Ebola Hemorrhagic Fever Deadly African Virus

Ebola Hemorrhagic Fever
Deadly African Virus
Dr. Hythum Salah H. Mohamed NGHA -KAMC-Riyadh 6th August 2014

Historical Background
 Ebola first appeared in 1976 in 2 simultaneous outbreaks, first in Nzara which is small town
in south of Sudan which infected over 284 people, with a mortality rate of 53%.
 After view month another out break occurred in Yambuku in Democratic Republic of Congo.
The latter was in a village situated near the Ebola River, from which the disease takes its
name
 In Congo outbreak 318 people infected with highest mortality rate of 88% .
www.who.int
WWW.web.stanford.edu
Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014

Ebola Outbreaks
 24 outbreaks reported by WHO from 1976 till 2012 .
 first outbreak occurred in Sudan( Newly south of Sudan ) and Democratic
Republic of Congo with mortality rate of 53% and 88% respectively .
 Countries involved in outbreaks was , Sudan , Congo , Uganda ,Gabon , South
Africa ( one case in 1996 ) and Cote d'Ivoire ( one case in 1994).
 No case reported out of Africa till 2012 .
 The maximum No of infected patients was 425 in Uganda outbreak 2000 .
www.who.int

Ebola 2014 Outbreak
 August 1, 2014, the Guinea Ministry of Health announced a total of 485
suspect and confirmed cases of Ebola virus disease (EVD), including 358 fatal
cases.
 340 cases across Guinea have been confirmed by laboratory testing to be
positive for Ebola virus infection.
 August 1, 2014, the Ministry of Health and Sanitation of Sierra Leone and
WHO reported a cumulative total of 646 suspect and confirmed cases,
including 540 laboratory confirmations and 273 reported fatal cases.
www.cdc.gov update 4th August 2014

 August 1, 2014, the Ministry of Health and Social Welfare of Liberia and WHO
have reported 468 suspect and confirmed EHF cases (including 129 laboratory
confirmations) and 255 reported fatalities.
 August 1, 2014, the Nigerian Ministry of Health and WHO reported 4 suspect
and probable cases and 1 fatal probable case.
 Nigerian Suspected and Confirmed Case Count are 4 .
www.cdc.gov update 4th August 2014

Geographical Map of 2014 Outbreak

Genus of Ebola Virus
 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:
1-Bundibugyo ebolavirus (BDBV)
2-Zaire ebolavirus (EBOV)
3-Reston ebolavirus (RESTV)
4-Sudan ebolavirus (SUDV)
5-Taï Forest ebolavirus (TAFV).
www.who.int
Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th
August 2014

 Bundibugyo , Zaire and Sudan Ebola virus species are associated with have
with large Ebola virus disease outbreaks in Africa .
 Reston ebolavirus (RESTV) and Taï Forest ebolavirus (TAFV) have not
associated with EVD in Africa .
 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.
www.who.int

Transmission of EVD .
 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 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.
www.who.int

 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 7 weeks after recovery from illness.
 Health-care workers have frequently been infected while treating patients with
suspected or confirmed EVD.
 However, the only available evidence available comes from healthy adult males.
It would be premature to extrapolate the health effects of the virus to all
population groups, such as immuno-compromised persons, persons with underlying
medical conditions, pregnant women and children.
www.who.int

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.
www.who.int
Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh
6th August 2014

Signs and Symptoms of Ebola Haemorrhagic Fever
 Fever (90%-100%)
 Headache (40%-90%)
 Chills
 Myalgia/arthralgia (40%-80%)
 Malaise (75%-85%)
 Pharyngitis (20%-40%)
 Loss of appetite
 Vomiting (59%)
 Hematemesis (10%-40%)
 Non-bloody diarrhea (81%)
http://web.stanford.edu/group/virus/filo/humandiseases.htm
l Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th August 2014

 Blood fails to clot (71%-78%)
 Abdominal pain (60-80%)
 Dry and sore throat (63%)
 Chest pain (83%)
 Hemorrhagic diathesis (71%-78%)
 Maculopapular rash (5%-20%)
 Hiccups (15 %)
 Hepatic damage
 Renal failure
http://web.stanford.edu/group/virus/filo/humandiseases.html

 CNS involvement (infrequently)
 Terminal shock
 Lymphopenia
 Severe thrombocytopenia
 Transaminase elevation
 Hyperamylasemia
 During the convalescent stage:
1-Loss of memory
2-Central nervous system disorders
3-Loss of hair
http://web.stanford.edu/group/virus/filo/humandiseases.html

Diagnosis
 Ebola virus infections can be diagnosed definitively in a laboratory through
several types of tests:
1-antibody-capture enzyme-linked immunosorbent assay (ELISA)
2-antigen detection tests
3-serum neutralization test
4-reverse transcriptase polymerase chain reaction (RT-PCR) assay
5-electron microscopy
6-virus isolation by cell culture.
www.who.int

Treatment
 No specific treatment is available .
 Standard treatment for Ebola HF is still limited to supportive therapy. This
consists of:
1-balancing the patient’s fluids and electrolytes
2-maintaining their oxygen status and blood pressure
3-treating them for any complicating infections .
www.cdc.gov

 During the 1995 Ebola Zaire outbreak in Kikwit, whole blood from
convalescent patients was administered to eight patients late in their clinical
course . Only one patient died, suggesting that even small amounts of
transfused blood had a beneficial effect. However, a subsequent analysis
demonstrated that, due to good prognostic factors, these patients would have
likely survived without any intervention .
 convalescent serum , interferon-alpha , Ribavirin , immune globulin and
plasma exchange are tried but not provided evidence of therapeutic efficacy
.
www.uptodate.com

Post exposure prophylaxis
 At this time, there are no FDA-approved forms of post exposure prophylaxis
for Ebola HF.
 In Animal experiments Interferon-alpha showed effectiveness .
 In a very promising approach to postexposure prophylaxis, an experimental
live-virus vaccine has been developed using recombinant vesicular stomatitis
virus (VSV) encoding the Marburg or Ebola surface glycoproteins. A single
injection is completely protective as a standard preexposure vaccine
www.uptodate.com

Infection Control
Controlling infection in health-care settings
 it is important that health-care 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 and safe injection
practices and safe burial practices.
 When in close contact (within 1 metre) of
patients with EBV, health-care workers
should wear face protection (a face shield
or a medical mask and goggles), a clean,
non-sterile long-sleeved gown, and gloves
(sterile gloves for some procedures).
www.who.int
6th August 2014

 face shields or surgical masks and eye
protection (e.g., goggles or eyeglasses
with side shields) should be worn by
persons coming within approximately 3
feet of the patient.
 Patients who are hospitalized or treated
in an outpatient healthcare setting should
be placed in a private room and Standard,
Contact, and Droplet Precautions should
be initiated .
 Nonessential staff and visitors should be
restricted from entering the room of
patients with suspected VHF.
www.cdc.gov/vhf/abroad/pdf/vhf-interim-
guidance.pdf-2005.
6th August 2014

 Laboratory workers are also at
risk.
 Samples taken from suspected
human and animal Ebola cases for
diagnosis should be handled by
trained staff and processed in
suitably equipped laboratories.
www.who.int
6th August 2014

Reducing the risk of Ebola infection in people
 raising awareness of the risk factors for
Ebola infection and the protective
measures individuals can take is the only
way to reduce human infection and death.
 Reducing the risk of wildlife-to-human
transmission from contact with infected
fruit bats or monkeys/apes and the
consumption of their raw meat
 handled with gloves and other
appropriate protective clothing. Animal
products (blood and meat) should be
thoroughly cooked before consumption.
www.who.int
Dr. Hythum Salah H. Mohamed -- NGHA -KAMC-Riyadh 6th
August 2014

 Reducing the risk of human-to-human
transmission in the
community arising from direct or
close contact with infected
patients, particularly with their
bodily fluids. Close physical
contact with Ebola patients should
be avoided.
 Gloves and appropriate personal
protective equipment should be
worn when taking care of ill
patients at home and burial of the
dead .
www.who.int
6th August 2014

Ebola Reported
Outside Africa
 Ebola in Saudi Arabia
Ebola in Saudi Arabia
6th August 2014

Ebola Hemorrhagic Fever Deadly African Virus

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