Ebola virus disease: a zoonotic disease with an extremely high fatality rate / 中国热带医学

@# Ebola virus disease (EVD) is a severe infectious disease caused by Ebola virus in humans and primates. The main clinical features are fever and bleeding. The disease was first identified in Zaire and Sudan in Africa in 1976. Since then, it has caused many large-scale epidemics in Africa. One of the largest and most complex Ebola outbreaks in history was the 2014-2016 outbreak in West Africa, which caused more cases and deaths than all previous outbreaks combined. As of 2022, about 35 000 EVD cases and 15 000 deaths have been reported. During the African pandemic, EVD also spread to other regions outside the African continent, such as the Americas and Europe, and became a public health issue of worldwide concern. In Africa, the re-emergence of the disease in Uganda and the Republic of Congo in 2022 has attracted much attention from the world. This article systematically summarizes the history, epidemiological distribution, route of infection, clinical symptoms, diagnosis, treatment, prevention and control of Ebola virus disease, so as to provide reference for relevant workers in China.

Global Epidemic of Ebola Virus Disease and the Importation Risk into China: An Assessment Based on the Risk Matrix Method / 生物医学与环境科学（英文）

OBJECTIVE@#To analyze the global epidemic status of the Ebola virus disease (EVD) and assess the importation risk into China.@*METHODS@#Data from World Health Organization reports were used. We described the global epidemic status of EVD from 1976-2021, and assessed and ranked the importation risk of EVD from the disease-outbreaking countries into China using the risk matrix and Borda count methods, respectively.@*RESULTS@#From 1976-2021, EVD mainly occurred in western and central Africa, with the highest cumulative number of cases (14,124 cases) in Sierra Leone, and the highest cumulative fatality rate (85%) in the Congo. Outbreaks of EVD have occurred in the Democratic Republic of the Congo and Guinea since 2018. The importation risk into China varies across countries with outbreaks of disease. The Democratic Republic of the Congo had an extremely high risk (23 Borda points), followed by Guinea and Liberia. Countries with a moderate importation risk were Nigeria, Uganda, Congo, Sierra Leone, Mali, and Gabon, while countries with a low importation risk included Sudan, Senegal, and Co

Points of entry dynamics: understanding the cross-border threats for Ebola virus disease and COVID-19 in Ghana using a logic model approach

Background. The influx of people across the national borders of Ghana has been of interest and concern in the public health and national security community in recent times due to the low capacity for the prevention and management of epidemics and other public health risks. Although the International Health Regulations (IHR) stipulate core public health capacities for designated border facilities such as international airports, seaports, and ground crossings, contextual factors that influence the attainment of effective public health measures and response capabilities remain understudied. Objective. To assess the relationship between contextual factors and COVID-19 procurement to help strengthen infrastructure resources for points of entry (PoE) public health surveillance functions, thereby eliminating gaps in the design, implementation, monitoring, and evaluation of pandemicrelated interventions in Ghana. Materials and Methods. This study employed a mixed-methods design, where quantitative variables were examined for relationships and effect size interactions using multiple linear regression techniques and the wild bootstrap technique. Country-level data was sourced from multiple publicly available sources using the social-ecological framework, logic model, and IHR capacity monitoring framework. The qualitative portion included triangulation with an expert panel to determine areas of convergence and divergence. Results. The most general findings were that laboratory capacity and KIA testing center positively predicted COVID-19 procurement, and public health response and airline boarding rule negatively predicted COVID-19 procurement. Conclusion. Contextual understanding of the COVID-19 pandemic and Ebola epidemic is vital for strengthening PoE mitigation measures and preventing disease importation.

Caracterización clínico epidemiológica de pacientes con ébola en un centro de tratamiento de Sierra Leona / Clinical-epidemiological characterization of Ebola disease in patients at a treatment center in Sierra Leone

Introducción: La enfermedad del ébola se dio a conocer por primera vez en 1976, con una letalidad muy elevada en todos los brotes detectados. Objetivo: Caracterizar clínica y epidemiológicamente a los pacientes portadores de la enfermedad por el virus del Ébola. Métodos: Se realizó un estudio observacional, descriptivo y transversal en 424 pacientes ingresados en un centro de tratamiento de ébola en la República de Sierra Leona, África occidental, con el diagnóstico confirmado mediante la técnica de reacción en cadena de la polimerasa para virus Ébola, durante el período de noviembre de 2014 hasta marzo de 2015. Resultados: Se muestra que el grupo etario más afectado fue el de 25 a 34 con un 25,9 por ciento. La mayor letalidad se presentó en los pacientes con más de 65 años de edad con un 44,4 por ciento. El síntoma que prevaleció fue la fiebre para un 61,8 por ciento, y el hipo se presentó en el 88,8 por ciento de los fallecidos. Conclusión: Se concluye que la enfermedad no tuvo distinción significativa con el sexo. La mayor letalidad se presentó en las edades geriátricas. Los síntomas más frecuentes fueron la fiebre, diarrea y el decaimiento. El hipo fue el signo que más se presentó en los pacientes que fallecieron(AU)

Introduction: Ebola disease was first reported in 1976 with a very high lethality in all outbreaks. Objective: To clinically and epidemiologically characterize the patients carriers of Ebola virus disease. Methods: we conducted an observational, descriptive and cross-sectional study in 424 patients admitted to an Ebola Treatment Center in the Republic of Sierra Leone, West Africa from November 2014 to March 2015. The polymerase chain reaction technique for Ebola virus confirmed the diagnosis. Medical records provided all data. Results: The age group most affected was 25 to 34 (25.9 percent). The highest lethality occurred in those over 65 years of age (44.4 percent ). Fever was the prevailing symptom (61.8 percent) and hiccups occurred in 88.8 percent of the deceased. Conclusion: Clinical manifestations were variable, although fever was the main symptom. Hiccup was a sign of poor prognosis when associated with a higher percentage of mortality. Lethality was high(AU)

Medical service and management of pregnant women during the Ebola epidemic / 中华实验和临床病毒学杂志

The Ebola epidemic occurrence during 2014-2016 is the largest-ever Ebola virus outbreak with an unprecedented scale and impact. The difficulties faced by pregnant women living within the epidemic area are complex and multi-factorial which merits our concern. In this review, we aimed to summarize some of the guidelines published by the World Health Organization during the outbreak, and to provide a broad overview of the issues that arise from pregnant women. Based on our own experience in Sierra Leone, we also made an analysis of the complex interaction between the Ebola virus disease, pregnancy, medical staff, public health systems and the society, and intended to afford peers useful information. The management strategies should be prepared in advance to against the potential epidemic threats and ensure the reliability of life-saving maternity services in China.

An update on the 2014 Ebola outbreak in Western Africa

The recent Ebola outbreak in Western Africa was the most devastating outbreak witnessed in recent times. There have been remarkable local and international efforts to control the crisis. Ebola Virus Disease is the focus of immense research activity. The progression of events in the region has been evolving swiftly and it is of paramount importance to the medical community to be acquainted with the situation. Over 28000 people were inflicted with the condition, over 11000 have died. Novel data has emerged regarding modes of transmission, providing rationale for recent flare-ups. Similarly, studies on survivors are elucidating the later stages of the disease recovery process. Novel techniques for diagnosis are also discussed. Finally, the current research regarding treatment and vaccine development is reviewed, particularly the implementation of rVSV-ZEBOV vaccination programs.

An update on the 2014 Ebola outbreak in Western Africa

The recent Ebola outbreak in Western Africa was the most devastating outbreak witnessed in recent times. There have been remarkable local and international efforts to control the crisis. Ebola Virus Disease is the focus of immense research activity. The progression of events in the region has been evolving swiftly and it is of paramount importance to the medical community to be acquainted with the situation. Over 28 000 people were inflicted with the condition, over 11 000 have died. Novel data has emerged regarding modes of transmission, providing rationale for recent flare-ups. Similarly, studies on survivors are elucidating the later stages of the disease recovery process. Novel techniques for diagnosis are also discussed. Finally, the current research regarding treatment and vaccine development is reviewed, particularly the implementation of rVSV-ZEBOV vaccination programs.

Avances científicos en las estrategias terapéuticas contra la enfermedad por virus del ébola / Scientific advances in therapeutic strategies against disease by ebola virus

La enfermedad por el virus del Ébola se conoce desde hace treinta años como mortal, contagiosa y de difícil diagnóstico y tratamiento. Numerosos estudios se han realizado para comprender la patogénesis del virus y con ello los posibles tratamientos que puedan generar control de la enfermedad. Sin embargo, no hay hasta la fecha un fármaco o vacuna con licencia para combatir el virus del Ébola. El tratamiento está basado solo en aliviar los síntomas y prevenir el contagio por medio de acciones que ayuden a minimizar el riesgo de infección. En esta revisión, se presentan las diferentes perspectivas del estado actual de la investigación sobre fármacos antivirales y vacunas en fases de desarrollo para la infección del virus del Ébola.

Ebola virus disease has been known for thirty years as a lethal, contagious and difficult to diagnose and treat disease. Numerous studies have been conducted to understand the pathogenesis of the virus and thus the possible treatments that may promote disease control. However, to date there is no licensed vaccine or medicine to fight Ebola virus. The treatment is based only on relieving symptoms and preventing contagion through actions that help minimize the risk of infection. This review presents different perspectives of the current state of research on antiviral medicine and vaccines in development stages for Ebola virus infection.

Information needs and sources for ebola virus disease among staff of a college of medicine in ENUGU, Nigeria

This study was carried out to ascertain the information needs and sources for Ebola among staff of College of Medicine, Enugu State University of Science and Technology (ESUT) Enugu. The study adopted the descriptive survey design. A total of 200 questionnaires were used to elicit information from the respondents. The 200 questionnaire were administered to the respondents and all the responses were retrieved accordingly for data analysis. The data were analyzed using percentages. Findings showed that a good number of the respondents correctly identified best preventive measures against Ebola as avoiding raw foods especially under cooked meat and washing hands regularly with soap or use of hand sanitizers. This show the respondents are aware of the disease. Information is needed most on the causes of Ebola virus and television and radio were major sources of information on Ebola. In conclusion, the study noted that there is need for planned and proper dissemination of information on of Ebola Virus Disease. This will help the citizens to prevent the disease as well as manage any outbreak.

Ebola virus disease: Emerging outbreak.

Ebola Virus Disease or Ebola Haemorrhagic Fever is one of the highly fatal viral disease caused by ebola virus in humans. Mortality rate as high as 90% is reported. Virus is transmitted to humans through bats and other animals infected from bats. Although Ebola Virus Disease is reported since 1976 but currently West Africa is facing the largest outbreak of disease with danger of spread to other parts of the world. More than 5000 cases with mortality of more than 2600 cases has been reported till the end of 3rd quarter of year 2014. There is no specific treatment and vaccination available till date. Mainstay for managing patient is supportive care with early fluid resuscitation and symptomatic treatment. Our main target is to prevent human transmission by educating and supporting the community.

Ebola virus disease: Past, present and future

Ebola virus disease is one of the most deadly ailments known to mankind due to its high mortality rate (up to 90%) accompanying with the disease. Ebola haemorrhagic fever (EHF) is an infectious disease of animal that can be transmitted to both human and non-human primates. The first epidemic of EHF occurred in 1976 in the Democratic Republic of the Congo. The incubation period of ebola is less than 21 days. Ebola virus infections are depicted by immune suppression and a systemic inflammatory response that leads to damage of the vascular, coagulation and immune systems, causing multi-organ failure and shock. Five genetically distinct members of the Filoviridae family responsible for EHF are as follows: Zaire ebolavirus, Sudan ebolavirus, Côte d'Ivoire ebolavirus, Bundibugyo ebolavirus and Reston ebolavirus. The ongoing 2014 West Africa ebola epidemic has been considered as the most serious panic in the medical field with respect to both the number of human cases and death toll. The natural host for ebola virus is unknown, thus it is not possible to carry out programs to regulate or abolish virus from transmission to people. The ebola virus infection provides little chance to develop acquired immunity causing rapid progression of the disease. It is pertinent to mention that at present, there is no antiviral therapy or vaccine that is helpful against ebola virus infection in humans. The impediment of EHF necessitates much better understanding of the epidemiology of the disease, particularly the role of wildlife, as well as bats, in the spread of ebola virus to humans.

Ebola preparedness in the Western Pacific Region, 2014

West Africa is currently experiencing the largest outbreak of Ebola virus disease (EVD) in history with intense transmission in several affected countries. For non-affected countries, the best protective measures are adequate levels of preparedness including vigilant surveillance to detect cases early and well-prepared health systems to ensure rapid containment of the virus and to avoid further spread. The World Health Organization Regional Office for the Western Pacific recently conducted two activities: a web-based EVD preparedness survey and an EVD simulation exercise to determine the overall level of EVD preparedness in the Region. The survey and exercise together demonstrate there is a good overall level of preparedness for a potential imported case of EVD in the Western Pacific Region. However, a number of areas still require further strengthening before the Region can efficiently and effectively respond to potential EVD events, including laboratory testing arrangements; clinical management and infection prevention and control; and public health intervention measures, particularly at points of entry. Importantly, the survey and exercise also highlight the unique situation in Pacific island countries and emphasize that special considerations are needed to better support these countries in EVD preparedness.

Hospital preparedness for Ebola virus disease: a training course in the Philippines

OBJECTIVE: To develop, teach and evaluate a training workshop that could rapidly prepare large numbers of health professionals working in hospitals in the Philippines to detect and safely manage Ebola virus disease (EVD). The strategy was to train teams (each usually with five members) of key health professionals from public, private and local government hospitals across the Philippines who could then guide Ebola preparedness in their hospitals. METHODS: The workshop was developed collaboratively by the Philippine Department of Health and the country office of the World Health Organization. It was evaluated using a pre- and post-workshop test and two evaluation forms. Chi-square tests and linear regression analyses were conducted comparing pre- and post-workshop test results. RESULTS: A three-day workshop was developed and used to train 364 doctors, nurses and medical technologists from 78 hospitals across the Philippines in three initial batches. Knowledge about EVD increased significantly (P < 0.009) although knowledge on transmission remained suboptimal. Confidence in managing EVD increased significantly (P = 0.018) with 96% of participants feeling more prepared to safely manage EVD cases. DISCUSSION: The three-day workshop to prepare hospital staff for EVD was effective at increasing the level of knowledge about EVD and the level of confidence in managing EVD safely. This workshop could be adapted for use as baseline training in EVD in other developing countries to prepare large numbers of hospital staff to rapidly detect, isolate and safely manage EVD cases.

Biological characteristics of Ebola virus:research advances / 军事医学

Ebola virus disease , which can cause ebola hemorrhagic fever , is a potent zoonotic infectious virus disease . In 2014 , Ebola virus spread across West Africa and it has become a new major threat to global public health .This article summarizes the structural features of Ebola virus , transmission characteristics , interactions ,animal models .

Practice and thinking of foreign staff in pre-service training in ETC / 中华医学教育探索杂志

The medical contingent of Chinese PLA to libera operated the China Ebola treatment center(ETC) with 100 beds,and employed 80 Liberian health workers according to the task requirements and the normal operation demand.Under consideration of current health education situation and epidemic prevention requirements,combined with experiences in the fight against SARS,the training content includes the Ebola prevention and control knowledge,isolation of patients and safe burial,malaria prevention and control knowledge,hospital disinfection technology,psychological intervention.Training methods diversified,with theoretical teaching,site visit,on-site demonstration and training and video guide.With the pass of the simulation training evaluation model in all staff,the expected goals of pre-service training have been achieved.

Pharmaceutical administration for anti-ebola outbreak mission of chinese military medical aid team in sierra leone / 中国药学杂志

OBJECTIVE: To summarize lessons of the medicine provision and management learned from the anti-Ebola outbreak mission in Sierra Leone executed by Chinese military medical aid team. METHODS: Summarizing the medicine preparing, shipping, storage and management procedure during the whole task period from 16 Sep, 2014 to 21 Mar, 2015. Anlyzing lessons and knowledge we have learned from the mission. RESULTS: According to the local health system situation and currently outbreak characters, the pharmaceutical group of the Chinese military medical aid team have prepared almost all types and dosages of medicines needed for the whole mission. Through feasible transportation pathway including cold chain, medicines were shipped to destination safely. Classified storage, detailed management and sorting system insured the high quality of the medicine distribution. CONCLUSION: The effective provision and scientific management of the pharmaceutical support of military medical aid team have made a good model for the emergency medical aid action abroad. The experiences we have obtained from this mission may be useful for the future performing of similar major overseas task of Chinese military.

Multiple organ dysfunctions and aggressive supportive therapies in patients with severe Ebola virus disease: A literature analysis / 第二军医大学学报

Objective To analyze and summarize the characteristics of multiple organ dysfunctions and the associated supportive therapies in patients with severe Ebola virus disease (EVD) through a systematic literature review. Methods Medline and EMbase were searched since 2014 for eligible studies on severe EVD patients in ICU. The data of clinical presentations, treatment procedures as well as prognosis of these patients were summarized and analyzed. Results Ten patients from 7 reports were finally enrolled in the present study. Internal environment disturbance, liver injury and thrombocytopenia occurred in almost all of the patients. Respiratory failure was found in 4 patients and 3 of them were also complicated with renal failure. All of the patients received aggressive supportive therapies, such as maintaining the stability of internal environment, transfusion of blood products, mechanical ventilation, renal replacement therapy, antiviral therapy, etc. Of the 10 patients, 9 recovered and 1 died. Conclusion Severe EVD patients are always complicated with multiple organ dysfunctions and effective supportive therapies can improve the organ dysfunctions and prognosis of these patients.

Evaluation of anti-Ebola training system in the PLA Medical Team to Liberia and some suggestion / 第二军医大学学报

Objective To summarize the characteristics of the training system for the Second Medical Team of Chinese People's Liberation Army (PLA) to Liberia for anti-Ebola mission and to give some suggestion. Methods Before going to Liberia, the Second Medical Team of Chinese PLA received pertinent training focusing on Ebola-related theories and practical protection skills. Training on working regulation and procedures, emergency protocol and foreign affair was also given. Theory learning was carried out by combining lectures and self-teaching; protection skills were strengthened by watching video, live demonstration and modular training. Finally, modular situation simulation and supervision assessment were used to integrate the theories, skills, working procedures and urgent drill, making each section coordinate and function well to achieve the designed training goals. Results The pertinent training was effective. We suggested that it is necessary to include general introduction of lemology, principles and rules of protection and control of communicable diseases in theory learning so as to guide the trainees to solve specific problems during their work. In addition, psychological counseling for the purpose of eliminating the members' fear and anxiety and other negative emotions, and learning self-grooming, are also helpful to facilitate the execution of mission in foreign areas. Conclusion The petinent training has laid a solid foundation for achieving the goal of "win the war, zero infection" during emergent medical situation. Modular scenario simulation training method is effective for emergent response training of medical team for communicable diseases, and it should be widely used.

Sanitation and antiepidemic practice in Chinese Ebola Treatment Unit in Liberia / 第二军医大学学报

Objective To summarize the design and implementation of standard work flow of sanitation and epidemic prevention work in the anti-Ebola mission in Liberia, so as to provide reference for treating infectious diseases in the future. Methods The working practice for sanitation and epidemic prevention in Chinese Ebola Treatment Unit in Liberia, including the organizational operation mode, work flow, quality control, and the improvement of the performance were reviewed. Then the importance of sanitation and epidemic prevention was analyzed and the experience and lessons were summarized. Results Deployed in Liberia for the mission of treating Ebola virus disease, the Medical Team of the Chinese People's Liberation Army (PLA) successfully achieved the goal of "win the war, zero infection", in which the sanitary and epidemic prevention work had played an important role. Conclusion The sound organization and management, excellent material preparation, reasonable arrangement of work flow, strict quality control and the continuous improvement of problems were the keys for successful sanitary and epidemic prevention work in the Chinese Ebola Treatment Unit in Liberia.

Ebola virus disease-related fear, stigma and discrimination can not be overlooked / 第二军医大学学报

Ebola virus disease (EVD)-related fear, stigma and discrimination are series of psychological barriers and behaviors during EVD epidemics, which are caused not only by the characters of EVD, such as high fatality rate, high transmission efficiency and clinical similarities to other infectious diseases, but also by the backward economy and educational levels, unsound hospital and health care system, traditional production mode and life style, and political unrest in West Africa countries. As members of the second batch of the Chinese People's Liberation Army (PLA) medical team to Liberia the authors noticed that not only EVD patients and the contacts, but also the medical workers had to face the fear, discrimination, and even the violence from other people, which decreased the effects of the EVD-prevention and control efforts. Prompt publicity and education about EVD in local communities, Ebola-prevention training programs to the local health workers, letting Ebola survivors to participate in the epidemic control mission, and providing more protective equipment should be employed to improve Ebola prevention and eliminate the Ebola-related fear, stigma and discrimination. It is suggested that strengthening the research on the specific vaccines and medicines against Ebola, all-around assistance from the international society and extensive publicity and education about Ebola can help to dismiss the psychological barriers of fear, stigma, and discrimination about EVD.