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The ebola virus

Never in our history has a biosecurity level 4 virus infected so many people, so quickly and in such an extensive area. What do we know about the Ebola virus? Is it contagious or infectious? How does the disease develop? Here we tell you everything you need to know.

Chronology
of the Ebola outbreak

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    1976

    Ebola virus is identified for the first time in Zaire (now the Democratic Republic of Congo), the outbreak causes 280 deaths. Another outbreak appears in Sudan (now Southern Sudan) causing 151 deaths.

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    1995

    Outbreak in the Democratic Republic of Congo, 315 cases are reported and 250 people die.

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    2000-01

    Outbreak in Uganda 425 cases reported and 224 dead.

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    2001-02

    Outbreak on the border between Gabon and the Democratic republic of Congo with the result of 96 deaths.

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    2002-03

    New outbreak in the Congo. 143 cases reported and 128 deaths.

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    2007

    Outbreak in the Congo: 187 deaths of the 264 reported cases. In Uganda 37 deaths of the 147 reported cases

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    2008

    The virus is detected in the Philippines, 5 people who work in a pig farm become infected from the animals. First case of the virus being found in pigs.

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    28 December 2013

    First case of this outbreak, a two-year-old boy called Emile dies in Guinea.

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    22 March 2014

    Guinea confirms that a fever with hemorrhaging that hadn’t been identified, and has already killed more than 50 people, is Ebola.

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    30 March 2014

    Liberia declares 2 cases of Ebola. It is believed there are more cases in Sierra Leone.

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    1 April 2014

    Medecins Sans Frontières and the WHO warn it could go further.

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    26 May 2014

    The WHO confirms the first death in Sierra Leone.

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    17 June 2014

    Liberia reports Ebola in the capital, Monrovia.

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    23 June 2014

    The number of deaths reaches 350. Medecins Sans Frontières warns that the situation is out of control.

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    25 July 2014

    First case of Ebola in Nigeria.

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    29 July 2014

    Doctor Sheik Umar Khan, who led the fight against Ebola, dies of the disease.

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    30 July 2014

    Liberia closes schools and quarantines the most infected communities, using soldiers for these tasks.

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    2 August 2014

    A missionary from the United States, who had been in Liberia, flies to Atlanta to be treated for Ebola.

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    8 August 2014

    The WHO declares Ebola an international public health emergency.

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    12 August 2014

    The WHO approves the use of drugs which haven’t yet been tested.

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    12 August 2014

    The Spanish priest in Madrid dies, due to Ebola.

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    15 August 2014

    Medecins Sans Frontières estimate it will take 6 months to get Ebola under control.

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    20 August 2014

    Security forces in Monrovia try to control the avalanche of people trying to break the quarantine restrictions, killing some civilians.

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    21 August 2014

    American missionaries treated in Atlanta discharged from hospital.

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    24 August 2014

    Democratic Republic of Congo announces first cases of Ebola.

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    29 August 2014

    Senegal confirms first case of Ebola.

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    3 September 2104

    The epidemic quickens, 1,900 deaths.

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    3 September 2104

    A third American missionary returns home to be treated.

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    5 September 2104

    More than 2,100 deaths and 4,000 people infected.

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    8 September 2014

    The United Kingdom sends troops and humanitarian experts to Sierra Leone; United States sends medical aid to Liberia.

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    16 September 2014

    United States promises 3,000 soldiers and healthcare professionals to help West Africa.

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    16 September 2014

    2,461 deaths and 4,985 people infected according to the WHO. The number of dead has doubled since the previous month.

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    16 September 2014

    First case in France.

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    19 September 2014

    Deserted streets in the Sierra Leone capital, due to a three-day curfew to try and control the epidemic.

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    22 September 2014

    The WHO announces the eradication of Ebola in Senegal and Nigeria.

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    23 September 2014

    The CDC estimates that by January there will be between half a million and 1.4 million people infected in West Africa.

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    30 September 2014

    First Ebola case diagnosed in the United States.

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    01 October 2014

    The WHO announces 3,338 deaths and 7,178 people infected.

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    04 October 2014

    The French patient recovers.

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    06 October 2014

    Spanish nurse Teresa Romero diagnosed with Ebola.

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    08 October 2014

    Duncan, the first Ebola case diagnosed in the United States, dies in a Dallas hospital.

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    08 October 2014

    The United States begins airport checks on passengers with a temperature.

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    09 October 2014

    The WHO announces 3,865 deaths and 8,033 people infected.

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    09 October 2014

    Excalibur, Teresa Romero’s dog, is put down.

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    12 October 2014

    The nurse who treated Duncan catches Ebola, first case of transmission in the United States.

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    15 October 2014

    4,493 deaths and 8,997 people infected, according to the WHO.

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    31 October 2014

    4,922 deaths and 13,567 infections.

What is the illness caused by the Ebola virus?

The illness from Ebola is an infection caused by a virus of the Filoviridae family.
  • More

    The Filoviridae virus was discovered in 1967 and today there are only two known members of this viral family: the Marburgvirus and the infamous Ebolavirus.

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This virus causes fever and internal hemorrhaging; it can lead to death in humans and other non-human primates.

Monkeys

Chimpanzees

Gorillas

Humans

Origin

The second of these was identified in 1976 in the north of Zaire (now the Democratic Republic of Congo) with two cases, very close to the River Ebola, which it takes its name from.

Strains of the Ebola virus

affecting humans

Ébola - Zaire

Sudan - Ebola

Taï Forest - Ebola

Bundibugyo - Ebola

affecting primates

Reston - Ebola

Where does this virus come from?

Accidentally these bats transmitted the virus to animals like chimpanzees, macaque monkeys, small antelopes, gorillas and porcupines
All indications point to it being a zoonotic virus transmitted by animals. The carrier animal was a frugivorous bat, commonly known as the fruit bat.
And they, in turn, passed it on to humans through contact with their organs, bodily fluids or blood of dead or hunted animals.

Ebola symptoms

It is especially important to detect the first symptoms given that the illness can only be transmitted once the symptoms have appeared.
The incubation period is between 2 and 21 days, with 7-9 being the most common according to the World Health Organisation.
Incubación

Incubation period

If an infected person overcomes this first phase it’s very likely they will overcome the illness and the antibodies will remain in their body for 11 years.
Incubación

First phase

Incubación

Second phase

On average, once the first symptoms appear patients die within
10
days
Incubación

Lifespan

Where is the virus found in the body?

Depending on the stage of the illness, the virus will be found in one part of the body or another.

Blood

Up to day 22

Saliva

Up to day 11

Urine

Up to day 25

Tears

Up to day 25

Semen

From day 17 to 92

Sweat

Up to day 6

Vaginal fluid

From day 22 to 43

Faeces

Up to day 30

Breastmilk

From day 12 to 22

How is Ebola transmitted?

The important thing to bear in mind is that the virus is not as contagious as infectious. The great problem is that people can become infected with just a small quantity of the virus. For example, the HIV virus is much more contagious, each infected person can pass it on to an average of four people, but it is much less infectious (a much higher viral load is needed to infect someone).
  • Blood

    By direct contact through fluids

  • Sweat

    By direct contact through fluids

  • Saliva

    By direct contact through fluids

  • Mucous

    By direct contact through fluids

  • Any other fluids

    By direct contact through fluids

It can also be passed on by touching contaminated objects which have been touched by a sick person.

How is it not transmitted?

By water
By water
By air
By air
By insect bites
By insect bites

Vaccines and Treatments

Given that there is currently no cure for Ebola, the symptoms are treated separately, that is, as they appear. The chances of surviving increase if:
Given that there is currently no cure for Ebola, the symptoms are treated separately, that is, as they appear. The chances of surviving increase if:
Líquidos
The patient is given liquids in order to keep them hydrated and keep the mineral salts in the body balanced (electrolyte balance).
Given that there is currently no cure for Ebola, the symptoms are treated separately, that is, as they appear. The chances of surviving increase if:
Niveles
Oxygen levels and blood pressure are kept constant.
Líquidos
Given that there is currently no cure for Ebola, the symptoms are treated separately, that is, as they appear. The chances of surviving increase if:
Infecciones
Other infections that arise are treated.
Niveles
Líquidos
Given that there is currently no cure for Ebola, the symptoms are treated separately, that is, as they appear. The chances of surviving increase if:
Fiebre
The fever is treated.
Infecciones
Niveles
Líquidos
These treatments are essential to overcome the illness, but equally so is the immune response of the patient against the virus.
Fiebre
Infecciones
Niveles
Líquidos
In addition, treatment doesn’t end when the patient is discharged, the psychological support and the necessary means to avoid stigmatization of people who have survived the illness are also fundamental. In many cases, they are taken back to their village where they are embraced in front of everyone to show that they cannot transmit the virus to anyone else.

How close are they to creating a vaccine? And what treatments are there?

Vaccines

At the moment there is no vaccine against Ebola which would be truly effective and has been sufficiently tested to be safe and reliable. Even so, there are two candidates which look like they could put an end to the epidemic in the future:

EEUU EEUU

cAd3-ZEBOV

Developed by the pharmaceutical company GlaxoSmithKline (GSK) along with the National Institute of Alergy and Infectious Diseases of the USA (NIAID)

Canada Canada

rVSV-ZEBOV

A vaccine driven by the Public Health Agency of Canada, together with the Amercian pharmaceutical company NewLink Genetics, from Iowa.

What's the difference between a vaccine and treatment?
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    A vaccine is a drug which is provided before a person has been infected whereas treatment, as is the case with ZMapp, is given to the patient once they are infected.

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Treatments

There is also a fairly promising treatment:

Pastillas
EEUU Canada

ZMapp

A drug developed by Mapp Biopharmaceutical Inc, which is still in the experimental phase and as such is not available in large enough quantities to be distributed in West Africa, as explained by the Centres for Disease Control and Prevention (CDC).

Some readers will certainly be wondering if Ebola started in 1979...

Why is there still no effective vaccine?

Partly, this is as a result of poor funding, aggravated by cutbacks which wealthier countries have had to make.
Until this last outbreak, there didn’t seem to be a sense of urgency to develop a vaccine and the low number of those infected made it very difficult to test effectiveness in humans.

First effective vaccine: 2015?

Thanks to this latest outbreak, the process of developing a vaccine for Ebola is going at record speed, so much so that the WHO suggests that in January 2015 the first vaccines could be ready.
Zaire-Ebola
Zaire-Ebola
Sudan-Ebola
Sudan-Ebola
Cheap
Cheap
One dose
One dose

Models to follow: Nigeria and Senegal

These countries have shown that Ebola can be controlled:
if the correct protocols are followed, things are done well.
If adequate infrastructure is available.
Medical training of the healthcare professionals, in both countries, has been fundamental.
Nigeria’s great experience with polio has been a great help.

Current situation

The epidemic continues to spread relentlessly through West Africa. In addition, as the WHO points out, collecting data in all these countries is very difficult, a fact which complicates making previsions to help improve the situation.
Liberia is currently the country which has suffered most. Its hospitals only have 21% of the necessary beds.
According to the NGO Save the Children, every hour 5 new cases of Ebola are recorded in West Africa.

Economic cost

The World Bank puts the cost, for the end of 2015, at around 25 million Euros, since facilities have had to be created to deal with the disease. Until now these countries, with scarce sanitary resources, were used to treating cases of diarrhea, vomiting or AIDS.
25,000,000,000$

Spread of the epidemic

The WHO, estimates that in December 2014 it will reach 10,000 new cases each week. In addition this dramatic scene increases with the increase in fatalities caused by other diseases, such as diarrhea, which they are paying less attention to or confusing with Ebola. Not to mention the villages in quarantine where providers of basic supplies (food, dairy products…) in many cases refuse to deliver for fear of catching the disease.
10,000
new cases each week

Initiatives and aid

In these countries, due to the shortages and overcrowding of health resources, there is a long tradition to care for each other at home.
Some countries, like the United States, have already deployed aid to these countries.
NGOs like Doctors Without Borders or Save the Children are increasing their resources to try and stop the epidemic.
In Sierra Leone, the government is distributing a domestic kit so that the actual family can take care of sick family members. This action was started by Doctors Wfithout Borders, distributing hazmat suits, masks and chlorine, not so much to cure the sick but to protect the rest of the family from catching the virus. The WHO advises that these sick patients should be transferred to specialist centres.

Understanding the 2014 Ebola crisis in context

Ebola
deaths

4,000
in 38 years
When we talk about Ebola, we must bear in mind that never, in our history, has a biosecurity level 4 virus, the highest level that exists, infected so many people, so quickly and in such an extensive area.

Tuberculosis
deaths

3,500
a day

Chances that an outbreak of Ebola would flourish in western countries

The chances that an outbreak of Ebola would flourish in western countries are really low and to give us a little context, whooping cough or measles are 10 times more infectious than Ebola.

Transmission ratio

  • Ebola
    Ebola ratio 1.4 - 1.6
  • HIV
    HIV ratio 4
  • Measles
    Measles ratio 18

So, why is there such a widespread outbreak in Africa?

Doctors / 100,000 people

Liberia
1
España
380
Unfortunately, Africa’s big problem, which we already know: poverty and the lack of doctors and material. The scarcity is such that in some parts of West Africa, doctors and health personnel have to look after patients without running water.

Main country at risk from spreading the virus: India

Experts are now suggesting that one of the countries most at risk of spreading the virus is India.

At the moment, and as a preventative measure, the Indian authorities should locate and improve control of all passengers arriving from Africa. These measures have already been applied in the United States and the United Kingdom to break any chains of transmission there might be.

Almost 50,000 people of Indian origin live in these regions and frequently travel form one to the other.

Risk ratio

  • High urban density of population

  • Insufficient health infrastructure

  • Large emigrant population in West Africa