Ebola: The Biological Threat

Directorate of CBRN Defence and Operational Support
With the current Ebola outbreak at the forefront of international headlines, and the world on high alert, it is important for us in the Canadian Armed Forces (CAF) to understand implications on the individual and the Forces as a whole, and how disease can be potentially a biological threat.

At the Department of National Defence (DND), those involved with chemical, biological, radiological and nuclear (CBRN) defence know it is only effective when we identify potential threats and develop mechanisms to combat them. The World Health Organization (WHO), the Geneva-based UN health agency, has the international lead on monitoring the issue, and we at DND will continue to watch closely as the story unfolds.

Research has identified five distinct RNA-viral species which have been characterized and categorized under the taxonomic genus Ebolavirus. Of these, four have caused human illness and are responsible for the recent outbreaks in Africa. The average incubation period is 8 to 10 days (but can incubate as quickly as 2, or as long as 21 days), and the resulting disease is Ebola virus disease (EVD), formally known as Ebola hemorrhagic fever.

Human-to-human transmission occurs when an individual comes into direct contact with the blood or bodily secretions of an infected person or cadaver. Secondary exposure is also possible through contact with objects, such as medical equipment, that are contaminated with Ebolavirus. It is important to note that there have been no documented cases of human-to-human transmission via airborne contamination in previous EVD outbreaks.

The initial symptoms of EVD appear very similar to those of other diseases that are also endemic in Africa, such as malaria. These symptoms include: fever, sore throat, muscle pains and headache. The late-stage symptoms include vomiting and diarrhea, which can lead to dehydration and impaired liver and kidney function. Finally, in some but not all cases, internal and external bleeding will present.

Currently, there exists no approved vaccine or specific treatment for this virus. Viral hemorrhagic fever is generally managed by providing supportive care and symptomatic treatment.

Statistics on the West Africa Ebola Outbreak
The pathogen attributed to this outbreak is Zaire Ebolavirus (ZEBOV) and there have been more recorded outbreaks from ZEBOV than any other species. In terms of both total number affected and fatalities, this is the largest EVD outbreak ever recorded. As of 25 September 2014, there have been 6263 cases attributed to EVD, with 2917 deaths confirmed by the Centers for Disease Control and Prevention. This equates to a fatality rate of 47%, though some cases may be unreported.

The outbreak began in Guinea in March 2014, and has spread to three other African countries: Liberia, Sierra Leone and Nigeria. Insufficient clean drinking water has been recognized by Plan Guinea (an NGO that aims to protect children) as contributing to the spread of the disease. Plan Guinea’s Country Director, Mr. Ibrahima Touré, was quoted at the onset of the outbreak as saying: “The poor living conditions and lack of water and sanitation in most districts of Conakry pose a serious risk that the epidemic escalates into a crisis. People do not think to wash their hands when they do not have enough water to drink.”

Previous EVD outbreaks had been isolated to rural countries in Central Africa, which helped control the scale of the epidemic. Unfortunately with this outbreak, it migrated quickly to the capital of Guinea, Conakry – a densely populated area and the primary travel hub for the country.

Outbreak or Pandemic?
First and foremost, to effectively address the potential world-wide spread of this ­disease, it is important to understand the difference between an outbreak and a pandemic in today’s terms. The term outbreak is synonymous with epidemic, and is used to describe the prevalence of a specific disease above the statistical background levels in a particular geographical region. It is also used when the disease-inducing pathogen spreads to areas outside of the endemic region. The 2014 outbreak meets both of these criteria as the EVD is endemic to Central Africa. A pandemic, on the other hand, is an epidemic of world-wide proportions. The geographical boundaries for these definitions have changed over the past century because of the increased accessibility of global travel mechanisms.

As most readers are aware, the WHO is responsible for classifying epidemic/pandemic designations for individual health crises. As FrontLine goes to press, this particular crisis is still localized to Western Africa, therefore its scale is still classed in the “outbreak” range.

On 8 August, the WHO declared the Ebola epidemic to be an international health emergency and said in a statement, “A coordinated international response is deemed essential to stop and reverse the international spread of Ebola”. As the organization’s Director-General Margaret Chan said, when speaking about the regions where most Ebola cases have occurred, “if we do not, in global solidarity, come together to help these countries, they will be set back for many years”.

Fighting Back: Canada’s Contribution
In addition to 1000 beds and blankets, and personal protective equipment, Canada has donated a supply of unlicensed vaccine developed by the Public Health Agency of Canada (PHAC) to the WHO for use in post-exposure prophylaxis. In addition, through a joint US/Canada effort, an unlicensed combination of monoclonal antibodies, ZMapp, is being researched for the treatment of EVD.

Could the Canadian Healthcare Infrastructure Effectively Deal with an Ebola Outbreak?
The fact is, the risk of the Ebolavirus affecting Canadians in Canada is very low. If an EVD case did arrive in this country, our applicable federal, provincial/territorial and municipal infrastructure elements are prepared to respond. Having learned much from the SARS outbreak in 2003, agencies ranging from the Canada Border Services Agency to the Public Health Agency of Canada, as well as local healthcare facilities, are trained and ready for this unlikely event. Individual hospitals have invested in the installation of infection control technology, and procedures have been put in place to limit the spread of infection and to protect healthcare professionals. In addition, healthcare facilities are equipped with state-of-the-art isolation facilities, and have better access to rapid diagnostics tools.

Airline security officers, as well as authorities posted at Canadian ports of entry, have been specifically trained to look for the signs and symptoms of EVD, and to ask probing questions on previous travel itineraries. Additionally, quarantine officers are present at each port of entry. The most significant procedural development, as a direct result of our SARS experience, has been the establishment of a communication protocol to facilitate the dissemination of information among the different organizations at the municipal, provincial and federal levels of responsibility.

For the time being, Foreign Affairs, Trade and Development Canada is also advising against all non-essential travel to EVD-affected regions. There are no direct flights from West Africa to Canada, which will limit the ability of an infected traveller to access the country.

In general, the risk of infection is low for most travellers. Security precautions are being taken at West African airports to ensure travellers have not had previous exposure to diseased persons and that they are not presenting symptoms.

The Director for the U.S. Centers for Disease Control (CDC) has stated, “The bottom line with Ebola is we know how to stop it: traditional public health. Find patients, isolate and care for them, find their contacts, educate people, and strictly follow infection control in hospitals. Do those things with meticulous care and Ebola goes away.”

CBRN Omnibus Project
At D CBRN D&OS, we are focused on providing the Canadian Armed Forces with the most appropriate equipment, systems and operational support through the CBRN Omnibus Project. This project manages a group of subprojects that address capability improvement initiatives in the areas of chemical, biological and radiological agent detection, identification and monitoring, hazard management (decontamination), physical protection (general service respirator) and information management (sensor integration and decision support). These projects are all advancing to ensure that the CAF and its personnel are protected by world class knowledge, technology, and the right equipment to deal with CBRN threats, both domestic and internationally.

While the current risk of exposure to the Ebola virus is low in Canada, this crisis clearly illustrates that the threat of exposure to biological agents, be it endemic or intentional, is ever-present in today’s world. The mandate of the Directorate is to ensure that the CAF remains prepared and equipped to face potential CBRN threats and protect all Canadians, and we will continue to closely monitor the current Ebola outbreak and related stories.

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The Directorate of Chemical, Biological, Radiological and Nuclear (CBRN) Defence and Operational Support is the responsible for strategic advice and planning for CBRN defence within the Canadian Armed Forces.  It maintains and advances a variety of equipment projects through an omnibus program to maintain vital CBRN defence capabilities throughout Canada’s military.
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