ebola

1. PREVENTION OF
EBOLAVIRUS INFECTION
& THE ASSOCIATED
CHALLENGES
Dr.Chandan
House surgeon,
KIMS.
Guide:
Dr.Laxmikant Lokare
Associate Professor,
Dept. of Community Medicine,
KIMS.

2. PEOPLE AT RISK
Healthcare workers.
Contacts of Ebola patients.
People coming in contact with infected
wildlife.

3. CASE DEFINITIONS
SUSPECTED CASE:
Any person, alive or dead, suffering or having suffered from a
sudden onset of high fever and having
had contact with:
- a suspected, probable or confirmed case of Ebola
- a dead or sick animal.
OR: any person with inexplicable bleeding.
OR: any sudden, inexplicable death.
PROBABLE CASE:
Any suspected case evaluated by a clinician.

4. Instructions when a suspected case has
been identified:
• Report the case to the surveillance team.
• After obtaining express consent, collect a sample.
• Fill in a case notification form.
• Draw up a list of contacts of the suspected case.

5. LABORATORY TESTS
Timeline of Infection Diagnostic tests available
Within a few days after symptoms begin •Antigen-capture ELISA
•Polymerase chain reaction (PCR)
•Virus isolation
•IgM ELISA
Later in disease course or after recovery •IgM and IgG antibodies
Retrospectively in deceased patients •Immunohistochemistry testing
•PCR
•Virus isolation

6. SCREENING DURING
AIR TRAVEL
The DGCA has issued the following directives to all airlines
the operating on international routes in India-
• In flight announcement for self-reporting.
• Travellers on flights to be given the health-form.
• To keep a record of all passengers or families who are
returning to India after staying or visiting the West
African countries.
• The details of the passengers boarding from affected
countries must be sent in advance.

7. THERMAL SCANNERS
• The union health minister on Tuesday said
that 2 thermal scanners have been
installed in every International airport in
India.
• They have started functioning in the
country since yesterday.

8. ISOLATION &
QUARANTINE
• Isolation separates sick people with a
contagious disease from people who are not
sick.
• Quarantine separates and restricts the
movement of people who were exposed to a
contagious disease to see if they become sick.

9. ISOLATION
PROCEDURES
Isolation area must consist of :
1)An isolated toilet 2)Adequate ventilation 3)Screened
windows
A plan of the isolation area

10. Gather Recommended Supplies
Bed and mattress, Plastic sheeting, thermometers,
Covered container , Screens or other barriers
Plan disinfection for contaminated items
using
1)Ordinary Household Bleach 2)Soap and Clean Water
3)Sterilization
Set Up Changing Rooms for patient-care staff
Place Security Barrier Around Isolation Area

11. PRECAUTIONS DURING
TREATMENT
 Restrict all non essential staff.
 Limit the number of visitors.
 Ensure that all staff and visitors correctly use personal
protective equipment (PPE).
 Hand hygiene.
 Limit the use of needles and other sharp objects.
 Take the patients out of their rooms if they are free of
virus, or for essential, life-saving tests ONLY.
 Cleaning of the environment and patient care equipment.

12. CONTACT TRACING
Contact tracing means finding everyone who
comes in contact with an ebola patient.
The CDC quotes contact tracing as an
effective method in controlling the current
outbreak.

13. CONTACT TRACING

14. PRECAUTIONS FOR
HEALTHCARE WORKERS
• Wear protective clothing, including masks, gloves,
gowns, and eye protection.
• Practice proper infection control and sterilization
measures.
• Hand hygiene.
• Avoid direct contact with the bodies of Ebola victims.
• Handling the bodies of ebola victims must be done by
trained personnel only and with PPE.

16. WHO-RECOMMENDED
HANDRUB FORMULATIONS
FORMULATION 1
Ethanol 80% (v/v)
Glycerol 1.45% (v/v)
Hydrogen peroxide 0.125% (v/v)
FORMULATION 2:
Isopropyl alcohol 75%(v/v)
Glycerol 1.45% (v/v)
Hydrogen peroxide 0.125% (v/v)

17. WASTE MANAGEMENT
PROCEDURES
• Waste segregation.
• Sharp objects that has been in contact with blood or body
fluids should be placed inside puncture resistant waste
containers. These should be located as close as practical to
the patient care area where the items are used.
• Collect all solid, non-sharp, infectious waste using leak-proof
waste bags and covered bins. Bins should never be carried
against the body.
• Waste should be placed in a designated pit of appropriate
depth (e.g. 2 meters or about 7 feet) and filled . After each
waste load, the waste should be covered with a layer of soil
10 –15 cm deep.

18. • An incinerator may be used for short periods during an
outbreak to destroy solid waste. However, it is essential to
ensure that total incineration has taken place.
• Placenta and anatomical samples should be buried in a
separate pit.
• The area designated for the final treatment and disposal of
waste should have controlled access to prevent entry by
animals, untrained personnel or children.
• Waste, such as faeces, urine and vomit, and liquid waste from
washing, can be disposed of in the sanitary sewer or pit
latrine. No further treatment is necessary

19. VACCINES
Recombinant vesicular stomatitis
virus(rVSV-ZEBOV) encoding ebolavirus
glycoproteins.
Developed by the Public Health Agency of
Canada in Winnipeg.

20. Another vaccine developed by
GlaxoSmithKline in collaboration with the
US National Institute of Allergy and
Infectious Diseases is cAd3-ZEBOV.
It uses a chimpanzee-derived adenovirus
vector with an Ebola virus gene inserted.

21. POST EXPOSURE
PROPHYLAXIS
Post-exposures prophylaxis / treatment
• Interferon alpha
• ZMapp - “Secret Serum”
Three monoclonal antibodies against parts of
the glycoprotein
Manufactured in tobacco plant.
Suppresses viraemia and viral spread
Effective in non-human primates – 3 doses
starting on days 3 to 5

22. TKM – Ebola developed by Tekmira Pharmaceuticals Corp.
• Small interfering RNAs
• Zaire Ebola L polymerase, Zaire Ebola membrane-associated
protein (VP24), and Zaire Ebola polymerase
complex protein (VP35)
• Inhibits the replication of the virus
• Post-exposure prophylaxis in non-human primates given
in multiple doses (30 minutes after infection and then
either
day 1, 3 and 5 or daily for 6 days)
• Tekmira has commenced clinical trials in January 2014.

23. CHALLENGES IN THE
PREVENTION
• Health systems in the affected countries
are not highly functional.
• Lack of understanding about the disease
and receptivity to control measures on the
part of some of the affected populations.
• A large number of international travellers.
• Lack of cooperation between the countries
and the various health organizations.
• Poor economy of the countries.

24. • TECHNICAL CHALLENGES
• The virus and disease are incompletely
understood.
• Difficulties in research activities due to
high risk to those involved.
• No specific treatment is made available.
• No effective vaccine is made available.

25. REFERENCES
• Park’s Textbook Of Preventive And Social
Medicine e21 K.Park
• The WHO website http://www.who.int
• The CDC website http://www.cdc.gov
• Wikipedia- http://www.wikipedia.org
• The DGCA http://dgca.nic.in
• The Hindustan Times