Ebola is a highly contagious viral disease with an incubation period of up to 21 days. The disease is transmitted from person to person via bodily fluids such as blood, sweat, saliva or tears. Those diagnosed with the Ebola virus suffer severe diarrhoea, vomiting and bleeding, which can lead to severe dehydration, and ultimately organ failure and death.
Ebola is caused by a virus. The Ebola virus normally exists in animals but it can infect humans. Once Ebola is in the human community, it can be passed from person to person. Bats are the most likely reservoir hosts for the virus and can transmit it to other animals like monkeys and duiker (small antelopes) as well as to humans. People can become infected through preparing and eating infected bushmeat.
Ebola was first diagnosed in 1976 near the Ebola River in the Democratic Republic of Congo.
Ebola is a viral disease which is transmitted via bodily fluids (such as such as blood, sweat, saliva, tears, urine, faeces, vomit, and breastmilk) of an Ebola-infected person.
Ebola may also spread through contact with any surface, object or material such as bedding, clothing, medical equipment, bandages and so on that contains the body fluids of an infected person.
Ebola does NOT spread through air, clean water, food, or insects (such as mosquitoes). Healthcare workers, carers and those who have been in contact with infected people – including their dead bodies - are at high risk of becoming infected with Ebola because they are more likely to come into direct contact with body fluids.
The proper use of personal protective equipment greatly reduces this risk.
The time between exposure and when symptoms occur (incubation period) is 2 to 21 days. On average, symptoms develop in 8 to 10 days.
Primary symptoms are fever, headache and muscle pain, followed by abdominal pain, vomiting and diarrhoea. Severe diarrhoea, vomiting and bleeding can lead to dehydration and lethargy.
As the disease progresses, sufferers can haemorrhage internally and experience organ failure and die.
Many people who are affected by Ebola die. Without treatment, the mortality rate for Ebola can be as high as 90 per cent.
With timely treatment mortality is estimated between 50 and 60 per cent, or even lower in some contexts.
Ebola is very contagious. People may be unaware they have Ebola in the early stages, as the initial symptoms are similar to other illnesses. There are some other factors that make Ebola challenging to control:
- Movement of people: The natural movement of people across borders, plus the challenges of a conflict zone where people are fleeing their homes, facilitates the spread of disease, and makes it difficult to contain.
- Understanding communities and contexts to allow for an adapted response: For populations living in outbreak areas, Ebola is just one of many feared diseases. Seeing their relatives or loved ones disappear into an Ebola treatment centre with ‘uniformed people’, with more people dying in there than being cured, causes a lot of mistrust. Communicating with the population in a meaningful and effective way can take a lot of time – time that is often not available.
- Attacks on health workers and facilities: Several Ebola treatment facilities were attacked in 2019 in DRC. This targeted violence, along with mistrust, often stems from a lack of understanding and fear. It affects all activities including treatment, contact tracing, community health promotion and safe burials. It also discourages people from coming to Ebola Treatment Centres when they fall ill with Ebola-like symptoms.
- Traditional funeral practices, in which grieving relatives, friends and community members touch the body of someone who has died from Ebola, make it hard to contain contamination.
Avoiding contact with people who have or might have Ebola is the safest way of avoiding disease. If you are in contact with patients, follow strict hygiene and personal protection instructions such as wearing personal protective equipment when in direct contact with patients and avoidance of any contact with bodily fluids, whether direct or indirect.
If contact has happened, it is important to notify health personnel as soon as possible in order to be tested and receive treatment if needed.
When working in an environment with Ebola patients, it is advisable to be vaccinated prior to arriving.
Following an Ebola epidemic in 2014-2015 in West Africa, an investigational vaccine was developed that may help control an outbreak. The vaccine was being used in the DRC during 2019 as part of the overall strategy to protect medical and other frontline workers, as well as those in the community who had been in contact with Ebola patients. In collaboration with the Ministry of Health, MSF vaccinated Ebola frontline workers and patient contacts in remote communities in Bikoro, Equateur Province.
Although there is no proof of a specific cure and treatment is predominantly symptomatic, there are several experimental drugs that are being explored and used. Also, there are a few vaccines available, one of which is currently being used and evaluated in DRC.
However, the mainstay is to provide supportive treatment in the form of fluid given intravenously (IV), oxygen, blood pressure management, and treatment for secondary infections.
Survival depends on many things, including on how a patient’s immune system responds to the virus.
“Supportive care includes IV fluids, maintaining blood pressure, providing therapeutic food and prophylactic antibiotics to make sure that opportunistic infections don’t take hold. We routinely test patients for malaria so they can get treatments quickly if they are co-infected, and we give them pain relief. They are so sick, they don’t want to eat or drink, so they get dehydrated very quickly which makes it hard for their body to fight the disease. Keeping patients hydrated is really important.”
How Medecins Sans Frontieres responds to Ebola
Médecins Sans Frontières has a long history responding to outbreaks of Ebola in countries including the Democratic Republic of Congo, Uganda, Guinea, Sierra Leone and Liberia.
Médecins Sans Frontières has intervened in almost all reported outbreaks over the past years.
A swift response
When there are outbreaks of a highly infectious disease like Ebola, Médecins Sans Frontières acts quickly to support efforts to contain the epidemic and provide expert emergency medical assistance.
The needs of patients and affected communities remain at the heart of the response, which can be divided into six key themes: care and isolation of patients; tracing and follow up of patient contacts; conducting safe burials; actively seeking new cases; and supporting existing health structures.
The sixth is working with communities to determine how best to raise awareness (for example about what Ebola means, what the symptoms are, how to prevent Ebola and where to seek care).
“Once the community, the families, the health workers understand what is being done; understand the disease and how it’s transmitted then you can control the outbreak. But without that, it’s much more difficult.”
Diagnosing Ebola can be difficult as the initial symptoms are non-specific (common to a variety of illnesses). Ebola infections can only be diagnosed definitively in a laboratory. Médecins Sans Frontières medical staff take a blood sample from the patient, and the laboratory determines within hours whether or not the samples contain the Ebola virus.
Patients who are suspected to have Ebola are isolated until their status has been established. The patient is examined in the isolation unit by a team member wearing protective clothing. Because it is so contagious, all patients diagnosed with Ebola remain inside a specially constructed isolation ward for the duration of their treatment.
Contact tracing is done to ensure that people in touch with a known patient can be identified and offered protection in form of a vaccine, testing and treatment if relevant.
Médecins Sans Frontières outreach teams travel outside the centre of the outbreak to find other people who have been in contact with the patients.
If someone is displaying symptoms, they can then be tested for the virus and treated at the isolation unit; and if they have no symptoms but have had contact with a person diagnosed with Ebola, they can be offered the vaccine. They can also receive information on what to do if they start displaying symptoms.
Because healthcare workers and people caring for sick relatives are more likely to come into direct contact with body fluids, they are at high risk of developing Ebola. The proper use of personal protective equipment greatly reduces this risk.
The greatest threats to reducing Ebola transmission are:
- When we do not know that a person has Ebola – for example, in health centres when people present with fever.
- Relatives who take care of a sick person or dead body and become vulnerable to infection themselves.
- When suspected Ebola patients wait too long in isolation prior to receiving a diagnosis; the disease can progress in this time.
- Fear or lack of knowledge in the community that leads to hiding patients, accessing treatment too late which increases the risk of others being infected.
Therefore, supporting existing health facilities with triage, detection and isolation of suspected Ebola cases, and being rigorous with infection prevention and control, is crucial to mitigating the risk of infection spreading within hospitals and health centres and communities.
Reaching out to and working with communities to explain the disease as well as understand community members’ fears and concerns is essential to any successful response.