Following a number of recent media queries regarding the current Ebola outbreak in West Africa, Dr. Graham Fry, Medical Director of the Tropical Medical Bureau, has released the following comment.
Commenting today, Dr. Graham Fry, Medical Director of the Tropical Medical Bureau, said, “Ebola is a serious and very contagious viral disease which was first recognised in 1976 in Zaire (DR Congo – Ebola River region) and has been responsible for many deaths throughout the continent since that time. Typically the mortality associated with these outbreaks has been between 50 to 90% with many deaths occurring among close family members and the health care professionals who have dealt with the patients. The current outbreak in West Africa currently has a mortality of between 50 to 60%.
This virus can infect various animals, including bats, who do not suffer from the disease. Humans eating ‘bush meat’ may become infected and then spread the virus to others once they become ill themselves. The disease is not known to be air borne but once an individual is experiencing symptoms of infection it is then mainly spread through close personal contact with body fluids.
It is also recognised that a male who recovers from the disease may still transmit the Ebola virus in his semen for up to 6 weeks following recovery. Therefore unprotected sexual contact should be avoided under these circumstances. It is uncertain how contagious the disease is through perspiration of cough droplets and so avoiding crowded situations is a sensible precaution as this risk is being evaluated.
Some animals can contract the disease and suffer in the same way as humans (monkeys, chimpanzees etc) and others can ‘carry’ the disease without suffering the consequences (eg bats).
The main signs and symptoms of this disease are associated with the loss of integrity of the cell structure throughout the body of an infected individual. In other words the cell wall of the body’s organs and vessels become very permeable and start to leak their contents into surrounding tissues with devastating effects for the individual.
The initial symptoms are usually similar to a cold / flu with nasal congestion, reddened eyes and generalised muscular aches and pains. This progresses into a state of profound shock with loss of blood pressure as the cell walls become permeable. Death can then occur very rapidly – either from the shock state or associated with secondary infections.
This disease is one of the most infectious diseases known to man and has an extremely high mortality in comparison to other more commonly considered disease (eg Yellow Fever 20 to 30% mortality, SARS 10% mortality).
To stay safe avoid crowded meetings (eg cinemas, local transport etc) and also avoid shaking hands and any other avoidable personal contact. Funerals, hospitals and Ebola assessment/treatment centres are obvious higher risks as well as funeral homes and burial grounds.
Regarding the spread of Ebola on an aircraft it again comes down to close personal contact. The official line at present is that anyone sitting within six rows of an infected individual (usually identified after the flight) would be regarded as at higher risk and be quarantined or at least closely followed up by the health authorities.
It is possible for Ebola to come to Ireland, in the same way as any other country throughout the world. Basically the ‘challenge’ is that individuals may travel within the incubation period (1 to 3 days up to 21 days) when they are perfectly healthy and well and not known to be capable of passing the disease on to others, and then get ill themselves some days later.
During the time after the first symptoms occur they may continue to have contact with any number of individuals before they are recognised as having possibly contracted the disease and separated from others. However, it is not known if the individual could possibly be infectious for some hours before they do actually get these first symptoms and that is a of course a major worry.
There is no set time frame on how quickly it could spread. This depends on how many people could have been ‘touched’ by an infected individual during that initial phase before they become ill and how many of them could have contracted the illness through this exposure. In Western Europe that is thought to be quite an uncommon occurrence but if the disease should actually take hold within a Western city then the question of continuing to provide crowded public transport would need to be considered.
Best and worst case scenario
At the moment the best case scenario is that the heightened awareness of the potential global catastrophe will mean that healthcare staff will be more in tune with the health risks associated with international travel and increase their willingness to obtain a good geographical history from each and every patient they meet and to be aware of the consequences to them personally as well as their family and friends should they become lax.
The worst case scenario is that many further cases are identified globally and fear spreads to the extent that medical staff are unwilling to tend sick patients who could in fact have a multitude of other diseases and not Ebola. Another major concern would be that the disease (also same problem for Avian Influenza) becomes air-borne.
Bottom line is that despite the fact that this is a horrific disease which is frighteningly infectious and contagious with a colossal mortality, the disease is a small risk for the vast majority of the world’s population at this point in time. If sensible precautions are taken by the individual and if governments throughout the world support simple health education programmes as well as a clearly defined approach as to how their healthcare professionals should deal with a potential case then the risk of a true global pandemic should be averted.
What governments should be doing
Governments should consider hosting a 24/7 advice line (well covered easily available to all the population and also healthcare staff) as well as a number of suitably equipped mobile emergency teams who can travel across the country to assess potential risk individuals, then the spread of this disease can be interrupted at an early stage and before we seen it becoming embedded and a long term disaster within other countries.
Remember that, even though there is another dreadful killer in the Middle East (MERS) and also Marburg in Uganda at present, there are a heap of much more common ‘tropical’ illnesses killing significantly more each and every day throughout the world.”
To book an appointment, please contact the Tropical Medical Bureau on 1850 487674 or visit www.tmb.ie.