1.What is Ebola hemorrhagic fever?
Ebola hemorrhagic fever (hereafter referred to as Ebola) is a serious and often fatal disease with a mortality rate of up to 90%. The disease can affect humans and other primates (monkeys, gorillas and chimpanzees.) Ebola was first identified in 1976 in two simultaneous outbreaks, one in a village near the Ebola River in the Democratic Republic of Congo and the other in a remote area of Sudan. The origin of the virus is not known. Based on the available evidence, fruit bats (family Foxbatidae) are thought to be the likely natural hosts of Ebola virus.
2. How do people become infected with this virus?
In the current outbreaks in West African countries, most cases are caused by human-to-human transmission. Healthy people are infected through direct contact of broken skin or mucous membranes with the blood and secretions (such as feces, urine, saliva, semen) of an Ebola-infected person, or through contact of broken skin or mucous membranes with objects contaminated by body fluids of the patient, such as clothing, bed sheets or used needles.
More than 100 health care workers have been infected with Ebola during the course of patient care, either because they did not wear personal protective equipment or because they did not strictly enforce infection control measures during patient care. WHO does not recommend that patients with symptoms of Ebola hemorrhagic fever be treated at home or in the community, but rather at a hospital with the capacity and facilities to treat patients with Ebola hemorrhagic fever. If you choose to have the patient treated at home, WHO strongly recommends that you report to your local health department and receive training on the use of protective equipment (gloves and other personal protective equipment), how to dispose of it after use, and how to further prevent the virus from infecting yourself, other family members, or people in your community.
Funerals or burial ceremonies for deceased people with Ebola hemorrhagic fever can also lead to transmission of the virus. Direct contact between people and the body of the deceased is an important way in which Ebola virus is transmitted. Therefore, it is important that people wear protective clothing and gloves with better protection when handling the body of the deceased and bury the deceased immediately.WHO recommends that the deceased be buried by trained and strictly protected professionals.
Since Ebola is contagious as long as the patient has the virus in his or her blood and secretions, infected patients should be closely observed by health care workers and laboratory tests should be performed to ensure that the patient is free of the virus before discharge. Only when it is determined that the patient is no longer infectious should the health care provider send him or her home. Men may still transmit the virus to their partners through semen for up to 7 weeks after recovery from the disease. Therefore, men should avoid sexual intercourse for at least 7 weeks after recovery or wear a condom when having intercourse during this time.
3. Who is at the highest risk of infection?
In the event of an outbreak, those at higher risk of infection are
(1) Medical personnel;
(2) Family members or others who have close contact with the patient;
(3) People who have direct contact with the body of the deceased during the funeral process;
Whether immunosuppressed populations or those with other underlying diseases are more susceptible requires additional research. In clinics, hospitals, community gatherings or at home, the chance of virus exposure can be reduced by taking protective measures.
4. What are the typical signs and symptoms of Ebola virus infection?
Typical signs and symptoms include sudden onset of fever, extreme malaise, muscle pain, headache and sore throat. This is followed by vomiting, diarrhea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory test results include decreased blood white blood cell count and platelet count and elevated liver enzymes.
The incubation period is 2-21 days. Patients are infectious once they begin to show symptoms. Patients are not contagious during the incubation period. Ebola infection can only be confirmed by laboratory testing.
5. When should people seek medical attention?
People who have been to an area where Ebola is known to exist, or who have been in contact with someone known or suspected to be carrying Ebola, should seek medical attention as soon as symptoms begin to appear. When a patient is suspected of having the disease, he or she should immediately report it to the nearest health facility. Prompt medical attention is essential to improve the survival rate of patients. Infection control should also be strengthened to control the spread of the disease.
6. How are Ebola patients treated?
Severe patients require intensive supportive therapy. Patients often become dehydrated and thus require intravenous or oral rehydration for electrolyte replacement. There is no specific treatment available.
Some patients can recover with appropriate medical treatment. To control further spread of the virus, suspected or confirmed patients should be isolated from other patients and treated by medical staff with strict infection protection.
7.What can individuals do? Can the disease be prevented? Is there a vaccine available?
There is no approved vaccine or drug for Ebola, but several products are in development.
Ways to prevent infection and transmission
While the initial Ebola patients were infected during the handling of infected animals or their carcasses, the infection in the sequel cases was caused by direct contact with patient bodily fluids during unsafe patient management or burial. The majority of cases in this outbreak were caused by person-to-person transmission.
The following measures can help prevent infection and control or interrupt the spread of the disease.
(1) Understand the characteristics of the disease, modes of transmission, and methods of prevention.
(2) Follow the guidance documents issued by the national health department.
(3) Encourage and support people in the vicinity to seek medical attention from appropriate health care providers if they are suspected to be infected with Ebola.
(4) If you choose to have the patient treated at home, report to your local public health officials so that they can train you and provide you with appropriate personal protective equipment (PPE) and post-use disposal of PPE. WHO does not recommend that patients be treated at home and strongly recommends that individuals or their family members seek professional treatment from a health care provider.
(5) When visiting a patient in the hospital or caring for a family member at home, it is recommended that you wash your hands with soap after touching the patient or their body fluids or surrounding objects.
(6) Proper protective gear must be worn when handling the deceased Ebola patient, and the deceased must be buried immediately by personnel trained in safe burial. In addition, individuals should reduce contact with high-risk infected animals (such as bats, monkeys, or apes) in rainforest areas affected by the outbreak. If an animal is suspected to be infected, do not handle them again. Animal products (blood and meat) should be made sure they are cooked well before being consumed.
8. What is the situation of medical personnel? How do you protect yourself when treating cases?
Medical personnel treating Ebola cases are at a higher risk of infection than the rest of the population. During an outbreak, there are a number of important initiatives that will reduce or stop the spread of the virus, thereby protecting health care workers and others in the health care facility. These initiatives are called “standards and other protective measures” and are recommendations based on available evidence that can prevent the spread of the virus.
The following questions and answers describe specific precautionary requirements.
(1) Should suspected or confirmed Ebola cases be separated from other cases?
Suspected or confirmed Ebola cases should be isolated separately. If isolation rooms are not available, designated areas for suspected or confirmed cases should be separated from other patients. In these areas, suspected or confirmed cases should also be isolated separately. Access to these areas should also be restricted, equipment for treating suspected or confirmed cases should be dedicated to the area, and medical and other personnel working in this area should also be dedicated.
(2) Are visitors allowed at the site where a suspected or confirmed Ebola case is being treated?
It is best to prohibit visitors. If visits are necessary, only those necessary for the health and care of the patient, such as the parents of the child, should be allowed in.
(3) Do I need protective equipment to treat the case?
In addition to standard protective measures, medical staff should follow strict infection control measures to avoid exposure to toxic blood, body fluids or contaminated environments and objects, such as patient clothing or used needles.
All visitors and medical staff should strictly use personal protective equipment, which includes, at a minimum, gloves, leak-proof gowns, shoe covers, masks, and eye protection (goggles or face shields).
(4) Is hand hygiene important?
Alcohol-based hand sanitizers or running water can be used for hand hygiene, and specific hand washing methods can refer to the correct technical steps recommended by WHO. It is very important to wash hands with soap and running water when there is dirt on the hands. Hand sanitizer containing alcohol should be available at each health care site (inside and at the entrance of isolation rooms or isolation areas); access to running water, soap, and disposable paper towels should be ensured at all times.
(5) What are other matters that require special attention in a medical facility?
Other matters that require special attention are safe injection and blood collection procedures, including safe management of sharps, routine and strict environmental cleaning, disinfection of equipment and surfaces, and management of soiled linen and waste. In addition, the collection of specimens from suspected or confirmed cases, the handling of bodies or post-mortem remains, and the conduct of funerals should ensure the safety of the entire process. Any medical or other professional personnel involved in the operations related to the above suspected or confirmed cases should wear appropriate personal protective equipment and follow the preventive control measures recommended by WHO.
9. What do you think about the rumors that certain foods can prevent or treat infections?
WHO strongly recommends that people should obtain health advice on Ebola hemorrhagic fever from public health authorities. There are no specific drugs for Ebola hemorrhagic fever, and the best treatment is intensive supportive care for patients by hospital staff under strict infection control procedures. By following the recommended protective measures, the infection can be controlled.
10. How does WHO protect health during an outbreak?
WHO provides technical support to countries to prepare for and respond to the Ebola outbreak.
The actions taken by WHO are.
(1) to carry out disease surveillance, share information between regions, and monitor the dynamics of the outbreak
(2) Provide technical support for outbreak investigation and control in the event of an outbreak – for example, by assisting in the field with case identification and exploring patterns of disease transmission
(3) Advise on prevention and treatment programs
(4) Dispatch experts and provide health supplies (e.g., personal protective equipment for health workers) as requested by the country
(5) Enhance communication and raise awareness of disease characteristics and protective measures to control the spread of the virus
(6) Activate regional and global networks of experts to provide support as needed to reduce the potential international health impact of the outbreak and its impact on travel and trade
11. Why did the number of cases reported by health officials fluctuate during the outbreak?
In the event of an Ebola hemorrhagic fever outbreak, the number of cases and deaths that occur are reported by the public health department of the country in which the outbreak occurs. These numbers can change daily, and the number of cases includes both suspected and laboratory-confirmed cases, sometimes reporting suspected and confirmed cases together and sometimes reporting them separately. Therefore, changes may occur between the number of suspected and confirmed cases. Analysis of trends in case data over time, along with additional information, is useful in assessing the public health situation and determining the appropriate response needed.
12. Is it safe to travel during an outbreak and what are WHO’s travel recommendations?
During an epidemic, WHO regularly assesses the public health situation and makes recommendations for travel or trade restrictions as necessary and may notify national governments to implement them WHO is currently evaluating previous travel recommendations and is preparing to issue new recommendations in the near future. Although travelers should be vigilant about their health status and that of those around them, the risk of infection for travelers is low because interpersonal transmission of Ebola is caused by direct contact with body fluids or secretions from patients.
Is it safe to travel with someone who is carrying Ebola?
Like people with other diseases, people who have been exposed to Ebola are likely to choose to travel. If the individual has not yet developed symptoms, they will not spread the virus to those around them. If the individual develops symptoms, they should seek immediate medical attention at the first sign of discomfort. If the onset of symptoms occurs during transportation, the individual needs to report to the staff of the vehicle they are traveling on and seek medical attention as soon as they arrive at their destination. Travelers should be isolated at the onset of early symptoms of Ebola infection to prevent further transmission. Although the risk of infection to other travelers in this situation is very low, follow-up of contacts is still recommended.
Is it safe to travel to West Africa for business/office or to visit friends and family?
Persons traveling to an Ebola hemorrhagic fever endemic area or on business/office travel have a very low risk of contracting Ebola during the trip and developing the virus on the return trip, even if the trip includes travel to the areas where the most prominent cases have been reported. Transmission of the virus requires direct contact with the blood, secretions, organs or other body fluids of sick or infected animals, or dead patients and animals, to which the average traveler is unlikely to be exposed. Travelers are advised to avoid these exposures under all circumstances.
If you are visiting friends or family in an infected area, the risk is similarly low unless there is direct contact with the sick or deceased. If so, it is important to report to public health authorities and receive follow-up. The purpose of follow-up is to confirm whether you have been exposed to Ebola and to prevent further spread of the disease through surveillance.
WHO’s general travel recommendations.
(1) Travelers should avoid any contact with patients.
(2) Medical personnel traveling to an infected area should strictly follow the WHO recommended guidelines for infection prevention and control.
(3) Anyone who has spent time in areas where cases have recently been reported should be aware of the symptoms of the disease and seek medical attention at the first sign of illness.
(4) Clinicians should consider the possibility of Ebola infection when treating travelers returning from an infected area with related symptoms.