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Ebola virus

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Ebola virus

  1. 1. Ebola virus disease Ravi Kanta Mishra MPH, Third Batch National Medical College, Birgunj
  2. 2. Introduction  Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo.  The latter was in a village situated near the Ebola River, from which the disease takes its name.
  3. 3. Genus Ebolavirus is 1 of 3 members of the Filoviridae family (filovirus), along with genus Marburgvirus and genus Cuevavirus. Genus Ebolavirus comprises 5 distinct species:  Bundibugyo ebolavirus (BDBV)  Zaire ebolavirus (EBOV)  Reston ebolavirus (RESTV)  Sudan ebolavirus (SUDV)  Taï Forest ebolavirus (TAFV).
  4. 4. Natural host of Ebola virus In Africa, fruit bats, particularly species of the genera Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata, are considered possible natural hosts for Ebola virus. As a result, the geographic distribution of Ebolaviruses may overlap with the range of the fruit bats.
  5. 5. BDBV, EBOV, and SUDV have been associated with large EVD outbreaks in Africa, whereas RESTV and TAFV have not. The RESTV species, found in Philippines and the People’s Republic of China, can infect humans, but no illness or death in humans from this species has been reported to date.
  6. 6. Transmission  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.
  7. 7. Transmission…  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 with such fluids.
  8. 8. Transmission…
  9. 9. Signs and Symptoms EVD is a severe acute viral illness often characterized by  Sudden onset of fever  Joint and muscle aches  Weakness  Stomach pain  Lack of appetite  intense weakness,  headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.
  10. 10. Some patients may experience:  Red Eyes  Hiccups  Cough  Chest pain  Difficulty breathing  Difficulty swallowing  Bleeding inside and outside of the body People are infectious as long as their blood and secretions contain the virus. Ebola virus was isolated from semen 61 days after onset of illness in a man who was infected in a laboratory.  The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days, 8-10 days is most common.
  11. 11. Diagnosis Other diseases that should be ruled out before a diagnosis of EVD can be made include: malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers.
  12. 12. Diagnosis.. Ebola virus infections can be diagnosed definitively in a laboratory through several types of tests:  antibody-capture enzyme-linked immunosorbent assay (ELISA)  antigen detection tests  serum neutralization test  reverse transcriptase polymerase chain reaction (RT-PCR) assay  electron microscopy  virus isolation by cell culture. Samples from patients are an extreme biohazard risk; testing should be conducted under maximum biological containment conditions.
  13. 13. Vaccine and treatment  No licensed vaccine for EVD is available. Several vaccines are being tested, but none are available for clinical use.  Severely ill patients require intensive supportive care. Patients are frequently dehydrated and require oral rehydration with solutions containing electrolytes or intravenous fluids.  No specific treatment is available. New drug therapies are being evaluated.
  14. 14. Prevention and Control
  15. 15. How can Ebola infections be prevented ?  There is no vaccine or treatment for Ebola virus disease.  If you are or have been in a region where an Ebola outbreak has occurred, take these precautions.
  16. 16. 1. Avoid direct contact with blood, saliva, vomit, urine and other bodily fluids of people with Ebola virus disease or unknown illnesses.  Avoid direct contact with bodies of people who died of Ebola virus disease or unknown illnesses.  Avoid contact with any medical equipment, such as needles, contaminated with blood or bodily fluids.  If you are a health care worker, practise strict infection control measures. This includes isolating infected individuals and using personal protective equipment (gowns, masks, goggles and gloves).  If you are a health care worker, properly use and disinfect instruments and equipment used to treat or care for patients with Ebola—like needles and thermometers—before throwing them out.
  17. 17. 2. Avoid close contact with wild animals and avoid handling wild meat. Avoid potential carriers, both live and dead, since both can spread the virus. Potential carriers of the virus include:  chimpanzees  gorillas  monkeys  forest antelope  pigs  porcupines, and  fruit bats
  18. 18. 3. Know the symptoms of Ebola virus disease and see a health care provider if they develop.  Seek medical attention immediately if a fever and any other symptoms arise during or after travel.  Be sure to tell your health care provider that you have travelled to a region where Ebola virus disease was present.
  19. 19. Prevention 1. Controlling Reston ebola virus in domestic animals 2. Reducing the risk of Ebola infection in people 3. Controlling infection in health-care settings
  20. 20. Case Definition for Ebola Virus Disease (EVD) Early recognition is critical for infection control. Healthcare providers should be alert for and evaluate any patients suspected of having EVD. Person Under Investigation (PUI) A person who has both consistent symptoms and risk factors as follows: 1) Clinical criteria, which includes fever of greater than 38.6 degrees Celsius or 101.5 degrees Fahrenheit, and additional symptoms such as severe headache, muscle pain, vomiting, diarrhea, abdominal pain, or unexplained hemorrhage; AND 2) Epidemiologic risk factors within the past 21 days before the onset of symptoms, such as contact with blood or other body fluids or human remains of a patient known to have or suspected to have EVD; residence in—or travel to—an area where EVD transmission is active*; or direct handling of bats, rodents, or primates from
  21. 21. Definition… Probable Case  A PUI who is a contact of an EVD case with either a high or low risk exposure . Confirmed Case  A case with laboratory confirmed diagnostic evidence of ebola virus infection.
  22. 22. Definition.. Contacts of an EVD Case Contacts of an EVD case have different levels of exposure risk, as follows: High risk exposures  A high risk exposure includes any of the following:  Percutaneous, e.g. the needle stick, or mucous membrane exposure to body fluids of EVD patient  Direct care or exposure to body fluids of an EVD patient without appropriate personal protective equipment (PPE)  Laboratory worker processing body fluids of confirmed EVD patients without appropriate PPE or standard biosafety precautions  Participation in funeral rites which include direct exposure to human remains in the geographic area where outbreak is occurring without appropriate PPE
  23. 23. Definition… Low risk exposures  A low risk exposure includes any of the following  Household member or other casual contact1 with an EVD patient  Providing patient care or casual contact without high-risk exposure with EVD patients in health care facilities in EVD outbreak affected countries* No known exposure  Persons with no known exposure were present in an EVD outbreak affected country* in the past 21 days with no low risk or high risk exposures.
  24. 24. Epidemiology
  25. 25. Cases of Ebola Hemorrhagic Fever in Africa, 1976 - 2014 Country Town Cases Deaths Species Year Dem. Rep. of Congo Yambuku 318 280 Zaire ebolavirus 1976 South Sudan Nzara 284 151 Sudan ebolavirus 1976 Dem. Rep. of Congo Tandala 1 1 Zaire ebolavirus 1977 South Sudan Nzara 34 22 Sudan ebolavirus 1979 Gabon Mekouka 52 31 Zaire ebolavirus 1994 Ivory Coast Tai Forest 1 0 Taï Forest ebolavirus 1994 Dem. Rep. of Congo Kikwit 315 250 Zaire ebolavirus 1995 Gabon Mayibout 37 21 Zaire ebolavirus 1996 Gabon Booue 60 45 Zaire ebolavirus 1996 South Africa Johannesburg 2 1 Zaire ebolavirus 1996 Uganda Gulu 425 224 Zaire ebolavirus 2000 Gabon Libreville 65 53 Zaire ebolavirus 2001 Republic of Congo Not specified 57 43 Zaire ebolavirus 2001 Republic of Congo Mbomo 143 128 Zaire ebolavirus 2002 Republic of Congo Mbomo 35 29 Zaire ebolavirus 2003 South Sudan Yambio 17 7 Zaire ebolavirus 2004 Dem. Rep. of Congo Luebo 264 187 Zaire ebolavirus 2007 Uganda Bundibugyo 149 37 Bundibugyo ebolavirus 2007 Dem. Rep. of Congo Luebo 32 15 Zaire ebolavirus 2008 Uganda Luwero District 1 1 Sudan ebolavirus 2011 Uganda Kibaale District 11* 4* Sudan ebolavirus 2012 Dem. Rep. of Congo Isiro Health Zone 36* 13* Bundibugyo ebolavirus 2012 Uganda Luwero District 6* 3* Sudan ebolavirus 2012 Guinea, Sierra Leone, *Numbers reflect laboratory cmonuflitrimpleed cases only. 1176* 660* Zaire ebolavirus 2014 Liberia, Nigeria
  26. 26. Year Country Ebolavirus species Cases Deaths Case fatality 2012 Democratic Republic of Congo Bundibugyo 57 29 51% 2012 Uganda Sudan 7 4 57% 2012 Uganda Sudan 24 17 71% 2011 Uganda Sudan 1 1 100% 2008 Democratic Republic of Congo Zaire 32 14 44% 2007 Uganda Bundibugyo 149 37 25% 2007 Democratic Republic of Congo Zaire 264 187 71% 2005 Congo Zaire 12 10 83% 2004 Sudan Sudan 17 7 41% 2003 (Nov-Dec) Congo Zaire 35 29 83% 2003 (Jan-Apr) Congo Zaire 143 128 90% 2001-2002 Congo Zaire 59 44 75% 2001-2002 Gabon Zaire 65 53 82% 2000 Uganda Sudan 425 224 53%
  27. 27. 1996 South Africa (ex-Gabon) Zaire 1 1 100% 1996 (Jul-Dec) Gabon Zaire 60 45 75% 1996 (Jan-Apr) Gabon Zaire 31 21 68% 1995 Democratic Republic of Congo Zaire 315 254 81% 1994 Cote d'Ivoire Taï Forest 1 0 0% 1994 Gabon Zaire 52 31 60% 1979 Sudan Sudan 34 22 65% 1977 Democratic Republic of Congo Zaire 1 1 100% 1976 Sudan Sudan 284 151 53% 1976 Democratic Republic of Congo Zaire 318 280 88%
  28. 28. Key Facts  Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.  EVD outbreaks have a case fatality rate of up to 90%.  EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.  The virus is transmitted to people from wild animals and spreads in the human population through human-to- human transmission.  Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.  Severely ill patients require intensive supportive care. No licensed specific treatment or vaccine is available for use in people or animals.
  29. 29. Scenerio of Nepal Regarding EVD  No cases found yet  Establish Health Desk at Tribhuwan International Airport (From Today)  Referral hospital Sahid Sukraraj Tropical Hospital, Teku  Isolation ward established at Zonal, Regional Hospitals  Formally Call Technical Export from WHO by Health Minister Khag Raj Adhikari  Awareness through Radio ,Television and Newspaper.
  30. 30. Refrences: http://www.who.int/mediacentre/factsheets/fs103/en/ http://www.cdc.gov/vhf/ebola/symptoms/ http://www.phac-aspc.gc.ca/id-mi/vhf-fvh/ebola-prevention- eng.php
  31. 31. THANK YOU

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