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Ebola Transmission Discussion and More...

Nordica

Nordica

Well-known member
While reading all the news about the current Ebola outbreak I can?t help wondering how Ebola educated, medical professionals with full protection equipment can get infected with Ebola?

We are told that Ebola is only transmitted via direct contact, actually by touching an infected area, then it can go into your body via a wound or if you put your contaminated finger into your mouth, nose or eye.

But...is it the only way of transmission? :confused:
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

Medical professionals at the point of entry for ill people are generally not in protective gear. At this point, I hope that in the countries with Ebola, that they are at least wearing gloves, masks and glasses.

In terms of Brantly and Whitebol, it sounds like a coworker was infected, did not know it, came to work, had contact with them in a scrub room, and transmitted it to them. It concerns me, if they got it this way, because it means that the person was not drop dead sick when he spread it. It was a case of some one who didn't know they were sick spreading the disease.

I am of the opinion, that, it probably has the ability to spread, a short time before symptoms appear. It may have been during this window that Brantly and Whitebol contracted this. I am also concerned about how long a survivor sheds virus, and not just in semen, but in all bodily fluids. If it is sexually transmissible for 3 months, it's hard to believe it isn't in all bodily fluids, unless Ebola has a preference for sexual transmission.

I do NOT think it is possible to catch Ebola if you are properly using PPE and I don't think any cases have been recorded where a health professional caught it, while suited up. I do think that perhaps fomite contact needs to be re-evaluated. Given the rate of current spread, it seems highly unlikely that it is airborne in the same manner as flu or many more people would have it.
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

AnnaLisa said:
In terms of Brantly and Whitebol, it sounds like a coworker was infected, did not know it, came to work, had contact with them in a scrub room, and transmitted it to them. It concerns me, if they got it this way, because it means that the person was not drop dead sick when he spread it. It was a case of some one who didn't know they were sick spreading the disease.
Click to expand...

If this is how it happened, it really shows how contentious Ebola is. I guess they didn?t hug and kiss in the room and they must be persons that constantly wash their hands. So how did fluid from a college get into them?

Early symptoms are like a cold, could it be a sneeze or a cough spreading small droplets of fluid in the air that went into their lungs or eyes?

But as you say, if it was airborne so many more would get infected.


:tiphat: Thanks for your comment AnnaLisa!
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

I realize that the overall transmissibility of ebola is not nearly as efficient as flu, but if you think about it, how far would flu spread if we reacted to new flu outbreadks in the same way as ebola - isolation, PPE, contact tracing, etc. It seems to me that any flu outbreak could be stopped with that kind of response if the outbreaks started in remote areas like ebola. So, I don't think we can even compare transmissibility of ebola to flu based solely on the number of cases in a given outbreak without considering how we respond to outbreaks of both.

The question that cannot, of course, be answered is how would they compare in similar human contact situations with no special precautions to prevent transmission. They might not transmit in the same way or at the same rate, but would both ultimately infect the same number of people?
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

In answer to your question, they most likely caught it from somewhere else other than the quarantine area.

It is very contagious, not air-borne but it can hang around outside of the body for weeks.

summary, most likely caught it in the wild population, its as contagious as a non-airborne flu.
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

Norovirus is not airborne, but is extremely contagious.
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

I think "airborne" is a relative term. As JJackson pointed out in another thread, large droplets of saliva that are ejected into the air can probably transmit the virus at a short distance. It depends on droplet size and distance from the source. Ebola spread is not "airborne" like flu. So far it appears that in this epidemic ebola has not spread through the populations as a flu would. This indicates that ebola does not spread through the air in all circumstance.

In our flu forums we recommend that people keep a distance of 4-5 feet between themselves and others when in public. This might be a good recommendation for ebola too. If you are on the subway try to sit a distance from others. If you are in line at the bank, same thing, stand apart from the others in line.

Some cultures probably need to suspend some forms of greeting like hand shakes and kissing on each side of the face.

We can protect ourselves from ebola. We just have to be smart about disease transmission.
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

I agree. As a nurse, I would feel comfortable caring for an Ebola patient if I was in full PPE (altho I would be emotionally fearful-I would cognitively understand I was safe). I just wonder, with the lack of water, how well the staff in Africa, can wash and clean themselves and surfaces.

Ebola is spreading because families are caring for their own sick members, at the same time not quarantining themselves. It's catastrophic.

MSF ascertained back in March that this was a different situation in terms of being 'urban Ebola' and they got little support. I am not optimistic about being able to control this in Africa and in other parts of the world, with high population density and poor health infrastructure. It's going to spread worldwide, and only countries with good health infrastructure can handle it. Even they will be stressed if too many cases strain the system (altho we will not have a West Africa like situation). We don't have many strict isolation rooms in the US, certainly not with negative air flow. Our public health infrastructure could be a lot better if not for austerity.

That said, I am not overly concerned. I would be leery of airports at this point. That's about it.
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

Very interesting discussion. I have two thoughts (neither of which may be original) and one question. Is Ebola becoming less deadly but more transmissable? The mortality rate is about 60%, less that has been seen in (most?) previous outbreaks. Also, I think sweat has not been emphasized enough as a mode of transmission. I read somewhere that sharing taxis is a common practice and one resident expressed her fear of getting the disease this way. My question is this: has the current strain of Ebola been identified as identical to a previous strain known to cause outbreaks? What are the chances that this virus has mutated?
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

I think that the greatest concern here is the many different reports we have of patients remaining ambulatory, and apparently not too ill, right up to the period where they rapidly deteriorate (within hours) and die. This is contrary to the old 'mantra' that those infected are too ill to move, travel or spread virus.

We do not have sufficient data on viral loads at the different stages of infection vs level of apparent health and ability to continue functioning, but having people travelling (e.g. Sawyer and numerous other individuals travelling locally in guinea, Sierra Leone and Liberia whilst only moderately ill, with symptoms in common with other diseases e.g. malaria are rife from media reports) whilst infectious through any bodily fluid, including sweat, is not a good thing.
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

The flu is not transmitted by air droplets in tropical climates. Have been made studies on the transmission of the ebola virus at low temperature and humidity?
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

Have arthropods, i.e., mosquitos, fleas, flies ticks, been eliminated as possible vectors? Also, does excreta, feces, fluids, from quarantine go into the plumbing, then directly into sewer from commode flushing?
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

Public Health Agency of Canada
EBOLA VIRUS
...
INFECTIOUS DOSE: 1 - 10 aerosolized organisms are sufficient to cause infection in humans (21).

MODE OF TRANSMISSION: In an outbreak, it is hypothesized that the first patient becomes infected as a result of contact with an infected animal (15). Person-to-person transmission occurs via close personal contact with an infected individual or their body fluids during the late stages of infection or after death (1, 2, 15, 27). Nosocomial infections can occur through contact with infected body fluids due to the reuse of unsterilized syringes, needles, or other medical equipment contaminated with these fluids (1, 2). Humans may be infected by handling sick or dead non-human primates and are also at risk when handling the bodies of deceased humans in preparation for funerals, suggesting possible transmission through aerosol droplets (2, 6, 28). In the laboratory, infection through small-particle aerosols has been demonstrated in primates, and airborne spread among humans is strongly suspected, although it has not yet been conclusively demonstrated (1, 6, 13). The importance of this route of transmission is not clear. Poor hygienic conditions can aid the spread of the virus (6).

INCUBATION PERIOD: Two to 21 days, more often 4 - 9 days (1, 13, 14).

COMMUNICABILITY: Communicable as long as blood, secretions, organs, or semen contain the virus. Ebola virus has been isolated from semen 61 days after the onset of illness, and transmission through semen has occurred 7 weeks after clinical recovery (1, 2).
...
PHYSICAL INACTIVATION: Ebola are moderately thermolabile and can be inactivated by heating for 30 minutes to 60 minutes at 60ºC, boiling for 5 minutes, gamma irradiation (1.2 x106 rads to 1.27 x106 rads), and/or UV radiation (3, 6, 20, 32, 33).

SURVIVAL OUTSIDE HOST: The virus can survive in liquid or dried material for a number of days (23). Infectivity is found to be stable at room temperature or at 4°C for several days, and indefinitely stable at -70°C (6, 20). Infectivity can be preserved by lyophilisation.
...
SOURCES/SPECIMENS: Blood, serum, urine, respiratory and throat secretions, semen, and organs or their homogenates from human or animal hosts (1, 2, 35). Human or animal hosts, including non-human primates, may represent a further source of infection (35).

PRIMARY HAZARDS: Accidental parenteral inoculation, respiratory exposure to infectious aerosols and droplets, and/or direct contact with broken skin or mucous membranes (35).
...

Date Modified: 2014-08-01

http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/ebola-eng.php
 
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Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

The mortality rate will likely increase because there are still many unresolved cases, the majority of which, sadly, will probably die. In order to calculate a current fatality rate, we'd need to know how many people have recovered.

Gemineye said:
Very interesting discussion. I have two thoughts (neither of which may be original) and one question. Is Ebola becoming less deadly but more transmissable? The mortality rate is about 60%, less that has been seen in (most?) previous outbreaks. Also, I think sweat has not been emphasized enough as a mode of transmission. I read somewhere that sharing taxis is a common practice and one resident expressed her fear of getting the disease this way. My question is this: has the current strain of Ebola been identified as identical to a previous strain known to cause outbreaks? What are the chances that this virus has mutated?
Click to expand...
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

One common mode of transmission of viruses is through hand-to-eye, hand-to-nose, or hand-to-mouth. Again, the importance of washing hands frequently for 20 seconds with soap and water, and for those who do not have access to water, absolutely avoid touching the face until the hands are clean.

And concerning handshake, here is a great alternative: the fist bumps

 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

Gemineye said:
Very interesting discussion. I have two thoughts (neither of which may be original) and one question. Is Ebola becoming less deadly but more transmissable? The mortality rate is about 60%, less that has been seen in (most?) previous outbreaks. Also, I think sweat has not been emphasized enough as a mode of transmission. I read somewhere that sharing taxis is a common practice and one resident expressed her fear of getting the disease this way. My question is this: has the current strain of Ebola been identified as identical to a previous strain known to cause outbreaks? What are the chances that this virus has mutated?
Click to expand...

I have also wondered about the possible relationship between a lower mortality rate and transmissibility. It does appear that there is a correlation between the two with greater time for transmission.

I found this paper that examines the question:

Analysis of Ebola Glycoprotein Sequences from Strains of Varying Lethality

http://biochem218.stanford.edu/Projects 2002/Doukas.pdf
 
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Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

I would think that those plates were for patients. The health staff would not be eating while in PPEs.
 
Re: Ebola Transmission Discussion

Re: Ebola Transmission Discussion

Annalisa - yes - you are undoubtedly right .
 
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