Ebola
4 journalers for this copy...
FROM THE PUBLISHER
IT STRIKES WITHOUT WARNING—A HORRIFYING, LETHAL DISEASE WITH NO NAME. AND NO CURE. . . .
Now, from the molten center of the "hot zone," comes a terrifying, completely authentic novel of medical suspense by William T. Close, M.D., the American physician who lived in Zaire for sixteen years, and who worked desperately to contain the first outbreak of the virus in 1976. Haunted by the images from this wrenching time, and unable to forget the people he knew and lost, Dr. Close was compelled to tell their story. EBOLA, inspired by his personal experience and based upon extensive research, is an unforgettable portrait of this devastating drama, which all began with an invisible, unknown killer . . . .
EBOLA
At a Catholic mission in Yambuku, a remote area of Zaire, Mabalo Lokela, a local teacher, visits the clinic with a raging fever. Sister Lucie, a Flemish nun and nurse, gives him a shot of an anti-malarial drug, wipes off the syringe, and awaits her next patient. Within days, Mabolo is dead. Soon after, others become ill and die. Less than three weeks later, Sister Lucie, too, is dead. As panic erupts and the villagers flee from the sickness . . . as the roads leading out of Yambuku are blocked and the dying are turned away . . . as the single radio connecting the village to the outside world brings only bad news, the valiant nuns and medical personnel left behind at the mission can only pray and wonder: will the world ever hear their plea for help?
And always there is the virus, from which there is no escape . . . .
IT STRIKES WITHOUT WARNING—A HORRIFYING, LETHAL DISEASE WITH NO NAME. AND NO CURE. . . .
Now, from the molten center of the "hot zone," comes a terrifying, completely authentic novel of medical suspense by William T. Close, M.D., the American physician who lived in Zaire for sixteen years, and who worked desperately to contain the first outbreak of the virus in 1976. Haunted by the images from this wrenching time, and unable to forget the people he knew and lost, Dr. Close was compelled to tell their story. EBOLA, inspired by his personal experience and based upon extensive research, is an unforgettable portrait of this devastating drama, which all began with an invisible, unknown killer . . . .
EBOLA
At a Catholic mission in Yambuku, a remote area of Zaire, Mabalo Lokela, a local teacher, visits the clinic with a raging fever. Sister Lucie, a Flemish nun and nurse, gives him a shot of an anti-malarial drug, wipes off the syringe, and awaits her next patient. Within days, Mabolo is dead. Soon after, others become ill and die. Less than three weeks later, Sister Lucie, too, is dead. As panic erupts and the villagers flee from the sickness . . . as the roads leading out of Yambuku are blocked and the dying are turned away . . . as the single radio connecting the village to the outside world brings only bad news, the valiant nuns and medical personnel left behind at the mission can only pray and wonder: will the world ever hear their plea for help?
And always there is the virus, from which there is no escape . . . .
RELEASE NOTES:
At the meetup.
At the meetup.
This book was very moving and, although set in the 70s, very up-to-date. Living in Europe we feel so safe from ebola, bird flue, sars etc and everybody just jokes about it, but reading this book made me realise again what it means, when a new virus springs up and ravages a country. It opened my eyes and reminded me again that a deadly disease is not an abstract biological thing but something that affects people in many different ways.
Es bleibt weiterhin in der Afrika-Box.
This book is with me since 29th of March 2007, it arrived with the Afrika-Box.
Edit July 2008: I am reading this at the moment!
I would like to add this information from WIKIPEDIA:
Ebola is the common term for a group of viruses belonging to genus Ebola, family Filoviridae, and for the disease which they cause, Ebola hemorrhagic fever. Ebola viruses are morphologically similar to the Marburg virus, also in the family Filoviridae, and share similar disease symptoms. Ebola has caused outbreaks and deaths since its discovery.[1]
Overview
The Ebola virus first came to notice in 1976 in outbreaks of Ebola hemorrhagic fever in Zaire and Sudan.[2] The strain of Ebola which broke out in Zaire has one of the highest case fatality rates of any human pathogenic virus, roughly 90%. The strain which broke out later in Sudan has a mortality of approximately 50%. The virus is believed to be initially transmitted to a human via contact with an infected animal host. From the first human infected, the virus is then transmitted by human contact with infected blood and bodily fluids of a diseased person, and by human contact with contaminated medical equipment, such as needles. Both of these infectious mechanisms will occur in clinical (nosocomial) and non-clinical situations. Due to the high fatality rate, the rapidity of demise, and the often remote areas where infections occur, the potential for widespread epidemic outbreaks is considered low.
Ebola is believed to be a zoonotic virus as it is currently devastating the populations of lowland gorillas in Central Africa. As of late 2005, three species of fruit bat were identified as carrying the virus, and did not exhibit symptoms, and are now believed to be the natural host species, or reservoir, of the virus.
Ebola hemorrhagic fever is potentially lethal and encompasses a range of symptoms including fever, vomiting, diarrhea, generalized pain or malaise, and sometimes internal and external bleeding. Mortality rates are extremely high, with the human case-fatality rate ranging from 50% - 89%, according to viral subtype.[3] The cause of death is usually due to hypovolemic shock or organ failure.
Etymology
The virus is named after the Ebola River Valley in the Democratic Republic of the Congo (formerly Zaïre), near the site of the first recognized outbreak in 1976, in a mission run by Flemish nuns.[5]
Zaïre ebola virus
Known human cases and deaths during outbreaks of Zaïre Ebolavirus between 1976 and 2003The Zaïre Ebola virus has the highest mortality rate, up to 90% in some epidemics, with an average of approximately 83% mortality over 27 years. The case-fatality rates were 88% in 1976, 100% in 1977, 59% in 1994, 81% in 1995, 73% in 1996, 80% in 2001-2002 and 90% in 2003. There have been more outbreaks of Zaïre Ebola virus than any other strain.
The first outbreak took place on August 26, 1976 in Yambuku, a town in the north of Zaïre. The first recorded case was Mabalo Lokela, a 44-year-old schoolteacher returning from a trip around the north of the state. His high fever was diagnosed as possible malaria and he was subsequently given a quinine shot. Lokela returned to the hospital every day. A week later, his symptoms included uncontrolled vomiting, bloody diarrhea, headache, dizziness, and trouble breathing. Later, he began bleeding from his nose, mouth, and anus. Lokela died on September 8, 1976, roughly 14 days after the onset of symptoms.
Soon after, more patients arrived with varying but similar symptoms including fever, headache, muscle and joint aches, fatigue, nausea, and dizziness. These often progressed to bloody diarrhea, severe vomiting, and bleeding from the nose, mouth, and anus. The initial transmission was believed to be due to reuse of the needle for Lokela’s injection without sterilization. Subsequent transmission was also due to care of the sick patients without barrier nursing and the traditional burial preparation method, which involved washing and gastrointestinal tract cleansing.
Two nuns working in Yambuku as nurses also died in the same outbreak.
Transmission
Among humans, the virus is transmitted by direct contact with infected body fluids, or to a lesser extent, skin or mucous membrane contact. The incubation period can be anywhere from 2 to 21 days, but is generally between 5 and 10 days.
Although airborne transmission between monkeys has been demonstrated by an accidental outbreak in a laboratory located in Virginia, USA, there is very limited evidence for human-to-human airborne transmission in any reported epidemics. Nurse Mayinga might represent the only possible case. The means by which she contracted the virus remains uncertain.
So far, all epidemics of Ebola have occurred in sub-optimal hospital conditions, where practices of basic hygiene and sanitation are often either luxuries or unknown to caretakers and where disposable needles and autoclaves are unavailable or too expensive. In modern hospitals with disposable needles and knowledge of basic hygiene and barrier nursing techniques, Ebola has never spread on such a large scale.
In the early stages, Ebola may not be highly contagious. Contact with someone in early stages may not even transmit the disease. As the illness progresses, bodily fluids from diarrhea, vomiting, and bleeding represent an extreme biohazard. Due to lack of proper equipment and hygienic practices, large scale epidemics occur mostly in poor, isolated areas without modern hospitals or well-educated medical staff. Many areas where the infectious reservoir exists have just these characteristics. In such environments, all that can be done is to immediately cease all needle-sharing or use without adequate sterilization procedures, to isolate patients, and to observe strict barrier nursing procedures with the use of a medical rated disposable face mask, gloves, goggles, and a gown at all times. This should be strictly enforced for all medical personnel and visitors.
Ebola is unlikely to develop into a pandemic, or world-wide infection, due to its difficulty in spreading by airborne transmission and the period of time that the virus can use a living and contagious victim to spread compared to other infectious diseases. In isolated settings such as a quarantined hospital or a remote village, most victims are infected shortly after the first case of infection is present. In addition, the quick onset of symptoms from the time the disease becomes contagious in an individual makes it easy to identify sick individuals and limits an individual's ability to spread the disease by traveling. Because bodies of the deceased are still infectious, many doctors implemented measures[which?] to properly dispose of dead bodies in spite of some traditional local burial rituals.[14]
Treatments
A hospital isolation ward in Gulu, Uganda during the October 2000 outbreakThere is no standard treatment for Ebola HF. Treatment is primarily supportive and includes minimizing invasive procedures, balancing electrolytes since patients are frequently dehydrated, replacing lost coagulation factors to help stop bleeding, maintaining oxygen and blood levels, and treating any complicating infections. Convalescent Plasma (factors from those who have survived Ebola infection) shows promise as a treatment for the disease[citation needed]. Ribavirin is ineffective. Interferon is also thought to be ineffective. In monkeys, administration of an inhibitor of coagulation (rNAPc2) has shown some benefit, protecting 33% of infected animals from a usually 100% (for monkeys) lethal infection (unfortunately this inoculation does not work on humans). In early 2006, scientists at USAMRIID announced a 75% recovery rate after infecting four rhesus monkeys with Ebola virus and administering antisense drugs.[15]
Vaccines
Vaccines have been produced for both Ebola [16] and Marburg[17] that were 99% effective in protecting a group of monkeys from the disease. These vaccines are based on either a recombinant Vesicular stomatitis virus or a recombinant Adenovirus[18] carrying the Ebola spikeprotein on its surface. Early human vaccine efforts, like the one at NIAID in 2003, have so far not reported any successes.[19] The biggest problem with the vaccine is that unless the patient is given it near the onset of the virus (1-4 days after the symptoms begin) then there will be too much damage to the human body to repair, ie: ruptured arteries and capillaries, vomiting, and other symptoms which may still cause enough harm to kill or seriously traumatize the patient.
Viral reservoirs
Despite numerous studies, the wildlife reservoir of Ebolavirus has not been identified. Between 1976 and 1998, from 30,000 mammals, birds, reptiles, amphibians, and arthropods sampled from outbreak regions, no Ebolavirus was detected [20] apart from some genetic material found in six rodents (Mus setulosus and Praomys species) and a shrew (Sylvisorex ollula) collected from the Central African Republic in 1998.[21] Ebolavirus was detected in the carcasses of gorillas, chimpanzees and duikers during outbreaks in 2001 and 2003 (the carcasses were the source of the initial human infections) but the high mortality from infection in these species precludes them from acting as reservoirs.[20]
Plants, arthropods, and birds have also been considered as reservoirs, however bats are considered the most likely candidate[22]. Bats were known to reside in the cotton factory in which the index cases for the 1976 and 1979 outbreaks were employed and have also been implicated in Marburg infections in 1975 and 1980.[20] Of 24 plant species and 19 vertebrate species experimentally inoculated with Ebolavirus, only bats became infected.[23] The absence of clinical signs in these bats is characteristic of a reservoir species. In 2002-03, a survey of 1,030 animals from Gabon and the Republic of the Congo including 679 bats found Ebolavirus RNA in 13 fruit bats (Hyspignathus monstrosus, Epomops franquetti and Myonycteris torquata).[24] Bats are also known to be the reservoirs for a number of related viruses including Nipah virus, Hendra virus and lyssaviruses.
Edit July 2008: I am reading this at the moment!
I would like to add this information from WIKIPEDIA:
Ebola is the common term for a group of viruses belonging to genus Ebola, family Filoviridae, and for the disease which they cause, Ebola hemorrhagic fever. Ebola viruses are morphologically similar to the Marburg virus, also in the family Filoviridae, and share similar disease symptoms. Ebola has caused outbreaks and deaths since its discovery.[1]
Overview
The Ebola virus first came to notice in 1976 in outbreaks of Ebola hemorrhagic fever in Zaire and Sudan.[2] The strain of Ebola which broke out in Zaire has one of the highest case fatality rates of any human pathogenic virus, roughly 90%. The strain which broke out later in Sudan has a mortality of approximately 50%. The virus is believed to be initially transmitted to a human via contact with an infected animal host. From the first human infected, the virus is then transmitted by human contact with infected blood and bodily fluids of a diseased person, and by human contact with contaminated medical equipment, such as needles. Both of these infectious mechanisms will occur in clinical (nosocomial) and non-clinical situations. Due to the high fatality rate, the rapidity of demise, and the often remote areas where infections occur, the potential for widespread epidemic outbreaks is considered low.
Ebola is believed to be a zoonotic virus as it is currently devastating the populations of lowland gorillas in Central Africa. As of late 2005, three species of fruit bat were identified as carrying the virus, and did not exhibit symptoms, and are now believed to be the natural host species, or reservoir, of the virus.
Ebola hemorrhagic fever is potentially lethal and encompasses a range of symptoms including fever, vomiting, diarrhea, generalized pain or malaise, and sometimes internal and external bleeding. Mortality rates are extremely high, with the human case-fatality rate ranging from 50% - 89%, according to viral subtype.[3] The cause of death is usually due to hypovolemic shock or organ failure.
Etymology
The virus is named after the Ebola River Valley in the Democratic Republic of the Congo (formerly Zaïre), near the site of the first recognized outbreak in 1976, in a mission run by Flemish nuns.[5]
Zaïre ebola virus
Known human cases and deaths during outbreaks of Zaïre Ebolavirus between 1976 and 2003The Zaïre Ebola virus has the highest mortality rate, up to 90% in some epidemics, with an average of approximately 83% mortality over 27 years. The case-fatality rates were 88% in 1976, 100% in 1977, 59% in 1994, 81% in 1995, 73% in 1996, 80% in 2001-2002 and 90% in 2003. There have been more outbreaks of Zaïre Ebola virus than any other strain.
The first outbreak took place on August 26, 1976 in Yambuku, a town in the north of Zaïre. The first recorded case was Mabalo Lokela, a 44-year-old schoolteacher returning from a trip around the north of the state. His high fever was diagnosed as possible malaria and he was subsequently given a quinine shot. Lokela returned to the hospital every day. A week later, his symptoms included uncontrolled vomiting, bloody diarrhea, headache, dizziness, and trouble breathing. Later, he began bleeding from his nose, mouth, and anus. Lokela died on September 8, 1976, roughly 14 days after the onset of symptoms.
Soon after, more patients arrived with varying but similar symptoms including fever, headache, muscle and joint aches, fatigue, nausea, and dizziness. These often progressed to bloody diarrhea, severe vomiting, and bleeding from the nose, mouth, and anus. The initial transmission was believed to be due to reuse of the needle for Lokela’s injection without sterilization. Subsequent transmission was also due to care of the sick patients without barrier nursing and the traditional burial preparation method, which involved washing and gastrointestinal tract cleansing.
Two nuns working in Yambuku as nurses also died in the same outbreak.
Transmission
Among humans, the virus is transmitted by direct contact with infected body fluids, or to a lesser extent, skin or mucous membrane contact. The incubation period can be anywhere from 2 to 21 days, but is generally between 5 and 10 days.
Although airborne transmission between monkeys has been demonstrated by an accidental outbreak in a laboratory located in Virginia, USA, there is very limited evidence for human-to-human airborne transmission in any reported epidemics. Nurse Mayinga might represent the only possible case. The means by which she contracted the virus remains uncertain.
So far, all epidemics of Ebola have occurred in sub-optimal hospital conditions, where practices of basic hygiene and sanitation are often either luxuries or unknown to caretakers and where disposable needles and autoclaves are unavailable or too expensive. In modern hospitals with disposable needles and knowledge of basic hygiene and barrier nursing techniques, Ebola has never spread on such a large scale.
In the early stages, Ebola may not be highly contagious. Contact with someone in early stages may not even transmit the disease. As the illness progresses, bodily fluids from diarrhea, vomiting, and bleeding represent an extreme biohazard. Due to lack of proper equipment and hygienic practices, large scale epidemics occur mostly in poor, isolated areas without modern hospitals or well-educated medical staff. Many areas where the infectious reservoir exists have just these characteristics. In such environments, all that can be done is to immediately cease all needle-sharing or use without adequate sterilization procedures, to isolate patients, and to observe strict barrier nursing procedures with the use of a medical rated disposable face mask, gloves, goggles, and a gown at all times. This should be strictly enforced for all medical personnel and visitors.
Ebola is unlikely to develop into a pandemic, or world-wide infection, due to its difficulty in spreading by airborne transmission and the period of time that the virus can use a living and contagious victim to spread compared to other infectious diseases. In isolated settings such as a quarantined hospital or a remote village, most victims are infected shortly after the first case of infection is present. In addition, the quick onset of symptoms from the time the disease becomes contagious in an individual makes it easy to identify sick individuals and limits an individual's ability to spread the disease by traveling. Because bodies of the deceased are still infectious, many doctors implemented measures[which?] to properly dispose of dead bodies in spite of some traditional local burial rituals.[14]
Treatments
A hospital isolation ward in Gulu, Uganda during the October 2000 outbreakThere is no standard treatment for Ebola HF. Treatment is primarily supportive and includes minimizing invasive procedures, balancing electrolytes since patients are frequently dehydrated, replacing lost coagulation factors to help stop bleeding, maintaining oxygen and blood levels, and treating any complicating infections. Convalescent Plasma (factors from those who have survived Ebola infection) shows promise as a treatment for the disease[citation needed]. Ribavirin is ineffective. Interferon is also thought to be ineffective. In monkeys, administration of an inhibitor of coagulation (rNAPc2) has shown some benefit, protecting 33% of infected animals from a usually 100% (for monkeys) lethal infection (unfortunately this inoculation does not work on humans). In early 2006, scientists at USAMRIID announced a 75% recovery rate after infecting four rhesus monkeys with Ebola virus and administering antisense drugs.[15]
Vaccines
Vaccines have been produced for both Ebola [16] and Marburg[17] that were 99% effective in protecting a group of monkeys from the disease. These vaccines are based on either a recombinant Vesicular stomatitis virus or a recombinant Adenovirus[18] carrying the Ebola spikeprotein on its surface. Early human vaccine efforts, like the one at NIAID in 2003, have so far not reported any successes.[19] The biggest problem with the vaccine is that unless the patient is given it near the onset of the virus (1-4 days after the symptoms begin) then there will be too much damage to the human body to repair, ie: ruptured arteries and capillaries, vomiting, and other symptoms which may still cause enough harm to kill or seriously traumatize the patient.
Viral reservoirs
Despite numerous studies, the wildlife reservoir of Ebolavirus has not been identified. Between 1976 and 1998, from 30,000 mammals, birds, reptiles, amphibians, and arthropods sampled from outbreak regions, no Ebolavirus was detected [20] apart from some genetic material found in six rodents (Mus setulosus and Praomys species) and a shrew (Sylvisorex ollula) collected from the Central African Republic in 1998.[21] Ebolavirus was detected in the carcasses of gorillas, chimpanzees and duikers during outbreaks in 2001 and 2003 (the carcasses were the source of the initial human infections) but the high mortality from infection in these species precludes them from acting as reservoirs.[20]
Plants, arthropods, and birds have also been considered as reservoirs, however bats are considered the most likely candidate[22]. Bats were known to reside in the cotton factory in which the index cases for the 1976 and 1979 outbreaks were employed and have also been implicated in Marburg infections in 1975 and 1980.[20] Of 24 plant species and 19 vertebrate species experimentally inoculated with Ebolavirus, only bats became infected.[23] The absence of clinical signs in these bats is characteristic of a reservoir species. In 2002-03, a survey of 1,030 animals from Gabon and the Republic of the Congo including 679 bats found Ebolavirus RNA in 13 fruit bats (Hyspignathus monstrosus, Epomops franquetti and Myonycteris torquata).[24] Bats are also known to be the reservoirs for a number of related viruses including Nipah virus, Hendra virus and lyssaviruses.
I enjoyed this thrilling and interesting book.
The book will stay in Bukarest, Romania with a colleague(01.08.2008).
The book will stay in Bukarest, Romania with a colleague(01.08.2008).
