AN AFRICAN EBOLA OUTBREAK

The last few days I have received messages of concern from friends about the Ebola outbreak that seems to be spreading faster than health authorities would like.  It is causing a lot of concern and worry in West Africa at the moment, and an infected person flew on a commercial airplane a few days ago into Nigeria, so touchwood, East Africa will not be affected or should I say ‘infected’.  In saying that I travelled for 10 weeks through West Africa last year (September-November) and the first of the outbreaks started 4 months later, in the March of 2014.  So we were certainly out of the contagion period, but there is something weird about having just travelled through countries that has an outbreak of such a deadly disease.  I have Googled the virus this morning to find out more about it and, as a traveller, I think you would have to be pretty unlucky to contract Ebola.  It would involve having sexual intercourse with a local or the swapping of bodily fluids (work out all the options), getting involved in an accident where blood is transferred or the eating of an infected animal if not cooked thoroughly.  Pig farms in Africa can play a role in the amplification of infection because of the presence of fruit bats on these farms and pig-to-human transmission as a result of unsafe animal husbandry and slaughtering practices, unsafe consumption of fresh blood, raw milk or animal tissue.  Add to that the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat also needs to be taken into account.  There was not a lot of fresh food for us to eat on the overland trip, so many of our meals involved tinned spam and tuna, so the chances of eating infected meat was pretty much zero.  If we were able to purchase a meal it was either, a choice of chicken or fish, and both not big carriers of the Ebola virus, we probably still would have been okay. 

I am now thinking ahead to my West/Central Africa trip in January 2015.  I am not travelling the West African countries again, but the truck that I am joining is coming through the infected areas.  I am relying on my fellow travellers to have been cautious when they go out to clubs (not that there are many opportunities), eating out (again not a lot of options-only in big towns) and also where they are purchasing local food to stock the truck.  As the overland trips are share duties, everyone takes turns in cooking, washing and cleaning.  All it takes is a passenger to contract the disease unknowingly and then when cooking for example, sneezes over the food and then we all have the possibility of contracting the virus.  I am joining the trip in Ghana, which is technically still considered West Africa, but they are yet to report any fatalaties, and hopefully the passenger who landed in Nigeria, has not infected anyone from the flight and it doesn’t spread through that country, as we spend a week there.  I am not a hypochondriac, I am not looking at cancelling my trip, but it is food for thought as this virus grows and the authorities struggle to contain it.  The scariest thing is there is no cure, no vaccine that has been approved, so if you do contract the virus, the chances of you surviving are very slim, like 10% slim.    

The current Ebola virus outbreak in Africa has killed more than 670 people and infected more than 1,000.  A viral disease that can kill as many as 90% of those it infects, Ebola took root in Guinea roughly five months ago and spread quickly across West Africa's porous borders to neighbors Liberia and Sierra Leone.  The outbreak has been raging off and on ever since, frustrating health officials on the ground and internationally who are up against sizable populations that move between countries and cities and harbor suspicions of Western medicine. Local belief systems encourage family members to care personally for the infected sick and engage in burial rites that bring them in contact with the still-contagious deceased.  The World Health Organization is calling it the largest recorded outbreak of Ebola in history.  Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.  While Ebola has caused more than 20 outbreaks in central Africa since it was first identified in 1976, it is new to West Africa and has proved to be a much greater challenge to control.

Key facts

Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.

EVD outbreaks have a case fatality rate of up to 90%.

EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.

The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.

Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.

Severely ill patients require intensive supportive care. No licensed specific treatment or vaccine is available for use in people or animals.

What are the symptoms?

Initial symptoms include fever, intense weakness, muscle pain, headache and sore throat. These symptoms are followed by vomiting, diarrhea, rash, impaired kidney and liver function and sometimes internal and external bleeding.  Symptoms usually appear 8-10 days after infection, according to the Centers for Disease Control and Prevention.  WHO says lab tests of contaminated individuals find low white blood cell and platelet counts.  People are infectious as long as their blood and secretions contain the virus. The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days.

How does the virus spread?

The virus is transmitted from wild animals to humans. Humans spread the virus through contact with blood or other body fluids of an infected person, as well as exposure to objects like contaminated needles.  People most at risk include health workers and family members or others who are in contact with the infected people, according to WHO.  While people aren't contagious until they develop symptoms up until 21 days, which is the incubation period for Ebola.  It's unknown what the natural host for Ebola is, but it's believed to be the fruit bat. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.  Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

What is the treatment?

Currently, there is no vaccine. Treatment consists only of "supportive therapy". 

How deadly is Ebola?

In past outbreaks, up to 90% of humans who contract the virus have died. 

WHO describes Ebola as "one of the world's most virulent diseases."

The worst Ebola outbreak in history has prompted Liberian officials to close their borders, as the governments in several West African countries raced to convince many of their citizens that ebola is a real disease.  Liberian President Ellen Johnson Sirleaf ordered traffic to be channeled through a few entry points where people can be monitored and tested for Ebola. She said the airport would remain open, with passengers similarly screened.  Arik Air Ltd., West Africa's largest carrier, cancelled flights to Liberia on Sunday in response to the epidemic.  The president also banned large gatherings such as demonstrations and is considering quarantining certain urban neighborhoods.  West African governments struggled to prevent the spread of the extremely deadly Ebola virus, which has infected more than 1,000 people in three countries this year.  Closing a country's borders for an infectious disease is uncommon, but illustrates the level of frustration government and health officials are experiencing as the deadly outbreak rages through its fifth month, having infected at least 1,201 people and killing 672. The moves follow the death of one of Liberia's top doctors over the weekend, as well as news that two U.S. health-care workers working in Liberia have been infected.  President Sirleaf Johnson's moves will be difficult to enforce in a country where even many government workers haven't accepted the existence or epidemiology of the virus as scientific fact. 

Local pastors and medicine makers have all claimed the power to cure the disease, facilitating its spread. Liberian officials on Monday were hoping that the rising death toll had begun to persuade Liberians otherwise.  Funerals in particular are a point of transmission: Custom among West Africa's Muslim population holds that bodies should be buried within 24 hours of death, with family members often handling the corpse.  Government attempts to alter funeral rites meet resistance from Liberians who refuse to let doctors in protective suits deal with the bodies of their loved ones. Quarantining sections of the capital, Monrovia, a densely packed city of 1.2 million people, would prove difficult as neighborhoods blend together, demarcated from one another by hard-to-police back alleys cutting between shacks.  And even convincing Liberians that Ebola exists remains a challenge in a country where rumors fill the void left by the lack of formal education. Large numbers there believe Ebola is an evil spirit. One Liberia senator recently called it a scam by his government.  Liberian government workers have been screening videos showing the effects of the disease in local movie theaters. The government has been airing constant radio spots explaining the Ebola virus in the hope it will help to change minds. 

It's a rapidly changing situation and there are expected to be more cases in the coming weeks and months.  Those cases and the continuing outbreak prompted the Centers for Disease Control and Prevention in Atlanta on Monday to issue a health alert to U.S. health-care professionals to be on the lookout for patients who have travelled to West Africa recently and exhibit possible symptoms of Ebola—including fever, headache and diarrhea.  This could also make future travel plans a little tricky as you have to prove that you don’t have any symptoms.  I am lucky after my overland trip next year I am flying from South Africa back to Kenya, so I don’t have to deal with Australian or US immigration officers when you tell them where you have travelled.  Australia is bad enough when I tell them I came from Kenya, having to show my yellow fever card, imagine if I had to tell them I had travelled through Nigeria! 

To to my fellow travellers who start their overland journey in November this year, take care, really, be careful.  Be careful where you eat, who you converse with and the animals/wildlife that you have contact with.  It is not only yourself that you need to think of but also your fellow travellers, people who will become your travel family, and having done that route last year, you live and breathe together in close confines and it is a very serious situation to think about.  I’ll be seeing you in January, hopefully Ebola free, and ready to rock my 3 months on what will be, my last big trip-EVER.