Ask Dr. Pat

Dr. Pat Consults: The Ebola Epidemic—Fear of Flying to Africa

 Source: World Health Organization

 

Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly “Medical Monday” column for Women’s Voices for Change.  (Search our health archives for her posts—calling on the expertise of medical specialists—on topics from angiography to vulvar melanoma.)

The Ebola epidemic in Africa has alarmed all of us. To answer Gwen’s questions about the disease, Dr. Pat calls on a member of WVFC’s Medical Advisory Board, Jason S. Kendler, M.D., a Clinical Associate Professor of Medicine at the Weill Medical College of Cornell University. He is a specialist in Infectious Diseases.

 

Dear Dr. Allen:

I had planned an important business trip to Nigeria in September.  Now, I am concerned that I should postpone the trip because I have been following the news about the Ebola Virus Infection as it continues to spread. But I know that there have been very few people in Nigeria reported with Ebola.

Can you let me know more about this infection?  How did it get out of control?  Will there be enough health care workers and public health teams to track down everyone exposed, quarantine them, and treat them?  I am also concerned about being on airplanes with people who may not know they are infectious but are contagious. Why is this infection described as “deadly”? Is someone working on a vaccine?

Alice

 

Dr. Kendler Responds:

Dear Alice:

As of August 18, the World Health Organization reported 2,473 cases of Ebola virus infection and 1,350 deaths. This is the largest outbreak of this disease that has ever been recorded, and many suspect that the number of cases is actually much higher. All cases have been diagnosed in West Africa, in the countries of Liberia, Sierra Leone, Guinea, and Nigeria.  For this reason, the Centers for Disease Control (CDC) has issued the highest (Level 3) travel health warning with regard to travel to three of these countries, advising that U.S. residents “avoid nonessential travel to Sierra Leone, Guinea, and Liberia because of an unprecedented outbreak of Ebola.”  As for your question about travel to Nigeria, the CDC has instituted a lesser warning (Level 2), recommending that travelers to Nigeria protect themselves by avoiding contact with the blood and body fluids of people who are ill with Ebola.  Alice, if you choose to go to Nigeria in September, you should certainly avoid contact with anyone who is sick.  But if your trip can be postponed to another time, you may wish to make your travel plans in the future when, one hopes, this epidemic will have quieted down.

It is hypothesized that, following years without any human cases, outbreaks of Ebola virus infection may originate when a person comes into contact with an animal or eats an animal (perhaps an ape or a bat) that carries the virus. Once a person is infected, the virus can then spread to other people.  It is very important to know that the virus is spread only by DIRECT PHYSICAL CONTACT with an infected person’s bodily fluids (e.g, vomitus, urine, feces, sweat). Unlike viruses such as influenza (the flu), the Ebola virus is generally not spread from person to person in the air.  Because of this, traveling on an airplane with someone with the Ebola virus would NOT put you at risk, unless there is some direct physical contact with his or her bodily fluids.

Symptoms as a result of Ebola virus infection generally occur 4 to 10 days after exposure, but the onset of illness can begin as late as 21 days after exposure.  Symptoms of Ebola virus infection include fever, malaise, muscle ache, headache, vomiting, diarrhea, and rash.  Of those infected with the Ebola virus, more than 50 percent will die, generally in the second week of illness.  Death occurs as a result of organ failure.  Health care workers must take special precautions to protect themselves (such as wearing gowns, gloves, masks, and eye protection) when taking care of patients with Ebola virus infection.  No effective treatments for Ebola virus infection have been approved, but a treatment of antibodies against the virus has been studied and has been given to a few patients.  All patients should receive fluids to treat dehydration and should receive other supportive care.  Vaccines to protect from infection with the Ebola virus are being studied, but there is no vaccine available at this time.

Alice, your question as to how the outbreak got out of control is a good one that is difficult to answer.  Failure to recognize the severity of the problem at the onset of the outbreak, lack of public health infrastructure, lack of financial resources, lack of medical resources, and misinformation may all have contributed.

The only way to end the current outbreak (or any outbreak) of an incurable infectious disease like Ebola is to isolate all patients with known or suspected infection.  Isolation and quarantine of patients is not a simple task anywhere, but in a resource-poor region of the world, this is even more difficult.

Dr. Kendler

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  • Nana Gregory August 28, 2014 at 12:38 pm

    That was very timely and very helpful, Pat. Thank you.

    Reply