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Ebola

Ebola hemorrhagic fever is one of many known haemorrhagic fevers. They are serious, often fatal diseases in humans and primates (including, amongst others, chimpanzees and gorillas). Ebola hemorrhagic fever is caused by infection with the Ebola virus. Symptoms begin quite abruptly, sometimes as soon as two days after first contact with the virus. The Ebola virus was discovered during an outbreak in 1976 in the current DR Congo, along the River Ebola. The reservoir of the virus is unknown, but bats appear to play a major role in the spread of the disease. Current outbreak of Ebola haemorrhagic fever started in Guinea.

Transmission
Because the reservoir of Ebola viruses is unknown the manner in which it is transmitted to humans, the initial infection at the onset of an epidemic, is unclear. The most likely way is human contact with an infected animal: primates, bats or duikers (a breed of antelope). As soon as the person has been infected, the virus can be transmitted to others in various different ways. Among other things by direct contact with blood or other body fluids, or by materials that have been in such contact, such as needles. The disease is often spread within families or small communities because carers often care for the sick without protecting themselves. When medical personnel do not have proper preventive protection, strict isolation of the patient is not achieved and hygiene measures are not properly observed, the Ebola virus can often quickly spread within medical institutions.
 
Signs and symptoms
The first symptoms occur 2 to 21 days after exposure to the virus, usually within 8-10 days.

Typical symptoms of Ebola hemorrhagic fever are:
- Fever
- Headache
- Pain in the joints and muscles
- General weakness
- Diarrhea and abdominal discomfort
- Nausea and vomiting
- Loss of appetite
- Sometimes there is also a rash, red eyes, hiccups, cough, sore throat, chest pain, difficulty breathing, difficulty swallowing, and (internal) bleeding.


Risk of exposure
Because the reservoir of Ebola viruses is unknown, it is difficult to predict when and where there is a risk of transmission of the virus to humans. During an outbreak/epidemic the risk of transmission is greatest for health care workers and family members of infected individuals. Health facilities should be avoided if possible.

Diagnosis
Diagnosing Ebola hemorrhagic fever is difficult during the first few days because the first symptoms are often not specific to the Ebola virus and are also seen in many other diseases. There are several methods by which an Ebola hemorrhagic fever can be diagnosed. Which technique will be chosen for diagnosis will depend upon when, and the circumstances in which, the diagnosis is being made.

Treatment
Options for treating patients with Ebola hemorrhagic fever are limited. Supportive treatment consists of keeping up a patients fluids, providing them with oxygen and keeping their blood pressure in check, in addition to the treatment of any secondary infections.


Prevention
- Take the following precautions:
o Avoid contact with symptomatic patients with Ebola hemorrhagic fever and/or their bodily fluids ;
o Avoid contact with corpses and/or bodily fluids from deceased patients.
Generic precautions:
o Avoid any form of close contact with wild animals (including monkeys, antelopes, rodents and bats) and consumption of ‘bushmeat’;
o Wash and / or peel fruits and vegetables before consumption;
o Strictly practices ‘safe sex’;
o Strictly follow hand-washing routines;
o Follow instructions for malaria prophylaxis and vaccination

- In case of fever, adequate diagnostics are indicated. If you observed the precautions, risk for Ebola hemorrhagic fever is very small. The probability that symptoms are caused by another condition is substantially larger. State that you have been in an area with Ebola hemorrhagic fever.

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travelclinic@erasmusmc.nl
 

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