EBOLA an update2017 by DrT.V.Rao MD

1. EBOLA
an update
2017
Dr.T.V.Rao MD
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 1

2. EBOLA
What is
Ebola is a virus that
lives in bats and
some other animals
who live in Africa.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 2

3. 5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 3

4. Ebola Virus
 Prototype Viral Hemorrhagic Fever
Pathogen
• Filovirus: enveloped,
non-segmented, negative-stranded RNA virus
• Severe disease with high
case fatality
• Absence of specific treatment or vaccine
 >20 previous Ebola and Marburg virus
outbreaks
 2014 West Africa Ebola outbreak
caused by Zaire ebolavirus
species (five known Ebola virus species)
4

5. How Ebola
started
• Outbreaks of Ebola
began in 1976 in the
Democratic Republic
of Congo on the Ebola
River, and in Sudan,
with later outbreaks in
Uganda and other
African nations,
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 5

6. 5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 6

7. It can Kill the Health care
Workers
•Health workers often succumb to the disease
because of close contact with sick patients. Among
those infected with Ebola was Dr. Sheik Umar Khan,
former head of Ebola virus treatment in Sierra
Leone. He died from the disease on July 29, 2014.
The head doctor for Ebola treatments in Liberia, Dr.
Samuel Brisbane, died from the disease three days
earlier.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 7

8. Ebola is
caused by an
RNA virus.
• This emerging health
threat is the result of an
RNA (ribonucleic acid)
virus that infects wild
animals like fruit bats,
monkeys, gorillas, and
chimpanzees, as well as
people. It is very
unlikely to affect pets
like dogs or cats.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 8

9. How do people get
EBOLA?
eople get Ebola by touching
Body fluids from a person who is
sick with or has died from Ebola.
Examples of body fluids include
blood, vomit, pee, poop, sweat,
or spit.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 9

10. 5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 10

11. Human-to-Human Transmission
 Infected persons are not contagious until onset of symptoms
• Possible that the virus can be transmitted through semen of a
man who has survived Ebola
 Infectiousness of body fluids (e.g., viral load) increases as
patient becomes more ill
• Remains from deceased infected persons are highly infectious
 Human-to-human transmission of Ebola virus via inhalation
(aerosols) has not been demonstrated
11

12. How humans get infected
•Contact with an
infected wild
animal’s blood or
body fluids is
probably the
original source of
the infectious
disease.5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 12

13. WHO
States
•The Ebola
outbreak
includes 24,282
cases and 9,976
deaths,
according to the
WHO.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 13

14. Current Ebola outbreak
•The current Ebola outbreak is most widespread and
intense in West Africa.
•The countries of Guinea, Sierra Leone, and Liberia have
reported the most infections, with an additional 20 cases
in Nigeria, one each in Senegal, the United Kingdom, and
Spain, four in the United States, and eight in Mali. To
date, the current outbreak includes 24,282 cases of Ebola
as of March 11, 2015, of whom 9,976 have died,
according to the World Health Organization (WHO).5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 14

15. Who are at
Risk
• People who are most
at risk are those in
close physical contact
with an infected
person, like family
members and the
healthcare workers
taking care of the
patient.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 15

16. What happens when someone gets sick
with EBOLA?
Symptoms include
• Fever
• Headache
• Tiredness
• Weakness
• Diarrhea
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 16

17. Ebola Virus Pathogenesis
 Direct infection of tissues
 Immune dysregulation
 Hypovolemia and vascular collapse
• Electrolyte abnormalities
• Multi-organ failure, septic shock
Disseminated intravascular
coagulation (DIC) and
coagulopathy
• Lancet. Mar 5, 2011; 377(9768): 849–862.
17
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 17

18. Early Ebola symptoms are also
symptoms of other viral infections.
• Early Ebola symptoms include fever,
headache, body aches, cough,
stomach pain, vomiting, and
diarrhea. Because these could be
symptoms of other diseases, it's
difficult to diagnose Ebola early on.
The time it takes from exposure to
Ebola to actually getting sick,
known as the incubation period, is
anywhere from 2 to 21 days
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 18

19. Early
Symptoms
with
Ebola
• Most people who are
infected with Ebola will
develop early symptoms
eight to nine days after
exposure to the virus,
according to the CDC.
Specific tests for
antibodies against Ebola
and viral DNA help doctors
make a conclusive
diagnosis.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 19

20. Bleeding is common in the later stages
of Ebola.
• Later symptoms of Ebola can
appear quickly: within a few
days after onset of early
symptoms. Due to internal
and external bleeding, the
patient's eyes may become
red, and they may vomit
blood, have bloody diarrhea,
and suffer cardiovascular
collapse and death,
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 20

21. Ebola is
often fatal.
• Almost half of the cases of
Ebola viral infection in
West Africa have
resulted in death, based
on WHO data. Of the
24,282 cases in the
current outbreak, 9,976
deaths were reported as
of March 11, according
to WHO statistics.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 21

22. Principles of Ebola Virus Diagnosis
 Real Time PCR (RT-PCR)
• Used to diagnose acute infection
• More sensitive than antigen detection ELISA
• Identification of specific viral genetic fragments
• Performed in select CLIA-certified laboratories
 RT-PCR sample collection
• Volume: minimum volume of 4mL whole blood
• Plastic collection tubes (not glass or heparinized tubes)
• Whole blood preserved with EDTA is preferred
o Whole blood preserved with sodium polyanethol sulfonate (SPS), citrate, or with clot
activator is acceptable
22

23. Diagnosis of Ebola
•Diagnosing Ebola in a
person who has been
infected for only a few
days is difficult because
the early symptoms, such
as fever, are nonspecific
to Ebola infection and
often are seen in patients
with more common
diseases, such as malaria
and typhoid fever.5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 23

24. Diagnostic tests
available
Within a few days after
symptoms begin
• Antigen-capture
enzyme-linked
immunosorbent assay
(ELISA) testing
• IgM ELISA
• Polymerase chain
reaction (PCR)
• Virus isolation
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 24

25. Retrospectively
in deceased
patients
•Immunohistoc
hemistry
testing
•PCR
•Virus isolation
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 25

26. Laboratories and Role of CDC
CDC has developed interim
guidance for U.S. laboratory
workers and other healthcare
personnel who collect or handle
specimens
This guidance includes
information about the
appropriate steps for collecting,
transporting, and testing
specimens from patients who
are suspected to be infected
with Ebola
Specimens should NOT be
shipped to CDC without
consultation with CDC and
local/state health departments 26

27. Symptoms of Ebola
and complications
are treated as they
appear
• Providing intravenous
fluids (IV) and
balancing electrolytes
(body salts).
• Maintaining oxygen
status and blood
pressure.
• Treating other
infections if they
occur.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 27

28. How do you keep yourself
Well?
Wash your hands often
with soap and water or
hand sanitizer.
Avoid close contact with
people who are sick.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 28

29. How do you keep yourself
Well?
• Avoid touching your
eyes,
nose, and mouth. Germs
spread this way.
• Get your flu shot.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 29

30. Supportive care
the best way
Ebola
• Recovery from Ebola
depends on good
supportive care and the
patient’s immune
response. People who
recover from Ebola
infection develop
antibodies that last for at
least 10 years, possibly
longer
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 30

31. Vaccines
are
Experiment
al• Experimental
vaccines and
treatments for Ebola
are under
development, but
they have not yet
been fully tested for
safety or
effectiveness.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 31

32. Healthcare
System
Preparedness
• Considering the need for appropriate
care and infection control of
identified patients and persons under
investigation, coordinate with
healthcare facilities, healthcare
coalitions, and emergency
management to develop local and
state emergency operations plans
that address the concerns and unique
needs of healthcare facilities for
Ebola response.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 32

33. 5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 33

34. Preparedne
ss of
Hospitals
• Assess the readiness
for Ebola response
within your
jurisdiction’s
hospitals, inpatient
and outpatient
healthcare facilities,
clinician practices,
and other clinical
settings.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 34

35. CDC Cautions
• the CDC says that anyone
who does travel to
Guinea, Liberia, or Sierra
Leone should avoid
touching blood or bodily
fluids from anyone who is
sick, as they could
possibly have the Ebola
disease.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 35

36. Universal
Precautions
Health Safety
Precautions
• Specifically, ensure that clinicians
who may care for Ebola patients or
persons under investigation are
trained on the following guidance
documents and consider the
resource needs (such as PPE and
other ancillary supplies) that would
be needed to implement the
guidance.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 36

37. Final trial results confirm Ebola
vaccine provides high protection
against disease
• An experimental Ebola vaccine
was highly protective against
the deadly virus in a major trial
in Guinea, according to results
published in The Lancet. The
vaccine is the first to prevent
infection from one of the most
lethal known pathogens, and
the findings add weight to
early trial results published last
year.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 37

38. How does the
new Ebola
vaccine
work?
• This prompts an immune
response, and the body
develops antibodies against
the Ebola protein, ... It's
used to deliver the Ebola
gene to a person's cells,
which, in turn, produce a
single Ebola protein. If the
vaccine works as it should,
this protein will cause an
immune response
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 38

39. Vaccine, called rVSV-
ZEBOV
• The vaccine, called rVSV-ZEBOV, was
studied in a trial involving 11 841
people in Guinea during 2015. Among
the 5837 people who received the
vaccine, no Ebola cases were recorded
10 days or more after vaccination. In
comparison, there were 23 cases 10
days or more after vaccination among
those who did not receive the vaccine
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 39

40. The Lancet study
on success of
Vaccine
• The Lancet study was done in
11,841 residents of Guinea
last year. Among the 5,837
people who got the vaccine,
none came down with Ebola
10 or more days later. There
were 23 Ebola cases among
the thousands of others not
immediately vaccinated.
5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 40

41. How are we helping the people in
in Africa?
CDC is
Teaching doctors and nurses
how to care for people with
Ebola.
Training people in West Africa
to care for people with Ebola.5/14/2017 Dr.T.V.Rao MD @ Ebola Infection 41

42. Interim Guidance for Monitoring and Movement of Persons with Ebola Exposure
CDC has created guidance for monitoring
people exposed
to Ebola virus but without symptoms
www.cdc.gov/vhf/ebola/hcp/monitoring-and-movement-of-persons-with-exposure.html
RISK LEVEL PUBLIC HEALTH ACTION
Monitoring Restricted
Public Activities
Restricted
Travel
HIGH risk Direct Active Monitoring Yes Yes
SOME risk Direct Active Monitoring
Case-by-case
assessment
Case-by-case
assessment
LOW risk
Active Monitoring
for some;
Direct Active Monitoring
for others
No No
NO risk No No No

43. References
CDC Govt Guidelines
WHO Protocols on Ebola Infections

44. •Program Created by Dr.T.V.Rao MD for
benefit of Pan African resources on
Infectious Diseases
• Email
• doctortvrao@gmail.com