outbreak

outbreak

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Filoviruses
Viruses are microscopic intracellular parasites that can only reproduce within a host cell. Viruses lack the enzymes for the process of metabolism and contain no ribosomes or other parts to make their own proteins.
The types of cells a virus can infect are limited to its host range. Filoviruses (Figure 1) belong to a virus family called Filoviridae and can cause severe hemorrhagic fever in humans and nonhuman primates. Filovirus virons appear in several shapes; these shapes are known as pleomorphism. They may either appear as long, often branched filaments, shorter filaments, or in a circle formation. The filaments can measure up to 14,000 nanometers in length, and have some have a diameter of up to 80 nanometers. Each is coated in a lipid membrane and contains a molecule of negative-sense RNA. Replication of filoviruses occurs through the production of buds on the surface of the host cell (See Figure 1).
The two types of filoviruses that have been identified are the Marburg virus and Ebola virus. There are four different subtypes of the Ebola virus: Ivory Coast, Sudan, Zaire, and Reston. Ebola-Reston does not cause any severe disease conditions in humans it can however, be fatal within monkeys.

Marburg
The Marburg disease (Figure 2) was first seen in the August, 1967 in Marburg, Germany. Three workers that were employed by Behringwerke AG, a vaccine-producing branch from pharmaceutical company, Hoechst AG were suffering from muscle aches and mild fevers.
The conditions the workers had were similar to characteristic of the flu, but it was strange to have the flu in the summer. They were then hospitalized. The following day they became nauseated. Their spleens became enlarged and their eyes became bloodshot. The demeanors grew morose but aggressive. In addition, the nurse and doctor who were taking care of the three patients became ill. By September 23, the number of patients suffering from this Marburg grew to 23. Two other outbreaks were occurring in Frankfurt and Yugoslavia. The people sick were also employees of pharmaceutical research or were in the field of patient care.
Many people feared that this deadly virus was airborne. A great deal of mystery surrounded the illness since no one was aware of how it was transmitted, what an effective treatment might be, or how many more people could potentially get sick.
Each patient exhibited the same symptoms and went through the same process before dying.

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After two days had passed, the patients had flu-like muscle aches and fever, large lymph nodes in throat, an inflamed spleen, a drop in the number of white blood cells, and a shortage of platelets that are necessary to stop bleeding. These are ordinary responses to viremia. This is when the circulatory system is flooded with new viruses. Once the sixth day have passes, the skin becomes covered in rashes that makes to skin extremely sensitive, the throat becomes too sore to eat. The next days are followed by severe diarrhea and the skin turns to a red color because the skin capillaries have been clogged with clots. The nerves send messages because of the lack of oxygen circulation, and this causes extreme pain. On the tenth day the patients begin vomiting up blood.
Many patients die because of the brain damage caused by clots or heart attacks because of the strain of pumping the thick coagulated blood. If they do survive to 21 days, the blood becomes pouring from the body and the skin peels off.
Of the 31 people who were infected with Marburg, seven died. The people who had survived experienced damage to their liver and psychosis, and it led to impotence in men.

Ebola
     Ebola (Figure 3) is a filovirus that shares is genetically similar to the Rhabdoviruses and the Paramyxoviruses. Ebola virus is transmitted by contact with blood, feces or body fluids from an infected person or by direct contact with the virus, as in a laboratory. People can be exposed to Ebola virus from direct contact with the blood or secretions of an infected person. This is why the virus has often been spread through the families and friends of infected persons: in the course of feeding, holding, or otherwise caring for them, family members and friends would come into close contact with such secretions. People can also be exposed to Ebola virus through contact with objects, such as needles, that have been contaminated with infected secretions. The incubation period --the period between contact with the virus and the appearance of symptoms, ranges from 2 to 21 days. The initial symptoms are usually high fever, headache, muscle aches, stomach pain, and diarrhea. There may also be sore throat, hiccups, and red and itchy eyes. The symptoms that tend to follow include vomiting and rash and bleeding problems with bloody nose, spitting up blood from the lungs and vomiting it up from the stomach, and bloody eyes. Then finally come chest pain, shock, and death.
A protein on the surface of the virus has been discovered that is responsible for the severe internal bleeding. The protein attacks and destroys the endothelial cells lining blood vessels, causing the vessels to leak and bleed. The chemical released by the Ebola macrophages is “cytokine storm.” The white blood cells in the surrounding area go through apoptosis when they come in contact with the cytokines. This results in the weakening of the immune system. The cytokine storm triggers blood clotting that generates many fibrin clots in organs such as the spleen. The hemorrhaging effect most likely occurs when the clotting factors are used up.

Ebola Zaire
The very first case of Ebola was in Zaire, now the Democratic Republic of Congo, in 1967. There were 312 cases 88% of which died. This disease occurred in Yambuku and surrounding area. Disease was spread by close personal contact and by use of contaminated needles and syringes in hospitals/clinics. This outbreak was the first recognition of the disease.
This virus attacked every organ of the body and tissue except the skeletal muscle and bones. It was a hemorrhagic virus and was not airborne either. The disease was contained by changing social behaviors such as burying the dead immediately and the homes of the deceased were burned. The disease was contained by changing social behaviors such as burying the dead immediately and the homes of the deceased were burned.
In 1977, there was another threat of Ebola Zaire. One person was a victim of the virus in the village of Tandala. The next outbreak of Ebola Zaire did not occur until 1994. This occurred in Gabon Mékouka. 49 people were infected, 59% of which died. It was initially thought to be yellow fever however, it was identified as Ebola hemorr hagic fever in 1995. The outbreak started in gold-mining caps deep in the rain forest and spread back in the village. Next there was another outbreak in the Democratic Republic of Congo. This was a major case where 315 people were infected and 81% died. It occurred in Kikwit and surrounding areas. It was traced back to an index case patient who worked in forest adjoining the city. The epidemic spread through families and hospitals. The outbreak was centered in the hospital, and the unsanitary conditions spread the disease further. Hypodermic needles were reused without sterilization. The outbreak eventually spread to other towns such as Mosango because of two nuns leaving Kikwit. The military contained the population so the virus would not spread to the capital that had a population in the millions.
In 1996 there were a total of 3 outbreaks in 2 different areas. Two of them occurred in Gabon. First there was a case where 31 people were infected and 68% died. This occurred in the Mayibout area. A chimpanzee found dead in the forest was eaten by people hunting for food. The World Health Organization officials contained the epidemic and they suspect a rodent to be the host animal. Nineteen people who were involved in the butchery of the animal became ill; other cases occurred in family members. Next there was a case with 60 people infected and 75% dead. This occurred in the Booué area with transports of patients to Libreville. The index case-patient was a hunter who lived in a forest camp. The disease was spread by close contact with infected persons and a dead chimpanzee found in the forest at the time was determined to be infected. The third case in 1996 was in South Africa. There was only 2 people infected, one of which died. A medical professional traveled from Gabon to Johannesburg, South Africa, after having treated Ebola virus-infected patients and thus having been exposed to the virus. He was hospitalized, and a nurse who took care of him became infected and died.
The final case of Ebola Zaire was found on 2001-2002 in Gabon and what was formerly Zaire. This was also a serious case where 122 people where infected and 79% died.

Ebola Sudan
The next outbreak was also in 1967. In this outbreak, there were 284 cases and 53% lethality rate. It occurred in Nzara, Maridi, and nearby areas. The disease was spread mainly through close personal contact within hospitals. Many medical care personnel were infected. In the same year, there was an Ebola Sudan threat/outbreak in England. This was not an actual outbreak because only one person had been infected due to laboratory infection by accidental stick of contaminated needle. However, they did not die.
In the year 1979 there was an outbreak in Sudan or Ebola Sudan in the same place as the 1976 outbreak. In this outbreak, 34 people were infected and 65 percent died. The very latest outbreak of Ebola Sudan started in 2000 finally finished in 2001. It was found in Uganda where 425 people were infected and 53% died.
The disease was traced to a woman who died around the beginning of September. The burial tradition involved a cleansing of the body, and this lead to her mother and daughter being the next victims. Basically, the reason for the outbreak was the improper personal protective measures. This virus was not airborne, and this made it harder to contract the virus.

Ebola Reston
     In 1989, the first Ebola strain in US appeared in a primate laboratory in Reston, Virginia. Hazleton Research Products imported Cynomolgus macaque monkeys from the Philippines. Many monkeys died from this infection in one room. USAMRIID finally decided to destroyed the monkeys in the first room. However, the ventilation system allowed the virus to spread to the other rooms where the monkeys were also destroyed. This was the first time a strain of Ebola proved to be airborne. However, the humans that were exposed did not become ill. It was discovered that the Reston strain of Ebola was airborne. Although humans were exposed, none became ill, but Ebola Reston has not been proven noninfectious and is still considered lethal. In 1992 there Ebola Reston virus was introduced to quarantine facilities in Sienna, Italy by monkeys imported from the same facility as the ones in US. No humans were infected.
This Texan facility was visited by Ebola Reston in 1990 when 44 monkeys died and another 100 had to be destroyed. This virus may be useful as it might be important in developing a vaccine for the strain of Ebola in Zaire
Once again, Ebola Reston appeared in Texas. Two monkeys in Alice, Texas in a primate breeding facility that had been imported from the Philippines died from a new strain of Ebola Reston. Though the strain did not affect humans, 10 employees were held under observation while the entire facility was quarantined. A third monkey died and the rest of the 48 monkeys were then killed. The supplier of the monkey was the same as the one in Reston, Virginia.
The Philippine Department of Environment and Natural Resources ordered all monkeys at the Fertile Scientific Research breeding center to be destroyed to eliminate any further possibilities of Ebola Reston being sent anywhere else in the world.

Ebola Ivory Coast
     Ebola Ivory Coast is also known as Ebola Tai. It was the first case of Ebola in western Africa. It occurred in a pack of chimpanzees that were being studied by a Swiss zoologist. The human was exposed to the virus when she did an autopsy on one of the chimpanzees. While the zoologist survived, the chimpanzees did not. She was flown to Switzerland where she did recover. Not much is know as there has only been one case.
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