Discuss About The Prevention Control World Health Organization.
The assignment deals with the Ebola a viral disease. It is a deadly disease that kills upto 90% of the effected people. The virus first appeared during two outbreaks in Africa, 1976. The Ebola virus disease is the “public health emergency of international concern” as declared by “World Health Organization” or WHO in 2014 (WHO, 2018). The outbreak of Ebola turned epidemic in 2016. It lasted for two years and infected around 26,700 people. It resulted in 11,300 deaths (World Health Organization, 2016). In regards to this deadly the disease the assignment aims to discuss the source of the infection and transmission of the virus as per the literature available. The report highlights the rationale for no vaccination for Ebola disease. It is compared and contrasted to other diseases that have vaccine while giving the insightful thinking. Next, the report highlights the public health management after epidemic and the prevention of the deadly disease. Based on the extensive research in this area and the valuable insights gained, an overall conclusion will be drawn.
The name of the disease and virus comes from Ebola River, in a city in Democratic Republic of Congo. The outbreak in the West Africa first started in the single infected person as per the recent genetic analysis. This was traced to event where a person was infected with bat. The single introduction led the major outbreaks. The source of the virus was found to be originated in Guinea. It was then observed to spread to Sierra Leone and Liberia in an outbreak. It was spread by human beings repeatedly being infected and not spread by animals infecting people repeatedly. The virus has been traced to have a common source as per the senior associate member at Harvard University. In Sierra Leone, a traditional healer treated infected patients from Guinea and after her death the patients flocked to her funeral and infected ten more people. Genetic sequences taken from one of the infected pregnant women confirm these findings. The evolution of the virus was traced by the mutation studies of the Virus (Osterholm et al., 2015). In West Africa it was found to mutate twice and was the reason for widespread outbreak.
Ebola also known as haemorrhagic fever is highly infectious viral disease. It is transmitted by direct and indirect contact with the infected person and body fluids according to WHO. It includes blood, urine, saliva, vomit, breast milk, semen, and vaginal fluid. The most infectious body fluids are vomit, faeces, blood. In males the semen contains virus persistently. The symptoms of the vaccine are diarrhea, rash, muscle pain, headache, fever, as well as bleeding in some cases (Muyembe-Tamfum et al., 2012). The virus is also known to be transmitted by the indirect contact to previously contaminated surfaces. The virus is known as deadly for its attack on the immune system cells thereby releasing the army of inflammatory molecules. It causes the bursting of tiny blood vessels which drops the blood pressure. It results in multiple organ failure (Osterholm et al., 2015). As per epidemiological data the soared of this virus is no the same as that of thee influenza vaccine.
There are no vaccines licensed for Ebola as there is still lack of data from medical standpoint on long term effects of the infection. Until the outbreak in 2013, the Ebola vaccine research was abandoned. There are several challenges faced by the researchers as the virus is very complicated to study. It has been observed since ages that researchers have tough time studying and developing treatments for viral diseases (Kibuuka et al., 2015). Folayan et al. (2016) argued that the unlike the antibacterial therapy, the antiviral therapy has always lagged behind. Virus being small molecules has fewer targets for treatment due to less protein. Therefore, there is fewer targets for the person’s immune system primed by the vaccines. The other barriers identified are the quick evolution of the virus. Therefore, there is huge uncertainty that the vaccine developed today would be effective against the future outbreaks. Considering the high mortality rate that is 90%, it implies for the researchers to work with high level safety precautions and facilities. Not all the cities have biosafety level 4″ laboratory needed for Ebola experimentation. A potential treatment for Ebola has been found to be promising in the animal models. A compound has been identified that interferes with the viral replication. Further treatment is targeted towards preventing the viral entry into cells by blocking the surface proteins that bind the virus. This vaccine was known as rVSV-ZEBOV. Another possible therapy that is in progress is the antibodies against viral parts raised in mice. In 2012, this formulation when applied on monkeys showed survivorship within two days. The vaccine rVSV-ZEBOV against Ebola met the safety criteria by the scientists but the efficacy trial does not indicate protection gains’ all the viral strains (Kibuuka et al., 2015).
There are challenges to the recruitment of the health care workers for research on Ebola vaccine. The workers may have mistaken beliefs when treating the patients that the vaccine may be beneficial. It may result in coercion and hamper the equity and justice. It is because the study does not involve participants who are not skilled health care providers. They may not be prioritised for vaccination. It is not yet clearly addressed if the study participants would contract the infection despite the use of experimental vaccine and provision of standard care. These concerns must be addressed transparently. It must be formalised as a part of ethics. For accessing the study products the TRIPS agreement needs must also be considered. There is a need of international support in this regard (Campoy Rubio, 2015). It may be possible only by engaging stakeholder at the regional, local, and international levels using various channels of communication. These concerns need to be addressed not only for the present but also the future epidemics. Even when there is no vaccine for Ebola, the complications of the illness can however be treated.
The point to be wondered here is the vaccination available for Influenza and not for Ebola although both have the potential to kill people. Unlike the influenza virus, Ebola does not spread by contaminated air. Ebola causes multi-organ failure and rapidly spreads through body fluids despite early treatment. It is also evident from the infected health care workers who returned from US after disease management for the patients. These care providers knew the process of the disease transmission and used personal protective equipment. It is indication of the highly contagious nature of the vitus (Uyeki et al., 2016). On the contrary, it was the same condition for Tuberculosis at one point of time. One third of the world’s population has been exposed to this disease and yet today there is better vaccination available in developing and developed countries. The airborne infection prevention was considered sinister but Ebola proved it wrong. Perspectives from the nurses and the physicians caring for Ebola patients, highlighted that the there are equal challenges with influenza as it is for Ebola caring. The influenza virus too mutates into new strains which may be beyond the available vaccinations. Yet the vaccination seems to work well even with evolution of different influenza strains argued (Håberg et al., 2013). Inspite of this development the vaccination is not considered the means to prevent the Ebola disease.
There is no exact cure or preventive treatment for Ebola despite intense research in the field. The fatal symptoms of the Ebola are managed by the administering the patients with fluids and electrolytes, oxygen, anti-hypertension medications, blood transfusions, and treatment for other infections. Treatment presently considered is the use of experimental serum destroying the infected cells (Uyeki et al., 2016). However, there are several measures taken to avoid contacting with infected people. It includes avoiding the contact with body fluids of the infected people. It is also recommended to people for avoiding contact with dead bodies of Ebola infected people. There are stringent protocols in discarding the medical equipments used for Ebola patients such as needles. Health care workers are trained to use PPE in handling patients and control risk of infection (World Health Organization, 2014). The health care professionals, infected and uninfected patients are educated to avoid contacting with wild animals as they are source of transmission. Effective hand hygiene protocols are designed for infection control (Camacho et al., 2014). However, these measures are only useful to prevent spread of infection.
Based on interactions from the Ebola survivors and the care process delivered by the health care professionals, there are strategies evolved that may help with future outbreaks. It includes ongoing specialised health care to the survivors. The health management for the infected individual has been has been well established in the urban locations of major cities. However, it is has been difficulty transporting for people in remote areas and with orphaned children (World Health Organization, 2014). Therefore, accessing services in right time is the major barrier. Further, barriers to health management to the Ebola virus affected individuals are the associated comorbidities. There are several health concerns for survivors including the joint pains, cataracts, and others. These comorbidities hamper the ability to give mental labour in patients especially in trading, and farming. There is lack of guidelines to facilitate high quality care to minimise the effects of infection (Alfaki et al., 2016). The concerns related to surgery and treatment is still questionable.
Lack of training among health care providers hinders the public health management after the epidemic ends. It is due to stigma, preventing the trading with survivors or sharing meal with them. Sexual life of male survivors is affected as there is no estimate on the presence of virus in semen (World Health Organization, 2014). In this regard Alfaki et al. (2016) argued that health care professionals are found to lack knowledge of the care needs and concerns of the patients. It has also been observed that the nurses and other care providers refuse to treat the patients. It is assumed that the survivors are still carrying the infection. The nurses and physicians must be trained that there is no harm in providing the non-invasive care to the survivors.
There is a need of livelihood support for the survivor. The patients receive no opportunities when the epidemic is over. During hospitalisation they receive great attention and also given livelihood opportunities. The patients were found with positive health outcomes in the isolation centres and hospitals. Stigmatisation and discrimination reduce the livlihood opportunities for the survivors. The recent data from randomised trials and the meta-analysis regards to vaccination is not yet disseminated. The new knowledge of the virus is not well circulated to the citizens in most affected countries. There is a need of community engagement method, in response to Ebola to reach out those in need (Alfaki et al., 2016). Ebola preventive measures are not yet detailed in literature. However, patient may be educated about preventive steps for future outbreaks.
It is evident from the existing literature that the affects of Ebola outbreaks will be continued for next few years across the world. There is a need to develop preventive measures for challenges faced by the global health community not only concerning the brief outbreak but also the future outbreaks
Conclusion
In the history of the outbreaks the Ebola epidemic and outbreaks has been deadliest. It can be controlled from the discussion that the global efforts in developing therapies for Ebola infection, prevention and management are still laudable. There are several ethical concerns associated with emergency immunisation plan for health care workers using experimental vaccines. Successful development of the Ebola vaccine requires the concerted efforts at public dialogue. The need is to address the misconceptions in selecting participants for clinical trials as well as equity and justice. There is need to discuss with patients honestly about the risks, and benefits associated with participation. Futter research in this area require effective communication with people, trusted locals, researchers, ethics committee, and the same must be negotiated between communities.
References
Alfaki, M. M., Salih, A. M., Elhuda, D. A. L., & Egail, M. S. (2016). Knowledge, attitude and practice of health care providers toward Ebola virus disease in hotspots in Khartoum and White Nile states, Sudan, 2014. American journal of infection control, 44(1), 20-23. DOI: https://doi.org/10.1016/j.ajic.2015.07.035
Camacho, A., Kucharski, A. J., Funk, S., Breman, J., Piot, P., & Edmunds, W. J. (2014). Potential for large outbreaks of Ebola virus disease. Epidemics, 9, 70-78. DOI: https://doi.org/10.1016/j.epidem.2014.09.003
Campoy Rubio, J. (2015). Ebola, R&D on Neglected Diseases and the Health Impact Fund. Browser Download This Paper. DOI: https://dx.doi.org/10.2139/ssrn.2663616
Folayan, M. O., Yakubu, A., Haire, B., & Peterson, K. (2016). Ebola vaccine development plan: ethics, concerns and proposed measures. BMC medical ethics, 17(1), 10. DOI: 10.1186/s12910-016-0094-4
Håberg, S. E., Trogstad, L., Gunnes, N., Wilcox, A. J., Gjessing, H. K., Samuelsen, S. O., … & Madsen, S. (2013). Risk of fetal death after pandemic influenza virus infection or vaccination. New England Journal of Medicine, 368(4), 333-340. DOI: 10.1056/NEJMoa1207210
Kibuuka, H., Berkowitz, N. M., Millard, M., Enama, M. E., Tindikahwa, A., Sekiziyivu, A. B., … & Joshi, G. (2015). Safety and immunogenicity of Ebola virus and Marburg virus glycoprotein DNA vaccines assessed separately and concomitantly in healthy Ugandan adults: a phase 1b, randomised, double-blind, placebo-controlled clinical trial. The Lancet, 385(9977), 1545-1554. DOI: https://doi.org/10.1016/S0140-6736(14)62385-0
Muyembe-Tamfum, J. J., Mulangu, S., Masumu, J., Kayembe, J. M., Kemp, A., & Paweska, J. T. (2012). Ebola virus outbreaks in Africa: past and present. Onderstepoort Journal of Veterinary Research, 79(2), 06-13. Retrived from: https://www.scielo.org.za/scielo.php?pid=S0030-24652012000200003&script=sci_arttext&tlng=es
Osterholm, M. T., Moore, K. A., Kelley, N. S., Brosseau, L. M., Wong, G., Murphy, F. A., … & Kapetshi, J. (2015). Transmission of Ebola viruses: what we know and what we do not know. MBio, 6(2), e00137-15. DOI: 10.1128/mBio.00137-15
Uyeki, T. M., Mehta, A. K., Davey Jr, R. T., Liddell, A. M., Wolf, T., Vetter, P., … & Evans, L. (2016). Clinical management of Ebola virus disease in the United States and Europe. New England Journal of Medicine, 374(7), 636-646. DOI: 10.1056/NEJMoa1504874
WHO. (2018). Infection prevention and control. World Health Organization. Retrieved 2 April 2018, from https://www.who.int/csr/disease/ebola/training/infection-prevention/en/
World Health Organization. (2014). Interim infection prevention and control guidance for care of patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola. Retrieved from: https://apps.who.int/iris/bitstream/handle/10665/130596/WHO_HIS_SDS_2014.4_eng.pdf;jsessionid=6155CA023E3598C7BB80064514F58066?sequence=1
World Health Organization. (2016). Final trial results confirm Ebola vaccine provides high protection against disease. World Health Organization. Retrieved 2 April 2018, from https://www.who.int/mediacentre/news/releases/2016/ebola-vaccine-results/en/
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