Sample Assignment Ebola virus disease

Introduction:

Ebola virus disease (EVD) is earlier designated as Ebola hemorrhagic fever is considered to be a fatal and uncommon infection caused by the Ebola virus strains, belongs to Filoviridae family. Ebola virus can infect both humans and nonhuman primates like chimpanzees, gorillas, and monkeys. Though there is subsequently less information available regarding the management strategies, nature of the agents, pathogenesis, and detailed virology of Ebola virus. The data collected during amid control endeavors coordinated toward the emergence of recent outbreaks has given significant key data about filoviruses (Peters & Peters, 1999). Mostly financially underprivileged nations are affected by EVD as constrained assets antagonistically influence a nation's framework and organization. Testing into the variables that prompted the across the board flare-up, putting forward plans to counter EVD cases in creating nations, and formulating complete measures to restrain the spread of the sickness are fundamental advances that must be quickly taken (Ghazanfar et al., 2015). This review will discuss the role of agents, hosts, environmental factors, additionally, summarize the policy responses regarding EVD to prevent the epidemic.

Discussion:

Ebola virus (EBOV) is considered as an emerging and re-emerging causative agent for fatal and acute Ebola hemorrhagic fever (EHF); its major outbreak can have high fatality rate (up to 90%). In 1976, two concurrent Ebola outbreaks were reported in the Yambuku and the Democratic Republic of the Congo, got its name Ebola after the small river near the Catholic mission of Yambuku, and also appeared in Nzara, Sudan (Marzi et al., 2011; McElroy et al., 2014).

Role of causal agent:

Ebola virus is categorized under the Filoviridae family (filovirus) and comprises of five distinct strains namely Bundibugyo ebolavirus (BDBV), Zaire ebolavirus (EBOV), Sudan Ebola virus (SUDV), Reston Ebola virus (RESTV), Taï Forest ebolavirus (TAFV) or formerly Côte d’Ivoire ebolavirus. Pathogenicity greatly varies with species; Zaire ebolavirus (EBOV) known to be a highly lethal strain and causing the EHF exhibiting up to 90% fatality rate in humans, however, SUDV with approximately 50% and Bundibugyo virus with around 40% case fatality rate come after. RESTV causes disease in non-human primates, and asymptomatically infect humans (Marzi et al., 2011; Kugelman et al., 2015). While TAFV is known to cause non-fatal human infections (Geisbert & Feldmann, 2011; Jones et al., 2005).

Ebola virus is pleomorphic i.e. appear in several shapes like long, or branched filaments or short filaments, or a circle; measuring up to 14,000 nm in length, having a homogeneous diameter of 80 nm, within a lipid membrane envelope (virion). The virion having single-stranded, non-segmented, and negative-sense around 19 kb long RNA genome. EBOV contain seven open reading frames to encode seven structural proteins in addition to virion envelope glycoprotein (GP), nucleoprotein (NP), and matrix proteins such as VP24 and VP40, also two nonstructural soluble glycoprotein (GP) such as soluble GP and small soluble GP namely VP30 and VP35, viral polymerase (reviewed in reference 28). The glycoproetin open reading frame brings about a soluble 60-70-kDa protein (sGP) and a full-length 150-170-kDa protein (GP) as a gene product by systematical viral replication which after the transcriptional editing process insert into the viral membrane (Sanchez et al., 1996; VOLCHKOV et al., 1995).

According to several researches the GP is synthesized either in a secreted (sGP) or full-length transmembrane form and each of which possesses different biochemical as well as biological properties. The viral GP assumes to have a principal part in the Ebola virus disease manifestations. The full length transmembranal GP emerges to form a trimeric complex (Sanchez et al., 1998) and preferentially binds to the target endothelial cells that are significant for pathogenesis. In particular, glycoprotein enables the infection to bring its substance into monocytes or potentially macrophages, additionally, damage or vulnerability of cells to the viral particles may bring about elevated levels of cytokinin inflammatory release (Ströher et al.,2001), irregularity in coagulation process, also causing trouble in fluid transportation. All of these abnormalities are found in case of hemorrhage and leakage in vascular tissues; which further prompt to shock and multiple organ failures (Feldmann & Geisbert, 2011; Mehedi et al., 2011; Zhi-yong et al., 2011). So, sGP through restraining activation of neutrophil may be able to change immune response, although the transmembrane GP through directing virus to cells of the reticuloendothelial complex and the blood vessels lining subsidize to the symptoms of hemorrhagic fever.

At the point when a disease occurs in people, the infection can be spread in a various processes like with direct contact through damaged or exposed skin or mucous membranes of eye, nose, and mouth etc.; other ways include blood or bodily fluids (saliva, tears, vomitus, breast milk, sweat, feces, urine, and semen) of an infected person during the acute stage; close contact with contaminated objects such as needles and syringes and this kind of nosocomial or occupational transmission has been recorded in 1976, during the first epidemics of Ebola the utilization of contaminated needles brought about the synchronous flare-up among more than one hundred people (Moghadam et al., 2015; Rewar & Mirdha, 2014). Healthcare workers are at high risk of acquiring an infection, by using contaminated hands to their own mouth or rubbing their eyes is the most widely identified cause. According to epidemiological research, the family members of affected individuals are more prone to the development of infection as they are in direct contact with infected body fluids or during burial ceremony preparation. As per the US CDC, EBOV and MARV have been named Category A bioterrorism causative agents because of their exceptionally irresistible character and probable utilization of biological methods (Sarwar et al., 2011).

Role of Hosts:

Despite the fact that natural host of Ebola infections has not yet been recognized, the route in which the infection initially emerges in a human towards the beginning of a flare-up is obscure. Many research has affirmed the significance of bats exclusively fruit bats of the Pteropodidae family as the potential natural reservoir species of the Ebola viruses; be that as it may, it is misty whether different species are additionally included or how transmission to people as well as primates happens. EHF is accepted to persevere in a reservoir category for the most part found in endemic spots. Ebola virus strains have been identified in the Central African Republic among terrestrial mammals (Morvan et al., 1999). EBOV infection was found in the species of Angola free-tailed bat (Mops condylurus), little free-tailed bat (Chaerephon pumilus), and Wahlberg's epauletted fruit bat (Epomophorus wahlbergi) (Swanepoel et al, 1996) and as of late, the infection was identified in the hammer-headed fruit bat (Hypsignathus monstrosus), Franquet's epauletted bat (Epomops franqueti), also in little-collared fruit bat (Myonycteris torquata) (Leroy et al., 2005). Exclusively frugivorous and insectivorous bat species have indicated infection replication and may produce high ebola titers without demonstrating EBOV-related disease (Swanepoel et al., 1996). The migratory bat species, for instance, straw-colored fruit bat of Africa have the potential to cover up to 2,500 km and by this way transmitting the infection (Hayman et al., 2012).

The transmission of EBOV to the other species like non-human primates, duiker is most likely to occur by consuming contaminated fruit by fruit bat’s feces and/or saliva (Leroy et al., 2005). The hunting for food in Chimpanzee species has beforehand been connected to Ebola rise in Côte d'Ivoire, where the searching and expenditure of food with monkey species was related with the spillover of Ebola among chimpanzees (Formenty et al., 1999) which was designated as the primary evidence of utilization of bushment responsible for Ebola outbreak in non-human primates. A substantial scale study of nonhuman primates crosswise over Central Africa just discovered noteworthy serologic confirmation regarding the occurrence of Ebola among chimpanzees, also proposing that non-fatal contaminations can take place in case of nonhuman primates (Leroy et al., 2004). All through the forest areas of Central Africa seropositive chimpanzees were discovered predominantly, distinguishing Ebola viral dissemination in ranges where human infection have not yet been recognized (Leroy et al., 2004).

Recognition of EBOV contamination in bats and rodents is a captivating finding, just like the identification of immune response. In any case, until and unless an Ebola infection is separated from a wild vertebrate, and exploratory contaminations unambiguously show that the infection continues as well as is shed by that animals and that sickness can be transmitted under controlled conditions, these discoveries will remain just favorable and captivating (Calisher et al., 2006).

Non-human primates other mammalian groups known to be vulnerable to Ebola virus infection. Non-human primates can be considered as the possible source of contamination for humans by ingestion of dead non-human primates, apes etc., but they are not anticipated to be a reservoir but instead an incidental host who are capable to continue managed viral transmission (Fisher-Hoch et al., 1992). The EBOV and TAFV outbreaks in 1994 which have been seen in apes (chimpanzees and gorillas), driving these species nearer to extinction (Walsh et al., 2003). Whereas, RESTV has known to cause acute EVD outbreaks among macaque monkey (Macaca fascicularis) species cultivated in the Philippines and recognized in the simultaneous years of in 1989, 1990 and 1996 in exotic monkey species into the USA, and transported from the Philippines in 1992 to Italy. In accordance with the experimental evidence of the transmission of vigorous infection with EBOV in African fruit and insectivorous bats was affirmed, however, a substantial association couldn't be accomplished (Walsh et al., 2003; Gatherer, 2014).

Role of Environmental factors:

It has been known that atmospheric factors are related to the several infections diseases also have a great impact on disease transmission and formation by building a strong and intricate network for contact (Anyamba et al., 2009). This is a practically genuine as the wildlife reservoirs are hugely required for the disease outbreak among wildlife animals as well as human beings. Within an inclined landscape, the climatic patterns of provincial as well as local regions go about as a potential principle influencing floral characteristics and traits of surface water. The sharing of natural resources can progressively impact on the population density, also wellness, behavior, migration, and distribution of species. All of these consequence impacts can profoundly affect contact probabilities amongst vulnerable and infected hosts within as well as between species and in addition the possibility for transmission of pathogen and outbreak among people (Alexander et al., 2012). Also, contact potentiality might be modified through deforestation and with changed land-use patterns, which may exacerbate the effect of atmospheric phenomenally additionally assemblage infected as well as susceptible hosts encompassing besides restricted resources.

There is insufficient data has been found regarding the related with Ebola spillover in relation to the atmospheric and hydrologic circumstances. The analysis of such procedures has been inhibited by the constrained accessibility of climatic position perceptions in Central Africa. A couple of studies have endeavored to go around this issue utilizing satellite evaluations of vegetation in the land surface. In this manner, Pinzon et al. (2004) inspected eight Ebola episodes amid 1994– 2002 and found a relationship with drier in comparison with usual conditions toward the finish of the rainy season. Positively, hydrologic changes could impact different natural resources. Exploring the behavioral patterns of frugivorous species as for example fruit bats, duikers, and nonhuman primates can be emphatically impacted via occasionally consumed secular and contiguous aggregating of scanty resources of fruit (Kingdon, 2015), conceivably thinking supply and vulnerable host species in these regions of expanded scrounging convenience. The current study distinguishes the possible zoonotic transmission slot as a domain that spreads more than 22 nations in Central and West Africa. Such territories are characterized by typical vegetation, temperature, altitude, transpiration, also area of suspicious bat reservoirs (Pigott et al., 2014).

Human-mediated modifications regarding environment reportedly huge, and possibly enhances the development of EBOV in the outbreak territory. Several the regions are there that are considered as a biodiversity hotspot as for example in Guinean forest the striking rate of human invasion most likely to be governed by agricultural activities into these spots cause around 83%–86% forest loss (Norris et al., 2010; Fahr et al., 2003). Such alterations within spillover areas can give chances to contact with infected bats, possibly making transmission pathways easier that don't depend on vulnerability to bushmeat. For instance, the little-collared fruit bat which mostly observed in forest or grassland at earlier, now are found in gardens of urban regions for the scanty of food resources (Mickleburgh et al., 1992; Mickleburgh et al., 2008). Whereas, straw-colored bats also have been recognized in human-mediated modified landscapes, also in urban parks (Mickleburgh et al., 2008). The hammer-headed fruit bat reportedly depending on cultivated crops for their food so been observed in extensive variety of natural habitats, along with farming territories (Mickleburgh et al., 2008).

The transmission and infection of the virus can be possible through water by the fecal and other virus contaminated waste (Hutton et al., 2007). Moreover, shortage of food and absence of sanitation in water is one of the variables why individuals in the territory are effectively infected by Ebola virus. Individuals frequently search for nourishment and may come in direct contact with contaminated wild animals (e.g. bats, non-human primates). Likewise, malnutrition and lack of food resources are considered as the principal causes for the development of Ebola outbreak among African population. As, malnutrition lessen the body immunity and cause physiological obstruction by making individual more susceptible to Ebola infection (Sullivan, 2003).

Role of potential Policy Response:

An extensive research has been conducted in vitro as well as with animal models in the development of proper vaccine and approved treatment for EBOV and MARV; however, administering to patients infected with Ebola as long as concurrently preventing transmission of further EBOV infection by the implementation of several policy considered to be a principal challenge to combat EBOV epidemic (Alexander et al, 2015).

The cytotoxic impacts of GP on endothelial tissues as well as on macrophages known to dysregulate inflammatory cellular response and vascular integrity. What's more, by changing the cell surface adhesion proteins, identification of immune molecules; also Ebola virus can damage the functioning of cytolytic-T-cell and activation of immune system, giving a reason to concentrating on GP as an objective for the development of potential vaccine and giving prompts other clinical intercessions (Sullivan et al, 2003). Development of coordinated communication and supervision approach, also national detection and response policy and protocols will be required. Planning of meeting with Health Ministers of various provinces, along with scientists and policymakers can provide a greater approach to oversee possible transmission and flare-up reaction (Muyembe-Tamfum et al., 1999). Rapid identification and acknowledgement of disease symptoms within the unique situation and limitations recognized in the nearby condition. Development of medical and relief team by providing necessary training regarding the use of medical equipment and how to give care and therapy on the basis of symptoms are required for disease management. A team of volunteers can be formed for the maintenance of proper sanitation and hygiene, also take care of the burial activities under safe conditions (Rewar & Mirdha, 2014). Incorporated methodologies associated with human health need to be evolved through legislation administration, research, and policy setting within the context. Protocols regarding isolation and test regimes of people showing primary symptoms of disease at cross-border crossings, along with specific inspections are expected to be followed to prevent illegal migrant (Frieden et al., 2014; Alexander et al, 2015). Administration of these migrants is frequently embraced by numerous organizations. Proper training and methods must be recognized to address the characteristics of agencies related to movement and to take into account protected and deferential administration of such people amid times of increased responsibility for EBOV transmission and human portability (Kerstiëns & Matthys, 1999). The laboratory and research team usually involved in collecting sample or DNA sequence; availability of such data to the public health community at the earliest opportunity so as to enable molecular study to progress and in order to understand transmission pathways, diagnostic confirmation, general wellbeing suggestions, among different territories of need (Rewar & Mirdha, 2014). This data is critically expected to direct the threat for EVD spillover and distinguishing proper controlling strategies. Modeling can give basic data on potential situations based on spillover advancement, intervention outline, disease management (Fineberg & Wilson, 2009; Alexander et al, 2015). The gap in data accumulation in the outbreak areas known to be critical, in any case, constraining the full utilization of this toolset and capability to direct functional requirements. Agent-based methodologies can consolidate intricate social and behavioral standards and that can be utilized to coordinate information accumulation from low-sources environments (Alexander et al., 2012). Data collected from social media is regularly utilized as a part of general wellbeing for trailing infection and in the conveyance of wellbeing information (Moorhead et al., 2013). Two sorts of methodologies will be critical, one that draws in new needs in a spillover and a moment coordinated at understanding more extensive components of the pestilence and forestalling future episodes. The extension and target of each are reciprocal and permit adaptable evaluations of current and future outbreak needs. Along with global and provincial demonstrating approach, community-based monitoring will be important to viably distinguish appearance of Ebola within wildlife and predict risk zones before episodes take place in the local regions. On that note, public health education will be vital in diminishing practices that enhance the danger of outbreak from wildlife commencement. Public health education regarding transmission and dynamics of Ebola is required progressively throughout the world. A communication oriented program by the public health officials is direly required and ought to include numerous channels, for instance, TV, radio, social networking sites. All of these interchanges ought to give genuine data concerning the administration of Ebola hazard within the context of particular community (Harvard School of Public Health, 2014).

Conclusion:

EVD is designated as re-emerging and exceptionally infectious disease and the outbreak is deadly as well. Flare-ups have been related with human periodical cases, including greater fatality rates and cause a social and financial depletion (Moghadam et al., 2015). The public healthcare authorities and Ministers of developing nations alongside with policymakers must originate strategies and protocols remembering the accessible assets, to manage the spillover before it happens (Ghazanfar et al, 2015). While considerable advancement has been accomplished over the previous years, improved supervision, pre-planned response execution on selected outlets, continuous sharing of information and making a quick move in view of the accessible data remain fundamental (Moghadam et al, 2015).

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