Health Update

By Ching M. Alano

With Christmas Day just a whisper away, meat eaters around must already be dreaming of pigging out on their favorite lechon or cochinillo (roast suckling pig) and other meat treats at the family table or buffet table in some restaurant. But hold your appetite for this fatty, cholesterol-raising indulgence. Stop, look, and listen (that is, if you haven’t heard the news yet): Ebola Reston virus was found in four piggery farms in Luzon.

Ebola what? No, it’s not quezo ebola, as one cheese lover must have mistakenly heard. It’s the dreaded Ebola Reston virus.

We asked our resident nutritionist Dr. Angel Respicio Jr. of Hawaii about Ebola and here, he tells us everything we didn’t know about the virus. “I just sent you a virus,” he texted me, referring to his e-mail.

PHILIPPINE STAR: How was ebola discovered?

DR. ANGEL RESPICIO JR.: The Department of Agriculture accidentally discovered the Ebola virus while investigating the previous outbreak of the Porcine Reproductive Respiratory Syndrome which affected the local hog industry last year. The DA had imposed the quarantine on four hog farms located in Pandi, Bulacan; Manaoag, Pangasinan; Cabanatuan City and Talavera in Nueva Ecija. But this is not the first time we had an Ebola virus outbreak in the Philippines. In 1989, 1992, and 1996, the Ebola-Reston virus had already affected some poultry farms in the Philippines. The virus infected a total of 25 people but they did not get ill.

The Ebola Reston virus was discovered in 1989 in monkeys called crab-eating macaques that Hazleton Laboratories in Reston, Virginia had imported from a Philippine farm through a Laguna export facility. There are four subtypes of the Ebola virus: the Zaire, Sudan, and Cote d’Ivoire strains which cause hemorrhagic fever just like dengue in humans. The Ebola Reston virus is the fourth subtype which is not yet proven harmful to humans but highly pathogenic to nonhumans.

The Center for Disease Control has the following information to help us understand better the Ebola virus.

What is Ebola hemorrhagic fever?

Ebola hemorrhagic fever (Ebola HF) is a severe, often-fatal disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees) that has appeared sporadically since its initial recognition in 1976.

The disease is caused by infection with Ebola virus, named after a river in the Democratic Republic of the Congo (formerly Zaire) in Africa, where it was first discovered. The virus is one of two members of a family of RNA viruses called the Filoviridae. There are four identified subtypes of Ebola virus. Three of the four have caused disease in humans: Ebola-Zaire, Ebola-Sudan, and Ebola-Ivory Coast. The fourth, Ebola-Reston, has caused disease in nonhuman primates, but not in humans.

Where is Ebola virus found in nature?

The exact origin, locations, and natural habitat (known as the “natural reservoir”) of the Ebola virus remain unknown. However, based on available evidence and the nature of similar viruses, researchers believe that the virus is zoonotic (animal-borne) and is normally maintained in an animal host that is native to the African continent. A similar host is probably associated with Ebola-Reston, which was isolated from infected cynomolgous (Macacus fascicularis) monkeys that were imported to the United States and Italy from the Philippines. The virus is not known to be native to other continents, such as North America.

Where do cases of Ebola hemorrhagic fever occur?

Confirmed cases of Ebola HF have been reported in the Democratic Republic of the Congo, Gabon, Sudan, the Ivory Coast, Uganda, and the Republic of the Congo. An individual with serologic evidence of infection but showing no apparent illness has been reported in Liberia, and a laboratory worker in England became ill as a result of an accidental needle-stick. No case of the disease in humans has ever been reported in the United States. Ebola-Reston virus caused severe illness and death in monkeys imported to research facilities in the United States and Italy from the Philippines. During these outbreaks, several research workers became infected with the virus, but did not become ill.

Ebola HF typically appears in sporadic outbreaks, usually spread within a health-care setting (a situation known as amplification). It is likely that sporadic, isolated cases occur as well, but go unrecognized.

How is Ebola virus spread?

Infections with the Ebola virus are acute. There is no carrier state. Because the natural reservoir of the virus is unknown, the manner in which the virus first appears in a human at the start of an outbreak has not been determined. However, researchers have hypothesized that the first patient becomes infected through contact with an infected animal.

After the first case-patient in an outbreak setting is infected, the virus can be transmitted in several ways. People can be exposed to the Ebola virus from direct contact with the blood and/or secretions of an infected person. Thus, the virus is often spread through families and friends because they come in close contact with such secretions when caring for infected persons. People can also be exposed to the Ebola virus through contact with objects, such as needles, that have been contaminated with infected secretions.

Nosocomial transmission refers to the spread of a disease within a health-care setting, such as a clinic or hospital. It occurs frequently during Ebola HF outbreaks. It includes both types of transmission described above. In African health-care facilities, patients are often cared for without the use of a mask, gown, or gloves. Exposure to the virus has occurred when health care workers treated individuals with Ebola HF without wearing these types of protective clothing. In addition, when needles or syringes are used, they may not be of the disposable type, or may not have been sterilized, but only rinsed before reinsertion into multi-use vials of medicine. If needles or syringes become contaminated with virus and are then reused, numerous people can become infected.

Ebola-Reston appeared in a primate research facility in Virginia, where it may have been transmitted from monkey to monkey through the air. While all Ebola virus species have displayed the ability to be spread through airborne particles (aerosols) under research conditions, this type of spread has not been documented among humans in a real-world setting, such as a hospital or household.

What are the symptoms of Ebola hemorrhagic fever?

The incubation period for Ebola HF ranges from 2 to 21 days. The onset of illness is abrupt and is characterized by fever, headache, joint and muscle aches, sore throat, and weakness, followed by diarrhea, vomiting, and stomach pain. A rash, red eyes, hiccups, internal and external bleeding may be seen in some patients.

Researchers do not understand why some people are able to recover from Ebola HF and others are not. However, it is known that patients who die usually have not developed a significant immune response to the virus at the time of death.

How is Ebola hemorrhagic fever clinically diagnosed?

Diagnosing Ebola HF in an individual who has been infected only a few days is difficult because early symptoms, such as red eyes and a skin rash, are nonspecific to the virus and are seen in other patients with diseases that occur much more frequently. However, if a person has the constellation of symptoms described above, and infection with the Ebola virus is suspected, isolate the patient and notify local and state health departments and the CDC.

What laboratory tests are used to diagnose Ebola hemorrhagic fever?

Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing, IgM ELISA, polymerase chain reaction (PCR), and virus isolation can be used to diagnose a case of Ebola HF within a few days of the onset of symptoms. Persons tested later in the course of the disease or after recovery can be tested for IgM and IgG antibodies. The disease can also be diagnosed retrospectively in deceased patients by using immunohistochemistry testing, virus isolation, or PCR.

How is Ebola hemorrhagic fever treated?

There is no standard treatment for Ebola HF. Patients receive supportive therapy. This consists of balancing the patient’s fluids and electrolytes, maintaining their oxygen status and blood pressure, and treating them for any complicating infections.

How is Ebola hemorrhagic fever prevented?

The prevention of Ebola HF in Africa presents many challenges. Because the identity and location of the natural reservoir of Ebola virus are unknown, there are few established primary prevention measures.

If cases of the disease do appear, current social and economic conditions often favor the spread of an epidemic within health-care facilities. Therefore, health-care providers must be able to recognize a case of Ebola HF should one appear. They must also have the capability to perform diagnostic tests and be ready to employ practical viral hemorrhagic fever isolation precautions, or barrier nursing techniques. These techniques include the wearing of protective clothing, such as masks, gloves, gowns, and goggles; the use of infection-control measures, including complete equipment sterilization; and the isolation of Ebola HF patients from contact with unprotected persons. All these techniques are designed to prevent any person’s contact with the blood or secretions of any patient. If a patient with Ebola HF dies, it is equally important that direct contact with the body of the deceased patient be prevented.

CDC has developed a set of tools to meet health-care facilities’ needs. In conjunction with the World Health Organization, CDC has developed practical, hospital-based guidelines, entitled “Infection Control for Viral Haemorrhagic Fevers In the African Health Care Setting.” The manual describes how to recognize cases of viral hemorrhagic fever, such as Ebola HF, and prevent further nosocomial transmission by using locally available materials and few financial resources. Similarly, a practical diagnostic test that uses tiny samples from patients’ skin has been developed to retrospectively diagnose Ebola HF in suspected case-patients who have died.

Thank you, Doc Jun, for the very meaty information you passed on to us.

So, how do we guard ourselves against Ebola?

Health experts advise that we should clean and cook meat, like pork, very well. Of course, a foolproof way is to totally abstain from pork.

Source: Philstar.com