As Virus Reemerges, Public Health is Prioritized
Ebola. The word alone prompts an array of emotions for anyone who has encountered the virus. Great respect for the local laboratory staff who worked continually to process infectious samples, even when their own families were affected. Sadness for the many people, families, and communities impacted by the disease. Incredible responsibility for ensuring the accuracy of our laboratory analysis of diagnostic samples. And an immense pride in the work many of our colleagues lead in response to the 2014-2016 outbreak in West Africa. This is a summary of the Ebola Virus Disease and our outbreak response.
In the past year, cases of Ebola have been reported in the Democratic Republic of the Congo (DRC) and Uganda, with possible cases also reported in South Sudan and Nigeria. This threat to public health requires greater understanding and an ongoing public health response.
What is Ebola?
Ebola Virus Disease (EVD) is a rare and deadly disease in people and nonhuman primates. The viruses that cause EVD are located mainly in sub-Saharan Africa. People can get EVD through direct contact with an infected animal (bat or nonhuman primate) or a sick or dead person infected with Ebola virus.
First discovered in 1976 near the Ebola River in what is now the Democratic Republic of Congo, the virus has been periodically infecting people, leading to outbreaks in several African countries.
The virus first spreads to people through direct contact with the blood, body fluids, and tissues of animals. Ebola virus then spreads to other people through direct contact with body fluids of a person who is sick with or has died from EVD. This can occur when a person touches these infected body fluids or objects that are contaminated with them. The virus then gets into the body through broken skin or mucous membranes in the eyes, nose, or mouth. People can get the virus through sexual contact with someone who is sick with or has recovered from EVD. The virus can persist in certain body fluids, like semen, even after recovery from the illness.
Symptoms may appear anywhere from 2 to 21 days after contact with the virus, with an average of 8 to 10 days. The course of the illness typically progresses from “dry” symptoms initially (such as fever, aches and pains, and fatigue), and then progresses to “wet” symptoms (such as diarrhea and vomiting) as the person becomes sicker. Continued illness can result in loss of appetite, gastrointestinal symptoms, unexplained hemorrhaging, and even death.
Since its discovery, Ebola outbreaks have occurred in Zaire (now Democratic Republic of Congo – DRC), Cote d’Ivoire, Guinea, Sierra Leone, and Liberia. In March 2014, the World Health Organization (WHO) reported cases of Ebola Virus Disease (EVD) in the forested rural region of southeastern Guinea. The identification of these early cases marked the beginning of the West Africa Ebola epidemic, the largest in history.
Why Does Ebola Continue?
In his book “Fevers, Feuds, and Diamonds: Ebola and the Ravages of History,” author Paul Farmer reports on the myriad of complex cultural, political, and economic factors that contribute to the conditions that allow Ebola to exist in West Africa. Though too numerous to list here, they include a lack of education, especially in poor and rural communities; Lack of infrastructure, including roads, hospitals, and clinics; Years of civil war and strife, driving professional outmigration; A lasting control-over-care legacy of colonial rule that officials use to quarantine and isolate the affected, rather than developing a medical and educational infrastructure that emphasizes a proactive approach to care; Caregiving practices, especially for the deceased, that are often the responsibility of the family – this results in the deceased spreading the virus to members of their family; The virus is difficult to study due to fear of infection, so even basic therapies aren’t fully understood.
In the wake of these many harrowing, ongoing, and compounding factors, the virus itself is sometimes seen as the final blow.
Mobile Laboratories in the Public Health Response
Our mobile laboratories have served as an important part of the public health response to Ebola. In 2014, as part of the U.S. Department of Defense’s response to Ebola outbreaks in Guinea and Sierra Leone, they called on us to design, fabricate, equip, and operate two mobile diagnostic laboratories, which we deployed in 2015. These laboratories helped decrease the turn-around time on diagnostics from 24 hours to under four hours. Upon our return from the field, this platform served as the basis for development of the Athena Mobile Laboratory, which is a ground-up redesign of the mobile lab system concept.
Despite protective measures, doctors sometimes get sick too. And when they do, it’s critical to provide them with the best possible medical treatment. To enable medical professionals the Ebola virus to promptly access care in the United States, we designed and fabricated the Containerized Bio-Containment System (CBCS), a flyable biocontainment unit that fits four patients and four caregivers.
Are Other Viruses Out There?
Viruses cause human suffering both in acute and chronic diseases, with one estimate suggesting that scientists have identified only 4,000 of the estimated 1.67 million viruses thought to exist on earth. At least some of these unknown viruses are zoonotic, or capable of “spillover” transmission from animals to humans at any time. Due to global trade and travel, climate change, and other factors, that risk has increased substantially in recent decades. And it is only a matter of time until a new infection is observed.
Other viruses that have made the jump from animals to humans have recently made news, impacting people around the world.
- Marburg Virus Disease – Marburg virus disease (MVD) is a rare but severe hemorrhagic fever which affects both people and non-human primates. MVD is caused by the Marburg virus, a genetically unique zoonotic (or, animal-borne) RNA virus of the filovirus family. The six species of Ebola virus are the only other known members of the filovirus family. In Sept. 2022, the Ministry of Health (MoH) of Ghana declared the end of the Marburg outbreak that affected three of the country’s regions.
- Monkeypox – Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox virus is part of the same family of viruses as variola virus, the virus that causes smallpox. Monkeypox symptoms are similar to smallpox symptoms, but milder, and monkeypox is rarely fatal. Monkeypox is not related to chickenpox. With more than 70,000 current cases globally, outbreaks are ongoing in the United States, South America, and across Europe.
- Crimean-Congo Hemorrhagic Fever – Crimean-Congo hemorrhagic fever (CCHF) is caused by infection with a tick-borne virus (Nairovirus) in the family Bunyaviridae. The disease was first characterized in the Crimea in 1944 and given the name Crimean hemorrhagic fever. It was then later recognized in 1969 as the cause of illness in the Congo, thus resulting in the current name of the disease. An outbreak occurred in Iraq earlier in 2022.
- Dengue – Dengue viruses are spread to people through the bite of an infected Aedes species (Ae. aegypti or Ae. albopictus) mosquito. Almost half of the world’s population, about four billion people, live in areas with a risk of dengue. Dengue is often a leading cause of illness in areas with risk. Dengue presents an endemic threat in countries like Mexico, India, and Pakistan.
The public health risks associated with Ebola and so many other infectious diseases around the world necessitate improved preventative measures to support a stronger public health response.
Biosurveillance
A key aspect of infectious disease response is biosurveillance, with the goal of developing effective surveillance, prevention, and operational capabilities to detect and counter infectious disease threats. Following the Ebola epidemic in 2014-2016, we collaborated with local human and animal health professionals to offer a series of trainings with the goal of enhancing biosurveillance and biosafety and biosecurity (BS&S) in West Africa. These trainings provided them the ideas, policies, and techniques to effectively implement BS&S efforts in the region, improving future response efforts.
GETTING STARTED AT MRIGLOBAL
Contact MRIGlobal to further understand our work in infectious diseases. We offer a broad portfolio of infectious disease testing assays and capabilities across diagnostic disciplines, from screening and diagnosis to genotyping, therapy, and monitoring. Those seeking analysis of infectious disease tests can trust in our breadth of experience and knowledge – not just on the subject matter, but FDA protocols as well.
To learn more about the work we’ve done or how we can help you, contact us today. If you are part of an agency, business, or academic institution seeking assistance with a project, use our Project Quote Tool to get started.
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