 | Wikivoyage is not a doctor: the medical information provided on Wikivoyage is general in nature at best and cannot substitute for the advice of a legally authorized healthcare professional. more... |
| Ebola virus disease | |
 | |
| Egyptian fruit bat (Rousettus aegyptiacus), one of the bats considered to be the natural reservoir of the Ebola virus. | |
| Information | |
| Region (s) | Africa sub-Saharan |
|---|---|
| Cause | Virus |
| Vector | Body fluids, mammal meat |
| Contagiousness |  Yes |
| CIM-10 | A98.4 |
| CIM-9 | 065.8 |
| Prophylaxis: | |
| * vaccine | yes (available in case of health emergency) |
| * medication |  no |
| Therapy: | no |
| Location | |
 | |
| Location of outbreaks in 1976 (black), from 1977 to 2012 (burgundy) and in 2014 (sky blue) | |
 Medical warning | |
The Ebola virus disease, also called Ebola hemorrhagic fever or simply Ebola is caused by the Ebola virus of the filovirus family (Filoviridae). This serious and very contagious can achieve a case fatality rate of up to 90-95% during epidemics.
Understand
The first virus of its kind Ebolavirus was identified during theepidemic initial of September 1976 by the Belgian doctor Peter Piot of the Institute of Tropical Medicine ofAntwerp, at Yambuku Hospital, in what is now Democratic Republic of Congo not far from the Ebola river, hence the name given to this discovery.
Normally, the disease is only spread via healthy carriers, fruit bats (although no viruses have ever been detected in these animals, they are carriers ofantibody ofEbolavirus) to mammals, especially great apes, of tropical rainforests. Contact with humans, whether with a bat or with an infected animal, being rare, the disease was often taken for an attack of malaria, a typhoid fever or any other infection endemic specific to the region. the patient zero reportedly transported a great ape carcass taken from the forest before infecting his family through contact with his bodily fluids.
Genre Ebolavirus(Ebolavirus) is a virus RNA (that is, it uses it as genetic material) from the filovirus family (Filoviridae), so called because they exhibit a filamentous "U", "6", hook or rod appearance, and can be branched. This family, which has three genera, also counts among its species the Marburgvirus Marburg(Marburgvirus Marburg) responsible for a viral hemorrhagic fever similar to that induced by the various Ebola viruses.
The genus has five identified species:
- Ebolavirus Zaire : the one that was identified in 1976 during the first epidemic known. It is also the most virulent and responsible for the 2014 epidemic in in West Africa and in the Equator province in Democratic Republic of Congo ;
- Ebolavirus Sudan : also identified in 1976. It is endemic to South sudan and in Uganda and is responsible, together with the previous one, for the majority of fatal cases;
- Ebolavirus Reston : identified in 1983 in the CDP of Reston in theState of virginia to United States. It is the least virulent for the human species because it only has healthy carriers that are totally asymptomatic (that is to say without a functional sign representing a manifestation of the disease);
- Ebolavirus Tai Forest : identified in 1994 in the Tai national park, in Ivory Coast ;
- Bundibugyo Ebolavirus : identified in 2008 in Bundibugyo district, in westernUganda.
|
Currently, the best response is only to contain the spread of the virus through constant vigilance on the part of all actors in health and the administration (not to say political). Thus, the epidemic, due to Ebolavirus Zaire, which affects, since the beginning of , the forests around 1 Likati in the province of Bas-Uele in Democratic Republic of Congo remains confined in these forests with, as a consequence, the death of three confirmed cases .
Location
Normally, the Ebola virus is confined to remote areas of tropical rainforests, both frequented by bats and monkeys,Africa and D'South East Asia. Seen its extreme contagious power and the rapid means of transport available to us, a epidemic is always likely to break out in any place on earth.
An example is the one that has plagued theState of virginia in 1983, because of monkeys imported from Philippines in a pet store. Another example is the epidemic that broke out in December 2013, from the south of the Guinea, before spreading to five of its neighboring countries and causing, in , 22,632 deaths identified and which is the first of its kind to declare itself outside thecentral Africa in a biotope different from tropical forests.
Vector protection
If the protection against the vector "food" is quite simple, it is very difficult to establish a strategy of protection against the vector "body fluids".
- Food: do not eat or touch bushmeat with your hands, especially if it is bat meat. If a long and intense cooking of this meat makes it possible to render the viruses inactive (heating at 60 ° C for 30 to 60 min or boil for 05 min), this will only shift the problem, the meat having become carcinogenic by the production of benzopyrene produced by incomplete combustion of fat (less than 300 ° C).
- Bodily fluids : direct contact with body fluids such as blood, semen, love juice, excretions, saliva, sweat, etc. from an infected person, alive or dead, is the main route of human-to-human contamination.
Other protective measures advocated by scientific authorities consist of:
- the systematic slaughter of infected animals using gloves and a mask and with rigorous monitoring of the burial or incineration of carcasses;
- the imposition of quarantine, with a ban on going to hospitals, the suspension of the practice of patient care as well as the isolation of these patients in separate closed places which are disinfected with bleach every two weeks apart;
- incineration of clothing and effects that affected the patient as well as, sometimes, of the deceased patient himself or even of the place where he was "treated" since the virus can survive and remain infectious for several days at room temperature or at 4 ° C both in a liquid and on a dry matter.
|
.jpg/150px-Army_researcher_fighting_Ebola_on_front_lines_(14841171181).jpg)
Virus protection
There is no prophylactic or therapeutic drug protection against the virus. However, since 2016, there has been a vaccine developed by Merck laboratories, rVSV-ZEBOV, available in the event of an outbreak of the disease and which should be commercially available before the end of 2017, i.e. be in phase IV clinical trials. Another vaccine that protects against both rage and against Ebola virus disease with the advantage of treating both human victims and the animal reservoir of Ebola virus as well as an antiviral drug based on favipiravir which is an RNA polymerase inhibitor RNA -dependent (i.e. on the enzyme which catalyzes the replication ofRNA) are also in phase III clinical trials but at a less advanced stage.
Laboratory research must be carried out in a P4 laboratory, that is to say of maximum security in the sense that they are, among other things, completely hermetic because they consist of several decontamination airlocks and watertight doors as well as deprived of air (to prevent the spread of a fire) which forces researchers to work in a scuba diving suit. There are only thirty laboratories of this type in the world, five of which are francophonie : two in France, two in Swiss and one at Gabon, which meet these criteria.
Diagnostic
Symptoms
After one incubation period which varies between 2 and 21 days, the first non-specific symptoms appear, reminiscent of those of flu : fever sudden physical fatigue, muscle and joint pain, headache, diarrhea, vomiting and abdominal pain. Four to five days after the start of theinvasion, appear hemorrhages externalized by the various openings of the body, such as the mouth, the nose, the anus as well as by the gums. A keratitis bilateral is also observable.
If the patient's body is able to activate an immune response to the virus, it will begin to recover in 7 to 9 days before starting, still in isolation, a long convalescence period. Indeed, as long as viral particles remain present in the patient's body, the latter remains contagious through these bodily secretions.
If the patient reaches state phase, we then observe a normothermia, of the'obsession, accelerated pulmonary ventilation and decreased urine volume. A maculopapular rash (that is, red spots on the skin) also sets in, as in infections of measles or scarlet fever. The vital prognosis will then be reduced to a 10 to 50% chance of survival.
Clinical signs
The clinical examination should first rule out other causes in order to rule out other infections such as malaria, severe forms of salmonellosis, the cholera, the typhus, viral hemorrhagic fever, etc. in order to make a differentiated diagnosis.
A test ELISA allows to detect antibody anti-Ebola or the presence ofantigens viral and must be carried out in a laboratory of maximum security P4.
During the invasion phase, settles a leukopenia and an thrombocytopenia as well as a proteinuria. The state phase is, for its part, accompanied by a coagulopathy, damage to the central nervous system and insufficient supply of oxygen-rich blood to cells.
If, in principle, the patient is no longer contagious 45 days after the start of the invasion phase, the virus can remain in semen for up to nine months after defervescence phase. In patients known to have recovered, certain clinical signs, such as the color of one eye iris different from the other or a uveitis (as in the case of doctor Ian Crozier), can show that the disease continues to affect it and more particularly its vital centers.
Therapy
There is no approved treatment for Ebola virus disease. The management of severe cases consists of intensive palliative care aimed at combatinghyperthermia and maintain kidney function andelectrolyte balance while limiting bleeding andState of shock. You should also know that most deaths result from dehydration resulting from gastric damage due to poor patient management.
A drug candidate, called "ZMapp", which comes in the form of a serum and consists of three antibody different was tested on several caregivers infected during the epidemic in West Africa who are or are in the process of being healed. Another candidate, called "TKM-110-802", also in the form of serum is also in the experimental phase. Finally, a third candidate based on favipiravir is also in the testing phase and has been shown to be effective in mice.
Remarks
- This disease is on the list of Infectious diseases mandatory in Belgium, in France, to Quebec, in Swiss as well as in Algeria, to Morocco and at Chad
- Patients admitted to hospitals must be accommodated in level 4 security services.
- France recommends, in case of doubt, to call directly the free emergency number "15" of the SAMU.
- The vital prognosis for a fetus is almost zero percent chance of survival.
Further information
- Media Center, Ebola Virus Disease – The Ebola virus disease page on the WHO website.
- Catholic University of Louvain – Recommendations for infectious isolation.
