Global Travel With Respect to Ebola-Free-Samples for Students

Question: Discuss about the Global travel with respect to Ebola. Answer: Background- An increase in the international journeys exposes the travellers to high risks of many infectious heath disorders. It is important to provide preventive measures by circulating information about the mode of transmission and promote well-being to those who travels frequently to countries with high risk (Merrill 2015). World Health Organisation (WHO) have implemented the primary strategies through vaccination, but with 900 million hike in international travellers occurring every year, it is essential to address other preventive measures to reduce the risk factors both in national and international wise (World Health Organization 2013) . The following essay discusses the safety measures while travelling in context to Ebola virus and for this a detailed understanding of this virus with respect to precautions and preventions are required. History- Ebola is a severe viral disease often observed fatal in humans. The largest outbreak of Ebola till date was recorded from West Africa, particularly from Guinea, Sierra, Liberia and Leone (Fisman Khoo and Tuite 2014). 7178 cases of Ebola Virus Disease (EVD) with 3338 deaths were reported on October 1, 2014 (Fasina et al. 2014). Apart from this incident, 20 cases of EVD were reported from Nigeria, but after this no such severe cases of EVD were observed since September 2014 (Weyer Grobbelaar and Blumberg 2015). The 20 cases that were reported resulted due to a particular importation through a traveller who was returning on July 2014 from Liberia (Shuaib et al. 2014). Ebola virus (Zaire ebolavirus) is responsible for hemorrhagic fever with increased rate of fatality. Till date five viruses of genus Ebola belonging to the family of Filoviridae are identified in which four viruses causes human EVD and the fifth species has been found in primates of nonhuman in nature (NHPS) (Rewa r and Mirdha 2014). The species are Bundibugyo ebolavirus (BDBV), Zaire ebolavirus (EBOV), Sudan ebolavirus (SUDV), Reston ebolavirus (RESTV) and Cte dIvoire ebolavirus (TAFV) respectively. The transmission of this virus occurs by direct contamination of blood, fluids of the body or derma of patients with EVD or through dead bodies due to this disease (Gebretadik et al. 2015). The pathogenic nature of these viruses varies, with EBOV being lethal to a great extent in humans. Pathophysiology- Zaire (EBOV) replications produce large quantity of virus found in monocytes, dendritic cells and macrophage cells. The chemical signals of high inflammation are released due to triggered monocytes (Falasca et al. 2015). Endothelial cells, liver cells, macrophages and monocytes are prone to this infection. This virus first infects the macrophages leading to cellular death and infection in endothelial cells occurs after 3 days of exposure. The vascular injury caused by breakdown of endothelial cells attributes to glycoproteins (GP) of EBOV. The affected people with haemorrhage undergo edema with hypovolemic shock. A small soluble glycoprotein (SGP) is secreted just after the infection. This glycoprotein attaches the virus to endothelial cells by forming one trimetric complex. The (SGP) interferes with neutrophils signalling by forming a dimer protein evades the virus to immune system by inhibiting the action of neutrophil. These infected white blood cells pass the vir us throughout the entire body into the organs such as liver, lungs, lymph nodes and spleen (Paessler and Walker 2013). The presence of virus within the cells causes cell damage and releases the chemical signals such as IL-6, IL-8 and TNF-? causing fever and inflammatory symptoms. The blood vessels integrity is reduced by the infection in endothelial cells which increases (GP) synthesis which in turn decreases the specific integrins. Lack of these integrins causes liver damage resulting in improper clotting. The proteins of EBOV blunt the immune system of humans by interfering the cells production ability with consequent response towards interferon proteins such as interferon alpha, beta and gamma (Meyer and Ly 2016). Mode of transmission- Identification of natural host reservoir of Ebola virus and how the virus appears in human at beginning of the outbreak are yet to be known. According to some scientists, the first person got infected through a direct contact with an animal such as primates or fruit bat infected by this virus. This condition is termed as spillover event (Chowell and Nishiura 2014). This then goes on transmitting other person affecting a large count of individuals. It is believed that the primates in past got affected by Ebola and people got infected too when they came in contact or consumed the infected primates. The mode of transmission of this virus occurs through various ways. The Ebola spreads through skin that is broken or via mucous membrane present in eyes, mouth and nose (Judson Prescott and Munster 2015). The virus spreads through blood or body fluids such as saliva, sweat, urine, semen, vomit and breast milk of an Ebola affected person. Other mode of transmission is th rough virus contaminated needles and injections. Transmission through fruit bat or apes and monkeys infected by this virus is also noted (Weingartl et al. 2012). Ebola is not an air borne disease neither it spreads through water or food. Transmission through mosquitoes or any other insects are not observed. This infection has been reported to confined species of mammals such as humans, apes and bats and hence plays active role in spreading the virus. The risk of transmission increases significantly when directly coming to the patient contact at the acute phase of the disease (Shears and O'Dempsey 2015). Incidence and prevalence of Ebola cases- The incidence of EVD and its current prevalence with respect to last few years is being tabulated in the Appendix comprising the morbidity and mortality numbers. Incubation period of Ebola- Ebola virus can thrive in liquid medium or the materials that are dry in nature. The gamma irradiation inactivates the virus along with 60 minutes heating at a temperature of 60C or 5 minutes of boiling. Bleaching with sodium hypochlorite and similar disinfectants can reduce their sensitivity. On the other hand, freezing them does not exert any affect on their sensitivity (Passi et al. 2015). The incubation duration that is the time period between the appearance of the first symptom and the infection varies between 4-10 days, sometimes the incubation starts from early 2 days extending to 21 days. The case fatality rates (CFRS) of the ZEBOV infections vary from 44% to 90% (Nanclares et al. 2016). The series of symptoms varies from individual to individual and manifestations include severe pain, feeling nausea and ill followed by bleeding. The fever in the second week either decreases or causes failure of multiple organs in the patient. The range of the mort ality rates are species dependent and depends on the virus strains of the species. Early symptoms are common to bacterial infections that are less severe such as malarial fever, influenza fever or typhoid fever. Initially, the fever is 101.8 Fahrenheit followed by pain, headache, throat sore, bleeding, nausea, dizziness with fatigue feeling. With the progression of the disease, the patient develop more critical issues such as faeces characterised by bloody and dark appearances, vomiting with blood, diarrhoea and eyes showing red appearances resulting in sclerotic arterioles haemorrhage. Other signs of secondary infection show tachycardia, decrease in blood pressure and hypovolemiatic shock (Beeching Fenech and Houlihan 2014). In certain cases the infected person starts bleeding from injures that is partially healed or site of injection in skin epidermis. It occurs when the virus affects blood platelets which in turn develop sutures into the capillary walls. Ebola alters the levels o f white blood corpuscles and platelets, making the blood clot more difficult with consequent haemorrhage over 50% patients (Goeijenbier et al. 2012). Diagnosis with possible treatment- The process of diagnosis is difficult in person with Ebola as the initial symptoms are nonspecific such as fever and often found in patients having malarial fever and typhoid fever. If any symptoms corresponding to Ebola are noticed, the person should be kept in isolation with prior notification to health professionals. Samples should be collected to confirm the infection. Detection of Ebola virus in the blood starts only after the symptoms onset through fever. It takes minimum 3 days to reach the detection stage. No such FDA-treatment such as treating by antiviral drugs is available for Ebola (Chmielecki 2015). But by following certain basic interventions in early stage can improve survival chances significantly. The strategic interventions are provided by intravenous fluids and by balancing the electrolytes of the body salts. Maintaining the oxygen rate with balanced blood pressure and taking proper care to treat other infections if any, reduces t he risk factors. Experimental treatments surrounding Ebola are under process but yet to be tested for effective safety implications. A good caring support can recover the incidence of Ebola by improving the immunity power of the patient. The antibodies developed by the recovered patients last for more than 10 years. It is still unknown that the people who recover are life immune or is there any possibility of getting infected by other species of Ebola. The recovered people have showed complications in joint and visualising (Blaser 2014). Vaccination- Treatment through vaccination in an experiment showed increased protection against the fatal virus that was trailed in Guinea (Kaushik et al. 2016). The vaccine that was used named rVSV-ZEBOV was experimented on 11841 people in 2015. No such cases of Ebola was recorded after 10 days of vaccination among 5837 people whereas 23 cases were there 10 days post vaccination among them who did not take the vaccination. WHO along with Ministry of Heath of Guinea collaborated with international partners in a protocol of ring vaccination. In this trail, some rings were vaccinated immediately after a detection of a case whereas the other rings were vaccinated after 3 weeks (Shu-Acquaye 2017). Prevention- Controlling the outbreak of this disease needs interventional package for managing the case, survey study with contact tracing, well equipped laboratory services, mobilising socially and controlled burials. The outbreaks can be successfully controlled by community engagement through increasing awareness about the risk factors for this infection and providing protective measurements such as through vaccination can thereby minimise human transmission. The messages of risk reduction are based on factors such as by reducing the transmission risk from wild animals to humans by avoiding contact with infected primates or fruit bats and avoiding their raw meat consumption. The handling of these animals should be done with gloves and protective clothing. The second factor is reducing the transmission risk between the same species such as human from coming in direct contact with Ebola detected patients specially body fluids of them. Patients should be handled by wearing gloves and protective clothing with regular hand sanitising. The third factor is by reducing the risk caused by sexual transmission (Regmi Gilbert and Thunhurst 2015). Developing control measures by heath workers- The health workers should follow standard precautions during the care of patients diagnosed by this viral symptom. They should control the transmission by maintaining hand and respiration hygiene along with protective equipment to avoid contact with materials infected and safe disposal of injections. The health workers allocated to the suspected patients should take extra control measures in order to avoid direct contact with blood and fluids of the patients body. Workers in close proximity of 1 metre of the patients should use mask, gloves, goggles with protective gown. Apart from the heath workers, the workers in the laboratory are also prone to infection. Proper handling of the infected sample should be carefully handled by staffs well trained and the sample should be processed in well equipped laboratories (West and von Saint Andr-von Arnim 2014). Roles of WHO in preventing the Ebola outbreaks- Ebola outbreaks are controlled by the WHO (World Health Organisation), an international Committee on Scientific and Technical Coordination. This committee implements measures to control the daily life activities conducted by certain working subgroups. The management team for patient isolates the clinical cases into quarantine ward and trains to equip proper preventive measures such as use of gloves, mask and protective clothes and also provides medical care corresponding to symptomatic theory in order to maintain the vital functioning of the body. The committee based on coordination controls all the epidemic activities by conducting meetings and writing reports for public related health authorities. The surveillance team on epidemiology finds the cases by verifying the case related rumours. The team for hygiene and sanitising disinfects and buries all the Ebola related dead bodies safely. The laboratory team collects, stores and ships t he samples to confirm the diagnosis (Gostin and Friedman 2015). Remarks- It can be concluded from the above discussion that the travellers returning from the affected regions should apply necessary measures to prevent the infection if any disease related symptoms starts developing within 21 days of return. The travellers specially the health workers suspecting Ebola symptoms should seek medical attention. They should report the travel history to the physician in order to under the root cause of the symptoms and hence proceed for prevention strategies. References: Beeching, N.J., Fenech, M. and Houlihan, C.F., 2014. Ebola virus disease.BmJ,349, p.g7348. Blaser, M., 2014.Missing microbes. Oneworld Publications. Camacho, A., Kucharski, A.J., Funk, S., Breman, J., Piot, P. and Edmunds, W.J., 2014. Potential for large outbreaks of Ebola virus disease.Epidemics,9, pp.70-78. Chmielecki, A., 2015. The Status of Expanded Access in Light of the 2014 Ebola Outbreak Introduction.J. Health Biomedical L.,11, p.25. Chowell, G. and Nishiura, H., 2014. 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