Primary Healthcare Nursing for Ebola Virus Disease - myassignmenthelp

Question: Discuss about thePrimary Healthcare Nursing for Ebola Virus Disease. Answer: The recent outbreak of Ebola virus disease spread across countries and caused many fatalities. The speed of international travel and the risk of unknown transmission of the virus that could spread through human to human contact brought into focus the need to prevent outbreaks and the safety measures required to control the spread of the deadly infectious disease. The Ebola virus genome is a 19 kb strand of negative sense RNA and has 7 viral genes (Baron, 1996). Helically arranged viral nucleoproteins envelop the virus and a lipid bilayer coats the virion. Upon infection, the monocytes, macrophages and the dendritic cells are the sites where replication of the virus occurs. Infected cells move to the lymph nodes, spleen and liver and the infection disseminates. The virus can infect a variety of cells and it can modulate the gene expression of the host immune response cells. This leads to apoptosis of the lymphocytes and attenuation of the interferons. Expression of pro-inflammatory cytokines, reduction in number of platelets causes bleeding complications. Kidney injury, hepatitis and pancreatitis ensue (BMJ, 2017). Infection from the Ebolavirus first occurred in the year 1976 in what is now Nzara, South Sudan and in Yumbaku, a village near the Ebola river, in the Democratic Republic of Congo. 20 other outbreaks have occurred since then. In recent times, the virus affected a multitude of people in West Africa in a large outbreak from 2014 to 2016 in which several people lost their lives. The epidemic proved to be complex, it began in Guinea and spread to the neighbouring countries of Sierra Leone and Liberia. An illness which can often be fatal, it can kill up to 90% of the people infected (National Academies of Sciences, 2016). In the 2014 to 2016 outbreak 28,646 people were diagnosed with Ebola virus infection and 11,323 deaths were reported, in what was one of the most difficult pandemic to deal with, in recent times (WHO, 2017). Since it was transmitted to the humans through the fruit bat, a loacal delicacy in sub-Saharan Africa, the Ebola virus disease is a zoonosis and causes high mortality. It is a single strand RNA virus. Exposure to infection occurs through mucus or ruptured skin. The cause of the spread of disease are dietary habits, insufficient supply of disposable equipment in hospitals and funeral rites. The virus remains active in the dead body, so quick disposal of dead bodies with minimum contact and wearing protecting clothing is important to curb the transmission of the virus. The infection also spreads through blood, organs, secretions and body fluids of the infected people. Even the surfaces, clothing and materials contaminated with infected fluids can cause infection if adequate care while handling is not taken(WHO, 2017). The infection may occur through contact with body fluids of the patient through mucosal surface, needles contaminated with the virus or abrasions on the skin, putting hea lthcare workers at high risk (Lee Saphire, 2009). Healthcare workers from other countries who were working in Africa and had come from Spain, The United Kingdom and the USA were also infected with the virus(Arima Shimada, 2015). The infection begins abruptly after an incubation period that varies from 2 days to 21 days. Influenza like symptoms develop and patients may suffer from shock and multiple organ failure. Symptoms of the digestive system that cause diarrhoea and vomiting occur commonly. Standard disinfectants used in hospitals and healthcare facilities can kill the virus (Karwowska, 2015). It is suspected that morbidity and mortality could be higher because several cases remain unreported. The genus Ebola has five known species, Bundibugyo, Sudan, Reston, Zaire and Tai Forest. The Zaire ebolavirus, the Bundibugyo ebolavirus and the Sudan ebolavirus have caused large outbreaks on the African continent. The latest outbreak from 2014-2016 was caused by the Zaire virus (WHO, 2 017). The incubation period of Ebola virus after infection occurs and it takes 2 to 21 days for the first symptoms to appear. Only a person with symptoms can pass on the infection but someone who is infected but is not showing symptoms cannot pass on infection to others. Sudden fever accompanied with considerable fatigue is the first symptom to appear. Headache, muscle pain and sore throat may often be seen in patients. Vomiting and diarrhea follow occur and some patients may complain of skin rash. Impairment of the kidney and liver function are followed by internal and external bleeding. Bleeding of gums and blood in stools are advanced symptoms and may be observed after a few days. A low white blood cell count and low platelet count are the usual results of laboratory diagnosis of blood samples. Liver enzymes remain elevated also (WHO, 2017). Patients are given supportive care and rehydration with oral or intravenous fluids is often effective. Treatment is given for specific symptoms that have been observed in the patient. A proven treatment or drug for the Ebola virus disease is yet to become available. Several therapies, drugs, blood products and immune therapies are currently being tested and evaluated for clinical use. An experimental Ebola vaccine has shown promise and has been found to offer protection from the virus in Guinea. The vaccine known as rVSV-ZEBOV was tested in a trial involving 11841 people in 2015. 5837 people of those who received the vaccine, did not return with an Ebola infection for 10 days after the vaccine was administered whereas, 23 cases were reported from among those who had not received a vaccine. Guinea's ministry of health, Norwegian Institute of Public Health, Medecins sans Frontieres collaborated with WHO and other international partners in conducting the trials of the vaccine. The vacci nation protocol adopted was of the ring type and the vaccine was the viral vector type of vaccine. Some rings were vaccinated after the detection of a case while other rings received a vaccination after a period of three weeks after detection. In a study on the rVSV?G-ZEBOV-GP vaccine, which is a recombinant, vaccine that is also replication competent the antibody titres persisted upto 360 days. The vaccine is based on vesicular stomatitis virus glycoprotein which has been replaced by the Zaire Ebola virus surface glycoprotein, which has been used as the main antigen for vaccine development against Ebola. The most important take away from this trial has been the longevity of the neutralizing antibody response until long after the vaccination was administered to the participants of the trial. A range of vaccine doses were examined during the study for immunogenicity. The lower doses of the vaccine also developed neutralising antibody titres but the response was rather slow and took longer than the higher doses of vaccine. In an outbreak setting, it would be important to develop immunity from the vaccine in a rapid manner, so only higher doses were then tested (Clarke Bradfute, 2017). Even at higher doses the incidence of a rthritis as a side effect of the vaccine was reported at a much lower rate than with some other Ebola vaccines that were tested earlier. This vaccine was developed by NewLink Genetics, Merck Vaccines and the Public Health Agency of Canada (WHO, 2015). Several other vaccines are in various stages of clinical trials. A 2-dose vaccine has been developed by Johnson Johnson and Bavarian Nordic. They have used an approach called heterologous prime-boost. The candidate vaccine that are being tested are Ad26EBOV and MVA-EBOV. The vaccine had undergone the Phase-I trials in 2015. Anothe r biotechnology company from the US, Novavax, has developed a recombinant vaccine based on the Guinea strain of the Ebola virus. The Phase I trials of this vaccine were done in Australia. A recombinant influenza vaccine candidate against Ebola was developed by the Russian Federal Ministry of Health. An oral adenovirus platform based vaccine, a vaccine based on the vesicular stomatitis virus is being tested by the company Profectus Biosciences. Protein Sciences, has developed an alternative recombinant protein based vaccine. Inovia,a company workin in the area of vaccine development has developed a DNA vaccine and the Jefferson University is working on a re combinant rabies vaccine. Other approaches for treatment that are being tried include transfusion of convalescent whole blood and plasma as a largely investigational therapy. This therapy has been used in several patients with Ebola virus disease. Trials were conducted in Liberia and Guinea. An antiviral drug Favipiravir from Fujifilm/Toyama in Japan has been tried on patients with low to moderate levels of virus under a Phase II trial. The antiviral drug has been found to be effective in treatment of patients who are suffering from early stage Ebola virus disease. The case fatality has been estimated to have decreased to 15% from an earlier 30%, but since the trial does not have concurrent controls the WHO is treading with caution when deciding about its efficacy (WHO, 2015). Another drug under Phase II trials is TKM-100802 (siRNA) by Tekmira, Canada at Kerry Town, Sierra Leone. siRNAis a short sequence of RNA that has the potential to cleave the Ebola RNA in cells of infected persons and can prevent the virus from multiplying. A 100% rate of treatment has been achieved when it was tested on monkeys. A human trial has been halted after a clinical endpoint was met. ZMapp from MappBio in US is a cocktail of three monoclonal antibodies was used to treat the Ebola virus disease at a rate of 100% among non human primates. This product has been used on patients on compassionate grounds. But its efficacy is yet to be proven. MIL-77 MabWorks, developed by a company in China is under Phase I trials is also based on monoclonal antibodies and is as effective as Zmapp. BCX-4430 Biocryst, USA is a broad spectrum nucleoside analogue and its safety data is being collected. Interferons that have been approved for treatment of Hepatitis B and C and multiple sclerosis have been tested as a therapy on a few Ebola patients (WHO, 2015). There are several control of outbreak measures that have been suggested by the WHO. Raising awareness of the risks for Ebola infection, taking protective measures, such as vaccination can reduce transmission of the disease. Surveillance and contact tracing, good laboratory services for prompt diagnosis, safety during burials and mobilisation of social resources is a good strategy for controlling the spread and preventing an outbreak if infection occurs. Risk reduction measures include reducing the risk of wildlife to human transmission that can occur due to consumption of raw meat of fruit bat or monkeys/apes. Handling should be done with gloves on and any consumption should be preceded with thorough cooking. Reducing risk of human to human transmission can be done by avoiding contact with body fluids. Gloves and protective gear and clothing should be used when caring for patients at home or in hospitals. Hand washing can prevent the spread of infection to a large extent. Risk of tra nsmission through sexual contact can be avoided by practice of safe sex by male patients for one year after the infection occurrence or until two successive semen specimens test negative for the virus. Outbreaks can be prevented by ensurinf a safe and prompt burial of the dead. Health of people who were in contct with patients should be monitored for up to 21 days and they should be checked for symptoms. The healthy should maintain a safe distance from the infected. Maintenance of good hygiene and a clean environment are necessary for prevention. The WHO supports countries at risk for prevention of Ebola virus disease and has developed plans for preparedness. Whenever an outbreak is reported the WHO responds by supporting surveillance, providing laboratory services, engaging the community, infection control mechanisms, logistical support provision, training and supporting safe burials. In conclusion, it is important to understand that if an outbreak caused by the Ebola virus occurs, the safety measures can reduce the spread of the infection among people of the community and health workers. Awareness among the community members, better diagnosis, prevention through vaccination, more research on treatment through drugs and control measures can be adopted to prevent an outbreak and reduce fatalities among patients. References Arima, Y. Shimada, T., 2015. Epidemiological situation of Ebola virus disease in West Africa.. Uirusu, pp. 65(1):47-54.. Baron, S., 1996. Medical Microbiology.. 4th ed. s.l.:Galveston (TX): University of Texas Medical Branch at Galveston. BMJ, 2017. /pathophysiology.html. [Online] Available at: https://bestpractice.bmj.com/best-practice/monograph/1210/basics/pathophysiology.html [Accessed 27 August 2017]. Clarke, E. Bradfute, S., 2017. Advances in Ebola virus vaccination. The Lancet Infectious Diseases, 17(8), p. 787788. Karwowska, K., 2015. Ebola virus disease. Pol Merkur Lekarski. , 38(223), pp. 42-45. Lee, J. E. Saphire, E. O., 2009. Ebolavirus glycoprotein structure and mechanism of entry. Future Virology, pp. 4(6), 621635. https://doi.org/10.2217/fvl.09.56. National Academies of Sciences, E. a. M., Division, H. a. M., Health, B. o. G. Threats., F. o. M., 2016. The Ebola Epidemic in West Africa: Proceedings of a Workshop.. s.l.: National Academies Press (US). WHO, 2015. emp_ebola_q_as/en/. [Online] Available at: https://www.who.int/medicines/emp_ebola_q_as/en/ [Accessed 27 August 2017]. WHO, 2017. ebola-situation-reports. [Online] Available at: https://apps.who.int/ebola/ebola-situation-reports [Accessed 27 August 2017]. 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