6 things to know about the 100-day cough
Ebola Virus Disease
Ebola virus disease is a rare but often deadly condition that causes fever, body aches, diarrhea, and sometimes bleeding inside and outside the body. It's caused by viruses commonly called Ebola viruses.
As these viruses spread through the body, they damage the immune system and organs. Ultimately, they cause levels of blood-clotting cells to drop. This can lead to severe, uncontrollable bleeding.
The disease was known as Ebola hemorrhagic fever but is now referred to as Ebola disease or Ebola virus disease (EVD).
While Ebola outbreaks have had death rates ranging from 25% to 90%, the average death rate is about 50%.
Ebola virus is actually a group of viruses, known as orthoebolaviruses.
These viruses first appeared in humans during two 1976 outbreaks in Africa, but they likely have existed for a very long time. Ebola gets its name from the Ebola River, which is near one of the villages in the Democratic Republic of Congo where the disease first appeared.
The viruses are found mostly in sub-Saharan Africa. They are thought to live mostly in fruit bats, which seem to live with the Ebola viruses without getting sick. But they can spread to other animals and humans, who do get sick from them. It's not clear why Ebola disease showed up in humans when it did.
There are four species of orthoebolaviruses that cause Ebola disease in people. They are named for the places they were found :
Scientists have found two other species of orthoebolaviruses:
Ebola isn't as contagious as more common viruses like colds, influenza, or measles. You can't get it by breathing the air. Instead, outbreaks start when it infects people who come in contact with the blood, secretions, or organs of an infected animal, like a monkey, chimp, or fruit bat. It's possible for this to happen when someone prepares or eats an infected animal.
Once inside one person, Ebola viruses can move from person to person through infected body fluids. Those who care for a sick person or bury someone who has died from the disease can get it if they come in contact with blood and other body fluids, either directly or through contaminated objects.
The virus can get in through breaks in your skin or through your eyes, nose, or mouth.
Ebola can spread through:
People who recover from Ebola may still be able to pass on the virus – through sex and breastfeeding, for example – as long as the virus remains in their bodies. Ebola can be present in breast milk and semen, even after recovery.
Other ways to get Ebola include touching contaminated needles, clothing, bedding, or medical equipment. There's no evidence that mosquitoes or other insects can spread it.
You're most likely to get Ebola if you come in physical contact with infected blood or body fluids of someone who has it. Generally, your risk of getting it isn't high if you're simply traveling to a country with an Ebola outbreak. But you should avoid going to the area or areas with an active outbreak unless you have a crucial health care or support role there.
Most infections happen in communities where outbreaks are active and in health care facilities where people from those communities go for help. The risk is highest if you're a:
Infections are most likely when caregivers or health providers don't use strict infection control methods, like wearing gowns, gloves, eye goggles, and respirators, and using disinfectants on contaminated surfaces.
Early on, Ebola can feel like the flu or other illnesses. Symptoms show up two to 21 days after an infection and usually include:
As the disease gets worse, it can cause bleeding inside the body, as well as from the eyes, ears, and nose. Some people will vomit or cough up blood, have bloody diarrhea, and get a rash.
Sometimes it's hard to tell if a person has Ebola from the symptoms alone. Doctors may test to rule out other diseases like cholera or malaria.
Tests of blood and tissues are the best ways to diagnose Ebola. Doctors can test for the virus or antibodies to the virus.
If you have Ebola, you'll be isolated from other people right away to prevent spreading the disease to others.
There's no cure for Ebola, though researchers are working on it.
Two drugs are approved for treating Ebola caused by the Zaire species (Orthoebolavirus zairense). Both are monoclonal antibody drugs, which work like your body's natural antibodies to target a particular infection. The drugs are Inmazeb, which is a combination of three monoclonal antibodies, and Ebanga, made from a single monoclonal antibody. These medicines are given through an IV (intravenous) line so that the drug goes directly into a vein.
Ebola treatment also includes supportive measures that can relieve symptoms and improve survival. These include:
These treatments may vary, depending on which symptoms and other conditions someone has.
Research shows that you're at risk of getting complications when you have Ebola, such as:
Long-term effects of the Ebola virus
Research has also shown that you're at risk of having symptoms and complications after you recover from Ebola, too, including:
There are two types of licensed vaccines available to prevent Ebola in people at risk:
Ervebo. This vaccine is approved by the U.S. FDA and by health agencies in several other countries to prevent illness from the Zaire strain of the virus. It can be used during an outbreak to try to limit spread.
The vaccine is approved for people ages 1 year and older. Ervebo isn't generally recommended for anyone pregnant or breastfeeding, but the World Health Organization says pregnant or breastfeeding people can consider whether their possible risks may be outweighed by potential benefits during an active Ebola outbreak.
Zabdeno and Mvabea. This vaccine is given in two doses. The European Medicines Agency authorized it in May 2020. People age 1 year or older can get the vaccine.
You'll get Zabdeno as your first vaccine dose. The second-dose Mvabea is given up to eight weeks later. But experts don't recommend this two-dose vaccine plan during an outbreak. That's because it's not designed to give you protection right away.
For high-risk people like health care workers or volunteers living and working in areas with an Ebola outbreak, if you've completed the two doses, you can get a Zabdeno booster shot four months after your second dose.
Keep in mind that Ebola poses little risk to most people. Caregivers and health workers responding to an outbreak are most at risk. If you are at risk, there are several ways you can protect yourself:
If you've traveled back from a place with an Ebola outbreak, watch out for symptoms for as long as 21 days. If you notice any, tell your doctor right away.
There's never been an Ebola disease outbreak in the United States. All the outbreaks have happened in sub-Saharan Africa.
A few cases of Ebola have been reported and treated in the United States, all related to a major outbreak in western Africa in 2014-2016. During that outbreak, 11 people with Ebola were treated in the United States. Nine of those people, mostly health workers, were infected in western Africa. Two died, including a Liberian visitor to the U.S. And a doctor who had treated Ebola patients in Sierra Leone. Two U.S. Nurses got Ebola while treating the Liberian patient, but both of them recovered.
In addition, four people in the United States who worked with infected lab monkeys got infected with the Reston strain of Ebola in 1989. But none of those people got sick.
Health experts say the risk of Ebola in the United States remains very low and that the U.S. Can help keep it low by helping other countries prevent and respond to outbreaks.
Ebola is a rare but serious disease that has caused outbreaks in Africa since since it was discovered in 1976. It's never caused a disease outbreak in humans in the United States. Risks for Americans, including travelers, remain low. Some drugs and vaccines are now available to help save lives and control outbreaks. Improved infection control practices and supportive care for patients can also make a difference.
U.S. Death From Lassa Fever, An Ebola-like Virus, Is Reported In Iowa
A person from Iowa who recently returned to the United States from West Africa has died after contracting Lassa fever, a virus that can cause Ebola-like illness in some patients. State health officials reported the case on Monday.
"I want to assure Iowans that the risk of transmission is incredibly low in our state. We continue to investigate and monitor this situation and are implementing the necessary public health protocols," Robert Kruse, state medical director of the Iowa Department of Health and Human Services, said in a statement posted to the department's website.
The unnamed person was described as a middle-aged individual from eastern Iowa. The statement said the person had been cared for at University of Iowa Health Care. It did not indicate how long he or she had been in care or if the individual had sought care anywhere else before being admitted to the hospital.
That is important because while person-to-person spread of the Lassa virus is rare, transmission can occur in health care settings, especially if health workers don't realize they are dealing with a patient who has the disease and don't take adequate precautions. Testing conducted on Monday by the Nebraska Laboratory Response Network indicated the person had Lassa fever; confirmatory testing will be done by the Centers for Disease Control and Prevention.
No details were released about when the person developed symptoms or even when he or she returned to the United States. The CDC said in a statement, however, that the individual was not sick while traveling, so "the risk to fellow airline passengers is extremely low."
Although there have been previous Lassa fever cases imported to the United States, they are not common occurrences. The statement said there have been eight known imported cases, including the new one, in the past 55 years.
There was a case in May 2015, in a New Jersey resident who had traveled to Liberia and another in a New Jersey resident in 2004. Both those people died. Minnesota reported a case in 2014; that person recovered.
Africa CDC faults U.S. Government over Marburg-related travel advisory to RwandaLassa fever is endemic to a number of countries in West Africa, including Nigeria, Ghana, Guinea, Sierra Leone, and Liberia. In these countries, the virus causes several hundred thousand infections and about 5,000 deaths every year.
The main source of the virus is a rodent called the multimammate rat. People contract the virus either by handling or eating infected rodents, or as a result of having the rodents in their homes. Food or household items that have been contaminated with urine or feces from infected rodents can transmit the disease.
Though severe Lassa fever causes symptoms like those seen with Ebola infection, it does not trigger large chains of human cases, as can occur during Ebola outbreaks, said Armand Sprecher, a viral hemorrhagic fever expert who works for Doctors Without Borders.
"You don't see a lot of human-to-human transmission," Sprecher told STAT. "Most people get it from the source, the reservoir."
The World Health Organization says that about eight of 10 people who contract the virus have no or only mild symptoms, which include headache, fatigue, and low-grade fever.
In those that go on to develop severe illness, symptoms can include bleeding, difficulty breathing, vomiting, and shock, according to the CDC. The WHO suggests that about 15% of people who develop severe Lassa disease die from the condition.
The death rate can be much higher in some places, said Robert Garry, a professor at Tulane Medical School in New Orleans who has been studying Lassa fever for the past couple of decades. In Sierra Leone, where Garry has research projects, the fatality rate among severe cases can be as high as 70%, he said. Good supportive care — for instance replenishment of fluids — can increase the chances of survival, he said.
He agreed that most cases are people who are infected by an animal source, but said some person-to-person transmission can occur, especially in hospitals. "It happens in West Africa, even in places where they're very aware of the possibility [of Lassa cases]. So, yeah, if you were not expecting a disease like that to show up in your hospital, it could happen."
That said, Garry said he doesn't expect to see transmission here. "There's very little chance that this is going to spread beyond that hospital setting. But they have to do the case contacts [investigations] and all that to make sure."
Of the diseases that cause viral hemorrhagic fevers — things like Ebola and Marburg fever — Lassa is probably the one that is most commonly imported to non-endemic countries, Garry said.
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