Few events affected laboratory medicine as acutely or abruptly as the widespread hysteria associated with the first laboratory confirmed case of Ebola in the United States on September 30, 2014. Clinical laboratories around the country were put on high alert—coordinating response teams, validating point-of-care instrumentation, and hoping that they would not be the next hospital faced with a “rule-out” Ebola patient. In retrospect, the experience with Ebola in the United States has been limited, with all patients being treated at one of four biocontainment facilities specially equipped to treat and contain highly infectious and lethal diseases. But Ebola did provide the opportunity for us as laboratorians to assess our preparedness in the face of a global epidemic, which many experts predict could occur in the next couple of decades.
Experts with first-hand experience treating patients with Ebola will speak at an afternoon symposium today, “Ebola Virus Disease: Inside the Serious Communicable Diseases Unit at Emory University Hospital.” Eileen Burd, PhD will provide an overview of the physical layout, maintenance, and activation of the Serious Communicable Diseases Unit (SCDU) at Emory University Hospital where four patients with Ebola virus disease were treated. Next, Colleen Kraft, MD will describe the clinical course of Ebola virus disease and the aggressive care, especially rehydration and correction of metabolic abnormalities. Lastly, Crystal Evans, MT(ASCP) will provide a snapshot of the journey and challenges encountered by the point of care section while providing near patient testing in the SCDU. Together, their unique perspective will provide insight into how we as laboratorians can provide state of the art diagnostic testing under extraordinary circumstances.
A member of the Filoviridae family of hemorrhagic fever virus, the culprit of the current outbreak is the species Zaire ebolavirus. The animal reservoir for the virus is the fruit bat, with transmission to humans occurring by direct contact with infected tissue or fluids.
It is important to emphasize that there is no evidence that human-to-human transmission can occur by coughing or sneezing. This idea was widely debated and fed the national panic. Symptoms, while somewhat nonspecific, often include fever, fatigue, and diarrhea and present from 2-21 days after exposure. Definitive diagnosis is made by detection of the virus in the blood using the polymerase chain reaction (PCR). Treatment for Ebola is primarily supportive, including management of fluid and electrolyte levels, nutritional support, and transfusion of blood components as needed. Treatment with ZMapp, an experimental cocktail of three Ebola virus glycoprotein-specific monoclonal antibodies (Mapp Biopharmaceutical and LeafBio) as well as administration of convalescent serum from Ebola survivors have been used, but inferences with respect to the benefit of such treatment are impossible without a controlled clinical trial.
While Ebola has not escalated to pandemic status, primarily because of its mode of transmission, it has allowed global health organizations to recognize the challenges facing local healthcare teams across the world. Recent experience with SARS in 2003 and H1N1 in 2009 has mobilized an international collaboration of scientists to model the progression of outbreaks as they happen in an effort to contain an outbreak.
It is impossible to be completely prepared for the unknown. But accurate information, awareness, and collaboration—all of which have all been elevated in response to Ebola—provide the foundation for whatever lies ahead.