Ebola, or Ebola fever, is an infectious disease that causes high fever and can lead to internal bleeding. The infection is caused by the Ebola virus and is transmissible from person to person.
What is Ebola?
Ebola was first documented in the 1970s in central Africa. In the case of the hemorraghic form of Ebola, the mortality rate is particularly high, with three out of four patients dying due to internal bleeding. The tropical disease was named after the African river of the same name where the disease first appeared. The occurrence of Ebola is limited to Central Africa. However, there have been isolated cases of Ebola outside of Africa, but all were due to a previous stay of the individuals in question in the respective areas of Africa. Ebola occurs from time to time in localized epidemics in which there are several hundred infected individuals, about half of whom survive the disease.
Causes
The causative agent of the disease Ebola belongs to the group of viruses that cause hemorraghic fever, which includes the yellow fever and dengue viruses. The group of Ebola virus also includes the Marburg virus, which was responsible for the death of several scientists in Marbug in 1967, who had contracted the Ebola-like virus in the laboratory on African monkeys. Therefore, it is believed that mainly monkeys, but also rodents, bats and insects are carriers of the dangerous Ebola viruses. The viruses can also be transmitted to humans by eating diseased animals. Human-to-human transmission occurs through body fluids such as blood, bodily secretions, or simple smear and droplet infection. It has been observed that only patients in the acute phase of illness are contagious. During the incubation period before disease onset and after recovery, patients do not transmit Ebola virus.
Symptoms, complaints, and signs
Schematic diagram of typical Ebola fever symptoms in humans. When infected with Ebola, the first symptoms appear after two to 21 days. Main symptoms of the disease subd headache and pain in the limbs, as well as nausea and [[vomiting]9. Patients experience a growing [[loss of appetite]9, which leads relatively quickly to [[weight loss
The time between infection and onset of Ebola can range from 5 to 20 days. Sudden onset of high fever, chills, severe headache, sore throat, and aching limbs are the first symptoms of Ebola. Flu-like symptoms often do not immediately suggest Ebola. Later, stomach cramps, vomiting and diarrhea occur. In the severe hemorraghic course, there are clotting disorders of the blood and, as a result, internal and external bleeding. Ebola sufferers visibly bleed from all mucous membranes such as the eyes, mouth and genital area. In addition, there is the dangerous internal bleeding, especially in the gastrointestinal tract. The blood loss leads to shock, circulatory collapse and multiple organ failure, from which the patient dies in most cases. In the diagnosis of Ebola, the virus is detected in the patient’s blood, urine, saliva or tissue samples. In most cases, the territorial origin of the patient or a previous trip to the affected areas of Africa already provides an initial indication of the presence of Ebola disease.
Is there a danger for Germany, Austria and Switzerland?
The exponential progression of total reported illnesses (red) and deaths (black) since the outbreak of the Ebola fever epidemic in 2014 until October 1, 2014. There is no blanket yes or no answer to the question. Theoretically, there is a small risk that travelers and refugees from Africa will also introduce Ebola disease to Central Europe. The Hamburg virus expert Jonas Schmidt-Chanasit from the Bernhard Nocht Institute for Tropical Medicine said in this regard: “Through international air traffic, it is possible that such a case is imported to Germany. But we will never have an outbreak like the one in West Africa. Our health care system and our cultural conditions are completely different.” One security procedure already in place in risk countries is so-called “exit screening.” This involves screening passengers who want to fly to Europe for epidemics, Ebola fever and other symptoms. If there is a suspicion that the traveler has been infected, an onward flight is refused. In any case, with the exception of Brussels Airlines, no European Union airlines currently fly to the Ebola-endemic countries of Liberia, Guinea and Sierra Leone. This also minimizes the immediate threat to Germany, Austria and Switzerland (as of October 2014). However, more and more refugees from Africa are arriving in Europe by land or via the Mediterranean Sea. Here, the risk of introducing the disease is greater and more unpredictable. In Germany, there are quite a number of hospitals and clinics with special isolation wards for patients with highly contagious diseases such as Ebola. For example, in Hamburg, Berlin, Frankfurt am Main, Düsseldorf, Leipzig, Stuttgart, Würzburg and Munich. In the event of an outbreak, larger cities would initially be at risk, as their airports make them a hub for travelers and refugees from Africa. Infectious droplet and smear infections could then also be possible in subways and commuter trains. Sparsely populated areas, such as Mecklenburg-Western Pomerania, the Bavarian Forest, Hunsrück, Eifel, Emsland and the high Alps, would have an extremely low risk of Ebola spreading. However, if a chain infection were to occur in Germany, the federal government could use the Infection Protection Act (IfSG) to declare a state of emergency and forcibly isolate and treat infected people to protect them from the rest of the population. Due to the modern medical training of doctors and the excellent medical infrastructure in Europe, there is a very low risk of a mass epidemic with the Ebola virus, unlike many poor countries in Africa. World Bank President Jim Yong Kim recently put it very radically: “Thousands of people are dying of Ebola in Africa because they were unfortunate enough to be born in the wrong place in the world.” The bottom line is that even if some people in Germany were to contract the Ebola virus, the chances of survival are good.
Complications
Ebola is a viral infectious disease that is usually very severe. The Ebola virus that causes the disease is one of the most dangerous viruses known to date. The disease usually begins harmlessly with flu-like symptoms. Patients often complain of headaches and aching limbs. Very soon, the first complications appear in the form of high fever, nausea and vomiting. Skin rashes and conjunctivitis are also regularly observed. Frequently, there is also a disturbance of kidney and liver function. Blood tests regularly show a reduced number of platelets and white blood cells. After a few days, the other symptoms are joined by severe internal and external bleeding, which mainly affects the mucous membranes. Predominantly the eyes and the gastrointestinal tract are affected, but other organs may also be attacked. As the disease progresses, various organs often fail, especially the kidneys, liver, spleen and lungs. Inflammation of the brain can be expected as a further complication. In addition, secondary bacterial infections of the skin or lungs often occur. In severe disease progression, a type of septic shock also regularly occurs. Patients in these cases often die of heart failure.
When should you see a doctor?
If symptoms such as fever, chills, headache, sore throat, muscle aches, and loss of appetite are noticed, it is possibly Ebola.Anyone who experiences these symptoms one to three weeks after traveling to a risk area may have become infected and should consult a doctor. Medical clarification is also necessary if the aforementioned complaints do not subside after two to three days at the latest. If internal and external bleeding occurs, the nearest clinic must be consulted immediately. The same applies if accompanying symptoms such as stomach cramps or diarrhea occur. If an Ebola infection remains untreated, shock and eventually circulatory collapse or heart failure will inevitably occur. If a doctor has not been called by then, emergency services must be alerted immediately. First responders should provide first aid in the meantime and inform the emergency physician of the symptoms when he arrives. In principle, however, Ebola should already be clarified and treated at the first signs. Anyone who has a concrete suspicion must discuss this immediately with the family doctor and, if necessary, go directly to inpatient treatment.
Treatment and therapy
There is no ebola-specific treatment to date. Only the symptoms of the disease are treated, especially the blood clotting disorders in the hemorraghic form of Ebola, in order to stop the internal and external bleeding. Inpatient treatment in isolation wards is also an important measure to prevent further spread of the virus.Because poor hygienic conditions prevail in African hospitals for the most part, localized epidemic-like outbreaks often occur. The high mortality rate of those infected with Ebola in Africa is primarily due to late diagnosis and initiation of treatment, as well as inadequate treatment options.
Outlook and prognosis
The prognosis for infection with an Ebola virus is generally very poor. For example, mortality ranges from 30 to 90 percent. Here, the lethality depends on the type of pathogen. The chances of survival and recovery also improve somewhat with immediate emergency medical aid. However, there is no causal therapy. The body must cope with the virus itself. However, this can be supported by symptomatic therapy. This treatment consists of stabilizing the water and electrolyte balance in the organism. In this way, fatal courses due to dehydration can be reduced. However, the greatest danger to the organism is the extensive bleeding in the internal organs. Depending on the intensity of the bleeding, multi-organ failure is very common. There is currently no therapy that could stop the bleeding during the acute phase of the infection. If the immune system manages to fight the pathogen before organ failure occurs, there is a good chance for a complete cure. Whether immunity to the pathogen will then develop has not yet been conclusively determined. However, it is assumed that immunity against the respective pathogen exists for at least a few years. The greatest risk of infection is during the illness. After the symptoms have subsided, patients are usually no longer contagious. However, the virus is still detected in the semen months after infection, so that transmission is possible during sexual contacts even a long time after the disease.
Prevention
There is not yet an effective method such as medication or vaccination to prevent Ebola. The first experimental Ebola vaccines will be tested in Africa in 2015. However, scientists are working hard to identify the main carrier of the Ebola virus. Only then can effective prevention be achieved with targeted measures by avoiding contact with this particular carrier. Since 1976, approximately 2500 Ebola cases have been counted, of which about half of the patients have survived the disease. Since the main areas of spread in the Central African Congo, Côte d’Ivoire, Uganda and Gabon are not tourist destinations, no spread outside of Africa was expected until the summer of 2014. However, in connection with the 2014 Ebola fever epidemic, two infected Americans were flown out to the United States for further treatment. A Spaniard was also flown out to Spain for closer examination and treatment. On August 19, 2014, a woman in Berlin was quarantined in the isolation ward of Berlin’s Charité hospital with suspected Ebola. Instead of Ebola, however, the woman was suffering from malaria, as it turned out the next day.The Federal Foreign Office has therefore been advising against travel to West Africa since August 1, 2014. The World Health Organization (WHO) also declared the Ebola epidemic an international emergency.
Aftercare
Measures or options for aftercare are severely limited in most cases of Ebola. In the first place, the disease must be treated by a doctor as quickly as possible to prevent the death of the affected person. There can be no self-healing and the symptoms of the disease increase enormously if no treatment is given. For this reason, the main focus in Ebola is the early detection and treatment of the disease, so that there are no further complications. In case of Ebola, the affected person should isolate himself in any case and not come into contact with other people. This is the only way to prevent further infection. Treatment is usually carried out by taking medication. Care must be taken to ensure that the correct dosage is taken and that the medication is taken regularly in order to alleviate internal bleeding and other symptoms. Even after the symptoms have subsided, medical examinations of the internal organs should be performed to detect and treat any damage. The life expectancy of the affected person is significantly reduced by Ebola if the disease is detected and treated late. Further measures of follow-up care are usually not necessary in this case.
What you can do yourself
Ebola is an acutely life-threatening infectious disease. Due to the severity of the disease as well as the risk of infection, patients must not attempt to control the treatment themselves under any circumstances. Persons suffering from Ebola must absolutely and immediately seek medical care after the first symptoms. For this reason, there are hardly any possibilities for patients to help themselves to the disease. In the foreground are the medical instructions, especially regarding the intake of medical agents. Probably the only measure for those affected is to stop physical activities as much as possible in order to allow the body to rest and not increase the feeling of physical weakness. Avoiding exercise is almost the only measure over which patients have any control. All other treatment decisions are the responsibility of the physicians in charge. In order to reduce the risk of infection for other people, patients strictly adhere to the quarantine measures and under no circumstances attempt to defy corresponding instructions. Otherwise, they acutely endanger the lives of other people. In addition, patients take all prescribed medications, such as fluid replacement for diarrhea symptoms or medications for internal bleeding. Usually, they receive adapted meals or infusions.
