Hello, everyone, and thanks so much for being with us today. I’m Valarie Basheda, Director of News and Special Projects at WebMD. We’ll be starting the chat in just a few minutes, but if you have a question for our experts, you can go ahead and get it in queue.
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Today we’ll be talking about the deadly Ebola outbreak—the worst in history. It’s caused more than 900 deaths in Africa, and now has hit close to home as two American patients with the virus were brought to the U.S. for treatment in the past week. Their cases have raised many questions about how the disease is spread and treated – questions that, no doubt, will be discussed at a U.S. House subcommittee meeting being held today to review the details of the outbreak.
We have a great lineup of experts on board to answer your questions today.
Amesh A. Adalja, MD, FACP, FACEP is an infectious disease physician—board certified in infectious disease, critical care medicine, emergency medicine, and internal medicine—at the University of Pittsburgh Medical Center and a senior associate at UPMC's Center for Health Security. He is also a member of the US Government's National Disaster Medical System that was deployed to Haiti in 2010 and the Infectious Diseases Society of America's (IDSA) public health committee.
Thomas W. Geisbert, PhD, is a professor of microbiology and immunology at University of Texas medical branch, and has been studying the ebola virus since 1988.
Robert Glatter, MD, is an emergency medicine physician at Lenox Hill Hospital and serves on the editorial board for Medscape.
Michael Smith, MD, is the chief medical editor at WebMD.
Thank you to all for joining us today!
Hi, looking forward to your questions.
Hi everyone. Looking forward to the live event and your great questions.
Hi Im looking forward to your questions!
We've been getting a lot of questions about the health care workers who are getting infected with the virus. People are wondering how they are getting the disease even though they are taking precautions.
Ebola is contracted solely by contact with blood and bodily fluids. When treating patients that may have Ebola donning the appropriate personal protective equipment (gloves, gowns, masks, eye protection) can prevent this from occurring. Also, avoiding exposure to bodily fluids of those who are deceased is crucial. However, in resource-poor settings even gloves may not be available and healthcare providers often take care of individuals without full protection placing themselves at heightened risk
Dental patients who are ill with fever or have vomiting or diarrhea should not be receiving dental procedures in the first place in this heightened environment. There should be screening questions prior to beginning the dental exam. Double gloves and eye protection such as goggles and a mask covering the face are recommended along with a plastic gown. There is minimal risk to those who take universal precautions while treating dental patients.
One issue we face with ebola is that the first symptoms look like a bad case of the flu with high fever, muscles aches, sore throat, weakness. But that’s followed quickly by vomiting and diarrhea and then the more severe effects like internal and external bleeding. Ultimately, this leads to internal organ failure, so the kidneys, liver, and other organs may stop working. A person can be infected with ebola for up to 3 weeks before showing symptoms. But they’re not contagious until they have symptoms.
It is unlikely to transmit the Ebola virus by just casual contact on an airplane. The virus is spread by close and direct intimate contact. That said, I would wash my hands thoroughly, and avoid touching my eyes nose or mouth. The virus is not known to have sustained airborne or droplet transmission, and is much les contagious than the measles or influenza. If you do use a restroom, make sure you thoroughly clean your hands after touching any surfaces in the restroom and remember not to touch your mouth nose or eyes.
The experimental treatment that the 2 individuals in Atlanta received is in very early stages of development by a San Diego-area company. It is only available in small quantities at present and a lot of safety testing in humans remains to be performed. It is very promising but will need more study before it is approved for wider scale use.
Ebola has an incubation period from 2-21 days. That said, most patients develop symptoms at 8-9 days. It is important to remember that only patients with active symptoms such as fever, vomiting and diarrhea can transmit the virus. Direct contact with secretions such as vomit, diarrhea, blood, saliva or semen is necessary to transmit the virus.
Ordinary hospital environmental cleaning substances can inactivate the Ebola virus. Bleach (10%), hospital grade phenol, and hospital grade quaternary ammonium compounds can be used. Similarly, ordinary cleaning agents on airplanes can be used.
There is nothing definitive that one can really do to augment the immune system’s efforts against Ebola. Following general health recommendations (diet, exercise, etc.) is what I would advise.
I am not very concerned about the virus mutating. Historically, there have been very little changes in the virus over very long periods of time. I am concerned that the outbreak could advance into urban areas but this would not likely be due to any mutation.
The Ebola virus directly attacks the immune system, entering cells and releasing inflammatory mediators that effect the ability to form clots, as well as the functioning of the kidney and liver. This can lead to kidney and liver failure, and internal bleeding as well. The end result is that there is massive fluid loss from diarrhea and vomiting. Patients develop shock, and may need blood transfusions as well as platelets.
It's tough to pinpoint why some people are hit harder by ebola than others. But age does seem to be a factor. We do know that people who are older tend to be more severely affected and more often die from severe ebola infection. That's true for most serious infections, though, and not specific to ebola.
The issue regarding making ZMapp available to West African nations is quite complicated. There have been no phase I clinical trials yet and ZMapp has not been approved by the US FDA for use in humans in the US. Licensure can be a fairly long process. It could of course be approved for compassionate use by the US FDA for use in the US. Things get really complex when you talk about using it in outbreak settings in other countries like in West Africa. For one thing the involved countries would need to make a request from the companies. The other issue is that it would take some time to make enough ZMapp to handle an outbreak of this size.
When individuals are infected with Ebola, they almost always manifest symptoms (with the exception of Ebola Reston). However, there is at least one study I know of that described individuals in close contact with Ebola-infected individuals that developed antibodies and did not have symptoms. It is unclear how contagious these individuals would be. This is an area that needs further research.
It is highly unlikely to transmit the virus unless there has been direct and prolonged contact with someone who has been caring for someone ill with the virus or having contact with infected secretions. If your boyfriend has not traveled to West Africa in the past several months, and has not had contact with anyone who may have a suspected exposure, you do not need to be concerned.
Yes, there is a rapid test that can diagnose ebola with a blood test. The results take up to several days to return results but may be as fast as 24 hours. If you were suspicious someone had ebola, first you would want to quarantine them and then test them to confirm whether it's ebola or not.
There are no vaccines at the moment that are in Phase I clinical trials. To be licensed in the US a vaccine would need to be approved under the FDA "Animal Rule" meaning that you have to show that the vaccine 1) protects laboratory animals (nonhuman primates) against Ebola and 2) conduct a Phase 1 trial to show that the vaccine is safe in healthy humans. There are at least 5 different vaccines that have been shown to protect nonhuman primates against Ebola. Given the increased interest from the current outbreak I am hopeful that these vaccines will be moved into Phase I trials so that they could be used for humans in the future.
There is a risk of an infected traveler appearing in the US—something that has happened before with other viral hemorrhagic diseases (Lassa Fever, Marburg). However, there is unlikely to be secondary transmission and no chance that Ebola will find the US a hospitable place because of standard infection control practices in place at all hospitals and the different approach taken with funerals here.
Reports from the field have stated that personal protective equipment (PPE) is scarce and there have been calls for donations of equipment. There also is a concern that PPE may not work optimally in the weather conditions in West Africa. It is unclear how Dr. Brantly was infected but, it must be emphasized, that the health infrastructure in these nations is poor and very conducive to lapses in infection control (even when PPE is available).
There have been no published herbal compounds that have demonstrated any activity against the virus, in animal models or in vitro. There has been some interest in colloidal compounds in their ability to hide the virus from the immune system, but these have not been shown to have any proven utility thus far. There is some research from TekMira pharmaceuticals looking at Lipid coated nanoparticles that is promising in nonhuman primate models utilizing small interfering mRNA compounds.