Communicable Disease - Ebola Community Health and Population-Focused Nursing C228

Community Outbreak-Ebola

Crystal Michael

Community Health and Population-Focused Nursing C228

Western Governors University

May 27, 2019

Community Outbreak-Ebola

  A communicable disease is an infectious agent that is spread from one person to another. This can occur through contact through the air, bites from insects or animals, or direct contact with blood or other bodily fluids or surfaces contaminated by blood or bodily fluids. Examples of the most common communicable diseases are influenza (the flu), tuberculosis (TB), varicella (chickenpox), hepatitis, and HIV.  Ebola is a communicable disease that is anything but common. It is a severe virus that can affect humans and non-human primates. It is often fatal if left untreated. Ebola viral disease (EVD) is formerly known as Ebola hemorrhagic fever.  There have been 25 reported outbreaks reported since the discovery in 1976. In 2014-2016, Ebola viral disease reached pandemic status.  Widespread transmission occurred across multiple West African countries and crossed international borders. Origination began in Guinea then spread to Liberia and Sierra Leone. Over 28,00 people were infected. Isolated cases were also reported in Nigeria, Mali, Senegal. The outbreak spread within a year. Travel-associated cases appeared in places outside of Africa, including Europe and the United States.

Description of Outbreak

Ebola was first discovered in 1976 in Africa. Consecutive outbreaks occurred in two countries of central Africa. One outbreak occurred in the Democratic Republic of Congo (formerly known as Zaire) in a village near the Ebola River. (WHO, 2018) The onset of the outbreak in Zaire began on September 1, 1976. A 42-year-old man presented to the outpatient clinic at the local hospital experiencing chills and fever. The outbreak lasted through October 1976 and had a total of 318 cases with 280 deaths. (JID, 2016) The other outbreak occurred in South Sudan, over 500 miles away. The outbreak in southern Sudan occurred between June and November of 1976. There was a total of 284 cases; 67 in the source town of Nzara, 213 in Maridi, 3 in Tembura, and 1 in Juba. The outbreak in Nzara appears to have originated in the workers of a cotton factory. (NCBI,1978)

Epidemiological Determinants and Risk Factors

Ebola viral disease belong to a family of viruses called Filoviridae. These viruses affect multiple organ systems in the body. The vascular system is damaged, and hemostasis is not able to function properly.  Three genres of this family of viruses have been identified-Cuevavirus, Marburgvirus and Ebolavirus. Currently, six species of Ebola virus have been identified and have been traced to an African (sub-Saharan) origin. Research has suggested that Ebola is a zoonotic (animal-borne) pathogen. Fruit Bats are the most likely reservoir of the virus. Bats infect other animals such as apes, monkeys, and antelope. Humans become infected when close contact with infected animal hosts occur through hunting or preparation of meat for cooking. (CDC,2018) 

Once humans are infected with the Ebola virus, transmission occurs through person-to-person contact. People at higher risk for contracting the disease are family members or others in close contact with an infected person, persons that have direct contact during burial rites, and healthcare workers. (WHO, 2018) Indirect infections can also occur by contact with objects and materials (i.e.-needles, unsterilized medical equipment, sheets) that are contaminated with bodily fluids.

Route of Transmission

Ebola virus spreads from human to human through direct contact with blood and bodily fluids (feces, urine, or vomit) through broken skin and mucous membranes. It is not an airborne infection and cannot be contracted through casual sneezing or coughing. The virus has been detected in breast milk and semen. Research has shown that the virus can persist in recovering male semen between 70-90 days. Abstinence or consistent condom use is highly recommended during this timeframe.

Signs and symptoms of EVD have an early phase and a late phase. Early symptoms begin with sudden onset which can include fever, nausea, severe headache, sore throat, muscle pain and weakness, fatigue. Symptoms in the early phase are common to many viral illness so infected individuals may not seek medical attention immediately. Late symptoms include vomiting, diarrhea, abdominal pain, impaired kidney and liver function, unusual bruising and internal and/or external bleeding. As late symptoms develop, increased risk of death occurs. Symptoms usually start 2- 21 days after contact with the virus. A person is considered infectious when symptoms start.

Impact on Community

         If an EVD outbreak were to occur in my local community of Columbia, we would be adequately prepared. The South Carolina Emergency Management Division (SCEMD) resides in the county.  The State Emergency Operations Center can coordinate activities of more than 50 government and private organizations from this central location. The Army National Guard shares the same building with SCEMD.  If necessary, the National Guard can be activated to assist with logistics, defense, building infrastructure, and distribution of supplies to residents of the community.  The American Red Cross is also located here in the area. Emergency prepared, trained personnel can be readily mobilized and deployed to areas of need.  The local hospital is a Level 1 trauma facility and participates in drills and training sessions for disaster and mass casualty events. Residents of the local community can be issued warnings and subsequent updates regarding the outbreak by radio, tv, and cell phone alerts.