Ebola

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Ebola

• The Deadly
• African Virus

Davood Yadegarinia Professor of Infectious
Diseases and Tropical Medicine Research Center,
Shahid Beheshti University of Medical Sciences
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Definition

• Ebola virus disease (formerly known as Ebola
  hemorrhagic fever) is
• A disease caused by the Ebola virus
• Is severe- fatality rate 90
• Affects human and non human primates

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Ebola Taxonomy

• Scientific Classification
• Order Mononegavirales
• Family Filoviridae
• Genus Ebola like viruses
• Species Ebola
• Subtypes -5 types
• Ebola-Zaire, Ebola-Sudan,Ebola-Ivory Coast
• disease in humans
• Ebola-Reston
• disease in nonhuman primates

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Ebola Taxonomy

• Group Group V (-)sense RNA
• Order Mononegavirales
• Family Filoviridae
• Genus Ebolavirus

Species
Sudan (SUDV)
Bundibugyo (BDBV)
Tai forest (TAFV) Formerly Cote d-Ivoire
Zaire ebola (EBOV) The most dangerous
Reston (RESTV) Non-humans
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Ebola hemorrhagic fever

• Fatality Rates
• Ebola-Sudan 60
• Ebola-Zaire 77-88
• Ebola-Reston Found in monkeys, has not shown to
  be fatal in humans
• Ebola-Cote DIvoire Only one human case
  recorded, patient survived
• Not much is known about the bodys response
  because of the dangers of handling samples from
  infected patients and the short time span
  available for investigation.

MASS GRAVES FOR EBOLA VICTIMS
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Filoviridae or Filoviruses

• Most mysterious virus group
• Pathogenesis poorly understood
• Ebola
• natural history/reservoirs unknown , researchers
  believe the most likely natural hosts are fruit
  bats
• exist throughout the world
• endemic to Africa
• filamentous ssRNA- (antisense) viruses

Image courtesy of the Centers for Disease Control
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Natural Reservoir

• Suspected to be a zoonotic (animal-borne)
• However, it is unknown what organism carries it
  naturally without being infected
• Suspected vectors
• Bats
• Primates (in some cases, have been confirmed)
• Basically any other animal native to Africa,
  including mosquitoes, ticks, birds, reptiles

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History of Ebola virus

• Ebola first appeared in 1976 in two simultaneous
  outbreaks.
• - Near the Ebola River in the
  Democratic Republic of Congo
• - A remote area of Sudan.

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STROKES YEAR REGIONS AFFECTED DISCRIPTION
FIRST 1976 Democratic republic of congo (ZAIRE) sudan First outbreak of Ebola. Hemorrhagic fever
SECOND 1989 Reston ,Virginia mysterious outbreak.  (initially diagnosed as Simian hemorrhagic fever virus (SHFV)) among a shipment of crab-eating macaque monkeys imported from the Philippines.  named Reston ebolavirus (REBOV)
THIRD 2014 WEST AFRICA  -affecting Guinea, Sierra Leone, Liberia and Nigeria. largest outbreak to the date
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Case counts as of October 20, 2014
Total Case Count Laboratory Confirmed Cases Total Deaths
9216 4218 4555
Numbers are lower than actual laboratory
confirmed cases and deaths because stratified
data are temporarily unavailable for Liberia.
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Case counts as of October 20, 2014
Countries with Widespread Transmission
Cases by Country Total Case Count Laboratory Confirmed Cases Total Deaths
Guinea 1519 1217 862
Liberia 4249 ? 2484
Sierra Leone 3410 2977 1200
Total Case Count 9178 4194 4546
Numbers remain unchanged or are lower than
actual cases because stratified data are
temporarily unavailable for Liberia.
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Countries with Travel-associated Cases
Case by country Total case count Laboratory confirmed cases Total death
Senegal 1 1 0
Spain 1 1 0
Countries with Localized Transmission
Case by country Total case count Laboratory confirmed cases Total death
Nigeria 20 19 8
United states 3 3 1
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Transmission

• Environment to Human
• Fruit bats-natural reservoir
• Gorilla, chimpanzee, monkey, porcupine, duiker
• Human to human
• Direct contact
• Contaminated medical equipment
• Traditional burial rituals
• Medical workers
• Survivors(via semen for 2 months)

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how do people become infected with the virus?

• 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 occurred through the
  handling of infected chimpanzees, gorillas, fruit
  bats, monkeys, forest antelope and porcupines
  found ill or dead or in the rainforest.

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Transmission(cont)

• Ebola is extremely infectious but not extremely
  contagious. It is infectious, because a very
  small amount can cause illness. Laboratory
  experiments on nonhuman primates suggest that
  even a single virus may be enough to trigger a
  fatal infection.
• Instead, Ebola could be considered moderately
  contagious, because the virus is not transmitted
  through the air. The most contagious diseases,
  such as measles or influenza, virus particles are
  airborne.

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You cant get E bola through air Facts
about Ebola
You cant get E bola through water
You cant get Ebola through food

• You can only get Ebola from
• Touching the blood or body fluids of a person who
  is sick with or has died from Ebola.
• Touching contaminated objects, like needles.
• Touching infected animals, their blood or other
  body luids, or their meat.
• Ebola poses no signiicant risk to the United
  States.

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Who is most at risk?

• 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 rain forest who come into contact
  with dead animals found lying in the
  forest.More research is needed to understand if
  some groups, such as immuno-compromisaed people
  are more susceptible than others to contracting
  the virus.

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EFFECT OF EBOLA

• the patients will have Diarrhea.
• Pharyngitis with the inflammation of the throat
  and eye.
• causes severe damage to the skin.
• attacks every tissue and organ of the body
  except the skeletal muscles and bones.
• can attack the connective tissues that are
  rapidly multiplying in collagen.
• causes small blood clots to form in the
  bloodstream of the patient and forms red spot on
  the skin
• Spontaneous bleeding then occurs from body
  orifices and gaps in the skin

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EHF EVD
EHF ( Ebola Hemorrhagic Fever )
Internal and External Bleeding occurs
Genital swelling
Increased feeling of pain in the skin
Rash over the entire body that often contains
blood Roof of mouth looks red
EVD ( Ebola Virus Disease)
Bleeding dose not occur
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Ebola hemorrhagic fever

• Target Organs and Damage Methods
• Target mainly small capillary vessels. Attach to
  walls, cause leakage of blood and serum into
  surrounding tissue.
• When white blood cells attack the virus, they
  dissolve this releases a chemical into the
  blood stream that signals the release of other
  chemicals (pro-inflammatory cytokines,
  pro-coagulants, and anticoagulants)
• These injure blood vessels even worse, resulting
  in permanent bleeding.
• Eventually, the entire body is leaking and
  dissolving

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Signs and Symptoms

• Early symptoms
• Influenza(fatigue,fever,headache,joint
  abdominal pain)
• Vomiting,diarrhea
• Loss of appetite
• Sore throat,chest pain,hiccups,shortness of
  breath, trouble swallowing
• Weakness
• Maculopular rash(50 cases)
• Myalgia(muscular pain or tenderness),back pain
• Mucosal redness of the oral cavity

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Signs and Symptoms

• Acute symptoms
• Bleeding from puncture sites and mucous
  membrane(eg.nose,gums and gastrointestinal tract)
• Internal and subcutaneous bleeding
• anuria(absence of urine formation)
• raddening of eyes,bloody vomit
• Impaired blood clotting
• Multiple organ dysfunction
• syndrome which leads to death

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Diagnosis

• Diagnosing Ebola in an 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 are seen often
  in patients with more commonly occurring
  diseases, such as malaria and typhoid fever.
• However, if a person has the early symptoms of
  Ebola and has had contact with the blood or body
  fluids of a person sick with Ebola, contact with
  objects that have been contaminated with the
  blood or body fluids of a person sick with Ebola,
  or contact with infected animals, they should be
  isolated and public health professionals
  notified. Samples from the patient can then be
  collected and tested to confirm infection.

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Laboratory tests used in diagnosis include
Timeline of Infection Diagnostic tests available
Within a few days after symptoms begin Antigen-capture ELISA testing IgM ELISA PCR Virus isolation
Later in disease course or after recovery IgM and IgG antibodies
Retrospectively in deceased patients Immunohistochemistry testing PCR Virus isolation
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Treatment

• No specific vaccine or medicine (e.g., antiviral
  drug) has been proven to be effective against
  Ebola.
• Symptoms of Ebola are treated as they appear.
• The following basic interventions, when used
  early, can significantly improve the chances of
  survival
• 1-Providing intravenous fluids (IV)and
  balancing electrolytes (body salts)
• 2-Maintaining oxygen status and blood
  pressure
• 3-Treating other infections if they occur

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Treatment

• Some experimental treatments developed for Ebola
  have been tested and proven effective in animals
  but have not yet been tested in randomized trials
  in humans.
• Recovery from Ebola depends on the patients
  immune response. People who recover from Ebola
  infection develop antibodies that last for at
  least 10 years, possibly longer.

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Prevention

• There is no FDA-approved vaccine available for
  Ebola.
• If you travel to or are in an area affected by an
  Ebola outbreak, make sure to do the following
• 1-Practice careful hygiene. Avoid contact
  with blood and body
• fluids.
• 2-Do not handle items that may have come in
  contact with an
• infected persons blood or body fluids.
• 3-Avoid funeral or burial rituals that
  require handling the
• body of someone who has died from Ebola.

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Prevention

• 4-Avoid contact with bats and nonhuman
  primates or
• blood, fluids, and raw meat prepared
  from these
• animals.
• 5-Avoid hospitals where Ebola patients are
  being
• treated. The U.S. embassy or consulate is
  often able
• to provide advice on facilities.
• 6-After you return, monitor your health for
  21 days
• and seek medical care immediately if you
  develop
• symptoms of Ebola

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Ebola hemorrhagic fever

• Prevention
• Classified as Biosafety level 4 (greatest threat
  to humans)
• Extensive precautions taken when dealing with
  suspected cases to limit transmission
• Several layers of protective clothing covering
  entire body (up to four)
• Complete equipment sterilization
• Quarantine of Ebola HF patients

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Prevention

• Healthcare workers who may be exposed to people
  with Ebola should follow these steps
• 1-Wear protective clothing, including
  masks, gloves, gowns,
• and eye protection.
• 2-Practice proper infection control and
  sterilization measures.
• 3-Isolate patients with Ebola from other
  patients.
• 4-Avoid direct contact with the bodies of
  people who have
• died from Ebola.

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Prevention

• Notify health officials if you have had direct
  contact with the blood or body fluids, such as
  but not limited to, feces, saliva, urine, vomit,
  and semen of a person who is sick with Ebola. The
  virus can enter the body through broken skin or
  unprotected mucous membranes in, for example, the
  eyes, nose, or mouth

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PRECAUTIONS

• Use Standard Precautions
• Routine Hand washing
• Handle and Dispose of Shar Instruments Safely
• Cook meat thoroughly
• Environment Cleaning

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FIVE TYPES OF HAND HYGEINE
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ISOLATION PROCEDURES

• Select Site for the Isolation Area
• Isolation area must consist of
• 1)An isolated toilet 2)Adequate ventilation
  3)Screened windows
• Plan How to Arrange the Isolation Area

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Thanks for your patience