Disease of the Month: Ebola Virus

An illness that can cause bleeding from the nose, eyes, ears and gums, along with internal haemorrhaging, the Ebola virus is the stuff of horror films.

As of 6 September 2014, the recent outbreak in West Africa has seen 4,293 suspected cases, including 2,296 deaths. However, the World Health Organisation has said that these numbers may be vastly underestimated.

Already causing more deaths than all previous outbreaks combined, the continent is experiencing the worst known outbreak of Ebola and with a fatality rate of up to 90%, is struggling to contain the virus.

At the time of writing, there has been just one isolated incident in the UK, but where does this deadly virus originate from, and is there a risk that the UK could also suffer a widespread infection? Here, we will explore the origins and diagnosis of Ebola, its spread, treatment and finally, the implications for life insurance.

The symptoms

The Ebola virus, formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans with mortality rates usually of 50%-90% of those infected. An infected person will usually develop a fever, headache, joint and muscle pain, sore throat and intense muscle weakness.

These symptoms start suddenly, between two and 21 days after becoming infected, but usually after five to seven days. Diarrhoea, vomiting, a rash, stomach pain and impaired kidney and liver function follow. The patient then bleeds internally, and may also bleed from the ears, eyes, nose or mouth. The sooner a person is given care, the better the chances that they will survive.

The history

The first identified case of Ebola was on 26 August 1976, in Yambuku, a small rural village in northern Democratic Republic of Congo (then known as Zaire). The first victim, and the index case for the disease, was village school headmaster Mabalo Lokela, who had toured an area near the Central African Republic border along the Ebola river between 12-22 August. On 8 September, he died of what would become known as the Ebola virus. 

Since then, there have been a host of outbreaks mostly in Central Africa with
one known imported case in South Africa
in 1996.

Diagnosis of Ebola

Diagnosing Ebola in a person who has been infected for only a few days is difficult, because the early symptoms, such as fever, are nonspecific to Ebola infection and are often seen in patients with more commonly occurring diseases, such as malaria, typhoid fever and meningitis.

A key part of diagnosis will involve questioning about recent whereabouts and the possibility of exposure to the virus. Confirmation that symptoms are caused by Ebola infection are made using various laboratory antigen and antibody tests, but samples from patients are an extreme biohazard risk; laboratory testing needs to be conducted under maximum biological containment conditions.

This is not always feasible in the remote areas where Ebola outbreaks have occurred, and many healthcare workers have themselves been infected in diagnosing those with the virus.

 How it spreads

The virus is transmitted to people through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest. It then spreads through human-to-human transmission via direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and with surfaces and materials (such as bedding and clothing) contaminated with these fluids.

Most people are infected by giving care to other infected people, either by directly touching the victim's body or by cleaning up body fluids (stools, urine or vomit) that carry infectious blood. 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.

Ebola is not spread through the air or by water, nor generally through routine social contact (such as shaking hands) with patients who do not have symptoms. The virus is not as infectious as diseases such as the flu, which are transmitted through the air.

Food is not a typical route of transmission either, but in Africa it may be spread as a result of handling bushmeat (wild animals hunted for food). People remain infectious as long as their blood and body fluids, including semen and breast milk, contain the virus. Once someone recovers from Ebola, they can no longer spread the virus. However, the Ebola virus has been found in semen for up to three months after infection.

Treatment

The following basic interventions, when used early, can significantly improve the chances of survival:

• Providing intravenous fluids and balancing electrolytes (body salts);
• Maintaining oxygen status and blood pressure;
• Treating other infections if they occur.

There is currently no licensed treatment or vaccine for the Ebola virus, although potential new vaccines and drug therapies are being developed and tested. Recovery from Ebola depends on the patient's immune response. People who recover from Ebola infection develop antibodies that last for at least ten years, possibly longer.

Prevention remains the best form of combating the virus currently, educating communities on modes of transmission and the importance of isolating those infected. But the work of informing at-risk populations is being thwarted by superstition and fear. The first step in containment is to get those affected to health centres where they can be isolated and treated.

As community members are taken to isolation wards (most never to be seen again), rumours often circulate that the wards are not for treatment but for something more sinister. These communities often already have a deep-seated suspicion of outsiders and the sudden arrival of health workers can create fear and distrust, leading to infected people actually hiding from those there to help.

Is there a risk to the UK?

The likelihood of catching Ebola virus disease is considered very low, unless an individual has travelled to a known infected area and had direct contact with a person with Ebola-like symptoms, or had contact with an infected animal or contaminated objects.

Apart from a British nurse airlifted home for treatment, there have been no Ebola cases from people returning to the UK from West Africa.

While it is possible that more people infected with Ebola could arrive in the UK on a plane, the virus is not easily transmitted as mentioned earlier.

Also, Ebola victims do not become infectious until shortly before they develop symptoms. The disease then progresses very rapidly, meaning infectious people do not walk around spreading the disease for long and are unlikely to travel during this period.

Underwriting Ebola

It is unlikely that applications for life insurance will be seen from individuals presently infected with Ebola.

For any individuals currently unwell, however, undergoing tests and investigations would be postponed until the results are available.

Recent travel to areas suffering an outbreak or particular occupation titles may arouse caution. However, the risk that someone will have travelled to the UK and had time to make an application in the short incubation period remains small.

If an infected person survives, recovery may be quick and complete. Prolonged cases are often complicated by the occurrence of long-term problems, such as joint pains, muscle pains, skin peeling or hair loss.

Eye symptoms, such as light sensitivity, excess tearing iritis, choroiditis and even blindness have also been described. Such ongoing issues may have implications for disability cover and each would need to be assessed on its own merits, most likely with full medical evidence from the GP.

 Andy Smith is automated underwriting manager at VitalityLife