DR Congo Ebola Outbreak Doubles in Size

The Ebola Outbreak in the Democratic Republic of Congo has doubled the number of victims in a week. The world health organisation have admitted the outbreak is not yet under control.  31 people are now infected with the hemorrhagic virus.

The Bundibugyo strain is different to the be which infected Uganda a few weeks ago and doctors say they are unrelated even though they are less that 60 miles apart.

There are five known strains of Ebola:

* Ebola Zaire: 80-90 % fatal.
* Ebola Sudan: 50% fatal
* Ebola Bundibugyo: 25% fatal
* Ebola Cote d’Ivoire: only 2 cases recorded, both survived
* Ebola Reston: no known human cases so far

Ebola Reston primarily affects primates and pigs.  Five Filipinos have been found with antibodies to Reston in their system – they all work with pigs.

The natural reservoir for Ebola has not at this point been discovered, but based on other viral haemorrhagic diseases it is likely to be either bats, primates, rodents or insects.

Ebola is classified as a filovirus and it appears as filaments under the microscope. It can be passed from human to human via blood, bodily fluids and in some cases respiratory secretions.  It has an incubation period of 4-16 days which can make isolating victims difficult due to the time period that has elapsed after exposure.

The symptoms are harsh and come on very suddenly. Fever, severe headaches and muscle aches that cannot be relieved are rapidly followed by almost total loss of appetite.

Within a few days the virus causes disseminated intravascular coagulation, an odd condition marked by blood clots in the internal organs and haemorrhages elsewhere.

Violent vomiting and diarrhoea both containing blood and mucus arrive next and are accompanied by a severe sore throat and conjunctivitis.

A maculopapular rash (discoloured raised skin eruptions) appears on the trunk, rapidly spreading to the limbs and head. This precedes the final stage of the disease.

Prior to death, spontaneous haemorrhages occur, causing the body to bleed from every orifice and any wounds or injection sites that are present. Once the bleeding has begun death usually follows quickly from either haemorrhagic shock (blood loss) or renal failure.

There is no known treatment for any strain of Ebola at this point in time. Currently care is mostly palliative and is aimed at keeping the patient as comfortable as possible. Intervention for those cases caught early enough is keeping electrolytes balanced and giving infusions of blood and plasma to try and control the bleeding.

Nursing Ebola patients should ideally be carried out in full biohazard suits as this is the only way to totally avoid contamination from a patient who is vomiting, bleeding and has no bowel control. If these suits are not available strict barrier nursing methods should be employed. This includes:

* Disposable surgical gowns
* Face masks with visors
* Two pairs of latex gloves worn at the same time
* All hair covered in a disposable cap
* Rubber boots

All organic waste from Ebola  patients should be handled wearing biohazard suits if possible. This waste, as well as inorganic materials such as bedding, clothes, towels and soiled mattresses, should be incinerated as soon as possible.

Dozens of flights a day bring home those who have vacationed in Uganda, where wildlife is abundant and people coming here from Uganda and DR Congo to visit friends and family, or returning from work, medical or missionary trips to the area, all have a possibility of transferring Ebola out of Africa.  We should all hope and pray that the only things they bring back are photographs, memories and gifts.