Ebola virus disease

Key facts

• Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.
• EVD outbreaks have a case fatality rate of up to 90%.
• EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.
• The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.
• Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.
• Severely ill patients require intensive supportive care. No licensed specific treatment or vaccine is available for use in people or animals.

Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.

Genus Ebolavirus is 1 of 3 members of the Filoviridae family (filovirus), along with genus Marburgvirus and genus Cuevavirus. Genus Ebolavirus comprises 5 distinct species:

• Bundibugyo ebolavirus (BDBV)
• Zaire ebolavirus (EBOV)
• Reston ebolavirus (RESTV)
• Sudan ebolavirus (SUDV)
• Taï Forest ebolavirus (TAFV).

BDBV, EBOV, and SUDV have been associated with large EVD outbreaks in Africa, whereas RESTV and TAFV have not. The RESTV species, found in Philippines and the People’s Republic of China, can infect humans, but no illness or death in humans from this species has been reported to date.

Transmission

Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

Among workers in contact with monkeys or pigs infected with Reston ebolavirus, several infections have been documented in people who were clinically asymptomatic. Thus, RESTV appears less capable of causing disease in humans than other Ebola species.

However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of RESTV are needed before definitive conclusions can be drawn about the pathogenicity and virulence of this virus in humans.

Signs and symptoms

EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

People are infectious as long as their blood and secretions contain the virus. Ebola virus was isolated from semen 61 days after onset of illness in a man who was infected in a laboratory.

The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days.

Diagnosis

Other diseases that should be ruled out before a diagnosis of EVD can be made include: malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers.

Ebola virus infections can be diagnosed definitively in a laboratory through several types of tests:

• antibody-capture enzyme-linked immunosorbent assay (ELISA)
• antigen detection tests
• serum neutralization test
• reverse transcriptase polymerase chain reaction (RT-PCR) assay
• electron microscopy
• virus isolation by cell culture.

Samples from patients are an extreme biohazard risk; testing should be conducted under maximum biological containment conditions.

Vaccine and treatment

No licensed vaccine for EVD is available. Several vaccines are being tested, but none are available for clinical use.

Severely ill patients require intensive supportive care. Patients are frequently dehydrated and require oral rehydration with solutions containing electrolytes or intravenous fluids.

No specific treatment is available. New drug therapies are being evaluated.

Natural host of Ebola virus

In Africa, fruit bats, particularly species of the genera Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata, are considered possible natural hosts for Ebola virus. As a result, the geographic distribution of Ebolaviruses may overlap with the range of the fruit bats.

Ebola virus in animals

Although non-human primates have been a source of infection for humans, they are not thought to be the reservoir but rather an accidental host like human beings. Since 1994, Ebola outbreaks from the EBOV and TAFV species have been observed in chimpanzees and gorillas.

RESTV has caused severe EVD outbreaks in macaque monkeys (Macaca fascicularis) farmed in Philippines and detected in monkeys imported into the USA in 1989, 1990 and 1996, and in monkeys imported to Italy from Philippines in 1992.

Since 2008, RESTV viruses have been detected during several outbreaks of a deadly disease in pigs in People’s Republic of China and Philippines. Asymptomatic infection in pigs has been reported and experimental inoculations have shown that RESTV cannot cause disease in pigs.

Prevention and control

Controlling Reston ebolavirus in domestic animals

No animal vaccine against RESTV is available. Routine cleaning and disinfection of pig or monkey farms (with sodium hypochlorite or other detergents) should be effective in inactivating the virus.

If an outbreak is suspected, the premises should be quarantined immediately. Culling of infected animals, with close supervision of burial or incineration of carcasses, may be necessary to reduce the risk of animal-to-human transmission. Restricting or banning the movement of animals from infected farms to other areas can reduce the spread of the disease.

As RESTV outbreaks in pigs and monkeys have preceded human infections, the establishment of an active animal health surveillance system to detect new cases is essential in providing early warning for veterinary and human public health authorities.

Reducing the risk of Ebola infection in people

In the absence of effective treatment and a human vaccine, raising awareness of the risk factors for Ebola infection and the protective measures individuals can take is the only way to reduce human infection and death.

In Africa, during EVD outbreaks, educational public health messages for risk reduction should focus on several factors:

• Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.
• Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their bodily fluids. Close physical contact with Ebola patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.
• Communities affected by Ebola should inform the population about the nature of the disease and about outbreak containment measures, including burial of the dead. People who have died from Ebola should be promptly and safely buried.

Pig farms in Africa can play a role in the amplification of infection because of the presence of fruit bats on these farms. Appropriate biosecurity measures should be in place to limit transmission. For RESTV, educational public health messages should focus on reducing the risk of pig-to-human transmission as a result of unsafe animal husbandry and slaughtering practices, and unsafe consumption of fresh blood, raw milk or animal tissue. Gloves and other appropriate protective clothing should be worn when handling sick animals or their tissues and when slaughtering animals. In regions where RESTV has been reported in pigs, all animal products (blood, meat and milk) should be thoroughly cooked before eating.

Controlling infection in health-care settings

Human-to-human transmission of the Ebola virus is primarily associated with direct or indirect contact with blood and body fluids. Transmission to health-care workers has been reported when appropriate infection control measures have not been observed.

It is not always possible to identify patients with EBV early because initial symptoms may be non-specific. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices at all times. These include basic hand hygiene, respiratory hygiene, the use of personal protective equipment (according to the risk of splashes or other contact with infected materials), safe injection practices and safe burial practices.

Health-care workers caring for patients with suspected or confirmed Ebola virus should apply, in addition to standard precautions, other infection control measures to avoid any exposure to the patient’s blood and body fluids and direct unprotected contact with the possibly contaminated environment. When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

Laboratory workers are also at risk. Samples taken from suspected human and animal Ebola cases for diagnosis should be handled by trained staff and processed in suitably equipped laboratories.

WHO response

WHO provides expertise and documentation to support disease investigation and control.

Recommendations for infection control while providing care to patients with suspected or confirmed Ebola haemorrhagic fever are provided in: Interim infection control recommendations for care of patients with suspected or confirmed Filovirus (Ebola, Marburg) haemorrhagic fever, March 2008. This document is currently being updated.

WHO has created an aide–memoire on standard precautions in health care (currently being updated). Standard precautions are meant to reduce the risk of transmission of bloodborne and other pathogens. If universally applied, the precautions would help prevent most transmission through exposure to blood and body fluids.

Standard precautions are recommended in the care and treatment of all patients regardless of their perceived or confirmed infectious status. They include the basic level of infection control—hand hygiene, use of personal protective equipment to avoid direct contact with blood and body fluids, prevention of needle stick and injuries from other sharp instruments, and a set of environmental controls.

Table: Chronology of previous Ebola virus disease outbreaks

Year	Country	Ebolavirus species	Cases	Deaths	Case fatality
2012	Democratic Republic of Congo	Bundibugyo	57	29	51%
2012	Uganda	Sudan	7	4	57%
2012	Uganda	Sudan	24	17	71%
2011	Uganda	Sudan	1	1	100%
2008	Democratic Republic of Congo	Zaire	32	14	44%
2007	Uganda	Bundibugyo	149	37	25%
2007	Democratic Republic of Congo	Zaire	264	187	71%
2005	Congo	Zaire	12	10	83%
2004	Sudan	Sudan	17	7	41%
2003 (Nov-Dec)	Congo	Zaire	35	29	83%
2003 (Jan-Apr)	Congo	Zaire	143	128	90%
2001-2002	Congo	Zaire	59	44	75%
2001-2002	Gabon	Zaire	65	53	82%
2000	Uganda	Sudan	425	224	53%
1996	South Africa (ex-Gabon)	Zaire	1	1	100%
1996 (Jul-Dec)	Gabon	Zaire	60	45	75%
1996 (Jan-Apr)	Gabon	Zaire	31	21	68%
1995	Democratic Republic of Congo	Zaire	315	254	81%
1994	Cote d'Ivoire	Taï Forest	1	0	0%
1994	Gabon	Zaire	52	31	60%
1979	Sudan	Sudan	34	22	65%
1977	Democratic Republic of Congo	Zaire	1	1	100%
1976	Sudan	Sudan	284	151	53%
1976	Democratic Republic of Congo	Zaire	318	280	88%

Foods That Improve Sperm Quality

What foods should I eat to improve my sperm quality?

Before we continue, we should know first about How is sperm quality measured? The World Health Organization identified five factors to assess sperm quality. All five are necessary for the best chances of conception:

• Number of sperm cells
• Concentration of sperm
• Sperm Motility
• Speed
• Morphology

For more information about normal parameters of sperm quality and what affects it you might want to check Sperm Disorders, Causes, and Treatments, with Video

So, what foods should i eat to improve my sperm quality? There are many studies that suggest eating foods rich in :

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• Zinc has been shown to increase number of sperm and sperm motility by 80% to 200% by aiding testosterone synthesis. Coupled with amino acids like L-Carnitine and L-Arginine, zinc should increase ejaculate volume significantly. Good sources of zinc is oysters. Bananas, avocado and almond or other nuts are also rich in zync.

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• Vitamin A has been shown to enhance sperm production and affect overall sperm quality. Good sources of Vitamin A are carrots, milk, chicken, fish oils, butter, cheese, eggs, and liver. Deficiencies in vitamin A in men have been linked to lowered fertility due to sluggish sperm,

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• Vitamin Cis another important nutrient that has been shown to improve sperm production and the motility of sperm cells. Good sources of Vitamin C are strawberries, oranges, broccoli, and kiwi fruit. According to practitioners, Vitamin C decreases sperm abnormalities and increases sperm number and quality. Vitamin C plays an especially important role in protecting the sperm’s genetic material (DNA) from damage. Ascorbic acid levels are much higher in seminal fluid than in other body fluids, including the blood.

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• Vitamin E is found in almonds, sunflower seeds, hazelnuts, peanut butter, peanuts, spinach, and broccoli. vitamin E is easy to find in food. studies show that men who have increased levels of vitamin E in their diet, have higher fertilization rates and better sperm motility than men who don’t have high levels of vitamin E.

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• Selenium is an antioxidant that can prevent chromosome breakage (a problem linked to both birth defects and miscarriages). Garlic is rich in selenium and therefore is a must for a fertility diet. Selenium and vitamins C and E can improve both your sperm cells’ production and their motility (swimming action)

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• L-Arginineis shown to double sperm and semen in recent studies; sperm health and activity also increase. Good sources of arginine include dairy products, beef, pork, granola, oatmeal, and nuts. Preliminary research indicates that taking L Arginine over a period of months helps boost sperm count, according to the University of Michigan Health System website. But in men with extremely low natural sperm count, L Arginine seems to be little or no help.

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• L-Carnitine is found in high concentrations in healthy sperm. Proven to significantly increase the percentage of highly motile sperm. This compound is biosynthesized from the amino acids lysine and methionine. L-Carnitine plays a powerful role in sperm formation, sperm maturation, and the maintenance of sperm quality. Beef is where you find high doses of L-carnitine, and there are small amounts in asparagus, and leafy greens. It is found in trace amounts from some select nuts and seeds.

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• Lycopene is the most common carotenoid in the human body and a very potent antioxidant. Lycopene has been shown to increase sperm quality. Fruits and vegetables that are high in lycopene include tomatoes, watermelon, pink grapefruit, pink guava, papaya, and red bell pepper. Armand Zini, MD, associate professor of surgery at McGill University in Montreal, addressed this issue during the 2004 meeting of the American Dietetic Association (ADA). He reported that oxidative damage is linked to male infertility, as is a low semen lycopene level.

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• Dont forget to drink enough WATER!. Dehydration is the number one cause of poor sperm production. Sperm components is mostly from water. Try to eat at least 8 glass of water a day.

How To Do It All In One Easy Step

When you eat a healthy, well-balanced diet that includes five servings of fruit and vegetables, two to three servings of dairy and protein products plus about five to six servings of grains, you automatically take in all the vitamins and minerals you need you need to produce healthy and high quality sperms every day. It is not recommended to eat the same menu over and over, instead well balanced diet is the key to maintain maximum benefit of every nutrients in food.

Beside foods, what should I do?

Other important lifestyle changes can also help increase sperm count, such as:

Exercise. Regular exercise will help reduce stress, and also improve your overall health but be careful. Excessive exercise can cause harm, as can certain exercises that may negatively impact the testicles, such as bicycling.

Enough rest. Make sure you sleep adequately about 6-8 hours a day to give the body enough time to regenerate itself, including sperm.

Ejaculating less often. The more often a man ejaculates, the less dense the semen will be. Maintain a gap of three days between ejaculations.

Try to eat organic foods. Some studies suggest a connection between chemical fertilizers and pesticides with both male and female infertility.

Early morning/afternoon ejaculation. It is believed that sperm levels are often highest in the morning, due to the peak testosteron level in the blood.

Lose any excess weight, which tends to cause testosterone/estrogen imbalances

What I Should NOT do?

Sperm quality also can be reduced by a number of factors.

Smoking definitely can lower sperm quality as can Excessive drinking/alcohol or drug use.

Avoid to highly stressing work or job, as stress can increase the amounts of free radicals in your body and therefore decrease your sperm quality.

Too frequent ejaculation can also slow sperm production, so try to wait 2-3 days between ejaculations.

Tight underpants, bathing in hot water for too long, and prolonged periods of sitting/ bicycling as these things have all been shown to lower sperm quality.

Anabolic steroid use and zinc deficiency have also been linked to low sperm quality.

TARO/ TARO ROOT - HEALTH BENEFITS AND USES: TARO AND BEEF CURRY RECIPE beniftis

TARO, DASHEEN, COLOCASIA ESCULENTA, KACHALO IN PUNJABI

Taro is a starchy corm which originated probably in Malaysia andIndia, where it still grows wild. It can grow in wet or dry places although there is one variety which has been bred to only grow in dry ones. It has heart shaped leaves which can be eaten like spinach, and the root looks like a Jerusalem artichoke only bigger. In Urdu it is arvi and kachalo in Punjabi. It was cultivated in the Indian subcontinent by 5000BC. The Hawaiians call it kalo and have really taken to this root over the centuries. It comes into their Creation myth, and they believe that people are related to this root. It is now found throughoutSE Asia and the Pacific Islands. It is known by other names around the world apart from those already listed, in Africa it is the old cocoyam and edoe or eddo is another name for it. It arrived in the Caribbean at some stage, and is now grown in many countries around the globe.

  The taro that grows on dry land is has a dark purple skin and white roots, and has a nutty flavour when cooked, and it must be cooked as it contains calcium oxalate a crystal-like substance that breaks down when cooked. You should take care when peeling taro as it can cause skin irritation.

  The Hawaiians hold this root sacred, and there are various ways of using it. It is used in traditional medicine, and when made into a purple paste they call poi, it turns up at the luaus or pig feasts. Research has been done into the health benefits of poi, and as the root is highly nutritious and easy to digest, it is good for infants who fail to thrive. Recent research has found that the root may be liver protective and can detoxify the liver, although the experiments were carried out in vitro on rat livers. It is also good for people who suffer from allergies.

  In 2004 researchers Amy C. Brown and Ana Valiere found that poi might be beneficial to sufferers of IBS (irritable bowel syndrome), diabetes, a depressed immune system, inadequate lactose digestion and some cancers, and Dr. Brown and others published results in 2005 which suggested that poi “might have novel tumour-specific anti-cancer activities”( Phytotherapy Research Journal 2005).

Taro leaves

  

It is believed that taro corms can help regulate blood pressure and blood sugar, and may help protect us from cardio-vascular disease and cancer.

Taro field

  Taro corms contain vitamins A, C, E and K plus the B-complex ones of thiamin, niacin, riboflavin, B6, folate B12 and pantothenic acid (B5) and choline. It also contains the mineralscalcium, iron, magnesium, manganese, phosphorous, sodium, zinc and selenium, as well as Omega-3 and-6 fatty acids. There are 18amino acids in the corm and bet-carotene, so it is packed with nutrients and a very healthy addition to a diet, which is good as it is a staple food in some Asian and African countries.

  It was also a staple in ancient Egypt and from there it became known to the Greeks and Romans. They ate not only the root or corm, but also the leaves which they say taste a bit like cabbage. I have only eaten the corm, which tasted like a starchy Jerusalem artichoke to me, in fact when I first saw it that’s what I thought it was. You can do the same with a taro corm as with a potato, a sweet potato or even a yam, and add them to soups or stews to thicken them.

  

The leaf juice is used to treat piles and as a laxative in some traditional medicines systems, while in Hawaii poi is mixed with arrowroot for diarrhoea. The heated tubers are applied to joints to ease rheumatic pains, and the raw juice is mixed with other plant juices for fevers. The ash of a burnt coconut shell is mixed with grated corms for thrush (candida) and it is also used for insect stings. In Pakistan and India taro corms are sold on the street in much the same way as in Britain you can buy a baked potato at a stall and take it away to eat.

  Because taro corms contain a fair amount of sodium, you may not want to add salt to them. Try this recipe and is you haven’t got taro you can substitute potatoes or yams.

TARO AND BEEF CURRY

Ingredients

½ kilo beef, cubed

4 large taro corms, peeled and cubed

1 large onion, chopped

3 or 4 garlic cloves, finely chopped

½ tsp mustard seeds

2 or 3 curry leaves

3 tomatoes, roughly chopped

1 tbsp tamarind (imli) paste

½ tsp turmeric (haldi)

1 tsp chilli powder

1 tbsp cumin seeds

2 tsps garam masala

2 tsps dry-fried coriander seeds,ground

1 cup water

oil for frying

Method

Heat the oil in a pan and add the cumin and mustard seed; fry until they release their aroma.

Add the onion, garlic and curry leaves and fry until translucent. Then add the meat and seal it on all sides.

Add the taro corms and fry for 3-4 minutes.

Now add the tomatoes, chilli powder and coriander and fry for 4 minutes.

Add the tamarind pulp cover, with water put a lid on the pot and cook for 30 mins.

Add the garam masala and black pepper, freshly ground if you want to use it (I do, but I can’t not have black pepper).

You shouldn’t need to add more water, but if you do add a little now.

Cook for 10 to 15 minutes then turn off the heat and let it settle for about 10 minutes.

Serve with rice.

This has Taste and is a Treat.