COMMUNICABLE INFECTION: EBOLA

The more developed the world health care system becomes, the more dangerous viruses are discovered. Diseases caused by viruses, which affect person’s health, are not effectively treated because medical professionals and patients lack knowledge about their prevention and diagnosis. Nowadays the viruses develop new forms due to unfavorable ecological conditions, production of low-quality medicines, and consumption of unhealthy food products. One of the recently discussed communicable infections is Ebola virus disease (EVD). It has raised many questions about its transmission and prevention. Currently, some of these issues are successfully responded and others, like effective treatment, still need proper research and financing.

Aetiology and Mode of Transmission

In order to understand how to fight a disease, healthcare specialists should know its aetiology. EVD is caused by RNA (ribonucleic acid) virus from the filovirus family (Fauci 2014). Ebola encompasses five separate species such as Zaireebolavirus, Bundibugyo ebolavirus, Taï Forest ebolavirus, Sudan ebolavirus, and Reston ebolavirus” (Fauci 2014). There are some modes of EVD transmission. The first one is contacting with infected people. The World Health Organization (WHO) (2014) states that “persons in close contact with Ebola cases (alive or dead) are at higher risk of infection.” The next mode is tactile contacts with fruit bats, however, this version is not one hundred percent confirmed. As the Ebola virus is considered to be a zoonotic pathogen, infected animals’ fluids transmit the disease as well (Fauci 2014). Thus, EVD is highly contagious.

Prevention, Short-Term and Long-Term Effects, Treatment Options

It is important to note that the world community had not recognized the scale of the EVD problem until a massive outbreak of the disease in the African region. On August 8, 2014 “the WHO declared the epidemic to be a Public Health Emergency of International Concern (PHEIC)” (Briand et al. 2014). As a result, the most effective preventive measures were developed. Frieden et al. (2014) looked back at the past experiences of fighting EVD and determined three main preventive measures. “The first is meticulous infection control in health care settings. The greatest risk of transmission is not from patients with diagnosed infection but from delayed detection and isolation” (Frieden et al. 2014). The second measure is supporting and educating a community at risk to modify funeral practices with the purpose of preventing contacts with the infected deceased and their fluids. The last measure includes avoiding touching bush meat or the mentioned fruit bats (Frieden et al. 2014).

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It is difficult to diagnose EVD as its symptoms are not specific. The majority of the patients reveal such short-term effects as fever, weakness, diarrhea, nausea, and vomiting. The long-term effects have not been properly studied yet, but the healthcare specialists confirm that fighting a serious disease does not pass without leaving any negative consequences such as body and joint aches, fatigue, nerve and eye inflammation (Fauci 2014). The EVD treatment is complicated by the fact that there is no effective vaccine approved for the state. Briand et al. (2014) summarized the measures taken by modern doctors to treat EVD and developed the following scheme of treatment: supportive care for the above-mentioned EVD effects and complications – recommended care (maintenance of blood pressure, oxygenation, pain control, nutrition support etc) – control and preventive measures (keeping track of all the patient’s contacts and testing all his/her fluids). Therefore, the scientists have made progress in researching the preventive measures for EVD, but the treatment of the disease is still a problem.

The Ebola History

The history of EVD dates back to 1976 when the first outbreak was identified in Zambuku, Zaire (now it is the territory of the Demographic Republic of Congo) and Nzara, South Sudan. The virus was named after a river in Zaire. The causative agents of EVD, enumerated above, were determined almost at once. Since the first EVD outbreak, there were 20 more, which caused fewer than 1600 deaths before 2014 (Fauci 2014). These outbreaks mostly covered the Western African territory. There were some single cases in Europe and the USA because of the African citizens, Americans, and Europeans, who traveled abroad and established contacts with infected humans (Briand et al. 2014).

The EVD outbreak of 2014 in Guinea caused more deaths than all other previous outbreaks taken together (Briand et al. 2014). The scientists joined their efforts to research the specifics of this last African EVD outbreak. Earlier it had been determined that “Ebola virus disease is associated with a case fatality rate of 30 to 90%, depending on the virus species” (Baize et al. 2014). In 2014, the scientists estimated that the EVD mortality rate in Africa was the highest in history. The discussed epidemic is a key element in the process of the disease prevention and fighting. It made the healthcare specialists recognize the danger of EVD and the importance of taking steps to stop it. The Guinean scientists, together with the foreign doctors, performed a great number of diagnostic assays, investigated the viral sequencing, and used electronic microscopes to check their conclusions. They analyzed the samples of 20 patients. As a result, they managed to determine the exact virus types causing the disease, the symptoms common for all the confirmed cases, and the exact area of the contamination (Baize et al. 2014). The epidemiological investigation demonstrated that “the suspected first case of the outbreak was a 2-year-old child who died in Meliandou in Guéckédou prefecture on December 6, 2013” (Baize et al. 2014). Team et al. (2015) also confirmed the significance of the Guinean outbreak for the disease research and stated that EVD was gradually transmitting from one country to other states and thus demonstrated its unpredictable character by the geographical shifting of its epicenter. The EVD evidence in Guinea has decreased from 11 to 2 cases, “whereas the incidence has increased sharply in the neighboring districts of Kerouane, Macenta, and N’zerekore” (Team et al. 2015). It is possible to state that the last (the current) EVD outbreak has forced the medical specialists to apply to the latest medical and technological innovations accessible to them to research the spread of the virus.

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The EVD history tells about the areas most affected by the disease and the performed experiments but does not reveal many facts about the treatment. As it has been mentioned above, the doctors state that there is no effective vaccine for treating EVD (Fauci 2014). However, some unofficial steps were made to support the symptomatic treatment of EVD by certain specific therapy. An unlicensed cocktail of humanized-mouse antibodies named “ZMapp” and tested on the primates was used in the treatment course of two infected U.S. citizens. Although they were cured, there are no any reasonable arguments to confirm that their positive health outcome was conditioned by the application of ZMapp as all other possible treatment options were used too. Currently, two more vaccines, containing vesicular stomatitis pseudo types, are being tested on people (Fauci 2014). There is a possibility that soon some specific EVD vaccine will be developed by the scientists.

Lessons Learned

The EVD history has almost 50 years. Within this period of time, there were both important discoveries made by the scientists and some failures of the healthcare system, which led to the uncontrolled EVD transmission. There is no doubt that this long period of time gave some lessons to the world community and healthcare specialists. The fact that as for now EVD has infected 24,000 people and led to 10,000 deaths “shed light on the weakness of health systems and the lack of investment in research and development (R&D) for diseases primarily impacting the poor, as well as underscored the need for forward-thinking investments in research and preparedness” (Global Health Technologies Coalition n.d.). Thus, it is possible to specify some lessons, learned by the world healthcare. First of all, the healthcare systems of all countries should be strengthened to be prepared to meet EVD outbreaks. Special attention should be paid to the low-income countries, where diseases spread easily because of the absence of good conditions in hospitals. Team et al. (2015) notice that the governments have already taken some measures in this direction. The United Nations Mission for Ebola Emergency Response contributed to the fact that the number of beds in the EVD treatment centers in the African countries exceeded the number of patients (Team et al. 2015). However, there are more issues to be solved, namely hospitals still experience the shortage of medical workers, lack of equipment and training of the personnel (Global Health Technologies Coalition n.d.). The WHO, together with the above-mentioned Ebola Mission, made some steps to improve the situation (World Health Organization 2014). The organization determined the contact tracing as a key element for preventing the disease. The WHO is ready to educate healthcare specialists, patients, and possible victims on how to manage their contacts with possibly infected people and how to perform a contact follow-up. The enumerated steps are not capable of correcting the mistakes of the past, but prove that the officials and healthcare systems are moving in the right direction.

The second lesson learned by the health professionals and governmental officials concerns the errors in financing the EVD research. As the areas most affected by the virus are poor African countries, which cannot cope with the problem independently, the EVD research needs proper common international financing. Only 37 out of 850 recently invented medical products are focused on neglected diseases. The governmental efforts in the aspect of the EVD research and treatment should be directed at state financing of EVD (Global Health Technologies Coalition n.d.).

Therefore, in order for the USA or any other country to contain EBV outbreak, there should be “a full toolkit of resources, including rapid diagnostic tests, protective gear, disinfection methods, novel vaccines and treatments, and enhanced surveillance systems” (Global Health Technologies Coalition n.d.). It is worth noting that the great error committed by the world healthcare system in the history of EVD investigation, which cannot be corrected, is not recognizing the scale of the issue and its possible consequences at once. It is good that nowadays medical specialists have become much more precautious and realize the importance of the EVD preventive interventions.

The Ebola Influence on the Society

Quick EVD transmission, covering more and more African countries, and lack of the medical resources needed to prevent the patients’ deaths have led to the fact that EBD has become not just a medical problem, but a social issue. Briand et al. (2015) call Ebola an economic and a humanitarian emergency as “schools are being closed, agriculture and mining are under threat as workers leave the affected areas, and cross-border commerce has slowed.”. Moreover, EVD has moved the ethical issues forward. Though the WHO (2014) insists on forming special surveillance teams for working with the infected patients, the healthcare providers work in the conditions of fear and discrimination. They are aware of the fact of how easily the disease is transmitted and do not want to have any contacts with the patients within the determined period of follow-up of three weeks. The term is defined as this time frame because the incubation period of EVD may last from 2 to 21 days. More than 150 medical workers were already infected and 80 of them died (Fauci 2014). Moreover, in some pagan African communities, EVD is considered to be witchcraft. The infected patients are not allowed to communicate with anybody and refuse to get any medical help, infecting others. Fear has even turned into hostility towards the medical providers involved and the international EVD teams experience certain difficulties in terms of care and equipment delivery to certain areas. The international traveling and business development have also been seriously damaged. Liberia and Nigeria screen all the travelers moving into and outside the countries either by planes or ships. Guinea has closed its borders with Sierra Leone and Liberia (Briand et al. 2014). Therefore, the last EVD outbreak, as the greatest in the disease development, has affected all social spheres of the states, suffering from the problem. The most effective solution for mitigating the negative impact is financial support to the third-world countries and education of the local specialists, who know the cultural traditions and healthcare difficulties in the region.

Conclusion and Recommendations

In spite of the fact that Ebola has been extensively investigated and recent interventions have given some positive results, the virus still stays one of the greatest mysteries to modern medicine. The doctors already know how EVD is transmitted and what to do to prevent it. However, the problem needs an effective solution. The government’s task is to provide all financial means for performing more experiments to determine which vaccine is capable of stopping the disease. Moreover, the outbreaks in a certain area, namely in Africa, do not mean that other regions are safe. Even developed countries need to implement proper preventive measures and possess all known means of treatment to be prepared.

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