Ebola is a fatal virus found in humans which causes hemorrhagic fever. It is also known as Zaire Ebola Virus in short EBOV. It also infects the animals. The epidemics caused by it is called the EVD i.e. Ebola Virus Disease. This is a deadly virus spread through animals to humans by direct or indirect contacts. But when found infected, it is a contagious disease, which spread rapidly in human beings and animals. Acute care must be taken when such epidemic outbreak happens. Its name is adopted from the Ebola River where its second epidemic outbreak was reported in Congo. It is predominantly detected in the African continent. It is classified in the Mononegavirales order of Filoviridae class which causes internal bleeding and high fever. Recently a vaccine is discovered and is pending for approval to test with human beings. More ebola.

MEASLES

Measles is an acute highly infectious disease of childhood cause by a specific virus of the group Myxoviruses. Measles is also known as English measles, morbii or rubeola and causes the infection of respiratory system, immune system and skin. The disease is clinically characterized by fever, symptoms of the upper respiratory tract followed by a typical rash.

TRANSMISSION:

Paramyxovirus is an enveloped RNA virus and so far only one serotype is known. The only source of infection is a case of measles. Carriers are not known to occur. Transmission occurs directly from person to person mainly by droplet infection (coughing and sneezing) and via close personal contact or direct contact with secretions from 4 days before onset of rash until 5 days thereafter. The portal of entry in a human being is the respiratory tract.

The virus virtually affects everyone between 6 months and 3 years of age in developing countries and older children usually over 5 years in developed countries. The incubation period is commonly 10 days from exposure to onset of fever and 14 days to appearance of rash.

CLINICAL FEATURES:

There are three stages in the natural history of measles which are as follows:

Prodromal Stage:

It begins 10 days after infection and lasts until about the 14th day. This stage is characterized by high fever, watering of eyes with sneezing, nasal discharge, cough, redness of eyes and often photophobia. There may be vomiting or diarrhea. A day or two before the rash appears, Koplik’s spots – small bluish white spots on a red base, smaller than a head of a pin appear on the buccal mucosa opposite the first and second lower molars. Their presence is pathognomonic of measles.

Eruptive Stage:

This phase is characterized by a typical, dusky-red, macular or maculo-popular rash. This rash begins behind the ears and spreads rapidly in a few hours over the face and neck and extends down to the body taking about 2 to 3 days to progress to the lower limbs. If no complications develop, the rash and the fever disappears in another 3 or 4 days which marks the end of the disease. The rash disappears in the same order of appearance leaving behind a brownish discoloration that may persist for 2 months or more.

During the prodromal stage and the first 2 to 5 days of the rash, the virus is present in all bodily fluids. Just as the rash appears the antibodies against virus become detectable, the viraemia disappears and the fever falls.

Post-Measles Stage:

The child may have lost weight and will remain weak for a number of days. Mostly children recover from measles. In a few cases, they may develop a number of complications. One attack of measles generally confers life-long immunity.

COMPLICATIONS:

The most common complications associated with measles are measles-associated diarrhea, pneumonia and other respiratory complications and otitis media. The more serious complications are neurological complications which include febrile convulsions, and encephalitis. Measles in pregnancy is associated with spontaneous abortion and premature delivery.

DIAGNOSIS:

Clinical diagnosis of measles requires a history of fever for at least 3 days with at least cough, coryza or redness of eyes. Observation of Koplik’s spots is diagnostic. In developed countries, where measles is uncommon, specific IgM antibodies are used for diagnosis. The measles virus can also be isolated from the RNA from the respiratory system of the infected individual.

TREATMENT:

There is no specific treatment for measles. Most people recover in a few days with rest and supportive treatment. However it is wise to seek medical treatment if the patient becomes further unwell as he may be developing complications. Other treatment includes treating the symptoms with Iboprufen or paracetamol to reduce fever and pain. Vitamin A use is found to be beneficial in children aged under two years.

PREVENTION:

Generally children are vaccinated against measles at the age of 12 months in developed countries as a part of the MMR vaccine (Measles, Mumps and Rubella). The vaccine is not given earlier as maternal antibodies provide sufficient protection during pregnancy against the disease and may persist in the new born which hampers the vaccine to be effective. A second dose is usually given to children between the ages of four to five.

In countries where measles in endemic, WHO doctors recommend two doses to be given at the age of nine and fifteen months. Where measles is highly endemic or in an area where sudden outbreak is experienced, the recommended ages of two doses is six and nine months. The vaccine should be given to all children regardless they are HIV infected or not. It isn’t found to be very effective in HIV infected children but with anti-retroviral therapies, the effectiveness of the vaccine can be increased.

Vaccination programs for measles are often used to deliver other kinds of child health interventions too e.g. vitamin A supplements, bed nets to protect against malaria and anti-parasite medicine etc.

MEASLES CASES AND OUTBREAKS:

In 2015, 68 people from 11 states in the US have been diagnosed with measles. Most of these cases are a part of the large outbreak that is linked to the amusement park in California. The US also experienced a record number of cases in 2014 with 644 cases from 27 states which is by far the greatest number of cases since measles elimination was documented in 2000. Most of the cases who contracted measles were unvaccinated. Also, travelers with the disease continue to bring measles into the country and it can spread in communities that are unvaccinated.

BOURBON VIRUS

Bourbon virus is a newly discovered virus first isolated in the Bourbon County, Kansas from a man who died after contracting the disease. It is a type of a thogotovirus from the family of Orthomyxoviridae RNA viruses. Although many closely related viral genomes are found in Eastern Europe, Asia and Africa, this is the first time that a thogotovirus has been identified in the Western Hemisphere. However none of the closely related viruses in those regions are known to cause disease in man.

CASE FINDINGS:

Bourbon virus has been isolated from a single individual in the United States last summer who died from the disease. In a video posted by University of Kansas Hospital, Dr. Dana Hawkinson who treated the patient talked about the stranger aspects of the disease.

“I think we have to assume this has been around for some time, and we haven’t been able to diagnose it,” Dr. Hawkinson told the New York Times. “We suspect there have been milder cases and people have recovered from them, but we don’t have a lot of information.”

Public health authorities intend to test other patients in Kansas who had similar symptoms as Bourbon virus disease but could not be diagnosed to determine if they have been infected by the new virus. This will help in determining the prevalence of the disease.

FEATURES:

Currently the ability of the virus to cause disease in human beings is unknown. No incubation period of the disease has been identified. The spectrum of the disease has not be established either. No vector other than ticks is known.

The United States of America is the home to many tick-borne diseases such as Q fever, Tularemia, Rocky Mountain Spotted fever etc. but Bourbon virus gives negative laboratory findings to almost all the lab tests of tick-borne diseases.

CLINICAL FINDINGS:

The patient who contracted the disease suffered from the following signs and symptoms:

  • High grade fever
  • Headache
  • Muscular pain
  • Nausea
  • Loss of appetite
  • And ultimately multiple organ failure.

The patient also demonstrated laboratory abnormalities similar to tick-borne diseases such as:

  • Decreased white cell count
  • Decreased red cell count
  • Deranged liver enzymes

The previously healthy patient died after only 10 days in the hospital. As there has been only a single case of the virus, it is not yet known if the virus is usually deadly or if milder cases of the viruses might occur from which patients can recover.

TREATMENT:

Although most tick-borne diseases are typically cured by antibiotics, the Kansas patient did not respond to any antibiotics as the disease causing agent was a virus. At this time there is no known vaccine, medication or treatment for Bourbon virus disease. Since the disease is transmitted through tick bites, the risk of getting the disease during winters is minimum.

PREVENTION:

In order to prevent tick borne or insect borne illnesses it is recommended that people:

  • Cover themselves adequately by wearing clothing with long sleeves and pants
  • Use products that contain permethrin on clothes
  • Use insect repellants when outside
  • Conduct a full body tick check after spending times outdoors
  • Avoid hiking in bushy areas and places with high grass
  • Examine pets and gear as ticks can ride home and then attach to people later
  • Bathe and shower as soon as coming inside after spending time outdoors
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