UJMR, Volume 6 Number 2, December, 2021, pp 130 - 134 ISSN: 2616 - 0668

https://doi.org/10.47430/ujmr.2162.018

Received: 15th November, 2021 Accepted: 31st December, 2021

Menace of Ebola Virus Disease: A Review

*1
Galadima, M.A.,2Ali, J. and 2Garba, K.
1
Community Health Department 2Medical Laboratory Science Department
College of Health Sciences and Technology P.M.B 1028, Nguru Yobe State Nigeria
*
Corresponding Author: [email protected]; Tel: +234-7034977924
Abstract
Ebola Virus Disease (EVD) a deadly disease that affect human and apes like gorilla, chimpanzee
antelopes and so on. The causative virus is found mostly in Africa. It had been uncovered first
in mid 1970s on the brink of the River of Ebola village. Since from the primary inception of the
strange disease in Democratic Republic of Congo, there has been a periodic outbreak of the
disease in some African countries, affecting many people within the region. A systematic
review was conducted using Google search Engine, Cochrane database systemic review (CDSR),
Centre for Disease Control and prevention and World Health Organization EVD report
Databases. The 2014-2016 Ebola outbreaks in West Africa were the most important and most
complex, which began in Guinea and spread to Liberia, Nigeria and Sierra Leone. Before the
disease is contained, it kills about 11,000 people and quite 28,000 people being affected from
it first mid 1970s detection to late 2016. The virus is transmitted from fruit bat in touch of
with other animals and passes on the infection to humans through handling infected, dead or
sick animals found within the forest or through direct contact with bats. Human to human
transmission occurs through direct contact with the blood, secretions and other body fluids.
Symptoms of the virus are: sudden onset of fever, fatigue, muscle pain, headache, sore throat,
vomiting, diarrhea, rash, impaired kidney and liver function, and bleeding from body openings.
Recent advancements have been carried out in the form of effective Ebola Virus Vaccine
Inmazeb and Ebanga for Zaire Ebola Virus and anti-Ebola virus drug rVSV-ZEBOV (Ervebo).
However, the rapid geographic propagation, non-specific clinical presentation, lack of
adequate vaccine and specific diagnostic assay are the possible challenges to combat the
dreaded public health menace of Ebola Virus Disease.
Key Words: Ebola Virus, Disease, Transmission, Treatment, Vaccine
INTRODUCTION contaminated with these fluids (WHO, 2021b).
Ebola virus diseases (EVD), formerly referred as The incubation time, that is the time intervals
Ebola Hemorrhagic fever (EHF), may be a rare from infection with the virus to onset of
but severe, often mortal illness in humans symptoms, is from 1-3 weeks. The symptoms of
(WHO, 2021a). Ebola may be a deadly disease EVD are often sudden and include fever,
caused by an epidemic, which is transmitted fatigue, muscle pain, headache and sore
from animals to humans, then from humans to throat. This is often followed by vomiting,
other humans (Nabil, 2014) The average Ebola diarrhea, rash, symptoms of impaired kidney
Disease case lethal rate is estimated to 50 per and liver function and in some cases internal
cent, with rates differed from 25 per cent to 90 and external bleeding (WHO, 2021b). The 2014-
per cent in past epidemics (WHO, 2021b). The 2016 epidemics in West Africa were the most
virus causes a quick, serious illness which is important Ebola epidemic since the virus was
usually mortal if untreated. Ebola virus disease primarily detected in 1976. The epidemic
(EVD) primarily emerged in 1976 in two (2) started in Guinea and spread across land
simultaneous epidemics, one in what is now borders to Sierra Leone and Liberia (WHO,
Nzara, South Sudan, and the other in Yanbuku, 2021a).
Democratic Republic of Congo (DRC) in a brink
of Ebola River, from which the disease takes its MATERIALS AND METHODS
name (“Sino”, 2021; WHO, 2021a). The disease The study review results of publications on all
is characterized by wide spread petechial Ebola Virus outbreaks. Information was
hemorrhages, focal necrosis of the kidney, obtained from websites of World Health
spleen and liver, shock and ultimately death Organization, Centre for Disease Control and
(“Sino”, 2021). The Ebola virus spreads through prevention, Food and Drug Administration and
contact with the body fluids like vomits, faeces Cochrane Library, and some articles were also
or blood of an infected person, or through taken from Google scholar. Abstracts and full
surfaces and materials like bedding, clothing texts were screened by the reviewers in
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 UJMR, Volume 6 Number 2, December, 2021, pp 130 - 134 ISSN: 2616 - 0668
selecting relevant articles based on the in Africa was prevented. WHO declared Nigeria
inclusion criteria. The review focus on the Ebola free on October 20, 2014 (WHO, 2014).
largest studies and the most recently published
study results at the time of this review (August- Mode of Transmission of Ebola Virus Disease
November, 2021). Studies were selected to The Ebola Virus Disease affects people living
cover major Ebola endemic affected countries. near tropical rain forest. The affected people
are mostly isolated and the people they have
Brief History of Ebola Virus Disease been in contact with should be tracked and
The Ebola Virus Disease was discovered first in monitored for three weeks for clinical
1976, during an outbreak of Ebola hemorrhagic symptoms of the disease. Scientist think people
fever that occurred in Zaire and later in Sudan are initially infected with Ebola virus through
in that time. There were about 300 victims in contact with infected animals, such as a fruit
each of the outbreak. The first person affected bat or non-human primates this is called
with Zaire Ebola Virus Disease was a Village spillover event. Subsequently, the disease
head Teacher Mabalo Lokela by name, who spread from human to human, potentially
stated displaying sign and symptoms of the infecting a versed number of human being
strange disease on August, 26 1976 (Makund et (Beth et al., 2016; CDC, 2021a). This virus
al., 2015). Tai Forest disease formally referred spreads through direct contact (like through
to as Ivory Cost Ebola virus Disease was broken skin or mucous membranes in the eye,
discovered in 1994 by a Scientist conducting mouth or nose) with: Blood or other body fluids
autopsies on Monkey and contracted the virus. (Urine, Sputum, Stool, Sperm, Breast Milk,
Zaire Ebola virus Disease second outbreak Sweat, Amniotic fluid and Vomit) of a person
occurred in 1995 in which 315 were affected who is ill with or has died from Ebola virus
and 254 people were death (Makund et al., disease (EVD). Things (such as Cloths, Needles
2015). Bedding and Medical care Equipments)
Makund et al. (2015) also reported that in the contaminated with body fluids from a person
year 2000, Uganda had an outbreak of Ebola who is ill with or has died from (EVD) Infected
Virus which affected and killed 425 and 224 fruit bats or non-primates (like Apes, Antelopes
respectively and Sudan Ebola virus was and Monkeys) Semen from a man who
responsible. There was another outbreak in recovered from EVD through oral, vaginal or
Democratic Republic of Congo in 2003 that anal sex. The disease may be left in some
affected 143 and killing 128 people. In 2007, certain body fluids like sperm of a patient who
new species of the virus surface in Uganda has regained from Ebola Disease, albeit they
named Bundibugyo affecting 149 and killing 37 are doing not to have signs of severe illness.
people (Makund et al., 2015). In March, 2014 There is no proof that Ebola disease can be
World Health Organization (WHO) reported an spread during sex or getting in touch with vulva
outbreak of Ebola virus Disease in Guinea, fluids from a woman that has had Ebola disease
which the researchers traced to a 24 months (CDC, 2021a). By the time human being
old child that died in the year 2013. It was becomes infected with Ebola disease, they do
rapidly spread to other countries like Liberia, not start showing clinical symptoms instantly.
Nigeria and Sierra Leone. This outbreak was the The interval between exposure to pathogen and
largest and most fatal outbreak ever recorded developing symptoms is termed the incubation
in the region affecting about 28,000 people and period. Human being can only spread Ebola
killing about 11,000 people (Makund et al., disease to others after developing clinical and
2015; WHO, 2014). symptoms of Ebola disease (Beth et al., 2016;
CDC, 2021a).
Ebola Virus Disease in Nigeria
During the West African Ebola virus epidemic in Symptoms of Ebola Virus Disease
July 2014, an infected person Liberian- Symptoms may appear anywhere from 2-21
American man, Patrick Sawyer Flew from days after contact with the virus, with an
Monrovia, Liberia, to Lagos, Nigeria, brought average of 7-10 days. The course of the illness
EVD into Nigeria. Exposed responders were typically progresses from “dry” symptoms
afterwards infected. To ward off a quick spread initially (like fever, aches and pains, and
within Africa’s most populous city, prompt fatigue), and then progresses to moist signs of
reaction efforts concentrated on quickly the disease which often includes: Fever, Aches
establishing Ebola treatment units, training and pains, like intense muscle and joint pain,
caregivers, and identifying all contacts for each headache and abdominal (stomach) pain,
case of Ebola. As a result of this rapid response, Weakness and fatigue, Gastrointestinal
the outbreak was confined to two cities, Lagos symptoms including diarrhea and vomiting,
and Port Harcourt, and additional spread of the Unexplained hemorrhaging bleeding or bruising
Ebola virus through Nigeria and into other areas (Beth et al., 2016; CDC, 2021a; Nabil, 2014).

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 UJMR, Volume 6 Number 2, December, 2021, pp 130 - 134 ISSN: 2616 - 0668
Other symptoms may include red eyes, skin are a variety of ways an individual can use to
rash, and hiccups (late stage) (CDC, 2021b). guard himself and stop the spread of Ebola
WHO (2021a) reported that symptoms of Ebola virus disease. Avoid contact with blood and
virus in some cases, there is both the internal body fluids (like Urine, Feces, Saliva, Sweat,
and external bleeding (for example oozing from Vomit, Breast Milk, Amniotic Fluids, Semen,
the gums, or in the stool). So many mutual and Vaginal Fluids) of people who are sick.
illnesses may have exerted clinical symptoms as Avoid contact with semen from a man who has
Ebola Disease, including typhoid fever, malaria, recovered from EVD until laboratory testing
tuberculosis or influenza (flu). shows that the virus is gone from his semen
Avoid contact with items which will have come
Diagnosis of Ebola Virus Disease in touch with an infected person’s blood or
It is often difficult to clinically distinguish Ebola body fluids (like Cloths, Bedding, Needles and
virus Disease from other communicable disease Medical Equipments). Avoid funeral or burial
like Malaria, Typhoid fever and Meningitis. practices that involve touching the body of
Many symptoms of pregnancy and Ebola disease someone who died from EVD or suspected EVD.
are also quite similar because of risk to the Avoid getting in touch with Bats, apes, Forest
pregnancy; pregnant women should ideally be Antelopes, and non-human Primates (e.g.
tested rapidly if Ebola is suspected (WHO, Monkeys, and Chimpanzees) blood, other bodily
2021a) Confirmation that symptoms are caused fluids or uncooked meat prepared from these or
by Ebola virus infection are made using the unfamiliar animals (bush meat) (CDC, 2021b).
subsequent diagnostic methods: Antibody-
capture Enzyme- Link Immunosorbent Assay Ebola Virus Vaccine
(ELISA), Antigen-capture Detection test- Serum CDC (2021a) reported that the United State
neutralization test, Reversed Transcriptase Food and Drug Administration (FDA) approved
Polymerase Chain Reaction (RT-PCR) Assay, the Ebola Vaccine rVSV-ZEBOV (called ErvevoTM)
Virus Isolation by cell Capture and Electron on December 19, 2020 This is the first FDA-
Microscopy (WHO, 2021a). approved vaccine for Ebola virus disease. This
vaccine is given as a one dose vaccine and has
Who are at risks of contacting Ebola Virus been found to be safe and protective against
Disease? Zaire Ebola virus, which has caused the most
Health care workers who do not use proper important and most deadly Ebola outbreak to
infection control while caring for Ebola patients date. On February 26, 2020, the Advisory
and family and relatives in touch with infected Committee on Immunization Practices (ACIP)
patients, are at the very best danger of getting suggested pre-exposure preventive vaccination
ill. Ebola disease may be transmitted when with rVSV-ZEBOV for adult’s ≥ 18 years age
people come in touch with infected blood or within the U.S population who are at potential
other related fluids. The Ebola disease only occupational risk of exposure to Zaire Ebola
poses a little danger to travelers or the public disease. This recommendation includes adults
who did not cared for or been in touch (within who are: Responding or getting to answer an
3 feet or 1 meter) with someone infected with epidemic of Ebola virus Disease, Laboratories or
the disease (CDC, 2021b). other staff working at biosafety facilities that
work with live Ebola virus, Healthcare
Persistence of Ebola Virus Disease personnel working at federally designated Ebola
The disease can stay in parts of the body that treatment centers in countries. A two-dose
are immune opportune sites after a short vaccine regimen of a different vaccine that was
infection. These are sites where viruses and also designed to protect against the Zaire Ebola
pathogens, like the Ebola disease are covered virus species Ebola- was used under a research
from the survivor’s system, even after being protocol in 2019 during an Ebola outbreak
cleared elsewhere in the body. These areas within the Democratic Republic of Congo. The
include the testis, aqueous humor of the eyes, two doses of this vaccine used two distinct
breast, placenta, and central nervous system, vaccine components (Ad 26. ZEBOV and MVA-
particularly the cerebrospinal fluid (CDC, BN-Filo) and the regimen requires an initial
2021b). Whether the virus is present in these dose and a ‘booster’ dose 56 days after. This
body areas and how long varies by survivors, vaccine is not yet endorsed by the Food and
researchers are now probing how long the virus Drug Administration for ordinary use (CDC,
remains in these body fluids within Ebola 2021b).
disease survivors (CDC, 2021b). WHO (2021b) recounted that, the Ervebo
vaccine had been shown to be efficient in
Mode of Prevention of Ebola Virus Disease protecting human being from the kind of Zaire
When living in or travelling to a neighborhood Ebola disease, and is recommended by the
where Ebola virus is potentially present, there strategic advisory group of experts on

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 UJMR, Volume 6 Number 2, December, 2021, pp 130 - 134 ISSN: 2616 - 0668
immunization as part of broader set of Ebola controlled trial during the 2018-2020 Ebola
outbreak response tools. In December, 2020, epidemics within the Democratic Republic of
the vaccine was endorsed by the U.S Food and Congo. The overall survival was much higher for
Drug Administration and prequalified by World patients receiving either of the two drugs that
Health Organization for use in individuals 18 were now endorsed by the FDA. Neither
years of age and older (excepts for pregnant InmazebTM nor EbangaTM are evaluated for
and breast feeding women) for protection efficacy against species apart from Zaire Ebola
against Ebola virus Disease caused by Zaire disease (CDC, 2021b).
Ebola virus. WHO (2021b) further reported that
the vaccine had been administered to more Supportive care to Ebola Virus Patients
than 350,000 people in Guinea and in the 2018- CDC (2021b) Reported that whether or not
2020 Ebola virus disease outbreaks in the other treatments are available, basic
Democratic Republic of Congo under interventions are often significantly improve
“Compassionate use” principle. The vaccine has chances of survival when provided early. These
shown to be safe and effective against the are mentioned as supportive care, and include:
species of Zaire Ebola Virus. A global stock pile Providing fluids and electrolytes (body salt)
of the Ervebo vaccine has been available orally or through infusion into the vein
starting January, 2021 (WHO, 2021a). In May (intravenously). Using medication to support
2020, the European Medicines Agency vital sign, reduce vomiting and diarrhea, and to
recommended granting marketing authorization manage fever and pain, testing other
for a 2- component vaccine called Zebdeno and infections, if they occur. Furthermore WHO
Mvabea for individuals 56 weeks upward. The (2021a) reported that rehydration with oral or
vaccine is taken in 2 doses: Zebdeno is taking intravenous fluids and treatment of specific
first followed by Mvabea which is given in 8 symptoms improved survival. A range of
weeks later as a second dose. This prophylactic potential treatments includes blood products,
2-dose regimen is therefore not suitable for an drug therapies and immune therapies are
outbreak response where immediate protection currently being evaluated.
is necessary (WHO, 2021a).
Controlling Infection in Healthcare Settings
Treatment of Ebola Virus Disease Medical workers must take necessary standard
CDC (2021b) reported that, there are currently preventive measures when caring for patients,
two treatments approved by the U.S. Food and no matter their presumed assayed result. The
Drug Administration (FDA) to manage EVD posed measures may include basic proper hand
by the Ebola disease, species Zaire Ebola virus, hygiene, respiratory hygiene, use of Personal
within adults and children. The primary drug Preventive Equipment (to block spills or other
approved in October, 2020. Inmazeb may be a in touch with infectious materials), safer
combination of three monoclonal antibodies injection and burial skills. Healthcare workers
(Atoltivimab, Maftivimab, and Odesimabebgn). caring for patients with suspected or confirmed
The other drug, Ebanga, may be a single Ebola virus should apply extra infection control
monoclonal antibody that was endorsed in measures to stop contact with the patient’s
December, 2020. Monoclonal antibodies (often blood and body fluids and contaminated surface
abbreviated as mAbs) are proteins produced in or materials like clothing and bedding. When in
a laboratory or other manufacturing facilities touch (within a meter) of patients with the
that act like natural antibodies to prevent a disease, medical personnel most use a face
germ like an epidemic from replicating after its mask (a face protector or an eye goggles), a
infected an individual. These particular mAbs clean, laboratory coat, and disposable hand
bind to a part of the Ebola disease’s surface gloves (sterile gloves for some procedures)
known as glycoprotein, which stop the virus (WHO, 2021b).
from entering a person’s cells (CDC, 2021b). In
a nut shell Inmazeb targets the glycoprotein Care for People who recovered from Ebola
that is on the surface of Ebola disease. Virus Disease
Glycoprotein binds to the cell receptor and A number of medical complications have been
fuses the viral and host cell membranes reported in people who recovered from Ebola,
allowing the virus into the cell. The three including psychological state issues. Ebola virus
antibodies that structure Inmazeb can bind to may persist in some body fluids, including
the present glycoprotein simultaneously and semen, pregnancy related fluids and breast
block attachment and entry of the virus into milk (WHO, 2021b). All Ebola virus survivors and
the cell. Ebanga blocks binding of the virus to their sexual partners should receive counseling
cell receptor, preventing its entry into the cell. to ensure safer sexual practices until their
Both of these managements, alongside two semen has twice tested negative. Survivors
others, were evaluated in a randomized should be giving condoms as a contraceptive or

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 UJMR, Volume 6 Number 2, December, 2021, pp 130 - 134 ISSN: 2616 - 0668
as a way to prevent the spread of the Ebola or until their semen tests negative twice for
disease through sex. Male Ebola survivors Ebola virus (WHO, 2021b)
should be offered semen testing at 3 months
after onset of disease, then for those that test CONCLUSION
positive, monthly thereafter until their semen Ebola Virus Disease has emerged as a big global
tests negative for virus twice by RT-PCR, with public health menace due to multiple disease
an interval of 1 week between tests. Ebola outbreaks in the last 3-4 decades. Recent
survivors and their sexual partners should advancements have been carried out in the
either abstained from all types of sex or form of effective Ebola Virus Vaccine Inmazeb
observed safer sex through correct and & Ebanga for Zaire Ebola Virus & anti-Ebola
consistent condom use until their semen has virus drug rVSV-ZEBOV (Ervebo). However, the
twice analyzed negative. The survivors may rapid geographic propagation, non-specific
continue normal intimacy practice when their clinical presentation, lack of adequate vaccine
sperm assay shows negative. & specific diagnostic test are the possible
WHO suggested that male who recovered from challenges to combat the dreaded public health
Ebola disease may practice safe sex and menace of Ebola virus Disease.
hygiene for 12 months from onset of symptoms

REFERENCES http://www.youtube.com/drebraheim
Beth, P.B., Inger, K.D., Daniel, B.J., Thomas, Sino (2021): What is Ebola Virus Disease? Sino
A.K., Sturt, T.N., John, P.O.C and online. Retrieved at
Jordan, W.T https://www.sinobiological.com/resear
.(2016). Over view, Control Strategies ch/virus/what-is-Ebola-virus-vaccine U.S.A on
& lesson learned in the CDC Response 29/04/2021
to the 2014-2016 Ebola epidemics. World Health Organization (2014) WHO declares
MMWR/July 8, 2016/ Vol. 65/No.3 US end of Ebola outbreak in Nigeria. Media
Department of Health and Human center statement, 20 October, 2014.
Service/ Center for Disease Control and www.who.int/mediacenter/news/state
Prevention ments/2014/nigeria-end-
Center for Disease Control & Prevention (2021a) ebola/en/Accessed 2/5/.2021
Morbidity & Mortality Weekly Report World Health Organization (2015) Health
(MMWR) over view, Control Strategies & Workers Ebola Infections in Guinea,
lesson learned in the CDC response to Liberia
the 2014-2016 Ebola epidemic. Sierra Leone: A Preliminary Report 21
Supplements/July 8, 2016 165 (3); 4-11. May 2015 Accessed 29/04/2021
Accessed 2/5/.2021 http://www.who.int/hil/documents/29
Center for Disease Control & Prevention /05/2015 web final
(2021b) Ebola outbreak in West World Health Organization (2021a). WHO Ebola
Africa/History/Ebola (EVD). Virus Disease. Fact sheet.
www.cdc.gov/vhf/ebola/history/2014- www.who.int/news-
2016-outbreak/index.html Accessed room/factsheets/details/ebola-virus-
2/5/.2021 disease Accessed 29/04/2021
Makund, J., Rajesh, P., Kuldip, S. and Jasbir, S. World Health Organization (2021b). News .un
(2015). The Ebola Menace: Epidemic .org/en/story/2021/02/1084692 UN
and News two dies as new Ebola outbreak
Expectations International Journal of declared in Southern Guinea Accessed
current Microbiology and Applied 29/04/2021
Sciences Volume 4 Number 1 (2015) Pp World Health Organization (2021c). WHO Africa
731-747 West African Countries ramp up Ebola
Nabil Ebrahiem (2014). YouTube Educational preparedness.www.afro.who.int/news/
animated video with English west-african-countries-ramp-ebola-
subtitles.describes the Ebola Virus preparedness cited 2/5/21.
Disease and how it is spread. Retrieved
on 2/5/.2021 from

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