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#4604, 13 August 2014
 
Ebola: Concerns for India
N Manoharan
Fellow, National Maritime Foundation (NMF), New Delhi
 

Should India be worried about the outbreak of Ebola virus in Western Africa that is more than 9000 km away? Is the situation so alarming? What it Ebola all about? What are the counter-measures required?

In an increasingly globalised world, no distance is far away. It is a matter of few hours by direct flight. The virus has been spreading fast. Thankfully, it is not an airborne disease. It is however communicable. Since the first case of outbreak reported in February 2014 in Guinea, the disease has spread to Sierra Leone, Liberia and recently to Nigeria, all along the West African coast. The main vector is the traveller, both within and outside the continent. Saudi Arabia has reported a case of an infected person, a returnee from Sierra Leone. The US has airlifted two of its infected citizens; Spain had flown an affected priest who has since passed. Usually an inland phenomenon, it is intriguing why the Ebola virus is spreading along the coast this time. The current outbreak has so far claimed over 900 lives, in addition to 2000 infected; more deadly than all the hitherto Ebola outbreaks. The cause for worry is the fact that the Ebola disease has neither a vaccine nor curative medicine; once infected there is only a 10 per cent chance of survival.

The disease took its name from the Ebola River, the site of the first outbreak in 1976 in the Democratic Republic of Congo (then Zaire). Genus Ebolavirus is one of three members of the filovirus family (the other two being Marburg Virus and Cueva Virus). Interestingly, Ebola Virus comprises five distinct species: Bundibugyo ebolavirus (BDBV), Zaire ebolavirus (EBOV), Sudan ebolavirus (SUDV), Reston ebolavirus (RESTV) and Taï Forest ebolavirus (TAFV). The present outbreak is EBOV, considered the most dangerous of all. The incubation period is 21 days.

According to the World Health Organisation (WHO), symptoms of the disease include the sudden onset of fever, intense weakness, muscle pain, headache and sore throat followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Patients report low white blood cell and platelet counts and elevated liver enzymes. These symptoms are broadly similar to one or the other diseases like malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers. This makes diagnosis all the more difficult.

Ebola is a zoonotic disease transmitted to people by wild animals or by other infected patients. Fruit bats are considered Ebola’s ‘reservoir host’, in which a pathogen or virus lives inconspicuously without causing symptoms. That means the geographic distribution of inhabitation of fruit bats is prone to Ebola. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. 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.

The outbreak is more concerning for India because of its increasing footprints in Africa. Nearly 50,000 Indian citizens are working in the affected West African countries alone. They range from businessmen, labourers, professionals and peacekeepers who travel back home frequently. India-Africa trade is about USD 35 billion. Oil is an important component of the trade, especially from Nigeria, Ghana, Equatorial Guinea, Côte d’Ivoire and Sudan, which are Ebola-prone countries.

India has stepped up preventive measures like screening and tracking of passengers originating or transiting from the region and travel advisory to defer non-essential travel to Africa, and rightly so. But this is not enough. All transit destinations like Dubai need to be alerted; flights and passengers from these transits should be screened. Maldives has already issued similar health alerts. Sri Lanka needs to follow as Colombo airport is a major travel hub. Oil-tankers and other merchant vessels have to be sanitised adequately. It is also important to raise awareness among the common man on the risk factors. Thorough cooking of animal products like milk and meat is advisable. Then, there are protective measures that require to be adopted by people closer to the patients like avoiding close physical contacts, wearing gloves and appropriate personal protective equipment when taking care of ill patients at home, regular hand washing with disinfectant after visiting patients, and prompt and safe cremation of those died of the disease. If ignored, consequences can be catastrophic in terms of lives, socio-economic disruption and spread to other countries. The longer the outbreak in West Africa persists, the more the chances for the Ebola virus to mutate and adapt. That is the main worry in the long-run.

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