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The World Health Organisation (WHO) has recommended to people to find different ways of greeting, apart from handshake, to reduce the chances of contracting the Ebola virus. It also advised people to wash their hands regularly with soap under running water as part of hygiene etiquette to avoid the Ebola virus and other contagious diseases. In an interview with the Daily Graphic on measures to prevent Ebola virus attack in Accra yesterday, the WHO Representative to Ghana, Dr Magda Robalo, said coughing into one�s elbow, instead of his or her hands, was one of the ways to help halt the spread of the disease. The deadly nature of the Ebola virus has led to the introduction of a new handshake craze in town, otherwise known as Ebola handshake, with people now greeting with their elbows or fists. This is to help minimise contact among people to contain the spread of the virus. Statistics from the WHO show that as of July 23, 2014, the cumulative number of cases attributed to Ebola virus disease (EVD) in Guinea, Liberia and Sierra Leone stand at 1,201, with 672 deaths. Last Friday, Nigeria reported its first probable case of EVD after a 40-year-old Liberian died in a private hospital, after which a sample conducted tested positive for Ebola virus. The WHO Regional Director for Africa, Dr Luis Gomes Sambo, after a tour of Liberia, Guinea and Sierra Leone last week, highlighted the seriousness of the outbreak and reiterated that it could be contained using known infection prevention and control measures. He said efforts were currently underway by the WHO to scale up and strengthen all aspects of the response in the three countries, including contact tracking, public information and community mobilisation, case management and infection prevention and control and coordination. Transmission Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest. Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact through broken skin or mucous membranes with the blood, secretions, organs or other bodily fluids of infected people and indirect contact with environments contaminated by such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to seven weeks after recovery from illness. Reducing the risk of Ebola infection In the absence of effective treatment and a human vaccine, raising awareness of the risk factors for Ebola infection and the protective measures individuals can take, according to the WHO, are the only ways to reduce human infection and death. The WHO says it is not always possible to identify patients with EVD early because initial symptoms may be non-specific. For this reason, it is important that healthcare workers apply standard precautions consistently with all patients � regardless of their diagnosis � in all work practices at all times. These include basic hand hygiene, respiratory hygiene, the use of personal protective equipment, safe injection practices and safe burial practices. Persons who have died of Ebola must be handled using strong protective clothing and gloves and be buried immediately. Who is most at risk? According to the WHO, during an outbreak, those at higher risk of infection are health workers, family members or others in close contact with infected people, mourners who have direct contact with the bodies of the deceased as part of burial ceremonies and hunters in the rainforest who come into contact with dead animals found lying in the forest. Signs and symptoms of infection? A sudden onset of fever, intense weakness, muscle pain, headache and sore throat are typical signs and symptoms. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function and, in some cases, both internal and external bleeding. The incubation period, or the time interval from infection to onset of symptoms, is from two to 21 days. The patients become contagious once they begin to show symptoms. They are not contagious during the incubation period. What is the treatment? Severely ill patients require intensive supportive care. They are frequently dehydrated and need intravenous fluids or oral rehydration with solutions that contain electrolytes. There is currently no specific treatment to cure the disease.