Ebola: The Role of medical laboratory science, public health in humanitarian emergencies in Malawi

As Ebola Virus Disease (EVD) rages across parts of West Africa without signs of abating, it is necessary to spread correct information to our communities. The virus is very aggressive but can be contained by adhering to simple public health measures in spite ofpanphobia it causes.

Lack of robust healthcare facilities in Malawi and many parts of Africa, makes it difficult to manage simple cases, as a result Africa appears to be cursed with disease burdens although the reality is that there is no country or continent that is spared of diseases. In resource-poor settings, it is easy for manageable cases to become overwhelming due to factors such as lack of knowledge, stigma, cultural and religious beliefs and lack of political will.

Isaac Thom Shawa
Isaac Thom Shawa

Ebola is not a ruthless beast that is out there to devour sinners. Despite many unsubstantiated theories about the outbreak, the fact remains ‘Ebola disease is real and natural’. In fact, sustained Ebola denialism is a serious and insidious problem that can antagonise efforts to halt the spread of the virus from reaching Malawi. We cannot afford to experience another impact of denialism as previously observed inearly decades of HIV pandemic.

Briefly,Ebola virusbelongs to Filoviridae family and contains negative-sense ssRNA genome. EVD is a zoonotic disease (transmitted from animals to people) similarly Rabies disease. Rabies virus infects warm blooded animals. Fatality rate for untreated cases isnearly 100%, on the contrary fatality rate for Ebola ranges between 50% – 90%.Rabies and Ebola viruses both belong to the same group of Baltimore viral classification system but their genomes encode different genes, hence different pathogenicity (mechanisms and ability to cause disease).

Ebola virus is able to evade body’s immune system by functionally inactivating infected cells and shielding them from being targeted for destruction. Researchers have tried to immunize non-primate animals with Rabies vaccine, the results showed some potent immune responses produced against Ebola virus.

We therefore anxiously await its successful development but currently there is neither licensed vaccine nor cure for Ebola virus. The experimental drug Zmapp has been reported to be 100% effective in animal studies. There is little information on its efficacy and effectiveness in humans. Contemporary trends show 71.4% effectiveness as two people out of the seven who were given the drug died.

Malawi may be challenged with Ebola screening methods. In the absence of molecular techniques, a comprehensive panel of laboratory investigations must be performed in tandem with clinical data to avoid misdiagnosis which can bring turmoil in the community. Viral antigen detection Enzyme linked immunosorbentassay (ELISA) is accurate and rapid in early stages of EVD.

As the diseases progresses, the patient becomes infectious, viral IgM and IgG immunoglobulins can be detected but in some cases a patient dies before seroconversion. EVD may show the following useful presumptive laboratory findings; Leukopenia (reduced while blood cells), Thrombocytopenia (low platelets), prolonged Prothrombin (PT) and partial thromboplastin times (PTT), normal to raised serum Amylase, Increased Liver function tests (LFTs) among others.

However, the bottle neck is;Ebola virus testing must be performed in a high level biosafety containment conditions. Lack of such biosafety facilities renders Ebola virus testing risky. The University of Malawi trains Medical Laboratory Scientists at College of Medicine who are capable enough to perform some viral diagnostic assays but limited resources renders such services unavailable.

Peradventure there is a suspected case of Ebola virus disease within our community, it would be wise and prudent to avoid unnecessary panic, get down to basics please. Avoid direct contact with victim’s blood or secretions with bare hands.Open wounds must be covered.

Customary handshakes must be minimized whenever possible. I know it is our traditional norm of moral reciprocity, but in crisis, such codes are overridden. Certain cultural practices such as washing dead bodies, sexual cleansing rituals and other primitive taboos can be abandoned. Regular hand washing practices prevent not only EVD but many other transmissible infections. The healthcare personnel must be provided with enough personal protective equipment (PPE), body bags and face masks to prevent the disease.

  • Isaac Thom Shawa, Lecturer, University of Malawi, College of Medicine

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