ONGOING COLUMNS: Global Health and Nursing
During the 2014-2016 epidemic of Ebola Virus Disease (EVD), 28,600 people were infected and 11,300 died. The disease is spread by contact with the body fluids of EVD patients as well as deceased victims. In contrast with previous epidemics, during the 2018 epidemic, EVD spread from isolated rural areas to densely populated cities in the Democratic Republic of the Congo (DRC). Complicating the 2018 epidemic is ongoing violence. According to Claude, Underschultz, and Hawkes (2018), an Ebola virus outbreak has not previously occurred in a war zone. Additional social determinants of health and illness include the presence of over a million internally displaced persons living in temporary camps who are at high risk for EVD, and a growing number of refugees entering from other countries. On a positive note, a promising new vaccine to counteract the virus is being used (Claude et al.). The source of the 2018 outbreak is currently unknown, Ebola Outbreak Epidemiology Team (2018) noted that this outbreak is the most complex and high risk they have ever experienced.
According to the Centers for Disease Control and Prevention (CDC, 2018), childbearing women are more susceptible to EVD than the general population, and are at increased risk of serious illness and death from this disease. Childbearing women testing positive for EVD are at risk for multiple complications, including perinatal loss, premature rupture of membranes, preterm birth, maternal hemorrhage, and maternal and neonatal death. Breastfeeding women having EVD remain positive for the virus more than 60 days after the onset of symptoms.
Shah et al. (2016) studied the clinical presentation of EVD in children under 5 years of age, it differs from adults. Clinical markers include fever, diarrhea, and vomiting which may be attributed to influenza or malaria. However, it is important that 25% of children presenting with the disease do not present with a fever and may be misdiagnosed (Lado & Howlett, 2016). Shah et al. also noted that symptoms such as hiccupping, hemorrhage, and confusion are associated with poorer outcomes.
By January 2019, during the current outbreak there have been 333 confirmed cases with over 200 deaths, many were children and infants (https://www.cbc.ca/news/health/congo-ebola-outbreak-to-last-into-2019-1.4903475). According to the BBC News (December 13, 2018), “a six-day-old baby survived Ebola” after being treated in the DRC Ebola Treatment Center in the city of Beni. Her mother had tested positive for Ebola and succumbed to the illness after giving birth. Neonates are managed using Comprehensive Ebola Interpersonal Contact Precautions for 21 days. According to WHO, there are no reports of newborn survival beyond the neonatal period (https://www.who.int/csr/resources/publications/ebola/pregnancy-guidance/en/)
The CDC (2018) has developed guidelines for screening and provision of care for pregnant women with EVD in healthcare facilities in the United States. As there is a 50% mortality rate for those who become ill with EVD, the importance of early detection, timely patient isolation, follow-up tracing contacts, appropriate burial of victims of EVD, and comprehensive vaccination with the rVSV-ZEBO vaccine cannot be overemphasized (Ebola Outbreak Epidemiology Team, 2018; Swaan et al., 2018).
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Ebola Outbreak Epidemiology Team. (2018). Outbreak of Ebola virus disease in the Democratic Republic of the Congo, April-May 2018: An epidemiological study. Lancet
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Lado M., Howlett P. (2016). Ebola virus disease in children: Towards a better clinical picture and improved management. The Lancet. Global Health
, 4(7), e436–e437. doi:10.1016/S2214-109X(16)30111-5
Shah T., Greig J., van der Plas L. M., Achar J., Caleo G., Squire J. S., ..., Lokuge K. (2016). Inpatient signs and symptoms and factors associated with death in children aged 5 years and younger admitted to two Ebola management centres in Sierra Leone, 2014: A retrospective cohort study. The Lancet. Global Health
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Swaan C. M., Öry A. V., Schol L. G. C., Jacobi A., Richardus J. H., Timen A. (2018). Ebola preparedness in the Netherlands: The need for coordination between the public health and the curative sector. Journal of Public Health Management and Practice
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