KOTA KINABALU: The public should be concerned about the outbreak of the Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, though no cases of Ebola have been reported in Malaysia yet.
Dr Timothy William, infectious disease consultant at Queen Elizabeth Hospital (QEH), said Ebola is a very infectious virus, even in small amounts.
In an interview yesterday, Dr Timothy, who is also the president of Infectious Disease Society of Kota Kinabalu, shared his knowledge on the Ebola virus, including the signs and symptoms of the disease.
EVD is caused by the Ebola virus. There are five different strains of which four can cause severe disease in humans and animals.
Since 1976, there have been about 30 recorded Ebola virus outbreaks that have affected humans.
The Ebola virus has a mortality rate up to 90 per cent, and it kills indiscriminately. Even young healthy adults are prone to be infected with the Ebola virus.
The World Health Organization (WHO) said there had been more than 1,600 cases of Ebola since the disease emerged in West Africa this year.
On Monday, WHO reported that the death toll had reached 887 in Guinea, Sierra Leone, Liberia and Nigeria as of Aug 1.
So far, the countries affected by this virus are the West African nations of Guinea, Liberia and Sierra Leone.
“The current outbreak is the only one to have occurred in urban areas and to cross national borders.”
Although Malaysia has no case of Ebola now, Dr Timothy said it was possible for a person to be infected when visiting an affected country or if someone gets infected from an affected country visits Malaysia.
“In today’s world that is interconnected, a disease is just a plane ride away,” he said, advising the public to limit travel to west African countries.
“I am very concerned. I am not saying that the public should panic, but they should definitely be concerned.”
Dr Timothy explained that viruses usually stay put in reservoirs, in this case, fruit bats, particularly species of the genera Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata.
The outbreak of the Ebola virus happens when there is a change of environment where the contact of human and wildlife gets closer. He elaborated that disease outbreaks often die out by itself, when infected people either pass away or some recover and stop spreading the virus.
“Disease like this burns out, till someone gets exposed again to another bat that is infected and the virus spreads again.”
Dr Timothy said Ebola virus is moderately contagious and can be spread from an infected human to another through body fluids such as blood, mucus, saliva and urine, or objects contaminated by the infected person. It is not airborne and hence cannot spread by air.
“Common cold is spread through the same way. It is easy to get common cold from someone, and it is just as easy to get Ebola from someone else,” he said.
The virus can be easily spread by, say, scratching your eyes after coming into contact with the bodily fluid of an infected person by touching a table that was previously touched by the latter; or when an infected person walks around on a plane and touches here and there, he said.
What’s more, the incubation period of Ebola, meaning the time interval from infection with the virus to onset of symptoms, is up to 21 days.
“During that time (incubation period), infected people do not show symptoms and they can travel around the world.
“They are not infectious during the incubation period, but when they start sneezing and getting fever they can spread (the virus).” Even a person who recovers from Ebola can potentially spread the virus for a few weeks, Dr Timothy said.
In addition, burial ceremonies in which mourners have direct contact with the body of the deceased person can also be infected. Healthcare workers have frequently been infected while treating patients with suspected or confirmed EVD.
“What’s scary is that 60 healthcare workers have died as of August 1 this year,” he pointed out.
Hence, anyone who experiences the above-mentioned symptoms should seek medical attention at the hospital immediately.
Symptoms of Ebola
Ebola is a disease that strikes a person suddenly. People who contracted the virus will experience high fever, lethargic, diarrhea, weakness, vomiting and stomach pain. Other symptoms include severe aches, rash, red eyes, chest paints, sore throat, difficulty in breathing and difficulty swallowing.
Dr Timothy pointed out that the symptoms of Ebola are non-specific, as they can be symptoms for influenza, malaria or dengue fever, making early detection of Ebola patients difficult.
“At the final stages, the patient can go into hemorrhage; external bleeding from the nose and mouth, and internal bleeding from the organs – liver, kidney, gastrointestinal system.”
Ebola patients will also show low white blood cells and platelet counts, as well as elevated liver enzymes.
Dr Timothy said the detection of the Ebola virus is done through blood tests. Having said that, the blood tests have to be done at a Biosafety Level 4 (BSL-4) Laboratory, which is not available in Sabah.
Setting up a BSL-4 laboratory here will be costly, he said.
However, Dr Timothy said there is a BSL-3 laboratory in the State at Universiti Malaysia Sabah (UMS), which can probably be used for blood tests, if necessary.
Currently there is no known vaccine or medicine for the disease. Patients are given supportive care with the hope that their own immune system and body will overcome the infection.
“If the patients’ blood pressure is low, we give them fluids; if their kidneys fail, we support their kidneys with dialysis; if they need ventilation, we incubate and ventilate them. That is supportive therapy.
“There is nothing to boost our immune system … that is the difficult part,” he said.
An experimental drug, known as ZMapp, has been developed by a biotech firm Mapp Biopharmaceutical Inc. based in San Diego. The drug previously was not tried in humans but has shown promise in small experiments with monkeys. Two infected healthcare workers from the United States, Dr Ken Brantly and Nancy Writebol’s conditions have significantly improved after receiving this medication.
Dr Timothy said ZMapp is not a licensed drug yet and its side effects and whether it works for everyone have yet to be known.
“The good thing is, two people who used it have gotten better and this gives us hope that there will be a treatment soon.”
Dr Timothy said clinicians and public health personnel have been put into high readiness to prepare in case of an Ebola outbreak here. “All health officers and personnel have been briefed on how to cope with Ebola through emails and meetings.”
In addition, Dr Timothy said the isolation rooms at the newly-erected twin towers at Queen Elizabeth Hospital 1 are fully functional and ready for use.
A few days ago, Malaysian Health Minister Datuk Seri Dr S. Subramaniam said the government was stepping up preparations to prevent the Ebola virus from reaching Malaysia.
Dr Subramaniam said all major entry points in the country, including the Kuala Lumpur International Airport (KLIA), were under an Ebola virus alert and clear instructions have been given to officers at the entry points on what to do to prevent transmissions from travelers.
Preventive measures include identifying and handling passengers with symptoms, immediately alerting the Health Ministry and referring cases to the nearest hospital. The National Crisis Preparedness and Response Centre must also be notified, Dr Subramaniam said.
Dr Timothy assured that there have always been public health officials at the airports in Sabah regardless of the Ebola virus, but now the officials are at heightened alertness to screen passengers who present Ebola symptoms, especially those who come from affected countries or have had travelled to the countries before.