EBOLA VIRUS - Potentially Sexually Transmitted

Electron micrograph of an Ebola virus virion

The Ebola Virus Disease (EVD) formerly known as Ebola Hemorrhagic Fever (EHF) has now claimed 2296 lives in the West African region, the World Health Organisation (WHO) reported on Tuesday. The death toll has jumped by almost 200 in a single day and has been described by the WHO as “the largest and most severe and most complex we have ever seen”, since it was first discovered in 1976.

More than 40 percent of the deaths have occurred in 3 weeks leading up to 3 September; WHO says indicating that the epidemic is fast outpacing efforts to control it.

Sexual Transmission of the Ebola is potentially a reason for this ferocious spread. In a 2007 report published in The Journal of Infectious Diseases entitled Assessment of the Risk of Ebola Virus Transmission from Bodily Fluids of Fomites written by an Associate Professor in the Department of Tropical Medicine at Tulane University Health Sciences Centre, Daniel Bausch has shown that Ebola can be transmitted sexually even after the man has recovered from the disease. He said, “The isolation of EBOV (Ebola Virus) from semen 40 days after the onset of illness underscores the risk of sexual transmission of the filoviruses during convalescence. Zaire EBOV has been detected in the semen of convalescent patients by virus isolation (82days)... Marbug virus has also been isolated from the semen and linked conclusively to sexual transmission 13 weeks in convalescence.”

The WHO has cited a specific instance when the Ebola virus was found in the semen of a man 61days after recovery. Medical Director of Emory University Hospital in Atlanta’s Infectious Disease Unit, Bruce Ribner has also said, “Many survivors actually have the virus in their semen or vaginal secretions. Many of these must be sexually active and henceforth, sexual intimacy might be the reason for the uncontrolled spreading of this epidemic.” This also implies that vaginal secretions of an infected woman and one that is in convalescence also carries the Ebola virus and henceforth can sexually transmit it to their partner.

Henceforth the Centre for Disease Control and Prevention which hosted a special hour-long Twitter chat to answer questions on Ebola has cautioned people to abstain from sex or to alternatively use condoms for up to 3 months after recovering from Ebola.

Ebola can also be transmitted from mother-to-child through breast milk, Bausch's research findings also revealed. He stated, “In-fact, breastfed children of the mothers whose milk was later tested in this study, died of laboratory confirmed EHF during early stages of the outbreak.” The research also proved that transmission of the virus from breast milk may occur even during convalescence. Hence Bausch advised mothers who survive EHF to avoid breastfeeding and contact with the mucous membranes of the eye for at least 3 months after recovery to avoid transmitting the virus to their infant. An epidemiologist at the Center of Disease Control and Prevention, Dr. Barbara Krust has said women were instructed to wean any children who have been breastfeeding because the Ebola virus tends to linger on in breast milk even after the woman has recovered.

Health Worker being sprayed clean with chlorine solution at
Foya Ebola management centre in Liberia. (Source: www.msf.org)

The WHO has recorded 4293 cases from West African countries as of 6 September but it still did not have new figures for Liberia, the worst affected country, suggesting the true toll is already much higher. Liberia has accounted for half of all the fatalities. Below are the latest statistics of the Ebola infections and fatalities from the WHO as of 6 September 2014;

	Total Number of People Infected	Deaths
	4293	2296
Liberia	2046	1224
Sierra Leone	1361	509
Guinea	862	555
Nigeria	21	8
Senegal	3	0

WHO says support teams are struggling to contain the disease as well as adequately attend to all patients due to the lack of resources. It sites as an example the need for up to 1000 beds in a case where they only have 240. Infected people were being driven to treatment centers only to be turned away, return home and create ‘flare-ups’ of deadly fever in their village. This, coupled with poor health care in these West African countries together with difficulties associated with the caring of patients poses a non-near-future containment of the disease. 

The name of the disease, 'Ebola' originates from the first recorded outbreak in 1976 in Yambuku, Democratic Republic of Congo (then Zaire) which lies on the Ebola River. There is no known cure or licensed vaccine for the virus and the use of experimental drugs has been deemed unethical.

So many are dying in such a painful and gruesome way, and the pictures are hardly easy on the eye. One United Nations Children's agency worker has described the situation in Liberia as "Biological war" and this is very much different from other forms of war zones where you get journalists streaming over to get pictures, interviews and exclusive stories. This place is exclusively voluntarily 'out of bounds'.