viruses called the Ebolavirus. The host of the diseases include nonhuman primates and wild bats. The environment represents the external factors which facilitate the transmission of the disease and this case the human body fluids and stool, form the environmental aspect.

Figure 1: Epidemiology Triangle of Ebola

Ebola Virus Special Considerations and Notifications

EVD is a deadly virus and can kill within a short period. Besides, as mentioned before, EVD is highly contagious and infectious. Once individual contact the disease, isolation follows as a preventive measure to other unaffected population, Ebola patients treated with special considerations and in isolated rooms. The health care professionals who deal with the disease must also take into account the various preventive measures. When the outbreak occurred in Sierra Leone, Liberia and Guinea, there was the general assumption that the healthcare professionals who devoted their lives to deal with the disease did not treat themselves with utmost consideration leading to the unprecedented deaths of the doctors.

The health care professionals must consider covering their whole with sterilized full body suit replete, gloves, masks, and plastic goggles. The patients are also handled in separate cleaned rooms to minimize the chances of the transmission — various health agencies such as the WHO play pivotal roles in notifying the public about the Ebola outbreaks as witnessed on 23rd March 2014 (Reddy et al, 2018). During this year, the WHO published formal notification of an Ebola outbreak in countries like Guinea and Sierra Leone on its website. The same information is derived from the respective governments which notify the general population.

Role of Community Health Care Nurse in the event of Ebola Outbreak

The community health care nurses play a very integral part in assessment processes, case findings, reporting, collecting and analyzing some data and doing the follow-up activities to the reported casualties and the general population. Before the outbreak of Ebola in various countries in West Africa, the community health care nurses provided a range of curative and preventive child health, newborn and maternal services. They reported multiple cases of assessment, diagnosis. Besides, they took part in case findings of the danger signs which could trigger immediate health facility referrals. During the Ebola outbreak, the Community Health nurses gave varied accounts of continued service provision of the integrated community case management (iCCM). They did this by collecting views from the respondents in the form of a research program. The nurses were also in charge of collecting data from the quantitative and the qualitative studies conducted. They trained on a revised “no-touch” rationale of the iCCM. They were consequently advised to continue providing care to children without making any contact with a patient or caregiver. This called for the inadequate use of the rapid diagnostic tests.

The World Health Organization

The WHO is a global organization which has played a pivotal role in sensitizing communities across the world about health issues. When the outbreak of Ebola occurred in Africa, the WHO was at the forefront to deliver the information to billions of their website users across the globe (World Health Organization, 2018). Their notification mechanisms reached even some governments on the same continent which had not heard about the Ebola outbreak. WHO works in close collaboration with the respective governments in sensitization and education approaches which help most citizens and health care professionals in the affected countries practice safe healthcare approaches (World Health Organization, 2018). The WHO has also promoted research-based practices which allow the various countries to get the fact files of the deadly virus. The various research works sponsored by this organization have been extensively used in educating the members of the global society and consequently reducing the transmissions of Ebola.

The organization also sponsored various Ebola training seminars in coordinating the Ebola response via the United Nations Mission for Ebola Emergency Response (UNMEER) program (World Health Organization, 2018). The program aimed to bring the Ebola outbreak under control. Since the invention of the UNMEER, many partners have been having various training of the personnel on the ground to educate the public through emergency preparedness and response. The other roles of the WHO in controlling Ebola include designing and delivering pre-deployment training for any caregiver who is going to work in the affected countries, coordinating and supporting training partners as well as various governments, providence scientifically sound advice and guidance for use during multiple trainings and ensuring the practice meet the quality standards required for Ebola control (World Health Organization, 2018).

Global Implication of Ebola

Ebola has devastating health effects if it encroaches in a country. Being one of the deadliest communicable diseases, each government is putting stringent measures on the traveling policies. During the outbreak in the 2014-2016 period, many domestic and international flights were significantly hampered. Countries like Liberia and Sierra Leone received strict measures and rules for their citizens to travel to overseas countries (Reddy et al, 2018). This involved strict screening at the various airports for Ebola virus and those found to be having even the slightest indication of the virus were either repatriated or denied travel permit (Reddy et al, 2018). This approach was basically to limit the transmission of the virus. After various countries made the travel policies, the various governments in a meeting convened by the WHO Director-General under the International Health Regulations (IHR) agreed to select various medical experts from their countries to participate in a joint mission of establishing the most effective vaccine, a convention of medical experts in 2014. This shows the extent to which governments are committed to controlling the spread of the virus. In several tests conducted on various bats, the results were not verifiable even though the disease is a major public concern. Before the outbreak, EVD was mistakenly thought not to be endemic to West Africa by the International Community.

Conclusion

To conclude this assignment, the EVD needs more sensitization regarding its prevention. The recent cases still show the virus could be still existing in some parts of DRC according to the latest report by WHO. The governments and varies agencies need to be more vigilant in tackling the spread of Ebola. The healthcare professionals across the globe should also ensure they provide the right healthcare education to the vulnerable population. Community health care nurse has a big role to play in conducting the case findings, collecting and reporting any slight indications of the virus.

References

Gatherer, D. (2018). Ebola returns to its Congo Basin heartland. Journal of General Virology.

Norris, S. L., Sawin, V. I., Ferri, M., Sastre, L. R., & Porgo, T. V. (2018). An evaluation of           emergency guidelines issued by the World Health Organization in response to four      infectious disease outbreaks. PloS one, 13(5), e0198125.

Reddy, S. K., Mazhar, S., & Lencucha, R. (2018). The financial sustainability of the World Health             Organization and the political economy of global health governance: a review of funding             proposals. Globalization and health, 14(1), 119.

World Health Organization. (2018). Ebola situation report 16 March 2016. Geneva: World Health             Organization, 2016.