International Journal of Nursing Research (IJNR) International Peer Reviewed Journal Review article Ebola virus disease: Comprehensive review Archana R. Dhanawade Bharati Vidyapeeth Deemed University College of Nursing,, Sangli, Maharashtra, India Abstract Ebola is a Filoviridae virus with characteristic filamentous structure of a thread virus. It became a global threat when its outbreak has affected lives of thousands of people including doctors, nursing staff, healthcare workers. The virus spreads via direct contact with blood or body fluids from an infected person in an uncontrolled manner with limited treatment options. The Ebola virus disease is a very serious health problem causing major deaths within a short period. As there are no specific treatment or vaccines available, prevention is the only option to control the spread of disease. So, the health team members, the staff nurses who are more prone to this disease should have adequate knowledge about the disease and its prevention to handle the situation. Keywords: Ebola Virus Disease, nursing, health problem *Corresponding author: Archana R. Dhanawade, Bharati Vidyapeeth Deemed University College of Nursing,, Sangli, Maharashtra, India, India. Email: [email protected] 1. Introduction of Ebola virus disease months later the second outbreak of Ebola virus emerged from Zaire with highest mortality rate The recent outbreak of Ebola Virus Disease (EVD) infecting 318 people. In spite of tremendous has revealed many weaknesses in the public efforts of experienced and dedicated researchers, healthcare system in controlling the spread of Ebola’s natural reservoir was not identified. The disease. In addition, the outbreak has affected third outbreak of Ebola was identified in 1989 lives of thousands of people including doctors, when infected monkeys were imported into nursing staff and healthcare workers [1]. This Reston, Virginia and Philippines [2]. The recent shows the importance of need for adequate outbreak of Ebola was reported in guinea a knowledge about EVD and proper training of western African country in the month of July. On healthcare personnel. 8th August, the WHO declared the epidemic to be This review focus on history, structure and an international public health emergency urging morphology, mode of transmission, clinical the world to offer help affected regions. The manifestation, complications, diagnostic Director General said that countries affected are evaluation, management and prevention of Ebola not capable to manage an outbreak of this size virus disease. and complexity on their own. By mid-August, the doctors reported “the situation in Liberia is 2. History of EVD detiorating daily”. They reported the fear of (Ebola River is Zaire) first emerged in Sudan and Ebola among staff members and patients which Zaire. The first outbreak of Ebola infected over resulted in leaving many people without 248 people with mortality rate of 53%.A few treatment. By late August, the disease spread to © International Journal of Nursing Research, All rights reserved Dhanawade, IJNR Vol 1 (1), 119-122, 2015 Nigeria. Reports released on 6thSeptember, 2014 3. Risk factors counted 4293 suspected cases of Ebola including Migratory populations who used to travel Ebola 2296 death; further to this, more than 120 health outbreak areas are most likely to get infected and care workers died due to lack of equipments and transmit the virus. Healthcare workers like staff long hours. Until November 2014, the number of nurses caring for Ebola patients in close contact death was more than 5000 and was infecting with Ebola patients are at the high risk of getting nearly 16000 people [3]. infection because they may come in contact with infected body fluids. Ebola also can be spread 2. Structure and morphology of Ebola virus through direct contact with objects like clothes, Ebola is one of the family Filoviridae viruses. It bedding, needles, syringes or medical equipment has the characteristic filamentous structure of a that have been contaminated with infected body thread virus. It is an envelope, single-stranded, fluids. Individuals with diabetics, negative-sense RNA virus. It appear U-shaped or immunocompromised patients, patients with coiled like a snail. Ebola is classified into 4 kidney and liver failure and HIV infected people subtypes based on their pathogenicity and lack are at high risk of getting this infection [10]. anantiviral drug or a vaccine. They are Ebola People can become sick with Ebola after coming Zaire, Ebola Sudan, Ebola Reston and Ebola-Tai in contact with infected wildlife. Ebola also [4]. However, recent update following the 2014 spread through sex or with semen from men who update has result in classification of this virus into have survived after Ebola attack [10]. five species as follows: Sudan ebolavirus, Zaire 4. Clinical manifestation ebolavirus, Tai Forest (Ivory Coast) ebolavirus, Symptoms may appear from 2 to 21 days after Reston ebolavirus and Bundibugyo ebolavirus. exposure to Ebola. The symptoms include fever, The largest outbreak in world history of Ebola is severe headache, muscle pain, weakness, fatigue, the recent one in 2014, which happened in West diarrhoea, vomiting, abdominal pain, Africa, Zaire ebolavirus. unexplained haemorrhage [11]. 3. Mode of transmission of EVD 5. Complications Fruit bats of the Pteropodidae family are believed Ebola viral infection usually begins suddenly with to be natural Ebola carrier and may spread the influenza like stages. Its incubation period is 2 to disease virus without being affected [5].The virus 21 days. 40 to 50% of cases, bleed from puncture is transmitted to people from wild animals and sites and mucous membrane. If the infected spreads in the human population through person does not recover, death is due to multiple human-to-human transmission [6]via direct organ dysfunctions [11]. contact with blood or body fluids from an infected person [7]. Though the method of 6. Diagnostic evaluation transmission was not officially determined, it is Ebola hemorrhagic fever outbreaks are becoming believedto spread through large droplets that more and more frequent in Africa, mostly in were suspended in the air [8]. relation to increasing contact with infected wildlife. Previous epidemics were detected after One of the primary reasons for spread is that the a long delay, especially because of the health systems in the parts Africa where the remoteness of the epidemic focus, the lack of disease occurs function poorly. Medical workers laboratory facilities and the poor knowledge of who do not wear appropriate protective clothing the disease in doctors and nurses, who confused may contract the disease. Hospital-acquired Ebola disease with malaria or typhoid fever [12]. transmission has occurred in African countries due to the reuse of needles and lack of universal Nevertheless, the US Food and Drug precautions. Some health care centers caring for Administration (FA) have approved the practice people with the disease do not have running and use of two new rapid tests to identify Ebola water [9]. infectionin humans [16]. These tests can detect 120 Dhanawade, IJNR Vol 1 (1), 119-122, 2015 S N Timeline of Infection Diagnostic tests available Antigen-capture enzyme-linked 1 immunosorbent assay (ELISA) testing Within a few days after symptoms begin IgM ELISA Polymerase chain reaction (PCR) Virus isolation 2 Later in disease course or after recovery IgM and IgG antibodies Immunohistochemistry testing 3 Retrospectively in deceased patients PCR Virus isolation the virus within an hour in blood or urine samples before administration of NPC1 blocking drugs and are performed even in hospitals using a [18]. simple easy to install equipment, BioFire Defense. 7. Management and prevention 6. Treatment Treatment options for patients infected Avoid travelling to a region where EVD was with Ebola virus are limited. Supportive therapy present. iscentered on fluid resuscitation, electrolyte Avoid direct contact with blood, saliva, vomit, imbalance correction, treating complicating urine and other body fluids of people with infections and preventing complications of shock. EVD or unknown illness. Experimental therapies like ZMapp, brincidofovir, Avoid close contact with wild animals and TKM-Ebola and favipiravir were used during the handling wild meat [14]. recent outbreak. Several medications such as amiodarone, chloroquine and clomiphene may The risk of transmission is increased among those prevent the transmission of or treat Ebola virus. caring for people infected. Recommended Different vaccine therapies are also in early-stage measures when caring for those who are infected development. One of the vaccine strategies using include isolating them; sterilizing equipments and recombinant vesicular stomatitis virus as a surfaces; and wearing protective clothing delivery vector has demonstrated efficacy when including masks, gloves, gowns and goggles. If a used for pre-exposure and post-xposure person with Ebola dies, direct contact with the prophylaxis [13]. Close supervision and care by body of the deceased patient should be avoided healthcare professionals is very important for this [15]. infection. A patient with Ebola virus disease may need intensive care unit (ICU) services. However, some of the facts of Ebola that should be borne in mind while planning a strategy for Recent advances in understanding the prevention of Ebola are [17]: pathogenesis of Ebola virus invasion of host cells especially that of humans revealed