Saturday, September 13, 2014

Ebola

Već više od 7 mjeseci u mnogim afričkim zemljama hara epidemija Ebole, opasne i smrtonosne bolesti izazivajući paniku, nerede i nepovijerenje. Radi se o najsmrtonosnijoj epidemiji ove bolesti u od otkrića iste 1976 godine. Trenutno zahvaćene države su (podaci do 31 Avgusta): Guinea (771 slučaj / 494 smrtna slučaja), Liberija (1698/871), Nigerija (21/7), Senegal (1/0), Siera Leone (1216/476), podaci su od Centra za Prevenciju i Kontrolu Bolesti (američki CDC). Zabilježeni slučajevi izvan Afrike su uglavnom inficirani medicinski radnici koji su pomagali u zaraženim oblastima, 2 slučaja u SAD, 1 u Španiji (koji je na žalost završio fatalno) i jedan u Saudijakoj Arabiji. Postoji i nekoliko lažnih alarma koji su prodrmali evropske medije, vidi link.

Seven months has passed since many African countries have been hit with a severe outbreak of Ebola virus hemorrhagic fever, dangerous and deadly disease, causing wide spread panic, death and mistrust. It is the deadliest outbreak of this disease since it's discovery in 1976. At the moment affected countries are Guinea (771 case / 494 deaths), Liberia (1698/871), Nigeria (21/7), Senegal (1/0), Sierra Leone (1216/476), data are from 31st August 2014 according CDC. The cases reported outside Africa are mostly medical and assistance workers helping the relief of outbreak regions, 2 cases in USA, 1 case in Spain (unfortunately fatal) and one in Saudi Arabia also fatal. There are few false alarms around mentioned in the media, see link

Ova mapa je od Jula sadrži nešto starije podatke ali daje dobar uvid u raširenost epidemije
This map is a bit old, from July, but it is suited to show the extent of the outbreak


Što je Ebola / What is Ebola

Ebola je virusna bolest koja izaziva izuzetno jaku hemoralgičnu groznicu (groznicu koja je popraćena gubitkom tečnosti kroz sluznice pa bolesnik izgleda kao da krvari iz svakog otvora na tjelu). Bolest je strahovito smrtonosna od 40% do 90%. Trenutna epidemija u Africi pokazuje smrtnost od oko 60% do 65%.

Ebola is a virus infection which causes a severe hemorrhagic fever (fever accompanied with significant loss of bloody fluids through mucous and body orifices). The infection is deadly with mortality rate from 40% to 90%. Observed mortality of this outbreak is 60% to 65%.


Inkubacija traje prosječno od 8 do 10 dana ali zabilježeni su slučaji i od 2 do 21. Simptomi počinju kao kod većine virusnih oboljenja (poput gripe), povišenom temperaturom, glavoboljom, bolovima u zglobovima i mišićima, proliv i povraćanje. Zatim ubrzo simptomi se pogoršavaju, moguća je pojava osipa ali najvažniji simptom je krvarenje. Bolesnik počinje krvariti kroz tkivo, sluznice, unutarnje organe. Stvaraju se podlivi na koži, ima krvavu stolicu i urin. Bolest u ovoj (krvavoj) fazi je najopasnija, većinom smrtonosna i najlakše se prenosi. Smrt nastaje zbog zatajenja svih važnih organa poput bubrega, jetre, pluća.


Incubation of this disease generally lasts from 8 to 10 days but there are known cases with ranges from 2 to 21 days. Symptoms initially are similar to any viral infection, sore throat, pain in muscles and joints, headache, high temperature, diarrhea, vomiting. Sometimes the patient develops rush and than stars bleeding through all possible openings and surfaces and organs. Hematoma develops under the skin, urine and stools are tainted with blood. The patient dies due to systemic organ failure.

Virus Ebole
Ebola Virus
Bolest izaziva virus, iz takozvane taksonomske grupe Ebolavirus, od kojih većina izaziva neki oblik hemoralgične groznice. Zanimljivo je i to da se radi o RNK virusu odnosno virusu koji koristi RNA kao svoj genetski materijal a ne DNK. (poznati primjeri takvih virusa su i svima poznati virusi gripe, prehlade, SARS, hepatitis C, polio ili boginje).

The infection is caused by a virus from ebolavirus family from which most of them can cause this type of fever. Interesting to note this virus is RNA type of virus and not a DNA based one. Many other notable infectious diseases have a RNA based pathogen like: SARS, influenza, hepatitis C, West Nile fever, common cold, polio and measles.


Virus je porijeklom životinjski i smatra se da potiče sa biljojednih sljepih miševa. Takođe je zarazan i za majmune i neke vrste antilopa. Ljudi se početno zaraze jedući nedovoljno kuhano meso ovih životinja. Zatim se bolest se prenosi sa čovijeka na čovijeka. Kako se to događa objašnjeno je u donjem pasusu.


The virus is of animal origin, prime suspects are fruit bats (but it is not deadly to them just a small malady). The infection is also severe and deadly to many types of apes and monkeys (some scientists think that this illness is partially to blame for endangerment of gorilla spices). Humans eat the infected meat, or come in contact in another way and get infected. Than it spreads from human to human in a pattern I´ll describe later.

Za ovu bolest nema lijeka niti vakcine. Međutim posljednjih mjeseci se ubrzano radi na razvoju vakcine i testovi obećavaju, smatra se da će testiranje eksperimentalne vakcine početi upravo u Septembru. Takođe postoji i eksperimentalni metodi lječenja upotrebom nekih antiviralnih supstanci te antitjela, međutim ovo je tek veoma eksperimentalna metoda lječenja koja još nije počela da se testira u ljudi. Detalji se mogu naći na ovom linku.

For this disease there is no cure and no vaccine. But recently few treatments are in development and in experimental phase, also a experimental vaccine is ready to start human trials as soon as this September. See details in this link.

Za sada jedini način da se olakša bolesnicima od ebole jeste simptomatska medicina, odnosno ublažavanje simptoma postojećim metodama, rehidracija (oralno ili infuzijom), nadomiještanje izgubljenih elektrolita i ublažavane simptoma groznice.

For now the only treatment is symptomatic, reducing the discomfort and consequences of symptoms, reducing dehydration and keeping the electrolyte balance in the body.


Takođe šire, koristi se i strogi karantin za spriječavanje širenja bolesti, ovo obuhvata strogu izolaciju dok medicinski radnici moraju biti u potpunosti zaštićeni hazmat odjelima.


Also for all outbreaks a strict quarantine is kept which consist of full isolation of the patient and people whom he came in contact with and wearing full bio hazmat suit, as seen in the picture.




Kako se bolest prenosi / How it is transmitted

Bolest se prenosi kroz sluznice ili otvorene ranice koje dolaze u dodir sa zaraženim tjelesnim fluidima, otpadom (poput fekalija) ili zaraženim medicinskim instrumentima. Važno je napomenuti da se bolest ne prenosi zrakom ili direktnim dodirom kože na kožu, ali je moguće da se prenese kroz kapljice sline koje nastaju kihanjem i kašnjem ako ove kapljice dođu u kontakt sa sluznicama (zdrava koža bi trebala biti u stanju zaštititi tijelo od prenošenja ove bolesti). Esencijalno ova bolest ima jako sličan metod prenošenja kao recimo SIDA.

The infection is transmitted through bodily fluids such as blood, urine, feces, plasma, semen and similar. Humans contract this disease if those infected fluids come in contact with exposes mucous or through injures on the skin. It can not pass through healthy skin but it is theoretically possible to transmit it if those fluids become aerosol through inhalation. But it was never confirmed and virus would probably be killed during process of aerosolization due to desiccation. Essentially this virus is transmitted in somewhat similar way as AIDS.

Ciklus bolesti sa životinja na ljude
Cycle of the disease from animals to humans

Zašto se onda ova bolest tako lako prenosi po Africi? / Why is than this disease so easily transmitted in affected African countries?

Serija idućih slika govori dosta o tome zašto se to događa:
The series of following photos show why:

















Na žalost u većem djelu Afrike ne postoji adekvatna medicinska zaštita, najveći dio stanovništva živi u dubokom siromaštvu. Mnogi bolnički smještaji su uglavnom ovakvi, oronuli ili sklepani na brzinu, bez mogućnosti da se vrši zadovoljavajuća sterilizacija opreme, bez napajanja strujom ili čak i bez čiste vode. U ovakvim uslovima same bolnice su smrtonosna zamka za mnoge požrtvovane medicinske radnike i dosta njih podlježe ovoj bolesti. Ovaj gubitak medicinskog osoblja se dalje odražava na ozbiljnost epidemije, smanjujući broj obučenog osblja koji se mogu zadovoljavajuće boriti protiv ove bolesti.

Unfortunately in most parts of Africa, adequate medical service does not exist, most of the population lives in deep poverty. Many hospitals are mostly like this, makeshift, decrepit facilities without possibility to do adequate medical care or sterilization, without running clean water or electrical power. In this condition hospitals became a death trap for many dedicated and needed medical workers and many of those (real heroes) have succumbed to the disease. This loss of medical personnel has terrible effect to the fight to stop the infection.

Osim toga afrička kultura vrvi od raznih praznovijerja koje običan i neobrazovan Afrikanac i te kako shvata ozbiljnima. Ovo stvara dodatne teškoće zbog stvaranja nepovijerenja među ljudima, bolest se pripisuje nadnaravnim uzrocima i u mnogim slučajevima se čak i sami medicinski radnici optužuju da namjerno šire bolest. Afrika je takođe jako pobožno mjesto i otpraćaj mrtvih je veoma složen obred, zavisno od etničkih i religijskih običaja u svakom slučaju mu se veoma predano prilazi. Kako je preminuli i dalje jak izvor zaraze događa se da se bolest prenese sa preminulog na ukućane zbog čestih dodira, kupanja ili oblačenja tjela. Pokušaj vlasti da limitiraju ili čak spriječe takve obrede samo rezultira produbljavanjem nepovijerenja i kontrola epidemije postaje sve teža.

Also the African culture if full of superstition which is taken seriously by mostly uneducated people living there. This causes even more problems as the outbreak is attributed to supernatural and even to medical personnel them selves whom are accused to spread it intentionally (which is not true). This deepens the mistrust and poses a full new sometimes insurmountable problem. Africa is also a devout land of many religions. The death and subsequent funerals are taken extremely seriously. This poses a big problem because, a deceased from this infection is still highly contagious and due to many rituals the corpse is touched, washed, dressed, making contact with many people who subsequently contract the disease. The attempts of governments to limit the rites or even to ban them were met to increased hostility which caused even more mistrust among the people.

Da ne govorim o tome da su i onako oronuli medicinski smještaji iznad svih mogućih kapaciteta i da mnogi bolesnici i kada se jave u te ustanove bivaju jednostavno odbijeni jer nema više mjesta. Ovaj idući video govori o jednom takvom bolnom primjeru. Ova reportaža New York Times-a prikazuje bolnu istinu ove Afričke tragedije, u njoj se sve vidi, oronulost, nepovjerenje i očaj kome su ovi ljudi izloženi. Gledateljima upozorenje da se radi o veoma emocionalno nabijenom videu.

It is also a sore fact that existing decrepit medical facilities are overwhelmed with this outbreak, all facilities are full many times over limit and personnel worked out to exhaustion. Many patients are turned down to their own devices. The next video, made by New York Times, shows full extent of this crisis. It is heart wrenching reality so viewers are advised for very emotional content.

Koliko je ostatak svijeta u opasnosti? / Is World at large in danger?

Opasnost postoji, u slučaju ovakvih događaja uvijek postoji vjerovatnost da se bolest šire otrgne kontroli. Ali moram napomenuti da mjesta za neki veću brigu u stvari nema. Zbog specifičnog načina prenošenja ova bolest se realno, dosta teško prenosi na mjestima gdje je higijena na visokom nivou a medicinska pomoć adekvatno razvijena. Razvijene zemlje sa zadovoljavajućom infrastrukturom (kanalizacijom, čistom vodom, bolnicama koje si se mogu priuštiti bilo kakav sanitarni standard i sa građanstvom koje ima razvijene sanitarne navike) nisu u direktnoj opasnosti te čak i da dođe do pojave bolesti ona bi bila ograničena tek na nekoliko slučajeva koji bi ubrzo bili izolirani i u karantinu. Široka epidemija kao u Africi bi vijerovatno bila nemoguća.

The danger always exist, there is always some probability that this outbreak could spread without control outside of Africa, through air travel or some other method. But I must stress that there is no any serious threat at this moment. The specific way this illness is transmitted is such that is easily prevented in countries with higher living standards. The authorities of those countries are always alert and existing facilities are more than enough to stop any outbreak if such happens to happen. The wide spread of this illness in technologically advanced countries is highly unlikely. 

S druge strane postoje mnoga mjesta na svijetu gdje sanitarni uslovi nisu mnogo bolji nego u Africi. Takva područja su u realnoj opasnosti od širenja ove zaraze, međutim da bi se to dogodilo zaražena osoba bi morala otputovati tamo, (skoro namjerno) jer su te oblasti obično izvan glavnih tokova prometa i transporta. Stoga širenje ove bolesti u tim područjima je takođe vrlo malo vjerovatno.

On the other hand many places on earth are not prepared in case of outbreak and have similar sanitary conditions like in Africa. In such places the infection would spread easily. But that to happen the infected would need to travel there (almost intentionally). Most of those places are remote and far outside of normal busy travel and commercial routes so Ebola appearing there is highly unlikely.

Na kraju postoji hipotetočka opasnost da ovaj virus mutira u neki agresivniji oblik, na primjer da se počne prenositi zrakom. Međutim ovakva promjena zahtjeva veoma kompleksne mutacije genoma ovog virusa koje bi uticale i na samu funkcionalnost istog. Takva promjena bi rezultirala posve novim virusom koji bi imao veoma drugačije karakteristike i malo zajedničkog sa originalnim. Tako obimna mutacija se može dogoditi ali vjerovatnoća da se to desi je zasnemariva. U biti ne postoji neka realna briga da bi se to moglo desiti iako su sve službe na oprezu.

There is always a remote hypothetical possibility that this virus can mutate in a more aggressive form, to become airborne for example. But that to happen the virus needs to pass through several fundamental mutations which would make it essentially a new spices with new set of abilities and even changing its epidemiology little in common with original strain. This extensive set of mutations could happen but probability of it is so small that nobody except some fear-mongering  conspiracy theorists take it seriously. In all seriousness there is no real fear that this will ever happen.

Teorije zavijere / Conspiracy theories


Internetom kruži gomila različitih teorija zavjere o ovoj bolesti i porijeklu epidmije. Od toga da je virus vještački i proizveden u nekoj tajnoj laboratoriji za proizvodnju biološkog oružja pa do neizbježnih vanzemaljaca. Naravno niti jedna od tih priča nije tačna. Takođe postoji čitav niz dezinformacija o ovoj bolesti, na primjer da se krije tačan broj žrtava, da se proširila svugdje po svijetu pa da se to krije, da je mutirala u oblik koji se prenosi zrakom itd. Sve to su gluposti i ništa od toga nije tačno. Kada se dođe do takvih bombastičnih vijesi, najbolje ih je uzeti sa zrncem soli i potražiti izvor takvih priča, najbolje kroz internet. Obično je izvor neki od mnogih siteova ili blogova koji šire ideje o teorijama zavijere poput toga da ljudi nikada se nisu spustili na Mjesec, da se HAARP koristi za kontrolu vremena, da CIA kontroliše naše mozgove preko radio valova (zato služe kape o aliminijske folije, da uzemlje tu naprednu CIA-inu tehnologiju), da su vanzemlajci među nama, da su X-Files u stvari dokumentarac, da reptili vladaju svjetom itd.

Internet and gossip press are full of conspiracy talks about this infection. From stories that this disease is man made biological weapon up to a wide alien plot to overtake our planet. None of those stories is true or even remotely serious. Also many disinformation's are afloat around, like story that the real amount of deaths is hidden, or that the disease have already spread across the world or that there is an eminent threat that this virus will mutate in to airborne pathogen. Also none of those are true, just a shameless fear-mongering of unscrupulous attention craving individuals or disreputable media. The reader of such stories is advised to seek the source of those news, in many cases he will find a source connected to other similar conspiracy bull**** like humans never visited the Moon or HAARP is used to control weather and our minds, or that reptiles rule the world or X-Files are a documentary disguised as a TV show.

Zakjučak / Conclusion

Ovo je jedna od najvećih tragedija modernog doba, pošast kojoj se na žalost ne nadzire kraj. Mnoge humanitarne organizacije poput Doktora Bez Granica neumorno rade na zaustavljanju i kontroli ove bolesti. Mnogi dobrovoljci iz cijelog svijeta rizikuju svoje živote da bi spriječili ovu bolest i pomogli tamošnjem stanovništvu. Međutim proći će još dosta mjeseci dok se njihov trud ne isplati, moraju se suočiti sa teškim uslovima rada, nepovijerenjem lokalnog stanovništva i sveobuhvatnim nedostatkom obrazovanja većine tamošnjih žitelja.

This one is one of the major disasters in modern era and for which there is no end in sight. Many charity organisations like Doctors Without Borders are tirelessly working to combat and stop this outbrake. Many private people bravely and under personal risk to life go there to help the population in need. But many months will pass until their effort will show any progress because they face a harsh climate, lack of basic equipment and growing mistrust of local people.

Ljudi koji žive izvan Afrike su relativno zaštićeni visokom standardom života ili zabačenošću, međutim nemojmo dozvoliti da nas ta činjenica uljuljka u potpunu sigurnost. Postoji uvijek rizik da nešto pođe po zlu i da se ova bolest povampiri na najgori mogući način i krene u haranje po svijetu. Zato uvijek treba pratiti razvoj situacije na terenu, kroz vijesti ili internet, međutim biti oprezan da se ne zaglavi na kakvo mijesto koje sadrži lažne informacije koje samo šire teorije zavijere i rekla kazala priče. Valjane su samo provijerene informacije koje nedvosmisleno upućuju na transparentni, poštovani i stručni izvor.

People living outside Africa are protected with higher standard of living or with remoteness, but we must not let our guard down. There is always a small risk that this illness could transform in to even more terrible monster. Because of that it is advised to follow this story until it´s (hopefully) positive ending, culminating in to the full defeat of this illness and development of a good working vaccine to prevent it to reappear ever again. Also be wary of all those unscrupulous fear-mongering individuals whom are so happy to serve you lies and untrue news just to promote them selves. Always search a good and reputable source for your news.

Afrika je domovina svih ljudi na svjetu i kao takva morali bi smo se više truditi da pomognemo tamošnjem narodu koji je u neku ruku ostao kod kuće. Ne samo u borbi protiv ove bolesti već i na druge načine. Najvažnije je širiti obrazovanje, graditi škole i učiti nove mlade generacije Afrikanaca o tome kako pomoći svom kontinentu, kroz nauku i kako odbraniti svoj bogati kulturni indentitet i biti ponosan na njega.

Africa is homeland of all the people on Earth and we should take care of it together. We need to help the nations whom stayed at home, from which all of us have departed to conquer the world so long time ago. Not only we need to stop the outbreak but we need to help in all other ways. Most important is to bring education to all and everyone there so the new generation of Africans can rise and change their continent for the better through science and their own unique culture.

Linkovi / Links:

http://www.cdc.gov/vhf/ebola/index.html?s_cid=cdc_homepage_feature_001

http://www.who.int/csr/disease/ebola/en/

http://www.who.int/mediacentre/factsheets/fs103/en/

http://www.doctorswithoutborders.org/

http://www.sciencedaily.com/articles/e/ebola.htm

http://www.webmd.com/a-to-z-guides/ebola-fever-virus-infection

http://en.wikipedia.org/wiki/Ebola_virus_disease

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