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Wednesday, 30 July 2014

Ebola - Threat analysis, reassurance and practical advice

Every once in a while an emerging disease threatens a number of people and draws considerable interest.  Based on global reactions, the threat posed by contagions has been embodied within the Ebola Virus.  Its repeated emergence with devastating consequences, followed by years of acquiescence bolster its image as the deadly monster lurking on unsuspecting human prey and attacking without warning. Ebola has received its share of attention by DrPHealth as well with a more definitive review in August 2012 at which time there were only a collective 2270 cases ever recorded.  

Hence it deserves a few more lines in the face of over 1200 cases to date in an outbreak that is reporting a 60% fatality rate.   Moreover where most previous outbreaks have occurred in the central jungle regions in the Ugandan, South Sudan, Congo,  Gabon  areas, this outbreak has centred around the Guinea and West Africa (putting the distance between epicentres about the same as from Vancouver to Toronto, or Halifax to Regina). 

Those keen on following its path should familiarize themselves with the WHO Ebola surveillance site
Sustained transmission in this outbreak is predominately through contact with infected blood and body fluids of infected persons.  Typical outbreaks occur through initial contact with infected animals (monkeys or pigs).  The natural reservoir of the virus appears to be fruit bats of which some species extend across the sub-Saharan regions from West to Central Africa where outbreaks have been noted. 

Prevention is through the most basic of infection prevention techniques, and while pictures of high level space suits with self contained breathing seem to dominate the graphic symbolization of the Ebola threat, much less rigourous infection prevention activities would likely be just as effective – of course who would want to try when such barrier techniques are readily available and the consequences of contracting the illness are so dramatic.

Hemorrhagic fevers are nasty illnesses.  Acute onset, high fevers, with rapid involvement on intestinal tract, muscle pains, kidney and liver.  Typified by low platelet counts which result in bleeding that can be terminal augment the fear about the disease.  It is not something that goes unnoticed when it occurs although speculation exists on less severe forms that may contribute to the sustaining of outbreaks.  

The risk to persons outside the area is far lower than rare infectious diseases that sporadically occur within Canada.  Exportations of Ebola have been very uncommon and countries like Canada  have viral hemorrhagic fever protocols that cover a host of potential threatening agents and overlap the bioterrorism response protocols.  As with any emergency response the key is to know the first few steps, and as public health workers to be able to provide advice on patient isolation, limitation on an invasive testing without laboratory containment in place, and how to contact the PHAC emergency line for national support on any suspect case.

Not that we should be retooling our systems to respond to the current threat, there are far more likely infectious agents lurking in our own neck of the world.  

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