Professor
of Molecular Biology and Genomics and Director, African Centre of
Excellence for Genomics of Infectious Diseases, Redeemer’s University,
Christian Happi, tells ARUKAINO UMUKORO how Nigerians can protect themselves from the Ebola virus
What is Ebola virus disease and how is it transmitted?
The Ebola virus causes a viral
haemorrhagic fever, a set of severe illnesses that is “multisystem” in
that it affects several of the body’s regulatory systems. These viral
diseases damage the circulatory system and may be accompanied by
bleeding or haemorrhaging. The virus causing the disease was named after
the Ebola River in the Democratic Republic of Congo, where the disease
claimed its first known victims in 1976. A separate strain broke out
simultaneously in Nzara, Sudan.
The Ebola virus is a ribonucleic acid
(RNA) virus. There are five known species of Ebola virus: Bundibugyo
Ebola virus; Zaire Ebola virus; Reston Ebola virus; Sudan Ebola virus;
and Taï Forest Ebola virus. All but the Reston strain can be fatal to
humans and are found in Africa. Something peculiar to RNA viruses is
that they (the RNA viruses) produce acute infections, severe for a short
time and then gone. Either they soon disappear or they kill you. The
virus can spread to primates and humans who handle infected meat – a
risk given the informal trade in “bush meat” in forested central and
West Africa. Ebola is thought to be a zoonotic or animal-borne virus.
The virus survives in a “reservoir” host – an animal or insect that
carries the virus at no cost to itself – and is passed on to other
animals or humans through contact with the bodily fluids, secretions or
organs of the host animal. The fruit bat is considered to be the natural
host or “reservoir” of the Ebola virus. The exact manner in which Ebola
enters human cells remains a mystery. Transmission to humans and
primates is thought to occur through direct contact with the animal
host, or through contact or consumption of the meat, bodily fluids or
secretions of animals that have become infected by contact with the
host.
Once it has presented in humans, Ebola is
transmitted through direct contact, where broken skin or mucous
membranes come into contact with the blood or secretions of the infected
person. It may also be transmitted indirectly “through exposure to
objects (such as needles) that have been contaminated with infected
secretions”, according to the US Centres for Disease Control and
Prevention. This means that health care workers, family and friends of
those infected with the virus are at a higher risk of infection.
The diagnosis of the Ebola
virus on the Liberian’s sample was successfully carried out in the
laboratories at the Lagos University Teaching Hospital and ACEGID. How
was the diagnosis reached?
Yes, it is true that the tests were
conducted at the laboratories of the African Centre of Excellence for
Genomics of Infectious Diseases in Redeemer’s University and Professor
Sunday Omilabu’s laboratory in LUTH. We received blood and urine samples
from the patient at 8:40 pm at the Redeemer’s University on Wednesday,
July 23. Samples processing and testing started the next day in the
morning. We were able to detect and confirm the presence of the Ebola
Zaire strain in both blood and urine obtained from the patient on
Friday, July 25, at 6:10 am in our laboratory at ACEGID. According to
information that was given to us, we were told that the World Health
Organisation reference laboratory in Dakar corroborated our findings.
What does this correct diagnosis say about the capacity of Nigeria’s medical practitioners in handling such cases?
The correct diagnosis is a clear
indication that the virus can be diagnosed in Nigeria, unlike what
happened in Guinea when the outbreak started. There was no capacity to
diagnose the virus, while the virus was ravaging the local population.
In Guinea, samples had to be sent out for confirmatory diagnosis.
Usually in such situation, the case fatality will be high because the
clinicians do not know how to manage the patients. Since they do not
know what the patient is suffering from.
What are the symptoms of Ebola and how long is the incubation period?
Patients will begin to show symptoms
anywhere from two to 21 days after exposure to the virus, mostly between
eight and 10 days. The symptoms are: fever, weakness, muscular pain,
headaches and sore throat. Unfortunately, the symptoms at this stage
make it difficult to distinguish Ebola from various other diseases,
including malaria, typhoid fever, meningitis or cholera. However, as the
disease develops, Ebola sufferers may experience vomiting, diarrhoea, a
red rash, difficulty in breathing and swallowing. The virus severely
compromises the immune system, and affects liver, kidney and respiratory
function, as well as the skin and blood. Blood clots may form and
patients may experience haemorrhaging, bleeding internally and
externally.
How true is it that Ebola has no cure but can be treated if detected early?
Yes, there is no vaccine or drug/cure for
the Ebola virus, though several vaccinations are currently being
tested. Treatment is thus limited and merely supportive of the body’s
immune function: providing fluids, electrolytes and oxygen; keeping
blood pressure constant; and treating additional infections with
antibiotics. It is however, unclear why some people infected with the
virus survive where so many do not, but it is thought to relate to the
strength of the individual’s immune system, the strain of the virus and
the viral dose the person has been exposed to. In addition to supportive
and symptomatic treatment, health workers can only really control the
spread of the virus: isolating those infected, raising awareness of the
virus and how it is spread in affected communities, ensuring appropriate
protective gear is worn by all in contact with Ebola sufferers and
ensuring the quick and safe burial of those who have succumbed.
The Lagos State government
claimed to have identified 59 people who had contact with the Liberian,
what does this portend for the country?
It means that efforts are being made.
However, the question is, are all the 59 people presently in quarantine?
I don’t think so. We should fish out all these individuals and put them
under observation in quarantine for at least three weeks.
What should the Federal Government and health authorities do to check the disease in the country?
We need mass education to create
awareness. This is not just the duty of the Federal Government and
health authorities. The media have a very important role to play in the
campaign. We are all stakeholders and all hands should be on deck
educating the masses, reporting new cases if they occur and reassuring
our people.
What are the precautionary measures to be taken to prevent being infected by Ebola?
I believe that Ebola is not particularly
easy to catch. One needs really close contact with an infected
individual in order to get infected. The virus spreads from direct
contact, for instance through broken skin or mucous membranes, with the
blood, secretions, organs or other bodily fluids of infected people, and
indirect contact with environments contaminated with such fluids. In
order not to get infected, direct contact with either suspected Ebola
patients or infected individual should be avoided. More important,
people should avoid contamination through process of burial of their
loved ones. What we observed in Sierra-Leone is the fact that the first
cases of Ebola in the country was through people who attended the burial
ceremony of their relative that died of Ebola virus infection. So, if
your loved one or relative dies of Ebola virus diseases, please let it
be buried by health authorities who will know how to handle the dead
body. Individuals should avoid handling “bush meat” and especially fruit
bats. Through contact, processing or consumption of the “bush meat” and
bats bodily fluids or secretions one can become infected.
What should be done in Nigeria and the West African region to arrest the spread of the virus?
This is an epidemic characterising
dysfunctional health systems. If the disease surveillance systems in
West African countries were very active, we would have prevented the
spread of the virus once the epidemic started in Guinea in December,
2013. Now, this epidemic can no longer be considered as a West African
problem. Remember that the ASKY flight carrying nationals from many
African countries came from Liberia through Togo and landed in Lagos.
This same aircraft flew through many other African countries prior to
confirmation of the Ebola case in Nigeria. So, you can see that there is
the potential that people from many African countries could have come
in close contact with the Liberian that was infected with Ebola.
Therefore, the risk of epidemic in other African countries cannot be
ruled out. In this regard, African countries have to come together and
develop an agenda for surveillance in this emergency situation. There is
a need for collaboration and cooperation between all health agencies in
the African regions for diseases surveillance. There is also a need for
mass education and awareness campaign in the African region on Ebola
virus and prevention of infections.
I understand that the Federal Government
and the Lagos State government are making a lot of efforts to contain
the current situation. However, I don’t know how really prepared we are
in case of major outbreak. We are very fortunate that we have the
diagnostic capability in country, but I am not sure if the laboratories
have enough reagents and supplies in case of a major outbreak. I believe
that the government has a small window of opportunities now to really
stock these reference laboratories with equipment, supplies and reagents
in order to face the epidemic. The government should quickly refurbish
some medical facilities and dedicate them for the management of viral
haemorraghic fevers as a major step towards preparing for a major Ebola
outbreak if it occurs.
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