Ebola: Lessons from the Latest Pandemic
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Expires September 30, 2016
The 2014 re-emergence of Ebola virus disease (EVD) quickly became the largest and deadliest outbreak of the disease ever recorded. Originating in Guinea, it spread to neighboring countries and others around the globe. As potentially the firstline health care contacts during a pandemic, all primary care providers need to be aware of the signs and symptoms of EVD so that they can quickly identify, isolate, and treat affected patients. This article describes the history, pathophysiology, diagnosis, and treatment of the disease.
PROGNOSIS
Of the five identified ebola virus species, each differs in its virulence, morbidity, mortality, and prognosis. The mildest species is the nonfatal Reston ebolavirus, which is found in Asia and apparently causes asymptomatic infection in humans. Bundibugyo ebolavirus has a mortality rate of less than 40%, while Sudan ebolavirus has a mortality rate of about 50%.29 The mortality rate of Tai Forest ebolavirus is unknown because there has been only one recorded case of human infection. The current outbreak is caused by a strain of Zaire ebolavirus, which has the highest mortality rate at 70% to 90% (see Table 3).29
Despite the differing mortality rates among the ebolaviruses, fatality rate also depends on factors beyond the biologic characteristics of the species of ebolavirus responsible for the infection. According to WHO data collected during the first nine months of the current epidemic, the fatality rate among hospitalized patients in Liberia, Guinea, and Sierra Leone is 64.3%, lower than the average fatality rate of 70.8% in these countries.4 This data, however, represents only patients treated in the affected countries in Africa.
Given the lack of medical and governmental infrastructure in the nations where the research took place, it can be assumed that better, faster diagnosis and supportive treatment could increase survival in countries with robust health care systems, such as those in the US and Europe. In addition, demographic factors such as age affect mortality, with older age (> 45) carrying a worse prognosis.4 Other risk factors for increased mortality include general symptoms such as diarrhea, conjunctivitis, dyspnea, dysphagia, confusion, and unconsciousness or coma, as well as hemorrhagic symptoms.4
Due to a lack of health care infrastructure in affected West African nations, patients with EVD are receiving insufficient supportive treatment. In order to increase survival, it is essential to treat hypovolemia and electrolyte imbalance with therapies such as IV fluids and electrolyte repletion.30 All health care providers must be encouraged to use every tool at their disposal for providing supportive care for patients with EVD.
CONCLUSION
The US has a robust health care system capable of providing the training and resources necessary for containing outbreaks of diseases like EVD. Recognition of this can help to maintain public calm in the event of a full-scale epidemic of EVD in the US (however unlikely this may be). EVD is highly transmissible in its symptomatic stages, and recent cases in Texas and New York illustrate the need for PCPs and hospitals to be on alert for patients with possible exposure. Similarly, patient care teams must work together, exercise effective communication, and utilize pre-established plans for identification, isolation, and treatment in epidemics. Patients exhibiting fever and other signs and symptoms of EBOV must be asked about any recent travel to Liberia, Sierra Leone, and Guinea, and if they have had any contact with sick persons prior to their symptoms. Health care workers play an important role in epidemic control. As such, they should be familiar with risks, precautions, and protocols set forth by the WHO, CDC, and local health authorities.
