Ebola Research Term Paper

Ebola Research Term Paper

Abstract

On August 8th, 2014, the World Health Organization declared the Ebola virus disease (EVD) outbreak in West Africa a Public Health Emergency of International Concern. Stressing the need for international attention and collaboration to control the outbreak. At this moment, a total of 5,335 cases with 2,622 deaths have been confirmed. This paper reviews what Ebola is, what it does to the human body, what area of the world it affects, and overall the efforts being done to prevent and treat those who are currently infected with the virus. The paper also tells the events that unfolded in Dallas, Texas; that led to the first confirmed cases of EVD in the United States. And how that outbreak led to the importance of adequate isolation methods, training of personnel, and the use of personal protective equipment. Lastly, the final paragraph will summarize the importance of what the outbreak means to the healthcare field, and what nurses can do to help.

Ebola is a virus that is spread through direct contact with bodily fluids of a person who is sick or has died from EVD. The virus enters the body through broken skin or mucous membranes in the eyes, nose and mouth. Signs and symptoms of the virus typically appear two to three weeks after contracting the virus. Symptoms include fever, sore throat, muscle aches, and headaches. As the virus progresses in the body, the function of the liver and kidneys decreases. At this time, individuals who are infected begin to bleed out internally and externally. The disease kills between 25-90% of those who are infected (Goeijenbier, M., Ebola virus disease: a review on epidemiology, symptoms, treatment and pathogenesis. Neth J Med, 72(9), 442-8). Immediate access to healthcare is what ultimately determines your survival rate.

Diagnosis of EVD can be difficult. Symptoms such as fever, headache and weakness are not specific to Ebola. Therefore, to determine if Ebola virus is a possible diagnosis there must be a combination of symptoms present in the individual and possible exposure of EVD within 21 days before the onset of the symptoms. Exposure includes, being around anyone infected with EVD, manipulating objects used to treat an individual with EVD (inanimate objects such as a syringe), exposure to fruit bats or primates, or semen from a man who has recovered from EVD. If an individual shows signs of EVD or has had possible exposure, he or she should immediately be isolated, and public health authorities (CDC) should be notified. Blood will then be drawn from the patient to confirm the diagnosis of Ebola. The virus may take up to three days after onset of symptoms to be detectable in blood. Once a positive laboratory test of Ebola is confirmed, public health authorities conduct and investigation which includes tracing back to the source and treating all possibly exposed contacts. Such measures are taken by the CDC in order to prevent transmission of the disease, and prevent a possible epidemic in the U.S.

On September 25th, 2014 the U.S had its first confirmed case of Ebola. A man 45 years old, who had arrived in the United States from Liberia 5 days earlier, went to a Dallas County, Texas, emergency department with fever, initially 100.1°F but increased to 102.9°F, abdominal pain, and headache. He was treated for possible sinusitis and discharged. On September 28, the man returned to the hospital by ambulance with persistent fever, abdominal pain, and new onset of diarrhea; he was placed in a private room under standard, droplet and contact precautions and was tested for Ebola. On September 30, the Texas Department of State Health Services and CDC confirmed that he was positive for Ebola virus. This represented the first imported Ebola virus infection diagnosed in the United States. A CDC team arrived in Dallas later that night to assist with its investigation. The objectives were to identify potentially exposed contacts of the Ebola virus, initiate monitoring of contacts, review plans for triaging and testing suspected Ebola patients, and review infection control practices. Throughout the investigation two nurses who treated the man in the emergency department also came forward with Ebola like symptoms, and tested positive for the virus. On October 8th, 2014, the 45 year old man died. A rush to treat the two infected nurses and anyone they may have been in contact with swarmed the Dallas county area. Overall, 20 health care workers who may have come into contact with the nurses volunteered to quarantine themselves. In addition to contact tracing and monitoring, the Dallas Ebola investigation team conducted technical consultations with five Dallas area hospitals to assist them in planning for providing care for confirmed Ebola patients, established an emergency medical services transportation plan for known or suspected Ebola patients, developed a plan for safely handling Ebola patient remains, established capacity for Ebola testing to be conducted at the Dallas County public health laboratory, trained 160 HCWs on PPE use (e.g., proper selection and supervised donning and doffing) and infection control practices appropriate for caring for Ebola patients, and helped establish a triage unit for evaluating contacts with symptoms compatible with Ebola. During this investigation, CDC developed new infection control guidance and new guidance for assessing the risk of potential Ebola exposure. By November 7, all 177 people in contact with those 3 diagnosed with Ebola (some persons were contacts of more than one patient) completed 21 days of monitoring. In addition to the 3 confirmed patients, 12 people who had contact with one or more of the Ebola patients were tested for Ebola after they developed fever or other symptoms potentially compatible with the disease during their monitoring period. Active monitoring aided in the prompt identification and evaluation of these contacts. None of those evaluated were found to have Ebola. The two nurses initially infected, are now cured of Ebola, and are overall healthy.

Ebola was first discovered in 1976 near the Ebola River in what is now the Democratic Republic of Congo. It is believed that the transmission began through direct contact with a fruit bat or an infected animal. The Ebola outbreak is so widespread in West Africa due to fruit bats being hunted for food. In equatorial Africa, human consumption of fruit bats has been linked to animal-to-human transmission of Ebola. Bats carrying the virus can transmit it to other animals like apes, monkeys and even humans (Leroy, E. Fruit bats as reservoirs of Ebola virus. Nature, 438(7068), 575). This is called a spillover event. From there, the virus spreads from person to person, potentially affecting a large number of people.

The Ebola outbreak has affected large areas of Guinea, Sierra Leone, Liberia, and Nigeria. What is unfolding in these countries is a tragic, textbook example of a public health crisis affecting populations living in deep poverty — exacerbated by political strife, devastated economies, and lethargic bureaucracies. Extensive cross-border traffic and easy connections between rural communities and densely populated cities have helped spread the contagion. The health systems in all four countries suffer from a shortage of trained health care workers and depleted supplies, made worse by many years of civil war and conflict. The most recent outbreak as of August 1st, 2018 has been confirmed in large areas of the Democratic Republic of Congo. The Centers for Disease Control and Prevention is assisting the DRC government and countries bordering the area to coordinate activities and provide technical guidance related to surveillance, laboratory testing, contact tracing, infection control, border health screening, data management, risk communication and health education, vaccination and logistics. 512 confirmed cases of Ebola are affecting the DRC at this time. Treatment of symptoms EVD are treated as they appear. Basic interventions can significantly improve the chances of survival. Interventions include: providing fluids and electrolytes through intra-venous therapy. Oxygen therapy to maintain oxygen stats. Medication to support blood pressure, reducing vomiting and diarrhea and managing fever and pain. Recovery from EVD depends on access to medical interventions and the patient’s immune response. Those who do recover develop antibodies that can last ten years, even possibly longer. It is not known if people who recover are immune for life or can later become infected with a different strand of EVD. Some survivors later complain of chronic complications such as severe joint pain, and vision problems. The U.S Food and Drug Administration currently has no antiviral drug to treat EVD in infected individuals. Drugs are being developed to stop EVD from replicating itself in the body once an individual is infected. Blood transfusions from survivors and mechanical filtering of blood from patients are also being explored as possible treatments for EVD.

The humanitarian dimensions of the outbreak are staggering: according to a projection model released by the U.S. Centers for Disease Control and Prevention in late September, 1.4 million people in West Africa will become ill with Ebola by late January if the infection rate stays the same as it was in August (WHO Ebola Response Team. (2014). Ebola virus disease in West Africa—the first 9 months of the epidemic and forward projections. New England Journal of Medicine, 371(16), 1481-1495).

 But this only hints at the enormous fear, agony, and distressing physical consequences that the disease creates in communities and families throughout Guinea, Sierra Leone, and Liberia. Doctors and Nurses are hesitantly assisting the Red Cross in efforts to treat those infected. Many do not assist in fear that they too will become infected with the virus. Like members of the general public, nurses often have difficulty separating valid concerns from rumor and misinformation. In light of the controversies still surrounding EVD transmission, the nursing profession’s moral obligation to patients with EVD evaluates the organizational ethics mandated for hospitals to provide adequate education and protection for nurses. Whenever outbreaks like this one occur, nurses have protocols and procedures to review and information on precautions, transmission and treatments to share with staff. They and their teams need to be ready to give patients who may have Ebola everything they need. Including compassionate care free of judgement. This is an unprecedented teaching moment for nurses, and their top priority is teaching, vigilance, and preparedness. Flu season emphasizes this priority, as nurses need to be prepared to ask and answer questions that can differentiate between early symptoms caused by flu and those caused by Ebola — and alleviate fears of patients. Overall as nurses the best way to assist is to be educated on the disease.

The Ebola virus will continue to cause harm to those with limited access to healthcare, but by raising awareness and educating ourselves about the disease and the symptoms manifested by it, we can further prevent transmission of it.

References

1. Leroy, E. M., Kumulungui, B., Pourrut, X., Rouquet, P., Hassanin, A., Yaba, P., ... & Swanepoel, R. (2005). Fruit bats as reservoirs of Ebola virus. Nature, 438(7068), 575.
2. World Health Organization. (2014). WHO: Ebola response roadmap situation report 15 October 2014.
3. WHO Ebola Response Team. (2014). Ebola virus disease in West Africa—the first 9 months of the epidemic and forward projections. New England Journal of Medicine, 371(16), 1481-1495.
4. Lyon, G. M., Mehta, A. K., Varkey, J. B., Brantly, K., Plyler, L., McElroy, A. K., ... & Uyeki, T. M. (2014). Clinical care of two patients with Ebola virus disease in the United States. New England Journal of Medicine, 371(25), 2402-2409.
5. Uyeki, T. M., Mehta, A. K., Davey Jr, R. T., Liddell, A. M., Wolf, T., Vetter, P., ... & Evans, L. (2016). Clinical management of Ebola virus disease in the United States and Europe. New England Journal of Medicine, 374(7), 636-646.
6. Goeijenbier, M., Van Kampen, J. J., Reusken, C. B., Koopmans, M. P., & Van Gorp, E. C. (2014). Ebola virus disease: a review on epidemiology, symptoms, treatment and pathogenesis. Neth J Med, 72(9), 442-8.

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