As a rare strain of the Ebola virus continues to spread in the Democratic Republic of Congo and Uganda, Canadians need to know:
Are there different types of Ebola?
Yes. There are several strains of the virus that cause Ebola disease. The most common are the Ebola virus, also called the Zaire strain, and the Sudan virus, said Dr. Isaac Bogoch, an infectious disease specialist at the University Health Network in Toronto.
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The The type of Ebola causing the current outbreak is called Bundibugyo virus.
“Most of the outbreaks associated with the Ebola virus have occurred with the Zaire strain of the Ebola virus. And there, most of the research has been focused on vaccinations and therapeutics,” Bogoch said, noting that Canada’s National Microbiology Lab helped develop the first Ebola virus vaccine.
But one of the concerning things about the Bundibugyo outbreak is that there are no therapeutics or vaccines proven to work against this strain, he said.
Symptoms are similar across all strains of Ebola and can begin with fever, fatigue, muscle pain, headache and sore throat, according to the World Health Organization.
This can cause vomiting, diarrhea, abdominal pain, rash, and impaired kidney and liver function.
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Internal and external bleeding, including blood in the gums or stool, may also occur, but not as frequently as other symptoms.
“I think there’s a perception that bleeding is a common symptom, but it’s actually less common and really occurs at this late stage (of the disease),” said Meaghan Thumath, an assistant professor of public health and emergencies at the University of British Columbia, who worked with the World Health Organization during another Ebola outbreak in the Democratic Republic of Congo in 2019.
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One of the challenges in diagnosing Ebola is that some of the symptoms also occur in other infectious diseases such as malaria, typhoid and meningitis. Therefore, diagnostic tests are crucial.
The incubation period for Ebola is two to 21 days. People with Ebola are not contagious until they show symptoms, said Trish Newport, a Canadian who works as an emergency manager for Doctors Without Borders.
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The Ebola virus is transmitted through contact with body fluids.
“People with Ebola get very sick. So it can be vomit, diarrhea, blood (and) respiratory secretions,” Bogoch said.
“The people who often become infected with the Ebola virus are, unfortunately, family members of infected individuals who are directly caring for a close contact, or health care providers who either do not have access to appropriate PPE (personal protective equipment) or do not use their PPE properly in the event of a breach,” he said.
Ebola can also be transmitted at the funeral of people who died from the virus if relatives touch the body without taking appropriate precautions.
Monoclonal antibodies, which help the body fight off disease, could treat the Zaire strain, Bogoch said, but have not been proven to work in people infected with the Bundibugyo strain.
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There are also vaccines that can be given to someone exposed to the Zaire strain to either ward off infection or at least reduce the severity of the disease – but these, too, have not been tested with Bundibugyo.
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“The most important pillar of treatment is supportive care,” Bogoch said.
“That means you need a good hospital, you need good medical care, you need fluid and electrolyte replenishment because unfortunately one of the characteristics of the Ebola virus is terrible nausea, vomiting, diarrhea, organ dysfunction and occasionally bleeding. And you just need to carefully replace the fluids and electrolytes… over a long period of time.”
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Is a vaccine for the Bundibugyo Ebola virus in the works?
GAVI, the Vaccine Alliance and other partners are working to explore ways to accelerate the development of vaccine candidates that are in the research and development phase – but it could take months before doses are ready for clinical trials.
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GAVI is funding the stockpile of Ebola vaccines currently approved for use against Zaire Ebola and said in a press release that there are “currently no approved vaccines against BVD (Bundibugyo virus disease).”
“Given the extremely limited evidence available for cross-protection against non-Zairean species, any decision to use this vaccine in the current BVD outbreak will require further assessment and will be made in accordance with WHO guidance,” the press release issued on Thursday said.
“(It could be used) only with the express informed consent and understanding of the affected communities that the benefit of the vaccine against BVD is currently unknown.”
Would we be ready if there was an Ebola case in Canada?
There has never been a case of Ebola in Canada.
On Wednesday, Ontario’s Ministry of Health said it was testing someone who recently returned from East Africa “out of an abundance of caution.”
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Officials did not disclose what type of Ebola the patient was tested for in Ontario or where in the region he traveled.
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A spokesperson for the Public Health Agency of Canada said samples from the test were expected to arrive at the National Microbiology Laboratory in Winnipeg on Thursday.
If there were a case of Ebola in Canada, both Bogoch and Thumath said the country’s public health and hospital systems would be well equipped to handle it.
But one of the most important ways for Canadians to protect themselves from Ebola is to invest in containing its spread elsewhere, they said.
“The longer outbreaks last and the larger they become, the higher the likelihood of international spread,” Bogoch said.
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“The risk is small. But it’s not zero percent, and the longer this goes on and the bigger it gets, the bigger the risk becomes.”
Thumath said global outbreaks are important no matter where in the world we live.
“As we know, infectious diseases know no borders,” she said.
“In North America, I think there’s a perception of, ‘Oh, these (outbreaks) only happen there,’ but rapid containment is so critical to global health security. And so the best thing we can do is share our experts, share our resources and make sure it’s contained.”