Ebola

August 25th, 2014
by Morne Christou

Several DAN members have contacted us with concerns about the current Ebola epidemic. We therefore provide a summary by Dr Darryl Garth Vine of the Western Cape Department of Health with additional comments by DAN’s Medical Director – Dr Jack Meintjes.

1. What is Ebola?

Ebola virus disease (EVD) is a severe and often fatal disease in humans and non-human primates (monkeys, gorillas and chimpanzees).

2. How is it transmitted?

The Ebola virus can spread through direct contact (through broken skin or mucous membranes including the nose, mouth and eyes) with the blood, body fluids (including stool, urine, saliva, semen) or tissue of infected persons.
Ebola virus is not spread in the air, so simply being in the same room as an infected person without having the direct contact as described above is not a risk for infection.

3. Who is at risk for becoming infected?

During EVD outbreaks, those at highest risk include healthcare workers and the family members or friends in close contact with the infected individuals - because they are in close contact with the infectious secretions/bodily fluids when caring for ill persons.

4. The outbreak in West Africa

The current outbreak of Ebola in West Africa was first reported in March 2014, and involves four countries: Guinea, Liberia, Sierra Leone and Nigeria.
This is the largest ever known outbreak of Ebola.
Experts are working together in an international response to control the outbreak.

5. The risk to travellers to West Africa

The risk of a traveller contracting Ebola is very low in the absence of direct contact with the blood or body fluids of an infected person or animal.
Travellers must have a valid yellow fever vaccination certificate and take routine precautions to prevent infections including malaria prophylaxis, preventing mosquito bites, regular hand washing with clean water and soap, and adhering to safe food practices.

6. What is the risk to people in South Africa?

The risk of Ebola virus disease being imported into South Africa is considered to be low.

7. Current situation in South Africa

Currently, there have been no reported cases of EVD in South Africa associated with the outbreak.
Even though South Africa is unlikely to have such cases, the Department of Health has put various measures in place to ensure readiness to manage an imported case of EVD.
All the important role-players (Communicable Disease Control, and Port Health Services, Emergency Medical Services etc.) are working together to ensure the detection, reporting and management of a suspected EVD case.
Our South African Port Health authorities are on high alert for ill persons with EVD-compatible symptoms who have travelled from West Africa.

8. What are the signs & symptoms of someone affected with Ebola?

Symptoms may appear from 2 - 21 days after exposure to the ebola virus (on average 8 - 10 days).
The onset of symptoms is sudden - with fever, headache, joint and muscle pain, and intense weakness.
This is followed by vomiting, diarrhoea, abdominal pain, and sometimes a rash. Some (but not all) patients may experience bleeding inside and outside the body.

9. How is Ebola virus disease diagnosed?

If a person has the early symptoms of Ebola and there is reason to believe that Ebola virus disease should be considered, the patient should be isolated and public health officials notified. A blood sample can be tested to confirm infection.
A specialised laboratory at the National Institute for Communicable Diseases (NICD) in Johannesburg is able to test for Ebola virus disease.
EVD can only be diagnosed once a person develops signs and symptoms of the disease.

10. How can divers protect themselves from infection with Ebola virus?

You will not get Ebola even if sitting next to a person on the same flight during the early stages of disease; the chances escalate during the late phases (when they start bleeding) when there could be a risk of contact with blood and body fluids.
Divers should pay careful attention to identify individuals who seem very ill, particularly in the areas where Ebola might occur or where travellers with EBV might enter other countries – such as harbours and airports.
All physical contact with potentially infected individuals should be avoided, especially contact with blood and body fluids of an infected patient.
If contact with a person with Ebola is completely unavoidable, gloves and tight fitting surgical masks are mandatory; a face shield or surgical goggles are also required to prevent entry of blood and saliva droplets from entering the eye due to sneezing of coughing.
Do not share diving equipment with an individual who appears ill and discourage such individuals from diving. If appropriate notify the dive school or administrative staff of the hotel or resort.
Any contaminated equipment, clothing or materials should be carefully bagged and quarantined using gloves and masks.
Infected persons must be isolated and cared for by health professionals who are trained in the appropriate infection control measures.

11. What if you have travelled to the affected areas and developed early signs of Ebola virus disease?

Access healthcare immediately and inform the healthcare worker of your travel history and the level of contact with suspected or confirmed EVD cases.
You will be isolated and assessed by a healthcare worker (doctor) in consultation with the Infectious Disease Specialist to find out if EVD should be considered.
If your symptoms are compatible with EVD, a blood sample will be collected to confirm the infection.