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The re-emergence of Ebola: a raising concern for a potential epidemic in third-world countries?

2024; Wolters Kluwer; Volume: 7; Issue: 2 Linguagem: Inglês

10.1097/gh9.0000000000000433

2576-3342

Areesha Tanveer, Areebah Ansari, Hassan ul Hussain, Manahil Warsi, Mohammed Mahmmoud Fadelallah Eljack, Syeda Tayyaba Rehan,

Disaster Response and Management

The Ebola virus (EBOV) is the causative agent of the Ebola virus disease (EVD), one of the deadliest viral hemorrhagic fevers in humans1. It was discovered in 1967 upon isolation near the Ebola River in the Democratic Republic of Congo (DRC). It is a negative-strand RNA virus belonging to the Filoviridae family with a characteristic filamentous appearance2. Out of the five subtypes of EBOV, the Zaire EBOV strain causes the deadliest disease3. Over the years, EBOV has caused around 20 outbreaks in rural areas confined to Africa2. The DRC alone has an extensive history of 13 reported outbreaks as of May 20224. Regions of Africa such as Sudan, the DRC, Gabon, the Republic of the Congo, and Uganda remain the breeding grounds for EBOV2. EBOV fatality averages up to 50%. It can be as high as 90% with limited healthcare services and resources. However, with developments in awareness, disease control, and epidemic containment, it can be as low as 25%3. The last outbreak of EBOV lasted 3 years, from 2014 to 2016. It reported 28 652 confirmed cases and 11 325 mortalities. The magnitude of the outbreak was beyond the continent's healthcare capacity and imposed serious threats to the people of Africa5. Since its discovery in 1967, it has caused over 34 710 mortalities worldwide4. The 14th ongoing epidemic was declared on 23 April 2022, with the first case of a young student from Mbandaka. After engulfing areas of Equateur Province and North Kivu of the DRC, the epidemic has spread to the Mubende District of Uganda as of September 20226. According to WHO, 115 confirmed cases of EBOV have been reported in Uganda just within 1 month from September 2022 to October 2022 and the case fatality ratio (CFR) stands at 27.8%7. Figure 1 depicts the risk of importation of EBOV from different countries into China according to Shang et al.8.Figure 1: Risk of importation of EBOV from different countries into ChinaEBOV is initially transmitted to humans via wild animals, particularly fruit bats, which act as natural hosts. Subsequently, human-to-human transmission occurs via direct contact with body fluids including saliva, blood, urine, feces, sweat, breast milk, semen, or fomites of an EBOV-infected symptomatic person or dead body2,4,9,10. After the virus infects the host, there is an incubation period of 2–21 days2,10. The virus mainly targets phagocytes like dendritic cells, monocytes, and macrophages3. Replication inside host cells is initiated by the attachment of glycoprotein spikes, followed by binding of the transcriptional activator VP30 resulting in viral transcription10. This eventually inactivates the innate, adaptive, and intrinsic immune responses, causing immune-mediated cell damage and dysfunctions in multiple vital organs like the lungs, heart, kidney, and liver. The detrimental effects of this lead to multi-system organ failure11. The presence of EBOV induces cytokine release in blood, which activates acute phase reactants, causing cellular damage. The virus also disrupts the coagulation cascade, causing platelet aggregation and liver damage, further leading to a deficiency of coagulation factors3. EBOV presents as high-grade fever, headache, joint and muscle aches, sore throat, lethargy, abdominal pain, and loss of appetite. The patient might present with internal bleeding, bloody diarrhea, vomiting, skin rashes, red eyes, and hiccups later in the disease6. Studies have shown the presence of detectable antibodies in the blood of EBOV infection survivors up to 10 years after their recovery12. Polymerase chain reaction (PCR) is one of the most commonly used diagnostic methods since it detects the lowest levels of EBOV in the serum6,13. Previously, there was no proper literature on treatment of EVD except PCR and immunoassay, as they only reduce the risk of EVD2. But on 19 December 2019, the U.S. Food and Drug Administration (FDA) approved the Ebola vaccine rVSV-ZEBOV (called Ervebo). This was the first FDA vaccine which have been approved for EVD and has shown promising results in preventing EVD6. The following precautionary measures must be taken by the residents of epidemic regions or recent travelers: Avoid contact with the blood and body fluids of infected patients6. Avoid contact with semen from a patient after his recovery until testing confirms his negativity for the virus6. Avoid contact with items that may have come in contact with an infected person's blood6. Avoid the funeral or burial practices of the infected person6. Avoid contact with bats, forest antelopes, and nonhuman primates (such as monkeys and chimpanzees) or their blood and fluids6. On 26 February 2020, the Advisory Committee on Immunization Practices (ACIP) recommended pre-exposure prophylaxis vaccination with rVSV-ZEBOV for adults less than 18 years of age in the U.S. population who are at potential risk of exposure to Zaire ebolavirus6. The recent surge of EVD raises concerns about the exhaustion of resources for third-world countries. With ease in connectivity among the parts of the globe, there is a tendency to globalize illnesses. Growing at this rate, EBOV concerns the healthcare authorities of developing countries within and beyond Africa. EBOV outbreak can be a potential threat to third-world countries still recovering from the destructive aftermath of a global pandemic. Limitations regarding cure and prophylaxis treatment for EBOV demand more vigilance for early detection and thorough precautions, like people must quarantine themselves for a maximum of 14–21 days and monitor the symptoms after traveling from epidemic regions6. Ethical approval Ethical approval was not required for this correspondence. Consent Informed consent was not required for this correspondence. Sources of funding No financial support was acquired for this article. Author contribution A.T.: conceived the idea; A.T., A.A., H.U.H., and M.W.: retrieved the data and wrote up the letter; M.M.F.E. and S.T.R.: reviewed and provided inputs. All authors approved the final version of the manuscript. Research registration unique identifying number (UIN) Name of the registry: not available. Unique identifying number or registration ID: not available. Hyperlink to your specific registration (must be publicly accessible and will be checked): not available. Guarantor Mohammed Mahmmoud Fadelallah Eljack, Teaching assistant, Community Department, University of Bakht Alruda, Ad Duwaym, Sudan; MBBS, University of Bakht Alruda, P.O. Box 1311, Ad Duwaym 12556, Sudan; https://orcid.org/0000-0002-2370-9368; E-mail: [email protected]; Tel: +249 964656914. Provenance and peer review Not commissioned, externally peer-reviewed. Data availability statement The materials datasets used and/or analyzed during this study are available from the corresponding author upon reasonable request.