Out of Africa
Do we have the Ebola virus in the Philippines?
From published literature, the answer to this is yes.
There are six species, of which four are known to cause human disease. The one that has been isolated in the country is the Reston virus, which can infect humans but does not cause disease. The outbreaks that have been reported have come from animals, namely pigs and monkeys. Individuals who tested positive for the virus had occupational exposure as animal handlers or abattoir workers, and did not show any signs of illness. The Reston virus is not as virulent as Bundibugyo, which is rare, indigenous to Africa, and the cause of the current outbreak in the Democratic Republic of Congo. However, it should be a cause for concern because any change in its genetic sequence could make it more pathogenic to humans.
How is it transmitted? Infection begins when a human comes into contact with an infected animal and its bodily fluids. Human-to-human transmission occurs upon direct physical exposure to bodily fluids or secretions from a sick or deceased individual, or from contact with contaminated surfaces, clothing, or medical equipment.
What are the signs and symptoms? The incubation period is usually six to 12 days from exposure and can range from two to 21 days. Current evidence shows that individuals who are asymptomatic are not infectious to others. For patients who do manifest symptoms, these may be very nonspecific and may include fever, headache, body malaise, or myalgia. A rash, which can desquamate, has also been documented, as well as respiratory, neurologic, cardiac, and ocular manifestations. Diarrhea and vomiting may be profuse, which can cause severe dehydration. Despite it being labelled as a hemorrhagic fever, bleeding is only seen in the late stages of the disease. This can result into shock or multiorgan failure, which can lead to death.
What is the course of the disease? While it can be fatal, the infection may also be mild. In the absence of severe disease, clinical improvement is usually seen during the second week of illness. It is also important to know that for those who survive, in the convalescent period—which can take as long as two years—several studies have made mention of patients experiencing chronic musculoskeletal symptoms, insomnia, or neurologic and ocular symptoms.
How is it diagnosed? Given that the symptoms are very nonspecific and can resemble other viral hemorrhagic fevers, a high index of suspicion, a history of travel from or residence in an endemic area, or where a recognized Ebola outbreak is occurring, should be obtained. The virus can be detected from blood samples using reverse transcription polymerase chain reaction, or RT-PCR, and should be made in coordination with the Department of Health. Testing should be done for those who have significant exposure and manifest symptoms, while those with an identifiable risk but who are asymptomatic should be closely monitored and tested only if they become ill.
How is it managed? Management is basically supportive, and early recognition is essential not only to prevent further complications but also to implement infection control measures to avoid transmission of the virus. Antimicrobial therapy may be warranted for those who manifest a possible or concomitant bacterial infection.
How can it be prevented? Strict infection control precautions, such as wearing personal protective equipment, and adherence to isolation measures, should be observed and practiced for those who care for infected and deceased individuals. There are no available vaccines except for the one directed for the Zaire ebolavirus species, which is approved by the US Food and Drug Administration for individuals 12 months of age and older, and administered as a single dose.
The World Health Organization has declared the epidemic of Ebola disease caused by the Bundibugyo virus in the Democratic Republic of Congo and Uganda as a public health emergency of international concern, but it does not meet the criteria to qualify as a pandemic emergency. This should allay fears while at the same time should not encouraging complacency, no matter how distant the outbreak is from us geographically. There is great value in being adequately prepared not only for Ebola but for other emerging and reemerging diseases.
By now, you will have heard of the One Health approach, which seeks to balance and provide optimal health for people, animals, and the ecosystem. This is the key to surviving and coexisting.
Given that there is gross inequity in the distribution of resources, with the balance heavily favoring countries that are wealthier, how can we level the playing field so that we, as a nation, can be prepared?
Surveillance has long been recommended as one of the most effective tools in preventing outbreaks from becoming catastrophes. Given the possibilities, no matter how remote and unthinkable, and the fluidity of circumstances, isn’t it about time that we regard and treat it as an investment rather than an expense?
timgim_67@yahoo.com
