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104-648: Nzara was industrial center of the Azande Scheme also known as, Equatoria Project Scheme during the Anglo-Egyptian colonial period. The Government of South Sudan has since 2006 intended to revive the agro-industrial complex. Nzara was the site of the world's first recorded outbreak of the Ebola virus disease . In five months starting in June 1976, 151 people in the region died of the disease. Nzara served as

208-412: A coma near the end of life. Those who survive often have ongoing muscular and joint pain, liver inflammation , and decreased hearing, and may have continued tiredness, continued weakness, decreased appetite, and difficulty returning to pre-illness weight. Problems with vision may develop. It is recommended that survivors of EVD wear condoms for at least twelve months after initial infection or until

312-427: A septic state . EBOV is thought to infect humans through contact with mucous membranes or skin breaks. After infection, endothelial cells (cells lining the inside of blood vessels), liver cells, and several types of immune cells such as macrophages, monocytes , and dendritic cells are the main targets of attack. Following infection, immune cells carry the virus to nearby lymph nodes where further reproduction of

416-833: A 2012 published report, Nzara has housed one of the four Combined Operations Fusion Centers where intelligence and operations have been coordinated among the anti-LRA coalition. Ebola virus disease Ebola , also known as Ebola virus disease ( EVD ) and Ebola hemorrhagic fever ( EHF ), is a viral hemorrhagic fever in humans and other primates , caused by ebolaviruses . Symptoms typically start anywhere between two days and three weeks after infection. The first symptoms are usually fever , sore throat , muscle pain , and headaches . These are usually followed by vomiting , diarrhoea , rash and decreased liver and kidney function, at which point some people begin to bleed both internally and externally. It kills between 25% and 90% of those infected – about 50% on average. Death

520-406: A communicable disease within a broader population and also ethically obliged to warn individuals of their exposure. Simultaneously, infected individuals have a recognized right to medical confidentiality. Public health teams typically disclose the minimum amount of information required to achieve the objectives of contact tracing. For example, contacts are only told that they have been exposed to

624-506: A comprehensive program that encompasses counseling and medical care to treat the infection. The official title, contract tracers, was first implemented in the United Kingdom during the smallpox outbreaks. Dedicated individuals served on a surveillance-based team to curb the spread of disease. This process served as a blueprint for other public health agencies to have a formalized program. The United States soon followed and enacted

728-442: A contact tracing program for the prevention of infectious diseases which included TB , HIV, SARS , and now SARS-CoV-2 . Contact tracing generally involves the following steps as provided by CDC : The types of contacts that are relevant for public health management vary because of differing modes of transmission . For sexually transmitted infections, sexual contacts of the index case are relevant, as well as any babies born to

832-445: A means to identify high-risk and medically vulnerable populations who might be exposed to infection and facilitate appropriate medical care. In doing so, public health officials utilize contact tracing to conduct disease surveillance and prevent outbreaks. In cases of diseases of uncertain infectious potential, contact tracing is also sometimes performed to learn about disease characteristics, including infectiousness. Contact tracing

936-806: A particular infection, but not informed of the person who was the source of the exposure. In the United States, HIPAA is a legal measure for protecting health information. This ensures sharing of only relevant information in the contact tracing process. However, given the unprecedented spread and mortality of SARS-CoV2, advocacy groups argue the protections offered by HIPAA are spread thin. Some activists and health care providers have expressed concerns that contact tracing may discourage persons from seeking medical treatment for fear of loss of confidentiality and subsequent stigma, discrimination, or abuse. This has been of particular concern regarding contact tracing for HIV. Public health officials have recognized that

1040-480: A person who has developed symptoms of the disease. Body fluids that may contain Ebola viruses include saliva, mucus, vomit, feces, sweat, tears, breast milk, urine and semen . The WHO states that only people who are very sick are able to spread Ebola disease in saliva , and the virus has not been reported to be transmitted through sweat. Most people spread the virus through blood, feces and vomit. Entry points for

1144-553: A pioneer in utilizing digital contact tracing tools. Learning lessons from the MERS outbreak in 2015, the government executed a robust contact tracing program. Global positioning system (GPS) technology was used to track movement of individuals and appropriately notify persons who have been exposed. The South Korean government launched the Corona 100m application to implement their digital contact tracing measures. The application allowed

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1248-422: A priority of Doctors Without Borders . Ebolaviruses can be eliminated with heat (heating for 30 to 60 minutes at 60 °C or boiling for five minutes). To disinfect surfaces, some lipid solvents such as some alcohol-based products, detergents, sodium hypochlorite (bleach) or calcium hypochlorite (bleaching powder), and other suitable disinfectants may be used at appropriate concentrations. Education of

1352-455: A proper protective barrier between the dead body and the living. Social anthropologists may help find alternatives to traditional rules for burials. Transportation crews are instructed to follow a certain isolation procedure, should anyone exhibit symptoms resembling EVD. As of August 2014 , the WHO does not consider travel bans to be useful in decreasing spread of the disease. In October 2014,

1456-565: A rapid antigen test which gives results in 15 minutes was approved for use by WHO. It is able to confirm Ebola in 92% of those affected and rule it out in 85% of those not affected. Early symptoms of EVD may be similar to those of other diseases common in Africa, including malaria and dengue fever . The symptoms are also similar to those of other viral haemorrhagic fevers such as Marburg virus disease , Crimean–Congo haemorrhagic fever , and Lassa fever . The complete differential diagnosis

1560-429: A reservoir. Traces of EBOV were detected in the carcasses of gorillas and chimpanzees during outbreaks in 2001 and 2003, which later became the source of human infections. However, the high rates of death in these species resulting from EBOV infection make it unlikely that these species represent a natural reservoir for the virus. Deforestation has been mentioned as a possible contributor to recent outbreaks, including

1664-556: A result, fewer cases followed followed contemporary isolation recommendations. The age of digital contact tracing started gaining traction during the COVID-19 pandemic. With widespread transmission and shortage of contact tracers, technology serves as a resource to bridge gaps. In addition, digital applications automate the process and replace the manual steps contact tracers take to track and notify exposed individuals. There are few benefits of using digital contract tracing apps over

1768-414: A secreted glycoprotein , small soluble glycoprotein (sGP or GP) is synthesised. EBOV replication overwhelms protein synthesis of infected cells and the host immune defences. The GP forms a trimeric complex , which tethers the virus to the endothelial cells. The sGP forms a dimeric protein that interferes with the signalling of neutrophils , another type of white blood cell. This enables the virus to evade

1872-540: A sudden influenza -like stage characterised by fatigue , fever , weakness , decreased appetite , muscular pain , joint pain , headache, and sore throat. The fever is usually higher than 38.3 °C (101 °F). This is often followed by nausea, vomiting, diarrhoea , abdominal pain, and sometimes hiccups . The combination of severe vomiting and diarrhoea often leads to severe dehydration . Next, shortness of breath and chest pain may occur, along with swelling , headaches , and confusion . In about half of

1976-414: Is able to survive on objects for a few hours in a dried state, and can survive for a few days within body fluids outside of a person. The Ebola virus may be able to persist for more than three months in the semen after recovery, which could lead to infections via sexual intercourse . Virus persistence in semen for over a year has been recorded in a national screening programme. Ebola may also occur in

2080-445: Is an adaptable tool used by authorities to identify, notify, and curb transmission of infections. Backward (or reverse) tracing seeks to establish the source of an infection, by looking for contacts before infection. It can be used when a source of the infection is unknown and in situations of minimally monitored settings. The goal is identify the exposures associated with the index case and secondary exposures of those contact to halt

2184-460: Is commonly performed include tuberculosis , vaccine-preventable infections like measles , sexually transmitted infections (including HIV ), blood-borne infections , Ebola , bacterial infections , and novel virus infections (e.g., SARS-CoV , H1N1 , and SARS-CoV-2 ). Contact tracing has been a pillar of communicable disease control in public health for decades. With each outbreak and disease presenting with its own challenges, contact tracing

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2288-446: Is confirmed by isolating the virus, detecting its RNA or proteins, or detecting antibodies against the virus in a person's blood. Isolating the virus by cell culture , detecting the viral RNA by polymerase chain reaction (PCR) and detecting proteins by enzyme-linked immunosorbent assay (ELISA) are methods best used in the early stages of the disease and also for detecting the virus in human remains. Detecting antibodies against

2392-620: Is confirmed by testing blood samples for the presence of viral RNA , viral antibodies or the virus itself. Control of outbreaks requires coordinated medical services and community engagement, including rapid detection, contact tracing of those exposed, quick access to laboratory services, care for those infected, and proper disposal of the dead through cremation or burial. Prevention measures involve wearing proper protective clothing and washing hands when in close proximity to patients and while handling potentially infected bushmeat , as well as thoroughly cooking bushmeat. An Ebola vaccine

2496-754: Is considered evidence that these bats are a reservoir species of EBOV. In a 2002–2003 survey of 1,030 animals including 679 bats from Gabon and the Republic of the Congo , immunoglobulin G (IgG) immune defense molecules indicative of Ebola infection were found in three bat species; at various periods of study, between 2.2 and 22.6% of bats were found to contain both RNA sequences and IgG molecules indicating Ebola infection. Antibodies against Zaire and Reston viruses have been found in fruit bats in Bangladesh , suggesting that these bats are also potential hosts of

2600-911: Is considered low. Usually when someone has symptoms of the disease, they are unable to travel without assistance. Dead bodies remain infectious; thus, people handling human remains in practices such as traditional burial rituals or more modern processes such as embalming are at risk. Of the cases of Ebola infections in Guinea during the 2014 outbreak, 69% are believed to have been contracted via unprotected (or unsuitably protected) contact with infected corpses during certain Guinean burial rituals. Health-care workers treating people with Ebola are at greatest risk of infection. The risk increases when they do not have appropriate protective clothing such as masks, gowns, gloves and eye protection; do not wear it properly; or handle contaminated clothing incorrectly. This risk

2704-763: Is extensive and requires consideration of many other infectious diseases such as typhoid fever , shigellosis , rickettsial diseases , cholera , sepsis , borreliosis , EHEC enteritis , leptospirosis , scrub typhus , plague , Q fever , candidiasis , histoplasmosis , trypanosomiasis , visceral leishmaniasis , measles , and viral hepatitis among others. Non-infectious diseases that may result in symptoms similar to those of EVD include acute promyelocytic leukaemia , haemolytic uraemic syndrome , snake envenomation , clotting factor deficiencies/platelet disorders, thrombotic thrombocytopenic purpura , hereditary haemorrhagic telangiectasia , Kawasaki disease , and warfarin poisoning. An Ebola vaccine , rVSV-ZEBOV ,

2808-412: Is important for the infected and infection control People who care for those infected with Ebola should wear protective clothing including masks, gloves, gowns and goggles. The U.S. Centers for Disease Control (CDC) recommend that the protective gear leaves no skin exposed. These measures are also recommended for those who may handle objects contaminated by an infected person's body fluids. In 2014,

2912-425: Is limited by the resources dedicated to contact tracing. Journalist and author Laurie Garrett pointed out in late October 2020, however, that the amount of the virus in the U.S. is now so large that no health departments has the resources to contact and trace. Additionally, officials overlooked the effect of mistrust in the government and conspiracy theories regarding the virus on thwarting contact tracing efforts in

3016-583: Is not always the most efficient method of addressing infectious disease. In areas of high disease prevalence , screening or focused testing may be more cost-effective. The goals of contact tracing include: Contact tracing programs were first implemented to track syphilis cases in the 1930s. Initial efforts proved to be difficult given the stigmatization associated with sexually transmitted infections (STIs). Individuals were reluctant to report infections because they were concerned for their privacy. Revealing partner history and details about sexual activity

3120-539: Is not known. Plants, arthropods , rodents , and birds have also been considered possible viral reservoirs. Bats were known to roost in the cotton factory in which the first cases of the 1976 and 1979 outbreaks were observed, and they have also been implicated in Marburg virus infections in 1975 and 1980. Of 24 plant and 19 vertebrate species experimentally inoculated with EBOV, only bats became infected. The bats displayed no clinical signs of disease, which

3224-701: Is often due to shock from fluid loss , and typically occurs between six and 16 days after the first symptoms appear. Early treatment of symptoms increases the survival rate considerably compared to late start. An Ebola vaccine was approved by the US FDA in December 2019. The virus spreads through direct contact with body fluids , such as blood from infected humans or other animals, or from contact with items that have recently been contaminated with infected body fluids. There have been no documented cases, either in nature or under laboratory conditions, of spread through

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3328-487: Is particularly common in parts of Africa where the disease mostly occurs and health systems function poorly. There has been transmission in hospitals in some African countries that reuse hypodermic needles. Some health-care centres caring for people with the disease do not have running water. In the United States the spread to two medical workers treating infected patients prompted criticism of inadequate training and procedures. Human-to-human transmission of EBOV through

3432-464: Is the more conventional way to investigate cases and inform close contacts to either quarantine or isolate. For epidemics with high heterogeneity in infectiousness, adopting a hybrid strategy of forward contact tracing combined with contact tracing backwards is often used. Backward contact tracing is beneficial for identifying clusters of spreader events, while forward tracing can be used mitigate future transmission. The effectiveness of both approaches

3536-544: Is the most dangerous of the known EVD-causing viruses, and is responsible for the largest number of outbreaks. The fifth and sixth viruses, Reston virus (RESTV) and Bombali virus (BOMV), are not thought to cause disease in humans, but have caused disease in other primates. All six viruses are closely related to marburgviruses . Ebolaviruses contain single-stranded, non-infectious RNA genomes . Ebolavirus genomes contain seven genes including 3'-UTR - NP - VP35 - VP40 - GP - VP30 - VP24 - L - 5'-UTR . The genomes of

3640-399: Is the nucleoprotein, whose concentration in the host cell determines when L switches from gene transcription to genome replication. Replication of the viral genome results in full-length, positive-strand antigenomes that are, in turn, transcribed into genome copies of negative-strand virus progeny. Newly synthesised structural proteins and genomes self-assemble and accumulate near the inside of

3744-416: Is the process of identifying people who may have been exposed to an infected person ("contacts") and subsequent collection of further data to assess transmission. By tracing the contacts of infected individuals, testing them for infection, and isolating or treating the infected, this public health tool aims to reduce infections in the population. In addition to infection control, contact tracing serves as

3848-565: Is theoretically possible due to the presence of Ebola virus particles in saliva, which can be discharged into the air with a cough or sneeze, but observational data from previous epidemics suggests the actual risk of airborne transmission is low. A number of studies examining airborne transmission broadly concluded that transmission from pigs to primates could happen without direct contact because, unlike humans and primates, pigs with EVD get very high ebolavirus concentrations in their lungs, and not their bloodstream. Therefore, pigs with EVD can spread

3952-533: Is thought to begin with a virion attaching to specific cell-surface receptors such as C-type lectins , DC-SIGN , or integrins , which is followed by fusion of the viral envelope with cellular membranes . The virions taken up by the cell then travel to acidic endosomes and lysosomes where the viral envelope glycoprotein GP is cleaved. This processing appears to allow the virus to bind to cellular proteins enabling it to fuse with internal cellular membranes and release

4056-524: Is typically a cloud database that may have specialized features such as the ability to use SMS or email directly within the software to notify people believed to have been in close contact with someone carrying an infectious disease. Utilizing a database, provides benefit to track persons of interest and offers a platforms to look at data points such as race, zip code, and symptoms. Vendors offering contact tracing case management software include Salesforce , Microsoft and Watkyn . South Korea became

4160-432: Is unclear whether they played a role in spreading the disease to people. The natural reservoir for Ebola has yet to be confirmed; however, bats are considered to be the most likely candidate. Three types of fruit bats ( Hypsignathus monstrosus , Epomops franqueti and Myonycteris torquata ) were found to possibly carry the virus without getting sick. As of 2013 , whether other animals are involved in its spread

4264-631: The HIV epidemic, many affected person were hesitant to report information, which hindered the efforts to understand HIV and curb the spread. To combat some of the negative stigma associated with contact tracing and STIs, health departments sometimes referred to contact tracing as partner notification in the 1980s. Partner notification , also called partner care, is a subset of contact tracing aimed specifically at informing sexual partners of an infected person and addressing their health needs. This definition evolved from identifying infected individuals to including

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4368-512: The West African Ebola virus epidemic . Index cases of EVD have often been close to recently deforested lands. Like other filoviruses , EBOV replicates very efficiently in many cells , producing large amounts of virus in monocytes , macrophages , dendritic cells and other cells including liver cells , fibroblasts , and adrenal gland cells . Viral replication triggers high levels of inflammatory chemical signals and leads to

4472-704: The World Health Organization , there were 24 outbreaks of Ebola resulting in a total of 2,387 cases, and 1,590 deaths . The largest Ebola outbreak to date was an epidemic in West Africa from December 2013 to January 2016, with 28,646 cases and 11,323 deaths. On 29 March 2016, it was declared to no longer be an emergency. Other outbreaks in Africa began in the Democratic Republic of the Congo in May 2017, and 2018. In July 2019,

4576-423: The cell membrane . Virions bud off from the cell, gaining their envelopes from the cellular membrane from which they bud. The mature progeny particles then infect other cells to repeat the cycle. The genetics of the Ebola virus are difficult to study because of EBOV's virulent characteristics. It is believed that between people, Ebola disease spreads only by direct contact with the blood or other body fluids of

4680-671: The CDC began recommending that medical personnel receive training on the proper suit-up and removal of personal protective equipment (PPE); in addition, a designated person, appropriately trained in biosafety, should be watching each step of these procedures to ensure they are done correctly. In Sierra Leone, the typical training period for the use of such safety equipment lasts approximately 12 days. In 2022 in Uganda, lighter personal protection equipment has become available as well as possibilities to monitor and communicate with patients from windows in

4784-484: The CDC defined four risk levels used to determine the level of 21-day monitoring for symptoms and restrictions on public activities. In the United States, the CDC recommends that restrictions on public activity, including travel restrictions, are not required for the following defined risk levels: The CDC recommends monitoring for the symptoms of Ebola disease for those both at "low risk" and at higher risk. Contact tracing In public health , contact tracing

4888-507: The U.S. Contact tracing requires tremendous resources and work hours to effectively contain an infection. The COVID-19 pandemic is an unprecedented period where contact tracing and public health efforts were put to the test. Creative strategies were used to sustain public health efforts. Non-health personnel and volunteers were used to meet the shortage of contact tracers. Existing infrastructure such as call centers and national helpline services were used for operations. Individuals who were

4992-461: The US it was ~18%, possibly due to improved prevention of disseminated intravascular coagulation . Recovery may begin between seven and 14 days after first symptoms. Death, if it occurs, follows typically six to sixteen days from first symptoms and is often due to shock from fluid loss . In general, bleeding often indicates a worse outcome, and blood loss may result in death. People are often in

5096-573: The United States, contact tracing efforts varied by the respective health department in a particular state. Overall, effectiveness of contact tracing data in the country was determined by the caseload assigned to contact tracers. When on-demand testing was promoted, increases in negative tests were followed by increases in hospitalizations. Subsequent studies of cases and deaths found the same results. If increased testing were in response to surges, more testing should follow increases in cases, not precede them. An average of 208 extra miles were accumulated in

5200-559: The World Health Organization declared the Congo Ebola outbreak a world health emergency . The length of time between exposure to the virus and the development of symptoms ( incubation period ) is between 2 and 21 days, and usually between 4 and 10 days. However, recent estimates based on mathematical models predict that around 5% of cases may take longer than 21 days to develop. Symptoms usually begin with

5304-493: The air between humans or other primates . After recovering from Ebola, semen or breast milk may continue to carry the virus for anywhere between several weeks to several months. Fruit bats are believed to be the normal carrier in nature ; they are able to spread the virus without being affected by it. The symptoms of Ebola may resemble those of several other diseases, including malaria , cholera , typhoid fever , meningitis and other viral hemorrhagic fevers. Diagnosis

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5408-463: The air has not been reported to occur during EVD outbreaks, and airborne transmission has only been demonstrated in very strict laboratory conditions, and then only from pigs to primates , but not from primates to primates. Spread of EBOV by water, or food other than bushmeat, has not been observed. No spread by mosquitos or other insects has been reported. Other possible methods of transmission are being studied. Airborne transmission among humans

5512-502: The application—TraceTogether—which allowed smartphones to provide proximity information useful for contact tracing . Unlike South Korea, which utilized a central database to track cases, the Bluetooth-based apps reported information to an encrypted database that automatically deleted information after 14 days. The western world shortly followed and started developing their own Bluetooth-based applications. Facebook Labs patented

5616-405: The breast milk of women after recovery, and it is not known when it is safe to breastfeed again. The virus was also found in the eye of one patient , in 2014, two months after it was cleared from his blood. Otherwise, people who have recovered are not infectious. The potential for widespread infections in countries with medical systems capable of observing correct medical isolation procedures

5720-583: The bulk of its forces to Nzara in March 2009. About 2000 UPDF troops remained in the DRC, north of Faradge, and Nzara-based attack helicopters supported them in engagements against increasingly concentrated LRA forces. When LRA Major General Caesar Acellam was captured in May 2012, he was flown from Djema in the Central African Republic to Nzara where he gave a televised interview. According to

5824-524: The cases, the skin may develop a maculopapular rash , a flat red area covered with small bumps, five to seven days after symptoms begin. In some cases, internal and external bleeding may occur. This typically begins five to seven days after the first symptoms. All infected people show some decreased blood clotting . Bleeding from mucous membranes or from sites of needle punctures has been reported in 40–50% of cases. This may cause vomiting blood , coughing up of blood , or blood in stool . Bleeding into

5928-471: The cells' ability to produce and respond to interferon proteins such as interferon-alpha , interferon-beta , and interferon gamma . The VP24 and VP35 structural proteins of EBOV play a key role in this interference. When a cell is infected with EBOV, receptors located in the cell's cytosol (such as RIG-I and MDA5 ) or outside of the cytosol (such as Toll-like receptor 3 (TLR3) , TLR7 , TLR8 and TLR9 ) recognise infectious molecules associated with

6032-485: The contact to know whether they have been exposed. At a theoretical scale, digital applications propose mechanism to effectively prevent and stop epidemics. During the COVID-19 pandemic, manual contact tracers used technology to augment their tracing efforts. Case managers in particular were a group of professionals that benefited from this resource. Case management software is often used by contact tracers to maintain records of cases and contact tracing activities. This

6136-402: The contact. Moreover, the parameters set by the developers to contact trace vary and can miss potential cases. Such parameters include proximity or distance to trigger an exposure and the timeframe in which contacts are considered to be infectious (usually 14 days). Smartphone applications require people having access to smartphones and a competent infrastructure to provide internet access to

6240-616: The cycle of transmission. During the COVID-19 pandemic , the adoption by Japan in early spring 2020 of an approach focusing on backward contact tracing was hailed as successful, and other countries which managed to keep the epidemic under control, such as South Korea and Uruguay , are said to have also used the approach. In the United States, contact tracing had suboptimal impact on SARS-CoV-2 transmission, largely because 2 of 3 cases were either not reached for interview or named no contacts when interviewed. Engagement in contact tracing

6344-503: The date is an important ethical issue as well. Centralized vs. de-centralized databases have been implemented across the world during the COVID-19 pandemic. The culture within a nation and those who run the government have a huge role in deciding in what players have access to data. Therefore, governing bodies have to consider ethical principles related to transparency and accountability to the public. Moreover, whether participating in contact tracing efforts should be voluntary or mandatory

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6448-501: The disease through droplets in the air or on the ground when they sneeze or cough. By contrast, humans and other primates accumulate the virus throughout their body and specifically in their blood, but not very much in their lungs. It is believed that this is the reason researchers have observed pig to primate transmission without physical contact, but no evidence has been found of primates being infected without actual contact, even in experiments where infected and uninfected primates shared

6552-469: The disease, and to determine if secondary transmission is taking place in a particular community. Contact tracing has also been initiated among flight passengers during the containment phase of larger pandemics, such as the 2009 pandemic H1NI influenza. Contact tracing played a major role in investigating Ebola virus in the UK in 2014 and monkeypox in the UK in 2018. The eradication of smallpox , for example,

6656-495: The extent of data collected, how long the information is stored, who it is shared with, and for what purpose it is being utilized come with serious ethical considerations. Contact tracing efforts miss vulnerable and under resourced populations. Manual tracing efforts face difficulty tracking hard to reach individuals given social complexities. Digital tools require a smart phone and a reliable internet connection, two factors that might exclude certain individuals from benefiting from

6760-441: The five different ebolaviruses (BDBV, EBOV, RESTV, SUDV and TAFV) differ in sequence and the number and location of gene overlaps. As with all filoviruses , ebolavirus virions are filamentous particles that may appear in the shape of a shepherd's crook, of a "U" or of a "6," and they may be coiled, toroid or branched. In general, ebolavirions are 80 nanometers (nm) in width and may be as long as 14,000 nm. Their life cycle

6864-550: The general public about the risk factors for Ebola infection and of the protective measures individuals may take to prevent infection is recommended by the World Health Organization . These measures include avoiding direct contact with infected people and regular hand washing using soap and water. Bushmeat , an important source of protein in the diet of some Africans, should be handled and prepared with appropriate protective clothing and thoroughly cooked before consumption. Some research suggests that an outbreak of Ebola disease in

6968-557: The goals of contact tracing must be balanced with the maintenance of trust with vulnerable populations and sensitivity to individual situations. Privacy is still a concern even if individual information is not disclosed by public health practitioners. The data collected in databases by governments and tech companies could be utilized for unrelated purposes. Big tech companies have access to data which provides insight on where people visit, what types of interests they pursue, and who interacts with each other. Therefore, questions regarding

7072-441: The immune system by inhibiting early steps of neutrophil activation. Furthermore, the virus is capable of hijacking cellular metabolism. Studies have shown that Ebola virus-like particles can reprogram metabolism in both vascular and immune cells. Filoviral infection also interferes with proper functioning of the innate immune system . EBOV proteins blunt the human immune system's response to viral infections by interfering with

7176-467: The index case. This information is crucial for investigating congenital syphilis cases for example. For blood-borne infections, blood transfusion recipients, contacts who shared a needle, and anyone else who could have been exposed to the blood of the index case are relevant. This information becomes relevant for health systems to keep track of high risk populations and medical errors, unavoidable and preventable. For pulmonary tuberculosis, people living in

7280-438: The initial spread of the virus. With contact tracing, once a person was identified to be exposed, they were immediately isolated. In some instances the government provided housing for isolation to limit movements. In Turkey, the government launched a public forum that highlighted risk zones in various regions of the country. Residents can self-report their health status and track areas with reported high rates of transmission. In

7384-507: The intercellular structure and causes liver damage, leading to improper clotting . The widespread bleeding that occurs in affected people causes swelling and shock due to loss of blood volume . The dysfunctional bleeding and clotting commonly seen in EVD has been attributed to increased activation of the extrinsic pathway of the coagulation cascade due to excessive tissue factor production by macrophages and monocytes. After infection,

7488-656: The limitations mentioned above. In Pennsylvania, a digital exposure notification app for COVID-19 was downloaded by 5.7% of population (635,612 people). Unfortunately, only 0.1% of all reported cases in Pennsylvania used the app to notify their potential contacts of exposure during the study period (390 persons), resulting in 233 notifications as compared an estimated 573,298 eligible contacts. Challenges with contact tracing can arise related to issues of medical privacy and confidentiality. Public health practitioners often are mandated reporters , required to act to contain

7592-453: The liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST); and abnormalities in blood clotting often consistent with disseminated intravascular coagulation (DIC) such as a prolonged prothrombin time , partial thromboplastin time , and bleeding time . Filovirions such as EBOV may be identified by their unique filamentous shapes in cell cultures examined with electron microscopy . The specific diagnosis of EVD

7696-454: The most sick and medically vulnerable were prioritized as contacts over healthier people. The advent of technology and digital tracing tools were implemented at a global scale without much vetting and testing. Various countries had different adaptations and outcomes with contact tracing. China used pre-existing WeChat and Alipay platforms to track person health status and travel patterns. Singapore, South Korea, and Vietnam had success limiting

7800-795: The operational headquarters of the 4th Division of the Uganda People's Defence Force (UPDF), the Ugandan contingent in Operation Rudia II . This was part of the regional campaign military against the Lord's Resistance Army (LRA). After the LRA defeat at Camp Swahili, the UPDF ceded overall control of the operation to the Armed Forces of the Democratic Republic of the Congo (DRC) and moved

7904-461: The production of interferon-beta. By inhibiting these immune responses, EBOV may quickly spread throughout the body. When EVD is suspected, travel, work history, and exposure to wildlife are important factors with respect to further diagnostic efforts. Possible non-specific laboratory indicators of EVD include a low platelet count ; an initially decreased white blood cell count followed by an increased white blood cell count ; elevated levels of

8008-467: The public health agencies to track super spreader events, inform the public, and guide them to treatment if applicable. At the end of April 2020, South Korea reported over 10,000 infections and 204 deaths, numbers which were vastly superior to contemporaries in the European Union. Singapore was among the first countries to use Bluetooth technology in their contact tracing efforts. They launched

8112-452: The public. Not all countries can provide these services to their residents. Compliance is also a factor. Individuals must download the application, navigate the technology, and follow appropriate directions when notified. This becomes highly difficult when the use of smartphone applications is not mandated. Cohort studies which looked at the efficacy of digital contact tracing reported limited sensitivity in accurately catching cases due to

8216-491: The same air. Although it is not entirely clear how Ebola initially spreads from animals to humans, the spread is believed to involve direct contact with an infected wild animal or fruit bat. Besides bats, other wild animals that are sometimes infected with EBOV include several species of monkeys such as baboons , great apes ( chimpanzees and gorillas ), and duikers (a species of antelope ). Animals may become infected when they eat fruit partially eaten by bats carrying

8320-508: The same household or spending a significant amount of time in the same room as the index case are relevant. Understanding the pathology and transmissibility of the disease guides the approach to contact tracing strategy. Although contact tracing is most commonly used for control of diseases, it is also a critical tool for investigating new diseases or unusual outbreaks. For example, as was the case with SARS, contact tracing can be used to determine if probable cases are linked to known cases of

8424-507: The semen of a male survivor tests negative for Ebola virus on two separate occasions. Survivors develop antibodies against Ebola that last at least 10 years, but it is unclear whether they are immune to additional infections. EVD in humans is caused by four of six viruses of the genus Ebolavirus . The four are Bundibugyo virus (BDBV), Sudan virus (SUDV), Taï Forest virus (TAFV) and one simply called Ebola virus (EBOV, formerly Zaire Ebola virus). EBOV, species Zaire ebolavirus ,

8528-459: The signalling proteins STAT1 and STAT2 are activated and move to the cell's nucleus . This triggers the expression of interferon-stimulated genes , which code for proteins with antiviral properties. EBOV's V24 protein blocks the production of these antiviral proteins by preventing the STAT1 signalling protein in the neighbouring cell from entering the nucleus. The VP35 protein directly inhibits

8632-460: The skin may create petechiae , purpura , ecchymoses or haematomas (especially around needle injection sites). Bleeding into the whites of the eyes may also occur. Heavy bleeding is uncommon; if it occurs, it is usually in the gastrointestinal tract . The incidence of bleeding into the gastrointestinal tract was reported to be ~58% in the 2001 outbreak in Gabon, but in the 2014–15 outbreak in

8736-450: The technology. Data is still pre-mature as to the efficacy of digital tools. Some stakeholders argue whether it is appropriate to shift contact tracing into a complete digital capacity. Safeguards become topics of contention when designing digital contact tracing tools. Restrictions on which tracking software such as GPS, Wi-Fi, and Bluetooth are used and when those services are turned on are debated among stakeholders. Who has access to

8840-455: The traditional manual methods. Manual methods require a skilled workforce who put in significant hours to diligently follow the steps in contact tracing. This requires a heavy investment from the government, which at times is not feasible. Manual contact tracing is not suited to detect exposures unknown to the contact, as the process is limited to the interview and known knowledge. Areas such as restaurants and malls make it almost impossible for

8944-598: The treatment tents until it is necessary to enter if e.g. a patient's oxygen levels drop. The infected person should be in barrier-isolation from other people. All equipment, medical waste, patient waste and surfaces that may have come into contact with body fluids need to be disinfected . During the 2014 outbreak, kits were put together to help families treat Ebola disease in their homes, which included protective clothing as well as chlorine powder and other cleaning supplies. Education of caregivers in these techniques, and providing such barrier-separation supplies has been

9048-415: The use of Bluetooth on smartphones for this in 2018. On 10 April 2020, Apple and Google , which account for most of the world's mobile operating systems , announced COVID-19 apps for iOS and Android . Relying on Bluetooth Low Energy (BLE) wireless radio signals for proximity information, the new tools would warn people that they had been in contact with who are infected by SARS-CoV-2 . With

9152-403: The use of technology, certain limitations and challenges come with the territory. Tracking technology might not accurately notify individuals who have been exposed. Bluetooth does not differentiate between walls and structure, prompting incorrect notification of exposures. For instance, people separated by walls in an office building can be notified as exposed, even if they never interfaced with

9256-414: The viral nucleocapsid . The Ebolavirus structural glycoprotein (known as GP1,2) is responsible for the virus' ability to bind to and infect targeted cells. The viral RNA polymerase , encoded by the L gene, partially uncoats the nucleocapsid and transcribes the genes into positive-strand mRNAs , which are then translated into structural and nonstructural proteins. The most abundant protein produced

9360-535: The virus and that the filoviruses are present in Asia. Between 1976 and 1998, in 30,000 mammals, birds, reptiles, amphibians and arthropods sampled from regions of EBOV outbreaks, no Ebola virus was detected apart from some genetic traces found in six rodents (belonging to the species Mus setulosus and Praomys ) and one shrew ( Sylvisorex ollula ) collected from the Central African Republic . However, further research efforts have not confirmed rodents as

9464-399: The virus include the nose, mouth, eyes, open wounds, cuts and abrasions. Ebola may be spread through large droplets ; however, this is believed to occur only when a person is very sick. This contamination can happen if a person is splashed with droplets. Contact with surfaces or objects contaminated by the virus, particularly needles and syringes, may also transmit the infection. The virus

9568-572: The virus is most reliable in the later stages of the disease and in those who recover. IgM antibodies are detectable two days after symptom onset and IgG antibodies can be detected six to 18 days after symptom onset. During an outbreak, isolation of the virus with cell culture methods is often not feasible. In field or mobile hospitals, the most common and sensitive diagnostic methods are real-time PCR and ELISA. In 2014, with new mobile testing facilities deployed in parts of Liberia, test results were obtained 3–5 hours after sample submission. In 2015,

9672-428: The virus takes place. From there the virus can enter the bloodstream and lymphatic system and spread throughout the body. Macrophages are the first cells infected with the virus, and this infection results in programmed cell death . Other types of white blood cells , such as lymphocytes , also undergo programmed cell death leading to an abnormally low concentration of lymphocytes in the blood. This contributes to

9776-434: The virus. Fruit production, animal behavior and other factors may trigger outbreaks among animal populations. Evidence indicates that both domestic dogs and pigs can also be infected with EBOV. Dogs do not appear to develop symptoms when they carry the virus, and pigs appear to be able to transmit the virus to at least some primates. Although some dogs in an area in which a human outbreak occurred had antibodies to EBOV, it

9880-463: The virus. On TLR activation, proteins including interferon regulatory factor 3 and interferon regulatory factor 7 trigger a signalling cascade that leads to the expression of type 1 interferons . The type 1 interferons are then released and bind to the IFNAR1 and IFNAR2 receptors expressed on the surface of a neighbouring cell. Once interferon has bound to its receptors on the neighbouring cell,

9984-422: The weakened immune response seen in those infected with EBOV. Endothelial cells may be infected within three days after exposure to the virus. The breakdown of endothelial cells leading to blood vessel injury can be attributed to EBOV glycoproteins . This damage occurs due to the synthesis of Ebola virus glycoprotein (GP), which reduces the availability of specific integrins responsible for cell adhesion to

10088-546: The week following each negative test in U.S. counties. These results suggest that people who tested negative underestimated the risk of exposure when they traveled or visited. <Robertson, LS. Roads to COVID-19 Containment and Spread. </New York: Austin Macauley, 2023.> As self-administered, home-based tests became increasingly used as the primary method to detect SARS-CoV-2, fewer cases were reached for case investigation and contact tracing by public health departments. As

10192-432: The wild animals used for consumption may result in a corresponding human outbreak. Since 2003, such animal outbreaks have been monitored to predict and prevent Ebola outbreaks in humans. If a person with Ebola disease dies, direct contact with the body should be avoided. Certain burial rituals , which may have included making various direct contacts with a dead body, require reformulation so that they consistently maintain

10296-524: Was achieved by exhaustive contact tracing to find all infected persons. This was followed by isolation of infected individuals and immunization of the surrounding community and contacts at-risk of contracting smallpox. Contact tracing can help identify the etiology of a disease outbreak. In 1984, contact tracing provided the first direct evidence that AIDS may be spread by an infectious agent during sexual contacts. The infective agent has since been identified as HIV . Diseases for which contact tracing

10400-462: Was approved by the US FDA in December 2019. While there is no approved treatment for Ebola as of 2019 , two treatments ( atoltivimab/maftivimab/odesivimab and ansuvimab ) are associated with improved outcomes. Supportive efforts also improve outcomes. These include oral rehydration therapy (drinking slightly sweetened and salty water) or giving intravenous fluids , and treating symptoms. In October 2020, atoltivimab/maftivimab/odesivimab (Inmazeb)

10504-692: Was approved for medical use in the United States to treat the disease caused by Zaire ebolavirus . Ebola was first identified in 1976, in two simultaneous outbreaks, one in Nzara (a town in South Sudan ) and the other in Yambuku ( the Democratic Republic of the Congo ), a village near the Ebola River , for which the disease was named. Ebola outbreaks occur intermittently in tropical regions of sub-Saharan Africa . Between 1976 and 2012, according to

10608-505: Was approved in the United States in December 2019. It appears to be fully effective ten days after being given. It was studied in Guinea between 2014 and 2016. More than 100,000 people have been vaccinated against Ebola as of 2019 . The WHO reported that approximately 345,000 people were given the vaccine during the Kivu Ebola epidemic from 2018 to 2020. Community awareness of the benefits on survival chances of admitting cases early

10712-489: Was challenging as it affected relationships among individuals and community members. In addition, public health officials targeted certain populations such as sex workers, minorities, and at-risk populations further eliciting feeling of fear, shame, and guilt in society. With these negative implications of contact tracing, particularly in the space of sexually transmitted infections, public health officials found it difficult to elicit information from exposed individuals. During

10816-433: Was positively correlated with isolation and quarantine. However, most adults with COVID-19 isolated and self-notified contacts regardless of whether the public health workforce was able to reach them. Identifying and reaching contacts was challenging and limited the ability to promote quarantining, and testing. Forward tracing is the process of looking for contacts after infection, so as to prevent further disease spread. It

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